Obesity is a disease – food can be a cure : implementation of a pilot project

1. Obesity isa disease – food can bea cure : implementation of a pilot project Prim.mr.sc.Jagoda Dabo Institute of Public Health of the Primorsko-goranska County, City Council of the City of Rijeka, Rijeka, March 2009.

2. The majority of research activities in this field has been initiated because nutrition and inappropriate physical activity are significant risk factors for many common noncommunicable diseases. The top noncommunicable health problems (i.e. cardiovascular diseases,obesity,diabetes,osteporosis, and cancer)are lifestyle-related diseases and share common risk factors. They are: unhealthy nutrition, lack of physical activity, smoking and heavy drinking.

3. For the majority of adults in Europe who neither smoke nor drink excessively, what they eat and how physically active they are, represent the most significant controllable risk factors affecting their long-term health.

4. The goals Examineoverweight- and obesity-related risk behaviour, nutritional habits and physical activityamongschoolchildren, as well as influencing factors; assess programmes and services; indicate responses and interventions Who Primary schoolchildren, their parents and teachers Where Rijeka, 10 primary schools When This research was conducted throughout 2008

5. How Systematic examination contained: • Anamnesis and family anamnesis • Measuring weight and height • Calculating Body Mass Index (BMI) • Calculation Waist Hip Ratio (WHR) • Measuring skin fold • Measuring blood pressure

6. What makes schoolchildren vulnerable to overweightness and obesity? • Irregular meals • Irregular breakfast • Disbalanced nutrition • High intake of fats, sugars and refined victuals • Insufficient consumption of vegetables and fruits • Reduced physical activity

7. Contributing factors • Less cooking at home - less home-made food • Increased consumption of industrial premade food • Food consumption outside home • Trendy attitudes towards body weight

8. Contributing factors • Insufficient education (i.e. knowledge on healthy nutritional habits, eating disorders and obesity) • Lack of ‘opendoor’ guidance services • Lack of social skills • Lack of relevant programmes for children with such problems

9. What is available for young people (regarding obesity guidance and treatment) in the health care system in Croatia? GP offices School health services Health education and counselling Psychologist and nutriologist Endocrinologists in hospitals

10. Young people complained that these medical professionals... • …have no time • are not interested in their problems • are too close to their families • require announcement in advance • require referral or money...

11. Youth Friendly Services Project Education core group field team members peereducators Systematical check-ups Survey Youth Friendly Services - pilot phase

12. Sectors involved • Health(Institutes of Public Health - school health services) • Education(primary school teachers and school counsellors, schoolchildren) • Local government(City Council) Target population • Primary schoolchildren • Parents and teachers

13. Education Core team members - field team members Primary schoochildren education on healthy nutritional habits, eating disorders, obesity (using non-traditional interactive teaching methods, workshops, group discussion and role-playing) In schools Activitiesrelated to healthy lifestyle, eating disorders, obesity were organized anddiscussed in workshops, public discussions or aforum (not as part of the school curriculum) and schoolchildren play an active role in it

14. Youth Friendly Services The pilot phase of establishing ‘Open door YFC’ Regular working hours for eating disorder guidance services were established (2 hours twice a week) at the premises of the school health services School medicine specialists worked there, psychologist available when needed

15. Results : • Overweight children (centile distribution and BMI) 15,2% • Obese children3,4 • Irregular breakfast 31,2% (girls more often than boys) • At the same time, 25% of pupils consider themselves to be overweight. • 25% of examinees never or as rarely as once a week eat 1 portion of vegetables • 10% of children never eat fruit

16. Results : • Dairy drinks are never consumed by 6% of pupils • Alcoholic drinks are sometimes consumed by 11%-20% of pupils twice a month up to twice a week • Fast food is consumed 4 times a week up to every day by 13% of pupils, while 63% do so once a week • In last 7 days of the project, more than 34% pupils were physically active at least 1 hour a day

17. Conclusion : • There is a correlation between overweightness and obesity in childhood and in adulthood. • It is crucial to implement programmes of primary prevention that include promotion of healthy lifestyle, healthy and energy-balanced nutrition, moderate physical activity, reorganizqation of school kitchens and controlled menus in such a vulnerable period of growing up. • Intervention should be careful and paced as young people in that time of their lives are dealing with irrational experience of themselves and their bodies.

18. What we have learned • Additional education and interactive teaching/learning methods on overweightness and obesity in schools were welcomed and estimated as necessary • Availability of the ‘Open door YFS’ proved to be important for young people • In order to meet adolescents’ needs in YFC, it seems to be more important to have a medical doctor and a psychologist if needed

19. What we have learned • Schoolchildren with risk behaviour are still not properly covered by the existing health care system • Local authorities support proved to be of key importance for intersectorial collaboration and sustainability

20. And what with the sustainability?

21. Sustainability in Rijeka • The Municipality decided to support the continuation of the YFS as an additional activity of the school health services • After a year, the City of Rijeka,together with the Institute of Public Health, decided not only to support YFS, but to open the first Youth Service for Adolescent Eating Disorders and Obesity

22. Sustainability in Rijeka • Open-door guidance service was officially established in 2005 • school medicine specialist, psychologist, gynaecologist • Many donors helped with the equipment • Media covered it widely • … and young people said that it was what they were longing for..

24. ……….and we do hope that the story will go on