bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of the IDEFICS intervention across European countries: perceptions of parents and relationship with BMI
Authors: De Bourdeaudhuij I. , Verbestel V. , De Henauw S. , Maes L. , Mårild S. , Moreno L. A. , Barba G. , Siani A. , Kovács E. , Konstabel K. , Tornaritis M. , Pigeot I. , Ahrens W. 
Published: December 2015

SummaryObjectivesThe primary aim of the present study was to obtain insight into parents' perception of the IDEFICS intervention at the school or preschool/kindergarten and community levels and whether they received specific materials related to the intervention. The secondary aim was to analyse whether parents who reported higher levels of exposure to the IDEFICS intervention had children with more favourable changes in body mass index (BMI) z‐scores between baseline and after 2 years of intervention.MethodsProcess evaluation of the IDEFICS intervention investigated the implementation of the 2‐year intervention in the intervention communities. Intervention group parents (n = 4,180) in seven countries (Belgium, Cyprus, Estonia, Germany, Italy, Spain and Sweden) answered questions about their exposure to the IDEFICS study. To analyse the relationship between exposure and BMI z‐score, a composite score was calculated for exposure at the setting and at the community levels.ResultsThe frequency of parental exposure to the IDEFICS messages not only through the community but also through the (pre)school/kindergarten was lower than what was intended and planned. The dose received by the parents was considerably higher through the (pre)school/kindergarten settings than that through the community in all countries. Efforts by the settings or communities related to fruit and vegetable consumption (range 69% to 97%), physical activity promotion (range 67% to 91%) and drinking water (range 49% to 93%) were more visible and also realized more parental involvement than those related to TV viewing, sleep duration and spending time with the family (below 50%). Results showed no relation of parental exposure at the setting or the community level on more favourable changes in children's BMI z‐scores for the total sample. Country‐specific analyses for parental exposure at the setting level showed an expected positive effect in German girls and an unexpected negative effect in Italian boys.ConclusionParental exposure and involvement in the IDEFICS intervention in all countries was much less than aimed for, which might be due to the diverse focus (six key messages) and high intensity and duration of the intervention. It may also be that the human resources invested in the implementation and maintenance of intervention activities by the study centres, the caretakers and the community stakeholders were not sufficient. Higher levels of parental exposure were not related to more favourable changes in BMI z‐scores. © 2015 World Obesity
Parents' evaluation of the IDEFICS intervention: an analysis focussing on socio‐economic factors, child's weight status and intervention exposure
Authors: Nicholls S. G. , Pohlabeln H. , De Bourdeaudhuij I. , Chadjigeorgiou C. , Gwozdz W. , Hebestreit A. , Lauria F. , Lissner L. , Molnár D. , Santaliestra‐Pasías A. M. , Veidebaum T. , Williams G. 
Published: December 2015

SummaryIntroductionFrom April 2008 to August 2010 the Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children's health, we also wished to assess whether there were unwelcome aspects or negative side‐effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention.MethodsA total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert‐type scale. Demographic data were collected as part of the baseline (T0) and first follow‐up (T1) surveys; intervention exposure data was also collected in the T1 follow‐up survey. Anthropometric data was collected in the same surveys, and child's weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multilevel logistic regression was conducted to analyse the influence of socio‐economic factors, child's weight status and intervention exposure on parental responses.ResultsIn total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less‐educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects – above all, that ‘the intervention had made their child feel as if he/she was “fat” or “overweight.”’ConclusionWhile the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children.
The IDEFICS intervention trial to prevent childhood obesity: design and study methods
Authors: Pigeot I. , Baranowski T. , De Henauw S. ,   and the IDEFICS Intervention Study Group,   on behalf of the IDEFICS consortium
Published: December 2015

