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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 State Health Secretariat - Brazil. Disclosure Statement of Financial Interest.

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Minas Gerais State Health Secretariat - Brazil

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  1. 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

  2. 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.

  3. 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

  4. 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

  5. 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)

  6. Research team Training Teachers n =115 1 school year

  7. 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

  8. “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

  9. Stage of behavior change: Reduction in fatty food consumption 10% 32% 20% 16% 34% 19% 19% 21% 14% 20% Robespierre Costa Ribeiro PhD

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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)

  16. Factors associated with improvements in the behavior-change stages*

  17. 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

  18. 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

  19. DISCUSSION - Matching Table 1 (continued) Robespierre Costa Ribeiro PhD

  20. 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.

  21. 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.

  22. THANK YOU! Robespierre Costa Ribeiro PhD dr.robespierre@gmail.com www.robespierre.com.br (55-31) 9992-7700

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