Science and Technology in childhood Obesity Policy

Periodic Reporting for period 3 - STOP (Science and Technology in childhood Obesity Policy)

Período documentado: 2021-06-01 hasta 2022-11-30

Obesity has spread to more than one in ten children aged 5-19 throughout southern Europe, in parts of central-eastern Europe and in the UK, with more than one in three children overweight in countries such as Greece, Malta and Italy. Incentives from obesogenic environments and social influences add to material deprivation, exposing disadvantaged and vulnerable children to the highest risk of obesity, and making them less responsive to behaviour change interventions. The Covid-19 pandemic has exacerbated this picture, with evidence of sharp increases in BMI and obesity prevalence in children due to major reductions in physical activity and fitness, a worsening of dietary patterns and a reduced access to prevention and treatment services. These trends are expected to generate a widening of socio-economic inequalities in childhood obesity in Europe.

STOP aimed at expanding and consolidating the multidisciplinary evidence base upon which effective and sustainable policies can be built to prevent and manage childhood obesity. STOP's primary focus has been on the cumulative impacts of multiple and synergistic exposures in vulnerable and socially disadvantaged children and their families, which must be a priority target for the fight against childhood obesity in Europe to succeed. STOP aimed at identifying critical stages in childhood at which interventions can be most effective and efficient.

STOP accomplished the objectives set out in the GA and exceeded expectations, despite major disruption caused by the Covid-19 pandemic. STOP has accomplished the following:
1. Produced new evidence on the epidemiology of childhood obesity, trends over time within and beyond Europe, including evidence on height and BMI trajectories in different age groups, between urban and rural settings, and on socio-economic differences in prevalence.
2. Identified socioeconomic dimensions associated with childhood obesity and developed a novel standardised household income indicator.
3. Facilitated the development of a kindergarten-based BMI measurement and data collection protocol for the surveillance of obesity in preschool children.
4. Made extensive use of molecular biomarkers in the investigation of causal pathways linking early life and pre-birth exposures to obesity, leveraging European cohort data. Characterised key features of the external and internal exposomes.
5. Investigated the role of gut hormones and appetite regulation in the development of childhood obesity. Pioneered the use of urinary metabolomics for the assessment of children’s diets.
6. Identified a potential role for the gut microbiome in child growth trajectories and obesity.
7. Contributed to an improved understanding of the pathways through which highly industrially processed foods are linked to obesity and poor health outcomes.
8. Produced 15 systematic reviews of the determinants of childhood obesity and key policies and interventions to address the problem.
9. Jointly with PEN, benchmarked policies aimed at addressing obesity in 11 European countries, based on the Food-EPI/INFORMAS framework.
10. Generated new evidence on the potential for food and non-alcoholic beverage taxes to improve children’s diets.
11. Contributed to evidence of the effectiveness of SSB taxes at incentivising beverage reformulation by manufacturers. Shown which factors drive manufacturers to reducing sugar content following the UK SSB tax.
12. Through analysing two case studies of large multi-stakeholder campaigns, identified key success factors for social marketing campaigns.
13. Highlighted the use of behavioural science insights in the design of school interventions to improve children’s diet and increase their physical activity.
14. Produced analyses of the food business environment in Europe, France and Belgium, investigating industry commitments and actions based on the BIA Obesity methodology.
15. Demonstrated the applicability of a food reformulation methodology improving foods’ nutrient composition while maintaining appealing sensory characteristics to children’s foods.
16. Through four start-ups developing innovative approaches for improving children’s diet, has provided evidence of the potential, and limitations, of small entrepreneurial and grassroot initiatives.
17. Has produced new evidence of how a sustained physical education intervention in schools in Slovenia has reduced BMI and obesity.
18. Leveraging the detailed data available in Slovenia’s school-based surveillance system, has produced unique evidence of the impacts of lockdown measures adopted during the Covid-19 pandemic on physical fitness, BMI and obesity.
19. Conducted the “More and Less Europe” randomised controlled trial in Sweden, Spain, and Romania, showing the effectiveness of a primary care family-based childhood obesity intervention.
20. Developed Health-GPS, a computer-based policy simulation model capable of estimating the future health and economic impacts of childhood obesity policies, and simulated policies in European countries.
21. Knowledge translation efforts, including, among others, a set of Policy Briefs prepared by the WHO on the basis of STOP and other research.
22. Produced detailed analyses of key stakeholders’ attitudes and positioning in relation to childhood obesity policies through stakeholder surveys and dialogues. Developed a stakeholder engagement framework and an accountability framework.
23. Produced wide-ranging dissemination and communication outputs, including, but not limited to, the publication of 56 (so far) peer-reviewed papers and 2 journal supplements.
24. Actively engaged in research coordination and collaboration with other major European and international research efforts on diet, physical activity and childhood obesity (Co-Create, PEN, Best-ReMaP, and NCCOR).

The following are areas in which STOP has progressed beyond the state of the art:
A. Contributions on the epidemiology of childhood obesity, highlighting reduced height growth in some countries has been a factor in the development of childhood obesity; children’s socioeconomic status, and particularly household disposable income, is most strongly associated with obesity.
B. Molecular “signatures” predictive of childhood obesity have been identified through a range of epigenetics, metabolomics and proteomics biomarkers, as a fundamental step in assessing causal pathways, including those involving prenatal exposures, diets rich in ultra-processed foods, and obesogenic environments.
C. Analyses of policy initiatives, consumer and individual behaviours in selected European countries have provided evidence of the characteristics of fiscal and regulatory policies, social marketing interventions, physical education interventions, and food reformulation programmes that are most likely to generate positive impacts on childhood obesity.
D. A successful multi-country RCT of a behavioural intervention aimed at reducing BMI in young children with obesity, delivered to families in primary care settings, utilising biomarker data.
E. Analyses not originally planned have shown the major impacts of Covid-19 lockdown measures on children’s physical fitness, BMI and obesity.
F. Stakeholder analysis and engagement work, and policy and industry action benchmarking, have advanced our knowledge of stakeholder dynamics, setting the conditions for effective interactions and collaboration.

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Periodic Reporting for period 3 - STOP (Science and Technology in childhood Obesity Policy)

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