SummaryIntroductionOne of the major research dimensions of the Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) study involved the development, implementation and evaluation of a setting‐based community‐oriented intervention programme for primary prevention of childhood obesity. In this supplement of Obesity Reviews, a compilation of key results of the IDEFICS intervention is packaged in a series of complementary papers.ObjectiveThis paper describes the overall design and methods of the IDEFICS intervention in order to facilitate a comprehensive reading of the supplement. In addition, some ‘best practice’ examples are described.ResultsThe IDEFICS intervention trial was conducted to assess whether the IDEFICS intervention prevented obesity in young children aged 2 to 9.9 years. The study was a non‐randomized, quasi‐experimental trial with one intervention matched to one control region in each of eight participating countries. The intervention was designed following the intervention mapping framework, using a socio‐ecological theoretical approach. The intervention was designed to address several key obesity‐related behaviours in children, parents, schools and community actors; the primary outcome was the prevalence of overweight/obesity according to the IOTF criteria based on body mass index. The aim was to achieve a reduction of overweight/obesity prevalence in the intervention regions. The intervention was delivered in school and community settings over a 2‐year period. Data were collected in the intervention and control cohort regions at baseline and 2 years later.ConclusionThis paper offers an introductory framework for a comprehensive reading of this supplement on IDEFICS intervention key results.
Effects of a community‐oriented obesity prevention programme on indicators of body fatness in preschool and primary school children. Main results from the IDEFICS study
Authors: De Henauw S. , Huybrechts I. , De Bourdeaudhuij I. , Bammann K. , Barba G. , Lissner L. , Mårild S. , Molnár D. , Moreno L. A. , Pigeot I. , Tornaritis M. , Veidebaum T. , Verbestel V. , Ahrens W. ,   IDEFICS consortium
Published: December 2015

SummaryBackground/ObjectivesChildhood obesity is a major public health concern but evidence‐based approaches to tackle this epidemic sustainably are still lacking. The Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. Here, we report on the effects of the IDEFICS intervention on indicators of body fatness.Subjects/MethodsThe intervention modules addressed the community, school and parental level, focusing on diet, physical activity and stress‐related lifestyle factors. A cohort of 16,228 children aged 2–9.9 years – about 2000 per country – was equally divided over intervention and control regions. (Participating countries were Sweden, Germany, Estonia, Hungary, Cyprus, Italy, Spain and Belgium.) We compared the prevalence of overweight/obesity and mean values of body mass index z‐score, per cent body fat and waist‐to‐height ratio over 2 years of follow‐up. Mixed models adjusting for age and socioeconomic status of the parents and with an additional random effect for country accounted for the clustered study design.ResultsThe prevalence of overweight and obesity increased in both the intervention and control group from 18.0% at baseline to 22.9% at follow‐up in the control group and from 19.0% to 23.6% in the intervention group. The difference in changes between control and intervention was not statistically significant.For the cohort as a whole, the changes in indicators of body fatness did not show any clinically relevant differences between the intervention and control groups. Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators.ConclusionsOver the 2‐year‐observation period, the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole.
Behavioural effects of a community‐oriented setting‐based intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study
Authors: De Bourdeaudhuij I. , Verbestel V. , De Henauw S. , Maes L. , Huybrechts I. , Mårild S. , Eiben G. , Moreno L. A. , Barba G. , Kovács É. , Konstabel K. , Tornaritis M. , Gallois K. , Hebestreit A. , Pigeot I. ,   IDEFICS consortium
Published: December 2015

