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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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Minas gerais state health secretariat brazil

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


Minas gerais state health secretariat brazil

Disclosure Statement of Financial Interest promotion directed to school children for obesity prevention

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.


Minas gerais state health secretariat brazil

TIRE 10! promotion directed to school children for obesity prevention® 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


Minas gerais state health secretariat brazil

5 Undesirable promotion directed to school children for obesity preventionBehaviors 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


Minas gerais state health secretariat brazil

Cluster randomized controlled, promotion directed to school children for obesity preventionmulticomponent 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)


Minas gerais state health secretariat brazil

Research team promotion directed to school children for obesity prevention

Training

Teachers

n =115

1 school year


Minas gerais state health secretariat brazil

Matching: Intervention vs. Control promotion directed to school children for obesity prevention

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


Minas gerais state health secretariat brazil

“Children change its behavior promotion directed to school children for obesity preventionthrough 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


Minas gerais state health secretariat brazil

Stage of behavior promotion directed to school children for obesity preventionchange: Reduction in fatty food consumption

10%

32%

20%

16%

34%

19%

19%

21%

14%

20%

Robespierre Costa Ribeiro PhD


Minas gerais state health secretariat brazil

Time 2 promotion directed to school children for obesity prevention

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


Minas gerais state health secretariat brazil

Time 2 promotion directed to school children for obesity prevention

+ 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


Minas gerais state health secretariat brazil

Time 2 promotion directed to school children for obesity prevention

+ 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


Minas gerais state health secretariat brazil

Time 2 promotion directed to school children for obesity prevention

+ 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


Minas gerais state health secretariat brazil

Time 2 promotion directed to school children for obesity prevention

+ 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


Minas gerais state health secretariat brazil

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)



Minas gerais state health secretariat brazil

Clinical stages*significance of the association of intervention program & behavior improvement in post-intervention time 2

(TAKE 10!®)

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


Minas gerais state health secretariat brazil

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


Minas gerais state health secretariat brazil

DISCUSSION - intervention program on changing unhealthy Matching

Table 1 (continued)

Robespierre Costa Ribeiro PhD


Minas gerais state health secretariat brazil

LIMITATIONS intervention program on changing unhealthy

  • 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.


Minas gerais state health secretariat brazil

CONCLUSION intervention program on changing unhealthy

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.


Minas gerais state health secretariat brazil

THANK YOU! intervention program on changing unhealthy

Robespierre Costa Ribeiro PhD

dr.robespierre@gmail.com

www.robespierre.com.br

(55-31) 9992-7700