GrowH!

GrowH! is a collaborative research project addressing a well-known but still poorly understood public health problem: how to structurally and sustainably install and maintain healthy lifestyles at population level with the aim to reverse the current trends in childhood overweight and obesity, to foster prevention of chronic diseases and further enhance healthy life expectancy for the people in Europe. In particular, vulnerable groups, who have not been reached successfully by previous prevention measures, are being addressed with two different intervention studies in children conducted in Germany and Spain, adapted from participatory prevention projects from Canada (the Guelph Family Health study) and the Netherlands (the Kids in Action study) respectively. Both projects have already shown promising results in the prevention of obesity.

As part of the JPI HDHL programme, 6 research partners and 2 collaborating institutions are engaging with further experts, policy makers, stakeholders, interested citizens and target groups to explore the feasibility of implementing innovative promising strategies and approaches for obesity prevention in children and their families, and to explore whether these new approaches can be scaled up and adapted to the needs of different population groups. Finally, suggestions regarding systemic changes that are needed to support these prevention approaches will be made.

A considerable amount of work has been performed during the first half of the project. An obesity risk score that identifies children/adolescents at high-risk of becoming obese over a period of 4-6 years has been developed, based on a comprehensive set of 34 behavioural, environmental, familial, lifestyle and physiological risk factors. Age-specific associations between these risk factors and BMI development in the early life course with focus on differences by parental educational level have been investigated to assess sensitive time windows for intervention. The various analyses performed on data of the IDEFICS/I.Family and ABCD cohorts provide evidence that will feed into hypothetical interventions for childhood obesity prevention targeting vulnerable groups. An international multidisciplinary systems advisory board has been established that will provide expertise regarding the structural and regulatory requirements for implementation, transfer and up-scaling of the developed local intervention approaches. Both proof-of-feasibility studies in Germany and Spain have started. A scoping review is in progress, which will summarize the existing systems frameworks for childhood obesity prevention and extract the important elements of a systems approach. A system mapping protocol for the two intervention studies is being developed. In Zaragoza, Spain, the local determinants of physical activity, sedentary behaviour, sleep, and dietary behaviour among the children in one neighbourhood were already assessed and visualized in Causal Loop Diagrams (CLDs).

WP1. Creating an evidence base for effective obesity interventions in the early life-course

We developed and validated an obesity risk score that predicts high-risk children over a four-year period.
We observed age-specific associations between 34 risk factors and overweight/obesity in the early life course independent of parental education. The age of 9 to 11 years seems to be a sensitive time window for the adoption of unfavourable behaviours.
Cross-comparison of the IDEFICS/I.Family and ABCD cohorts revealed marked differences in health behaviour trajectories across European regions.

WP2. Development of proof-of-feasibility studies on a local level

We established an international multidisciplinary systems advisory board (SSAB), consisting of 6 systems science experts. The valuable advice of the board is being integrated in the project plans.
The protocols for the proof-of-feasibility studies in Bremen and Zaragoza are finalized, ethical approval is obtained, and both studies have started.
A scoping review will summarize the existing systems frameworks for childhood obesity prevention, and and will highlight the key elements related to the content, and the process of such a systems approach.

WP3. Implementation and evaluation of proof-of-feasibility studies

In Bremen, 6 focus groups helped to adapt the intervention and materials to the local context. The evaluation concept was finalised, including study measurements and standard operation procedures. Health educators of the local operational stakeholder received training in motivational interviewing.
In Zaragoza the participatory needs assessment has been completed. Three so-called ‘participatory action teams’, consisting of 6-8 children aged 9-10 and one facilitator, explored health behaviours, learned research skills, conducted peer-research, and created overviews to understand the (local) system and identify ‘leverage points’ for actions to improve their (system) behaviours.

WP4. Integration of the obtained evidence and know-how into a systems-oriented policy guidance

A systems mapping protocol for the two interventions is being finalized, including stakeholder mapping, neighbourhood mapping and causal loop diagram building.
The stakeholder mapping in Zaragoza revealed 46 potential stakeholders relating to the field of childhood obesity prevention, belonging to civil society organisations, government institutions, healthcare providers, the research community, and private businesses.
The causal loop diagram building for Zaragoza has been conducted as part of the participatory needs assessment (see WP3).

WP5. Project coordination and management

All activities were initiated in time and operational stakeholders became actively involved despite the restrictions caused by the Covid-19 pandemic.
First steps have been taken towards creating a network involving early career researchers within PREPHOBES projects, initiated with the support of GrowH! partners involved in the JPI-HDHL project Policy Evaluation Network.