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Best Practices Portal: Five New Interventions in Diabetes Prevention

Five New Interventions Added –

Prevention of Type 2 Diabetes by Addressing Obesity and Excess Weight

It is widely recognized that obesity increases the risk of many chronic diseases, including type 2 diabetes in adults. Children who are obese have a higher risk of developing health problems later in life. Interventions that successfully reduce the incidence of obesity have an important role to play in diminishing risk to the health of the Canadian population. 

The Canadian Best Practices Portal has recently updated its listings of evidence-based public health interventions that contribute to type 2 diabetes prevention by successfully addressing obesity. An extensive search of recent literature (peer-reviewed journal articles published up to February, 2014), followed by a rigorous assessment process, identified five new interventions. There is good evidence that these interventions were successful in contributing to weight reduction or maintenance in adults and children in diverse settings:

·      two were school-based

·      two interventions were delivered in the workplace, and

·      one  took place in a recreational setting

What do the new interventions have in common?

Researchers used a RCT (randomized control trial) or a quasi-experimental design to test the effectiveness of each intervention, comparing outcomes with similar participants who did not receive the intervention. People who participated in the intervention groups succeeded in reducing their weight or BMI (body mass index), or maintained their weight, while others gained weight over time. The successful interventions included one or several educational components targetting individuals (raising awareness, teaching strategies, monitoring behaviour using online methods or pedometers). Several also included one or more components targetting the environment (e.g., changing the workplace or school environment to support healthy behaviour).

Each of the five newly-added interventions is briefly described below. For more detail go to http://cbpp-pcpe.phac-aspc.gc.ca/

School-based interventions

Both the school-based interventions we include here were developed in Australia. One involved adolescents; the other targetted children in grades 5 and 6 (ages 9-12)

It's Your Move (Australia)

This three-year intervention aimed at preventing obesity in five Australian secondary schools. "It's Your Move" was based on a community capacity approach with multiple partners (government, local community organisations, schools), within the government's overall health promotion strategy and the international Pacific Obesity Prevention in Communities research study.  Goals included healthy eating, regular physical activity and healthy bodies. Rather than using a set curriculum and promotional materials, in adolescents in participating schools were encouraged to get directly involved in running the project. The adolescents themselves suggested the best ways to address the goals. Students gave the project the name, designed publicity materials, and developed action plans for their own schools. The intervention also involved families, schools and community organizations to sustain the health promotion message and activities.  After three years, students in the participating schools had significantly better weight and BMI scores than the students in the comparison group.

Switch-Play and Switch-2-Activity (Australia)

The primary aims of this 10-month intervention were to prevent weight gain, reduce screen time, and maintain physical activity levels among ten-year-old students in low SES schools. The intervention also hoped to increase children's enjoyment of physical activity, and improve movement skills related to childhood games and sports. Three types of approaches (behaviour modification (BM) alone; fundamental movement skills (FMS) alone, and a combination of behaviour modification and fundamental movement skills) were tested and compared. The supplementary curriculum was delivered in the school setting (classroom/outdoors) by trained physical education teachers supported by a detailed curriculum.  After 12 months, those children who participated in the combined (BM/FMS) stream were significantly less likely to be overweight. Boys and girls differed in their overall enjoyment of and participation in PA, and their fundamental movement skills. 

The intervention was tested again, under real-life conditions, as Switch-2-Activity.  This shortened version, delivered without the support of the trained PA specialist, had an effect in slightly reducing screen times for boys, and increasing self-efficacy, although physical activity levels were not changed significantly. This suggests that the full intervention, with the complete curriculum, intensity, and supports, might be required to achieve the best results.

Workplace Interventions

According to Statistics Canada, adults spend approximately 38 hours per week at the workplace (Source: Statistics Canada. Table 282-0028 - Labour force survey estimates (LFS), by total and average usual and actual hours worked, main or all jobs, type of work, sex and age group, annual (hours), CANSIM (database).It makes sense to try to use the workplace as an entry point for interventions that will improve health.

One intervention (Dow Chemical) was successful in maintaining weight among intervention participants compared to control, an important step in the right direction. The other intervention (POWER) succeeded in helping obese men reduce weight.

POWER (Preventing Obesity Without Eating like a Rabbit) (Australia)

Although shift work is a risk factor for developing work related morbidity, few health promotion interventions target shift workers. POWER (Preventing Obesity Without Eating like a Rabbit) is a weight reduction program for overweight and obese male shift workers.

The three-month weight-loss program consisted of an educational information session including behaviour change strategies (self-monitoring, goal setting and social support), a resource weight loss handbook, a pedometer, and a study website. Participants were encouraged to record their weight once each week online and submit online eating and exercise diaries. Based on these entries they received up to seven individualized feedback documents via email. Men could email the research team with any questions. Monetary incentives were provided for crews achieving high weight loss. These incentives also were designed to encourage social support and motivation.

After 14 weeks, men who participated in POWER had lost significantly more weight (on average 4.3 kg), about 5% of their baseline weight compared to controls. There were also significant effects on waist circumference, BMI, systolic blood pressure, resting heart rate and physical activity. Only 28% of men in the intervention group complied with the online component of the intervention, but those who did use the online program lost most weight.

Dow Chemical (US)

The intervention at the Dow Chemical company contributed to weight maintenance rather than weight loss. The intervention consisted of changing the workplace environment to increase employees’ level of physical activity, improve nutrition and manage weight. It required senior management buy-in to change policies and encourage leadership development to increase commitment for engaging workers in embracing an overall workplace wellness ‘culture’. More specifically, environmental prompts encouraged employees to make healthy food choices and be physically active.

To intensify intended health outcomes, interventions at the environmental/organizational level were combined with individual-level health promotion programs already established at the company. These consisted of health assessment and consultation services, health education, physical activity and weight management programs including pedometer use, and online behaviour change programs. The study showed that after two years employees in the more intense intervention group maintained their weight and BMI, whereas those in the control group gained an average of 1.3 pounds.

Intervention in a community recreational setting: Football Fans in Training (FFIT) (Scotland)

This 12-week weight-loss programme, targetting overweight men, was delivered free of charge to male fans of Scottish professional football clubs. Trained community coaches employed by the clubs led group sessions using a simple curriculum that included advice on healthy eating and weight loss, behaviour change motivation, and physical activity. The weekly sessions were gender-sensitive in setting, content, and style of delivery. Peer support, a pedometer-based walking programme, varied and football-related in-stadium physical activities, and post-programme weight management support were emphasized.  Participation rates were high. A post-programme weight maintenance phase consisted of e-mail prompts for nine months and a group reunion at six months. The intervention was effective in promoting significant weight loss: men who participated in the groups achieved at least 5% weight loss and maintained it after 12 months. The FFIT intervention has been assessed as cost-effective and inexpensive to deliver. It could easily be adapted to meet the needs of other types of sports fans.... how about a New Healthy Hockey League (NHHL) programme?