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Performing above the curve? The effectiveness of interventions adopting the EPODE methodology.

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction: The increasing obesity prevalence among youngsters is a major public health concern worldwide (Ng, Fleming et al., 2014; WHO, 2016). Accordingly, various pre- and intervention programs have been introduced, aiming to reduce childhood obesity (Kobes, Kretschmer, Timmerman, & Schreuder, 2018). Of particular influence in European policy-making has been a French intervention evaluation study conducted from 1992-2007, the Fleurbaix Laventie Ville Santé (FLVS) study, which focused on nutrition education in child settings (Romon et al., 2009). The FLVS approach has been instrumental in the design of the EPODE methodology: a far-reaching obesity prevention methodology that has been translated into various country-specific applications (Borys et al., 2012). The EPODE methodology has not been scientifically evaluated thus far, despite proposed evaluation plans (Mantziki et al., 2014). It is safe to say that no other weight-related intervention has a comparable implementation reach in Europe.
The Netherlands is one of many countries adopting the EPODE methodology in the form of the JOGG program (JOGG-aanpak, n.d.). Given the substantial amount of public money that has been invested in implementing JOGG (>$60.000 per municipality per year), it is of utmost importance to establish whether this expenditure actually has the chance to prevent and reduce overweight and obesity in youngsters. Alarmingly, this evidence seems to be lacking when considering published papers on the FLVS results which formed the basis for the EPODE methodology.

Method: We put available results on FLVS data to a stringent re-test by means of p-curve analysis. This method determines the distribution of significant p-values across a set of studies (Simonsohn, Nelson, & Simmons, 2014). The included significant p-values indicate whether children’s BMI, waist circumference, percentage body fat, skinfold thickness, physical activity and hours in front of the television changed over the course of several years. A right-skewed distribution of significant p-values suggests evidential value for the considered effect.

Results: Four scientific papers reported measures of children’s obesity related measures over time. Three papers contained enough information to extract or calculate test statistics corresponding to reported p-values. A surprising number of p-values (n=9, out of 11) reported undesired results: children’s obesity related measures (e.g., BMI, percentage body fat) increased instead of decreased. The p-curve analysis shows that these 9 p-values present evidential value (p<0.0001, Figure 1), meaning that this analysis supports the conclusion that the papers contain evidence for an increase in obesity related measures. Worth noting is that the paper not included in the p-curve analysis examined data from 2002-2004, while the papers included in the p-curve analyses (and demonstrating undesired results) examined data from 1992-2001.

Discussion: The results of this study give good reason to further investigate the products of the EPODE methodology, which is, amongst others, the Dutch JOGG intervention. JOGG has never been scientifically investigated before, despite being implemented for nearly a decade. Given the energy and money invested in JOGG, a next, logical step would thus be to evaluate the effectiveness of JOGG. Furthermore, p-curve analysis has proven to be very useful in better understanding and interpreting separate results.

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