Thin livingBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39409.451678.AD (Published 13 December 2007) Cite this as: BMJ 2007;335:1236
The campaign EPODE (Ensemble, prévenons l’obésité des enfants or Together, let’s prevent obesity in children) was launched in January 2004 in 10 towns in different regions of France. Interested towns applied to be considered and the organisers made a selection based on diversity.
Over the course of five years, the target group children, aged between 5 and 12 years, are measured and weighed annually to calculate their body mass index. In an interview with a school doctor, parents are given a letter explaining their child’s weight status and guidelines for diet and physical activity.
Overweight or at-risk children are encouraged to see a doctor while each town receives suggestions for activities, diets, and community initiatives. Leaflets are distributed in shops and supermarkets. Each town can also set up local initiatives which are submitted to the central committee for approval. Simple initiatives include eating a healthy breakfast, safe routes for walking to school, learning about vegetables in the classroom, inviting food professionals to talk in schools, organised games at playtime, and “discovery sessions” for finding out more about new foods.
The programme was launched after the success of a similar campaign in two towns in the region of Nord Pas de Calais, Fleurbaix and Laventie. Between 1992 and 1997, these towns followed a nutritional programme intended to change children’s eating habits; 80% of the two towns’ populations participated. The programme included special lessons in schools and colleges, distribution of 7200 breakfasts in schools, and factory visits. Local doctors supported the project, and teachers were shown how to incorporate healthy eating into the curriculum. Dietitians visited classes and organised lectures on healthy eating for parents.
The results showed that not only had the children acquired a better knowledge of nutrition but they had also significantly modified their eating habits. For example, the number of families that ate chips once a week fell from 56% to 39% (www.epode.fr). Obesity in children did not increase during 1992 to 2000; in the rest of the region, childhood obesity doubled. Long term studies also showed that mothers had gained less weight than those in other towns. A second study carried out between 1997 and 2002 looked more closely into the causes of obesity (www.epode.fr). Three thousand people participated and received an annual assessment of their health and lifestyle (eating habits, physical activity, smoking, weight, height, blood pressure, cholesterol, etc). This second study gave a better understanding of the factors that contribute to weight gain beyond that of diet, such as physical activity, hormones, biological or genetic factors, stress, and psychology.
In 2004, EPODE took up the baton. Since the enrolment of the 10 original towns, 113 French communities are now taking part. Presided over by an expert committee with the support of the Ministry for Health and the Family, EPODE’s partners in the private sector include the group Ferrero, the insurance company APS, Nestlé, and the Carrefour International Foundation. These businesses have committed human and technical resources as well as €675 000 (£484 000; $1m).
The organisers are keen to stress that EPODE is not a scientific study but a community initiative. The official results will be published in 2009, and until that date it is up to the discretion of each town to release results as and when they see fit.
Asnières sur Seine
Region: Ile de France
Department: Hauts de Seine
No of inhabitants: 78 000
No of children aged 5-12: 7500
In 2004, 21.5% of children aged 5-12 years were overweight or obese (the national average for obesity in children of the same age was 18.4%). By 2006, this figure had fallen by around 1%. Chantal Charles, the project leader in Asnières, says the results are encouraging but still incomplete: “The project isn’t over yet. We need to see results on a national level to come to any definitive conclusion.”
One local initiative involved taking the local children to the International Agricultural Fair in Paris to meet farmers and to find out where their food comes from.
No of inhabitants: 57 355
No of children aged 5-12: 6282
In 2004, 22% of the target group were overweight. By the second year of the project, obesity seemed to have fallen by 3%. However Frédéric Tessier, a teacher and researcher at Isab (the agricultural institute in Beauvais), advised caution: “It would be very surprising if these results were accurate after only a year. I suspect there may have been some errors when we first collected the figures.”
The results differed according to the sex of the child and where they lived. Girls tended to be more overweight than boys (22% versus 17%). In the neighbourhood of Notre Dame du Thil, 23% of children were overweight compared with 16% in the centre of town.
Tessier is using the EPODE project to study the children’s behaviour: “To see, for instance, if their consumption of fruit and vegetables increases. We have to be careful; obviously the results are fallible. You can’t be sure people give honest answers. For example, according to one study, it appears that 24% of children here watch television for more than four hours a day during the weekends and the holidays, and that one child in 10 drinks a bottle of soda once or twice a day.” These figures are higher than the French average.
