[Development of a conceptual model for interpretation of monitoring indicators of childhood obesity prevention from the Italian National Prevention Plan] Sviluppo di un modello concettuale di riferimento per l\u2019interpretazione degli indicatori di prevenzione dell\u2019obesit\ue0 infantile e nell'adolescenza nel Piano nazionale della prevenzione

INTRODUZIONE: il Piano nazionale della prevenzione (PNP) 2014-2018 ha indicato alle Regioni obiettivi e strategie per la prevenzione dell\u2019obesit\ue0 e si \ue8 dotato di un sistema di valutazione d\u2019impatto. OBIETTIVI: sviluppare un modello per l\u2019interpretazione delle variazioni negli indicatori relativi all\u2019obesit\ue0 infantile e nell\u2019adolescenza. METODI: da una revisione sistematica, DPSEEA (\uabforze trainanti\ubb, \uabpressioni\ubb, \uabstato\ubb, \uabesposizione\ubb, \uabeffetto\ubb, \uabazioni\ubb) \ue8 risultata la cornice concettuale pi\uf9 completa e applicabile. Un gruppo di esperti ha identificato determinanti e nessi causali e possano agire gli interventi proposti dal PNP come su questi. Il modello finale \ue8 stato ottenuto attraverso un processo iterativo che ha coinvolto un comitato consultivo di decisori e rappresentanti di societ\ue0 scientifiche. RISULTATI: \uabforze trainanti\ubb identificate sono legate a profitto dell\u2019industria alimentare, all\u2019alimentazione scolastica, al contesto domestico. Tra le \uabPressioni\ubb rientrano abitudini familiari, offerta delle mense scolastiche e fattori socioculturali, contesto di vita, organizzazione dell\u2019attivit\ue0 fisica (AF) scolastica ed extra-scolastica. Nello \uabstato\ubb sono inclusi: frequente consumo di cibo confezionato, alta quantit\ue0 di cibo ipercalorico disponibile, mancanza del pasto in famiglia, consumo di bevande gasate e zuccherate, interruzione precoce dell\u2019allattamento al seno, scarsa fruibilit\ue0 di spazi esterni, frequente uso del trasporto privato e scarsa offerta di AF nelle scuole. \uabEsposizione\ubb sono le opportunit\ue0 di AF e apporto calorico, che agiscono su \uabeffetto\ubb (prevalenza di obesit\ue0). CONCLUSIONI: il modello interpretativo colloca le \uabazioni\ubb e i meccanismi che dovrebbero modificare AF e apporto calorico, in una sequenza causale, rendendo esplicito il costrutto degli indicatori di monitoraggio e d\u2019impatto.BACKGROUND: the Italian National Prevention Plan (PNP) posed the standard to be achieved by Regions for the prevention of obesity in childhood and adolescence. The PNP also set up a monitoring system to assess the impact of implemented policies. OBJECTIVES: to develop a conceptual model to facilitate interpretation of variation in outcome indicators. METHODS: after a systematic review, the DPSEEA (\uabDriving forces\ubb, \uabPressures\ubb, \uabState\ubb, \uabExposure\ubb, \uabEffect\ubb, \uabActions!) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the framework were identified and indicators that allow measuring the changing of each of these factors were defined. RESULTS: the included \uabdriving forces\ubb were related to the profit-led food industry, to the nutrition environment at school, and to household-level factors. Among the \uabpressures\ubb, parenting behaviours, food provided by school canteens, sociocultural factors, social context, physical activity (PA), opportunities at school or after-school were included. In the State, the high consumption of processed food, the large quantities of high-calorie food easy available, the consumption of carbonated and sugar-sweetened beverages, the reduced social function of mealtimes in families, the early cessation of breastfeeding, the reduction of outdoors activity, active transportation, and PA at school for children were identified. The \uabexposure\ubb factors were the reduced opportunities of doing PA and the over-consumption of calories that influence the \uabeffect\ubb, described as the prevalence of children and adolescents affected by obesity. CONCLUSIONS: through the DPSEEA, a conceptual model was set up; it allows to place in the causal chain the \uabactions\ubb and the mechanisms through which these actions should impact on the \uabexposure\ubb (PA and over-consumption of calories), making the rationale of process and impact indicators explicit

Educational Intervention of Healthy Life Promotion for Children with a Migrant Background or at Socioeconomic Disadvantage in the North of Italy: Efficacy of Telematic Tools in Improving Nutritional and Physical Activity Knowledge

The aim of the "Smuovi La Salute " ( "Shake Your Health ") project was to implement an integrated and comprehensive model to prevent and treat overweight and obesity in low socioeconomic status (SES) and minority groups living in three different districts in the north of Italy. An app and a cookbook promoting transcultural nutrition and a healthy lifestyle were developed, and no-cost physical activities were organized. Healthy lifestyle teaching was implemented in 30 primary school classrooms. Learning was assessed through pre- and post-intervention questionnaires. At the Obesity Pediatric Clinic, overweight and obese children of migrant background or low SES were trained on transcultural nutrition and invited to participate in the project. Primary school students increased their knowledge about healthy nutrition and the importance of physical activity (p-value < 0.001). At the Obesity Pediatric Clinic, after 6 months, pre-post-intervention variation in their consumption of vegetables and fruit was +14% (p < 0.0001) and no variation in physical activity habits occurred (p = 0.34). In this group, the BMI z-score was not significantly decreased (-0.17 & PLUSMN; 0.63, p= 0.15). This study demonstrates the feasibility and efficacy of telematic tools and targeted community approaches in improving students' knowledge with regard to healthy lifestyle, particularly in schools in suburbs with a high density of migrants and SES families. Comprehensive and integrated approaches provided to the obese patients remain mostly ineffective