EPODE – A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities

European Endocrinology, 2013;9(2):116–20


Obesity is a global epidemic: it is estimated that the majority of the world’s adults will be overweight or obese by 2030. It is therefore important to reverse trends towards increasing childhood obesity by interventions at the community level. Ensemble Prévenons l’Obésité Des Enfants (EPODE, Together Let’s Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multi-stakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.
Keywords: Childhood obesity, community-based interventions, EPODE, overweight
Disclosure: The authors have no conflicts of interest to declare.
Received: March 18, 2013 Accepted May 18, 2013 Citation European Endocrinology, 2013;9(2):116–20
Correspondence: J-M Borys, 109–111 Rue Royale, 1000 Brussels, Belgium. E: jmborys@epode.be
Support: The publication of this article was supported by The Coca-Cola Company. The views and opinions expressed are those of the authors.

The prevalence of overweight and obesity has increased worldwide over the last 30 years. 1–5 It was estimated that in 2005, 23.3 % of the world population was overweight and 9.8 % was obese 6 and in 2009–10, 37 % of adults in the US and almost 17 % of youths were obese. 7 Predictions concerning overweight and obesity prevalence suggest that the majority of the world’s adults will be overweight or obese by 2030. In the US, it is estimated that 86.3 % of adults will be overweight and 51.1 % will be affected by obesity.8 Obesity and its associated health risks involve direct and indirect economic costs that impact significantly on healthcare systems. In the US, these costs were estimated at $147 billion in 2008. Heathcare costs are predicted to double every decade, reaching about $956.9 billion in 2030. 9 There is, therefore, a critical need for global strategies to prevent obesity.

A growing body of evidence shows that prevention through a lifestyle modification in eating habits and physical activity is one of the most efficient and cost-effective ways to tackle the obesity epidemic. 10 Furthermore, lifestyle modification is associated with substantial risk reductions for metabolic diseases; a recent epidemiological study found that individuals undertaking regular physical activity had a reduced risk for Type 2 diabetes (T2D): odds ratio (OR) 0.76 for men (95 % confidence interval [CI] 0.73–0.79) and 0.77 for women (95 % CI 0.73–0.82).11

In order to be effective, public interventions for the prevention of obesity should be implemented in three stages: targeting entire populations, high-risk subgroups of the population and individuals at high risk. This may be undertaken at national, state and community levels, and should involve numerous sectors, such as childcare facilities, schools, workplaces and seniors centres. A focus on specific populations may be required to ensure that interventions address disparities in social and environmental conditions related to food consumption and physical activity. A positive correlation has been demonstrated between low-socioeconomic status and obesity. A review of studies conducted in 13 EU member states suggested that over 20 % of the obesity in European men and over 40 % of the obesity in women was attributable to socioeconomic inequalities. In addition, obesity among children was associated with the socioeconomic status of their mothers.12

Public interventions targeting obesity have had varying degrees of success; however, a community-based intervention, the Fleurbaix Laventie Ville Santé Study (FLVS), demonstrated significant reductions in the prevalence of both overweight and obesity and in health inequalities. 13 This longterm intervention pilot programme formed the basis of the Ensemble, Prévenons l’Obésité des Enfants (EPODE) methodology, disseminated today in more than 17 countries. This article’s aim is to outline the EPODE methodology, to discuss its potential for transferability, and to suggest ways in which EPODE may be used as a model for future strategies to reduce the global incidence of other weight-related comorbidities.

Health Effects of Overweight and Obesity
Overweight and obesity in childhood are known to have significant impacts on both physical and psychological health and both are associated with abnormal glucose tolerance and an increased risk of T2D. Moreover, adipose tissue releases non-esterified fatty acids, glycerol, hormones and pro-inflammatory cytokines, all of which are associated with the development of insulin resistance.14 T2D has become a global epidemic and is associated with increased risk of cardiovascular disease (CVD) and premature mortality. Between 1980 and 2006, the number of adults with T2D rose from 153 million to 347 million worldwide.15

Obesity and overweight can result in numerous other adverse health outcomes, including dyslipidaemia, hypertension, coronary artery disease, certain cancers, sleep apnoea and an increased risk of mortality.16 In children, overweight has been associated with T2D, sleep apnoea, hypertension, dyslipidaemia, the metabolic syndrome and psychological disorders such as depression.17 Overweight children subsequently monitored in later life had increased incidence of CVD, digestive diseases and all-cause mortality compared with those who were lean.18,19

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Keywords: Childhood obesity, community-based interventions, EPODE, overweight
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