EPODE (Ensemble Prévenons l’Obésité Des Enfants / Together Let’s Prevent Childhood Obesity) is a coordinated, capacity-building approach to help communities reduce the prevalence of childhood obesity. EPODE delivers programs on a local level that help create healthier everyday norms for children by engaging all members of the community. The EPODE model relies on the support and involvement of community stakeholders, including politicians, community organizations, teachers and health professionals. EPODE local project managers implement community-based programs adapted to the needs of each community, providing training, resources and scientific advice, supporting by a central coordinating committee including scientific researchers and academics and a local steering committee of community stakeholders.

The result has been a significant reduction in the prevalence of overweight and obese children.  In France the EPODE FLVS study demonstrated a 10% reduction in the number of overweight and obese children [3], and more recently in Belgium the EPODE initiative VIASANO, demonstrated a 22% reduction [4] in the number of overweight and obese children compared to control towns.

HISTORY

EPODE was founded in France in 1992. It began as the Fleurbaix Laventie Ville Santé (FLVS) Study, a long-term intervention program conducted between 1992 and 2004 in two cities in the north of France. The aim of the study was to improve the eating and physical activity habits of children by providing nutrition and physical education in schools.

This pilot study was divided into two critical phases, the first from 1992-1999 when nutrition and physical activity education was only disseminated at schools, and the second from 2000-2004 when the entire community was mobilized. During the first phase, the prevalence of overweight and obese children steadily increased following a similar trend to the control towns (see figure 1).  From these results it became evident that a more holistic approach to preventing childhood obesity was necessary and so the whole community was mobilized.

FLVS STUDY: the rate of childhood obesity versus time, this graph showed that children in the FLVS study lost a significant amount of weight compared to the control town starting in 2001.

Figure 1: The rate of childhood obesity versus time in FLVS study and control towns.

Community members like local sports associations, catering companies, health professionals, elected representatives and members of local public and private sectors also became part of the intervention through various avenues of participation and helped to deliver and support key messages regarding diet and physical activity.

The impact of mobilizing local stakeholders and community members was dramatic. By 2005, obesity in children had dropped to 8.8%, whereas the prevalence had risen to 17.8% in the nearby control towns (see figure 1).

The FLVS study demonstrated that education combined with the participation of the local community could positively influence the habits of children and families, leading to better health outcomes. It was the success of EPODE and the FLVS study through community engagement, political support and public-private partnerships that laid the groundwork for the EPODE methodology, used in over 15 countries today. Today the EPODE program in France extends to 226 towns and the methodology has also been adapted in Belgium (VIASANO Program, in 16 towns) and Spain (THAO Salud Infantil Program, in 38 towns). The EPODE methodology has also been launched in 5 pilot towns in Greece in 2008 (PAIDEIATROFI program including 13 towns) and most recently in Canada (Healthy Kids Community Challenge, 35-40 towns).

References:

(1) Romon & Al., Public Health Nutrition, 2009; 12: 1735–1742

(2) J-M. Borys, & Al. EPODE approach for childhood obesity prevention: methods, progress and international development, Obesity Reviews

(3) Romon, M., et al., Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes. Public Health Nutr, 2009. 12(10): p. 1735-42.

(4) Borys, J.M., et al., Hydration and obesity prevention. Obes Facts, 2014. 7 Suppl 2: p. 37-48.