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Efficacy comparison of two programs for lifestyle change promotion directed to school children for obesity prevention. Minas Gerais State Health Secretariat - Brazil. Disclosure Statement of Financial Interest.

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Efficacy comparison of two programs for lifestyle change promotion directed to school children for obesity prevention

Minas Gerais StateHealthSecretariat - Brazil

Robespierre Costa Ribeiro MD, PhD

slide2

Disclosure Statement of Financial Interest

I, Robespierre Costa RibeiroDO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

slide3

TIRE 10!® Study: Cluster randomized controlled, multicomponent health-promotion community trial

  • To avoid intra-class correlation, the design effect was considered -- calculated to be 2.069 for the sedentary lifestyle variable in a previous study. Each sample group: 403 x 2.069 = 834 children.
  • Final sample-size target*: 1668 + 500 = 2168 students, or  2200 students.
  • Outcome: Change in stage of readiness to make a lifestyle change (“likelihood” to change behaviors).

* Assumes 30% attrition

slide4

5 Undesirable Behaviors Targeted for Change

(Assessed by Questionnaire)

  • Increased consumption of fatty foods,
  • DecreasedF&V intake (< 5 portions/day),
  • DecreasedPA (< 30 to 60 minutes a day of moderate to intense PA ),
  • Increased time spent in sedentary activity (evaluated as “screen time” > 2h/day)
    • Type I - TV, DVD - for more than 2 hours a day
    • Type II - games and computer use - for more than 2 hours a day
slide5

Cluster randomized controlled, multicomponent health-promotion community trial

“TAKE 10!®”

1191 (58.4%)

Intervention (TAKE 10!®)

18 Elementaryschools

(public & private)

ncalc: 2,200 children

Agita Galera “Shake it up, kids”

Sample:

Randomly assigned

847 (41.6%)

Comparison (control)

2,038 children

17% Attrition(Lost)

slide6

Research team

Training

Teachers

n =115

1 school year

slide7

Matching: Intervention vs. Control

Table 1: Frequency distributions of the baseline covariates in the intervention and comparison schools

Robespierre Costa Ribeiro PhD

* Pearson’s Chi-square test ** Student’s T-test

slide8

“Children change its behavior through 5 stages”

  • Action
  • (makingchangesandgettinggoodresults)
  • Preparation
  • (preparing to change)

James O. Prochaska

  • Contempla-tion
  • (thinking of changing)

Maintenance

(maintain changes and results)

Carlo DiClemente

Precon-templation (not thinking of changing)

TranstheoreticalModel (TTM) ofBehaviorChange

Transteoretical Model

slide9

Stage of behavior change: Reduction in fatty food consumption

10%

32%

20%

16%

34%

19%

19%

21%

14%

20%

Robespierre Costa Ribeiro PhD

slide10

Time 2

Time 1

+ 22%

(increase in numberofchildren)

55%

33%

Action

&

Mainten

More children

eating less fatty food

(two final stages)

  • Precont
  • &
  • Contemp
  • 52%
  • 26%
  • 26%
  • (decrease in numberofchildren)

Less children

eating fatty foods

(two first stages)

Reduction in fat food consumption

(p < 0.001)

Movement towards healthier behavior

Robespierre Costa Ribeiro PhD

slide11

Time 2

+ 18%

(increase in childrennumber)

46%

28%

Action

&

Mainten

Time 1

  • Precont
  • &
  • Contemp
  • 48%
  • 21%
  • 27%
  • (decrease in numberofchildren)

Increase in F&V consumption

(> 5 portions/day)

(p < 0.001)

Robespierre Costa Ribeiro PhD

slide12

Time 2

+ 21%

(increase in childrennumber)

76%

55%

Action

&

Mainten

Time 1

  • Precont
  • &
  • Contemp
  • 25%
  • 7%
  • 18%
  • (Decrease in childrennumber)

Increase in Physical Activity

(p < 0.001)

Robespierre Costa Ribeiro PhD

slide13

Time 2

+ 13%

(increasein childrennumber)

41

28

Action

&

Mainten

Time 1

  • Precont
  • &
  • Contemp
  • 42%
  • 19%
  • 23%
  • (Decrease in childrennumber)

Reduction TV/DVD “screen-time”

(< 2h/day)

(p < 0.001)

Robespierre Costa Ribeiro PhD

slide14

Time 2

+ 11%

61%

50%

Action

&

Mainten

  • Precont
  • &
  • Contemp
  • 28%
  • 15%
  • 13%
  • (Decrease in childrennumber)

Time 1

Reduction Games/Computer “screen-time”

(< 2h/day)

(p < 0.001)

Robespierre Costa Ribeiro PhD

slide15

Factors associated with improvements in the behavior-change stages*

* Multivariate analysis by Poisson model with Generalized Estimating Equations (GEE) methods (which consider intracluster correlation of the studied outcomes)

slide17

Clinicalsignificance of the association of intervention program & behavior improvement in post-intervention time 2

(TAKE 10!®)

ARR = Absolut Risk Reduction, NNT = Number Needed to Treat

slide18

Population Attributive Risk percentage (PAR) of the intervention program on changing unhealthy behaviors

Children improving at least 1 behavior

  • Reduced fatty food consumption
  • Improved all five behaviors

66.4%

99.4%

  • Increased F & V consumption

64.7%

  • Increased physical activity

60.1%

  • Reduced sedentary TV (screen time)

66.5%

  • Reduced sedentary Cp(screen time)

48.9%

Children improving all 5 behaviors

slide19

DISCUSSION - Matching

Table 1 (continued)

Robespierre Costa Ribeiro PhD

slide20

LIMITATIONS

  • Control group: Absence of a thirdno-intervention control group
    • A third no-intervention control group would be unethical since there is already a similar program offered by the Brazilian Ministry of Health and the present study design was a “superior trial” (and not a “non-inferior trial”)
  • Main outcomes: Absence of an anthropometric and/or behavior primary outcomes
    • Did not measure changes in weight & adiposity distribution, specific food eating frequency, or PA/sedentary direct parameters.
    • A health-centered, rather than a weight-centered, approach directed the study outcomes.*

* Berg F, Buechner J, Parham E; Weight Realities DivisionoftheSociety for NutritionEducation. Guidelines for childhood obesity prevention programs: promoting healthy weight in children. J Nutr Educ Behav. 2003; 35 (1): 1-4.

slide21

CONCLUSION

TAKE 10!® intervention program was highly effective in moving children closer to modifying their eating habits, physical activity and time spent in sedentary behaviors.

It promoted healthy behavior changes and has great potential for reducing the incidence & prevalence of excess body weight in children and its future comorbidities.

slide22

THANK YOU!

Robespierre Costa Ribeiro PhD

[email protected]

www.robespierre.com.br

(55-31) 9992-7700

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