SummaryObjectiveThe objective of this paper is to evaluate the behavioural effects, as reported by the parents of the participating boys and girls, of the IDEFICS (Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS) intervention.MethodsThe effectiveness of the IDEFICS intervention was evaluated through a cluster‐controlled trial in eight European countries (control and intervention communities in each country) including more than 16,000 children. The 2‐ to 9.9‐year‐old children in the intervention group were exposed to a culturally adapted intervention that aimed to prevent childhood obesity through the community, schools/kindergartens and family. Parents completed questionnaires to measure water, soft drink and fruit juice intake; fruit and vegetable intake; daily TV viewing and other sedentary behaviours; daily physical activity levels and strengthening of the parent–child relationships at baseline and follow‐up (2 years later). Mixed models with an additional random effect for country were used to account for the clustered study design, and results were stratified by sex.ResultsThe pan‐European analysis revealed no significant time by condition interaction effects, neither for boys nor girls, i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents (F = 0.0 to 3.3, all p > 0.05). Also very few significances were found in the country‐specific analyses. Positive intervention effects were only found for sport club participation in Swedish boys, for screen time in weekends for Spanish boys and for TV viewing in Belgian girls.ConclusionAlthough no expected intervention effects as reported by the parents on diet, physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort, a few favourable intervention effects were found on specific behaviours in some individual countries. More in‐depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect. © 2015 World Obesity
Effectiveness of the IDEFICS intervention on objectively measured physical activity and sedentary time in European children
Authors: Verbestel V. , De Henauw S. , Barba G. , Eiben G. , Gallois K. , Hadjigeorgiou C. , Konstabel K. , Maes L. , Mårild S. , Molnár D. , Moreno L. A. , Oja L. , Pitsiladis Y. , Ahrens W. , Pigeot I. , De Bourdeaudhuij I. ,   on behalf of the IDEFICS consortium
Published: December 2015

SummaryBackgroundThis paper reports on the effectiveness of the prevention of dietary‐ and lifestyle‐induced health effects in children and infants (IDEFICS) intervention on objectively measured physical activity (PA) and sedentary time (ST) in 2‐ to 9.9‐year‐old European boys and girls.MethodsThe intervention was evaluated after 2 years through a non‐randomized cluster‐controlled trial in eight European countries (one control and one intervention community per country). All children in the intervention group received a culturally adapted childhood obesity prevention programme through the community, schools/kindergartens and family. A random sub‐sample of children participating in the IDEFICS study wore an accelerometer at baseline and follow‐up for at least 3 days (n = 9,184). Of this sample, 81% provided valid accelerometer data at baseline (n = 7,413; 51% boys; 6.21 ± 1.76 years; boys: 617 ± 170 cpm day−1; girls 556 ± 156 cpm day−1) and 3,010 children provided valid accelerometer data at baseline and during the follow‐up survey 2 years later.ResultsIn boys and girls, no significant differences in PA and ST were found between intervention and control groups over 2 years. Strong temporal effects were found in the total sample of boys and girls: the percentage of time spent in light PA per day decreased by 4 percentage points in both boys and girls between baseline and follow‐up (both: p < 0.001), while time spent in ST per day increased by 4 percentage points in both sexes over time (both: p < 0.001). Percentage of time spent in moderate‐to‐vigorous PA per day remained stable over time in boys and girls.ConclusionDespite the socio‐ecological approach and implementation of a culturally adapted intervention in each country, no effects of the IDEFICS intervention were found on children's objectively measured PA and ST. Behavioural interventions for children may need to enhance specificity and intensity at the family level using other behaviour change techniques and more direct strategies to reach parents. © 2015 World Obesity
Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study
Authors: Kovács E. , Hunsberger M. , Reisch L. , Gwozdz W. , Eiben G. , De Bourdeaudhuij I. , Russo P. , Veidebaum T. , Hadjigeorgiou C. , Sieri S. , Moreno L. A. , Pigeot I. , Ahrens W. , Pohlabeln H. , Molnár D. ,   on behalf of the IDEFICS consortium
Published: December 2015

SummaryBackgroundThe Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme.MethodsPre‐intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2–9.9 years, depending on the behaviour. By means of multi‐level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese.ResultsAdherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65–1.01) compared with non‐adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37–0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal‐weight/thin children (12.9%)ConclusionThe selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep. © 2015 World Obesity
Process evaluation of the IDEFICS school intervention: putting the evaluation of the effect on children's objectively measured physical activity and sedentary time in context
Authors: Verloigne M. , Ahrens W. , De Henauw S. , Verbestel V. , Mårild S. , Pigeot I. , De Bourdeaudhuij I. ,   on behalf of the IDEFICS consortium
Published: December 2015