The project receives widespread support in the town. School canteens put up suggestions for evening meals alongside the lunch menu, while the town’s newspaper publicises the campaign.
Region: Languedoc Rousillon
No of inhabitants: 71 428
No of children aged 5-12: 10 899
At the start of the project, 19% of children were overweight. Although no results have been published, Monique Valaize, programme coordinator in Béziers, says, “The results are very encouraging in both the children and their parents. It’s good to see children passing on the message to their elders, explaining to them what foods are good for them. The education system has been reversed.”
A local initiative involved inviting the EPODE dietitian to organise a breakfast in school, after which parents, children, and teachers went for a run together in a nearby park with the intention that families rediscover the fun of being active together.
No of inhabitants: 54 000
No of children aged 5-12: 6500
In 2004, 19% of the target group were overweight. The EPODE project in Evreux is part of a wider public health policy. The town has launched other projects to support citizens at risk, including a project called “Aging Well,” which seeks to implement balanced diets for the retired population. They also organise breakfasts and tea in the local primary schools.
Another initiative was a Tastes of the Seasons week, which allowed children to discover unfamiliar foods. A tie-in recipe booklet allowed families to discover new dishes at home. The town built a model farm in the local shopping centre with cows and goats for the children to milk. The children also learnt to make yoghurt and tasted different kinds of cheese. Leaflets containing simple recipes and useful tips are handed out in schools, day care centres, the town hall, and doctors’ waiting rooms.
Region: Rhône Alpes
No of inhabitants: 28 009
No of children aged 5-12: 4000
In 2004, 25% of the target group were overweight. Sophie Tréppoz, paediatrician in the Rhône-Alpes region, says: “We intend to give back to our children the love of exercise and to make them aware of the dangers of eating badly. Every school term we look at different foods that aren’t usually present in our diet. Lentils, for example.”
Region: Poitou Charentes
Department: Charente Maritime
No of inhabitants: 17 210
No of children aged 5-12: 1365
In Royan, 1600 children in public and private schools are taking part. In 2004, 17% of children were overweight. Little change was seen in the following year, but in 2007, only 15% of children were categorised as overweight. The town is far from complacent. Alexandra Lubin, project leader in Royan, said, “We need to confirm these results over the long term.” The dietitian organises nutritional events during lunch time, including food discovery sessions, dietary advice, and handing out information leaflets on different foods.
Region: Nord Pas de Calais
No of inhabitants: 98 786
No of children aged 5-12: 21 000
In 2004, 23% of the target group were overweight. Roubaix is a town with great social disparity, and one of the organisers’ primary tasks is to ensure that the healthy eating message reaches all sectors of the community.
Breakfasts are organised regularly in the local schools in cooperation with the town’s dietitian and the school caterers. They provide an opportunity to explain to the entire family that a balanced breakfast helps them stay active until lunchtime without needing a mid-morning snack. Parents are encouraged to repeat the experience every day at home.
Region: Midi Pyrénées
No of inhabitants: 8448
No of children aged 5-12: 817
In 2004, 19% of children were overweight. A year later this figure was down to 13.5%. Children who are overweight are taken on by a multidisciplinary team for two years. Children get a medical, nutritional, and psychological check-up, followed by regular meetings with the child’s doctor and dietitian. Overweight or obese children are given simple goals, such as not having a second helping. The aim is to help them become nutritionally autonomous.
Saint Jean organised a conference entitled “Educating children about food and passing on the facts,” which provided answers to parents and healthcare professionals on diet habits and trends. The conference emphasised the essential role of taste awareness in learning to follow a balanced diet.
Department: Puy de Dôme
No of inhabitants: 13 361
No of children aged 5-12: 1350
In Thiers in 2003, 25% of children were overweight but no subsequent results have been published. To coincide with Nutrition and Exercise Week, the town organised a series of events for local children: hiking, a mini-Olympics with games for 5-10 year olds, and a sports and health drawing competition.
Department: Ille et Vilaine
No of inhabitants: 16 000
No of children aged 5-12: 1984
Vitré has a young population (30% of inhabitants are younger than 30) with low unemployment levels and has the lowest proportion of overweight children among the participating towns. In 2004, 10% of the target group children were overweight. Two years later the weight of boys in the target group had stagnated, while there was a slight increase in the number of overweight girls. Families with at-risk children benefit from free telephone consultations with a dietitian. The town runs a campaign to promote eating simply, healthily, and cheaply and encourages pupils and their parents to walk rather than drive to school.
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