Julia Gago, Oscar Rosas. FETP –Perú.

1. Effect of educational intervention to prevent and control the increase overweight and obesity in schoolchildren from public elementary schools in marginal-urban district of Villa El Salvador in Lima, Peru from 2010 to 2011. Julia Gago, Oscar Rosas. FETP –Perú.

2. Outline. • Definition. • Obesity • Situation • Objectives. • Methods. • Results. • Conclusions. • Recommendations.

3. Obesity. • It´sanabnormalorexcessivefataccumulation in adiposetissue, totheextentthathealthmaybeimpaired. • The WHO recommends the use of Body Mass Index (BMI); it provides the most useful, albeit crude, population-level measure of obesity. • BMI iswellcorralatedto: • relativeadiposity, • fatmass, and • cardiovascular riskfactors in chidren and adults. Source: WHO | Obesity: preventing and managing the global epidemic [Internet]. WHO. [citado 2012 mar 8]. Available: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/index.html

4. Obesity. Causes Consequences Psychosocial and economic consequences.  Increase of risk factors for chronical diseases. Increase on morbidity.  Increase on mortality. • Lowphysicalactivity. • Consumption of foods rich in fat and sugars. • Consumption of high-density, low-costfoods. • Expression of the “thrifty gene” and chronicundernutrition. Source: Frisancho A.R. Globalization of obesity: The price of industrialization. Humankind evolving: an exploration of the origins of human diversity. Kendall/Hunt; 2006. p. 436.

5. Prevalence of obesityworldwide - 2010. Prevalence of adultswithobesity Peru (In adultswomen 2008: 14.6%) Source: IATSO. International ObesityTaskForce. Avilable in: http://www.iaso.org/iotf/obesity/?map=adults

6. Prevalence of overweight and obesity in Schoolchildren in Lima Capital City - 2008. Source: IIN/ ILSI (2008) Perfil nutricional en escolares de Lima y Callao. Available in: http://www.iin.sld.pe/pdf/2008/Perfil_nutricional_en_escolares_de_limayallao.pdf?PHPSESSID=67705da3600ffbb650852b1bcc22b00b

7. Objective. • Determine the effectiveness of a nutrition education intervention on the prevention and control of overweight and obesity.

8. Methods • Non-randomized, controlled community intervention study. • 529 school children ( 5-12 yo) from four elementary schools in Villa El Salvador Lima –Peru. • Intervention: Educative intervention in nutrition and health. • Outcome: • Body Mass Index (BMI Z-score) • Proportion of overweight and obesity after intervention. • Analysis: We analyzed the mean differences of this index, using T-test.

9. Sub Tropical. RelativeHumidity 100%. 35.40 Km2. 175 m.o.s.l. De 18 a 19º C. (Mean) Variation of 6 ºC. Villa El Salvador Map. Districtschoolchildren: 41 218 DistrictPopulation 2010: 409 431 inhabitants. Fuente: Google maps.

10. Educativeinterventionprocess. Collect and consolidate the evidence Strengtheningskills in food and nutrition. Educational session for schoolchildren SignedEvidence. Parents sensitization.

11. Seveninterventionmessages.

12. Educativeinterventionmessages. Eat five dense meals home made daily. 2. Eat frequently animal rich iron foods.

13. Educativeinterventionmessages. 4. Avoid eating snacks, sweet and salty foods in excess, then will push you to overweight. 3. Eat five fruits and vegetables of different colors daily.

14. Educativeinterventionmessages. 5. Daily exercise will keep you well. 6. Keep personal hygiene, of hands, teeth and dishes.

15. Educativeinterventionmessages. 7. Balance your food.

16. Timeline of theintervention. Initial Evaluation Educative Intervention Final Evaluation Intervention design Commitment Jan 2009 Mar 2010 Mar 2010 May 2010 May 2010 Jun 2010 Jun 2010 Nov 2010 May 2011 Jun 2011

17. Enrollment. Interventiongroup (2 Schools) Control group (2 Schools) 223 367 Lost: 22 (9.9%) Lost: 39 (10.6%) n=201 n=328 Global Global Underweight: 4 (1.2%) Normal: 95 (47.2%) Overweight –Obese: 106 (52.8%) Normal: 177 (54%) Overweight –Obese: 147 (44.8%) Prevention Recovery Prevention Recovery

18. Results. Global effectiveness of intervention. InterventionGroup Initial Final p < 0.05 Control Group Initial Final p < 0.05

19. Results. Effectiveness on prevention of obesity and overweight. InterventionGroup Initial Final p < 0.05 Control Group Initial Final p < 0.05

20. Results. Effectiveness on recovery of obesity and overweight. InterventionGroup Initial Final p < 0.05 Control Group Initial Final p < 0.05

21. Results.

22. Conclusions. • The Nutritional intervention is effective in preventing and controlling overweight and obesity in the study period. • Growth was similar in each group. • A multi institutional partnership and commitment for educational intervention could be a community approach alternative to prevent and control overweight and obesity in schoolchildren from urban-marginal districts of major cities.

23. Limitations. • It was not possible to randomize because the kind of the study (Community intervention). • We could not intervene in school kiosk. • The study only reflects a periurban area of Lima city. • We could not know the educative level of parents. • We do not know the sustainability of the intervention yet.

24. Recommendations. • The "Health promotion team" must perform interventions with a managerial epidemiology approach. • Obtain the commitment from all involved. • A shared goal must be the foundation of this intervention between community; health and education sectors.

25. Learning for life. Healthy lifestyle. Get Experienced Learning Early learning Life time

26. Thanksforyourattention.