SummaryObjectivesThe first aim was to describe the intervention implementation and reception with specific regard to physical activity (PA) within Belgian schools participating in the IDEFICS (Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS) intervention. Second, we examined if a higher intervention process score in schools showed more favourable effects on children's objectively measured PA and sedentary time (ST).MethodsThe IDEFICS intervention focused on improving children's health behaviour (including PA) at the community, school/kindergarten and family level. Five process evaluation questionnaires completed by school working groups, and (physical education) teachers were used for the process evaluation of four intervention modules (school working groups, healthy weeks, school environment, health‐related physical education and PA). Items were summed to calculate a total intervention process score per school. Schools were subdivided into three groups (low, medium and high score). Multilevel models were used to examine if changes in PA or ST differed between schools with a low, medium or high score. In total, 333 children (54.1% girls, mean age 6.0 ± 1.5 years) from 34 intervention schools (18 pre‐schools and 16 primary schools) in the town of Geraardsbergen, Belgium, provided valid accelerometer data for two weekdays and one weekend day.ResultsMean intervention process score (maximum value = 44) was 20.9 ± 5.8 for schools. The breakdown per module showed which components were implemented and received well and which components could have been improved. After the intervention, the decrease in light PA and increase in ST was much higher in children from primary schools with a low intervention process score, whereas the behaviours remained relatively stable in children from primary schools with a medium or high score. The change in moderate to vigorous PA did not differ significantly between schools with a low, medium or high score.ConclusionThe IDEFICS intervention was relatively able to prevent unfavourable changes in ST and light PA in schools with a medium and high intervention process score. Further process evaluation research is needed to obtain a more profound picture of the IDEFICS intervention process.
The IDEFICS intervention: what can we learn for public policy?
Authors: Williams G. 
Published: December 2015

SummaryIntroductionAs considered in the rest of this volume, the effects of the IDEFICS intervention on obesity rates were not encouraging. This paper considers how far findings from the IDEFICS study and similar intervention studies are relevant to the policy process and political decision‐making.MethodsThe paper offers theoretical and policy‐level arguments concerning the evaluation of evidence and its implications for policymaking. The paper is divided into three parts. The first considers problems in the nature and applicability of evidence gained from school‐ and community‐level obesity interventions. The second part considers whether such interventions present a model that policymakers could implement. The third part considers how we should think about policy measures given the limited evidence we can obtain and the many different goals that public policy must take account of.ResultsThe paper argues that (1) there are clear reasons why we are not obtaining good evidence for effective school‐ and community‐level interventions; (2) public policy is not in a good position to mandate larger‐scale, long‐term versions of these interventions; and (3) there are serious problems in obtaining ‘evidence’ for most public policy options, but this should not deter us from pursuing options that tackle systemic problems and have a good likelihood of delivering benefits on several dimensions.ConclusionsResearch on school‐ and community‐level obesity interventions has not produced much evidence that is directly relevant to policymaking. Instead, it shows how difficult it is to affect obesity rates without changing wider social and economic factors. Public policy should focus on these.
Should the IDEFICS outcomes have been expected?
Authors: Baranowski T. , Lytle L. 
Published: December 2015

SummaryThe Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) study evaluated with a large sample a comprehensive carefully planned obesity prevention intervention targeting multiple levels of influence that were culturally adapted to the situations in eight European countries. Despite the great effort and attention to detail, the IDEFICS study did not achieve its targeted adiposity or behaviour change objectives. Should we be surprised that the IDEFICS trial did not have its intended effects? We think not, and would have been surprised if it did. Recent research has revealed the lack of consistent meaningful relationships between several apparently obesogenic behaviours and adiposity, weak or no relationships among behavioural change procedures, mediating variables and targeted behaviours and inadequate attention to moderating effects. Future obesity prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and the interrelationships with biological factors. While systems modelling has been proposed as providing the solution, important less complex identification of new constructs, new relationships and community interventions are still needed, both to find innovative solutions and to provide input into the systems models. We should question results from cross‐sectional studies and be satisfied only with longitudinal or experimental tests of relationships.