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Joint Action on Nutrition and Physical Activity [JANPA] [677063] - Joint Actions
Project abstract

In all EU Member states (MS), the high level of overweight and obesity in children and adolescents is of particular concern. In the EU, around 1 in 3 children 6-9 years old were overweight or obese in 2010, a sharp rise in prevalence despite numerous MS or EU initiatives.Physical inactivity and poor diet from birth (and even in utero) are important determinants of adiposity leading to overweight and obesity. They are also independently associated with various non-communicable disease risk factors leading to the main pathologies European populations are suffering from, including detrimental psychosocial outcomes. Overweight and obesity represent an economic burden with up to 7% of EU health budgets spent each year directly on diseases linked to obesity, with more indirect costs resulting from lost productivity. Nutritional problems and physical inactivity need to be addressed in an integrated way so as to promote healthier environments, to make the healthy option the easiest option and to inform and empower families.Within the general frame of the EU Action plan on childhood obesity 2014-2020, the JA’s general objective is to contribute to halting the rise in overweight and obesity in children and adolescents by 2020. Through the, identification, selection and sharing of best data and practices within the 25 countries involved, the JA will allow for : to advocate based on an estimation and forecast of economic cost of overweight and obesity; to improve the implementation of integrated interventions to promote nutrition and physical activity for pregnant women, families with young children; to improve actions within school settings; and to increase the use of nutritional information on foods by public health authorities, stakeholders and families for nutrition policy purposes. The JA will reinforce the links between national nutrition and physical activity policies initiated by the EU Strategy on nutrition, overweight and obesity-related health issues.

Summary of context, overal objectives, strategic, relevance and contribution of the action

In all EU Member states (MS), the high level of overweight and obesity in children and adolescents is of particular concern. In the EU, around 1 in 3 children 6-9 years old were overweight or obese in 2010, a sharp rise in prevalence despite numerous MS or EU initiatives. Physical inactivity and poor diet from birth (and even in utero) are important determinants of adiposity leading to overweight and obesity. They are also independently associated with various non-communicable disease risk factors leading to the main pathologies European populations are suffering from, including detrimental psychosocial outcomes. Social inequalities in Nutrition and Physical activity remain a main challenge for the different national nutrition policies. Overweight and obesity represent an economic burden with up to 7% of EU health budgets spent each year directly on diseases linked to obesity, with more indirect costs resulting from lost productivity. Nutritional problems and physical inactivity need to be addressed in an integrated way so as to promote healthier environments, to make the healthy option the easiest option and to inform and empower families. Within the general frame of the EU Action plan on childhood obesity 2014-2020, the Joint action’s (JA) general objective is to contribute to halting the rise in overweight and obesity in children and adolescents by 2020. Through the identification, selection and sharing of best data and practices within the 26 countries involved, the JA allows: to advocate based on an estimation and forecast of economic cost of overweight and obesity; to improve the implementation of integrated interventions to promote nutrition and physical activity for pregnant women, families with young children; to improve actions within school settings; and to increase the use of nutritional information on foods by public health authorities, stakeholders and families for nutrition policy purposes. The JA reinforces the links between national nutrition and physical activity policies initiated by the EU Strategy on nutrition, overweight and obesity-related health issues.

Methods and means

The Joint action (JA) consortium has 39 associated partners from 24 European countries and involves also an important number of collaborating stakeholders. In total, all but 3 (Denmark, The Netherlands, United Kingdom), i.e. 25 of the 28 EU MS, as well as Norway, participate in the JA. The consortium contains broad and diverse expertise relevant to carrying out the JA with success as the partners are all key actors in the European and national health and/or nutrition and physical activity programmes.
The JA offers a unique opportunity to share and analyse practices and to discuss recommendations on best practices in the many different fields necessary to improve the situation of childhood overweight and obesity. From this coordinated work, a harmonised and integrated approach to address this major public health challenge is developed. This work aims to improve the concrete practical coordination based on a networking of European nutrition and physical activity policies allowing as far as possible a harmonisation of strategies and actions.
Different types of actions are implemented in the Joint Action:
• The use of economic evaluation of the cost of children obesity to encourage public action,
• The sharing of specific tools to promote the improvement of the nutritional quality of foods and the consumer information at national level,
• The identification and sharing of integrated actions at local or national level for diet and physical activity, with children (from in utero to the end of school age) as a target, families and professionals as main actors of the actions, and pre-school and school settings as the main place to act.

To ensure the success and efficiency of the JA, close links with high-level policy makers and other stakeholders in the field of nutrition and physical activities is implemented through the active involvement of the collaborating stakeholders, and beyond, through the JA’s dissemination activities.

Work performed during the reporting period

The Joint Action on Nutrition and Physical Activity (JANPA) started on 1st September 2015. A Public Launch Event was organised on 28th September 2015 in Luxembourg and gathered around 50 participants from the JANPA partners' organisations, EC institutions, WHO and stakeholders. The kick-off meeting took place on 29 - 30 September 2015 and was attended by representatives from 32 of 39 associated partners and 3 collaborating partners.

The WP1 team managed all contractual, financial and administrative aspects of the project. WP1 established the management structure, defined the JA rules and procedures and elaborated the JANPA templates. A JA Quality Manual was established and disseminated to all partners. WP1 ensured the communication with the EC and managed unforeseen events (preparation and submission of 5 amendments to the JANPA Grant Agreement). WP1 also conducted internal technical and financial reporting approximately every six months and issued the corresponding internal reports. Templates for the two periodic reports to be submitted to Chafea were prepared to help partners to complete the reporting. The periodic technical and financial reports were then compiled and submitted to Chafea.
WP1 prepared the JA‘s General Assembly held 13-15 of September 2016 in Berlin and organised 14 steering committee meetings (conference calls or face-to-face meetings). All deliverables produced by the other WP were reviewed, commented and validated before submission to Chafea. The JANPA Position paper and the Layman version of the Final report were prepared in close collaboration with the WP2 team and with contributions from WP leaders and.

The WP2 team defined JANPA’s dissemination strategy and created the relevant communication tools: the visual identity, a website, an information leaflet, a poster and a tweeter as well as a “Facebook” account. It established and continuously updated a dissemination plan. With the contributions of all partners, WP2 leader compiled and analysed a list of stakeholders identified at country and EU levels in order to disseminate results and relevant information about JANPA in each MS and to establish contacts with other research projects at regional/national and European level. Six newsletters were produced and reached approximately 2 500 stakeholders. The WP2 team together with the WP leaders prepared factsheets of the JANPA main deliverables and disseminated them at the JANPA final conference and through the different JANPA dissemination channels. A Layman version of the Final report (a brochure of 16 pages) was prepared in November 2017 and described the main results of JANPA. The JANPA Position paper was established together with all WP leaders and contained recommendations for the implementation of the JANPA results.
The WP2 supported the Coordinator to prepare and promote the JANPA final conference (information shared through the dissemination channels, printed materials provided; …).

The WP3 team established the Evaluation plan, including the identification of 3 external experts to support the WP3 team, the Coordinator and the WP leaders in their activities. Two interim evaluation reports and two yearly evaluation reports were produced. The WP3 also prepared a final evaluation report and its layman version.
The JANPA evaluation was implemented through several on-line questionnaires (for the WP leaders, the JANPA partners, the stakeholders…), through evaluation forms completed by the external evaluators and through five meetings (face-to-face or conference calls).

The WP4 Irish team submitted four academic systematic reviews of the international literature for publication in peer-reviewed journals which cover prevalence of childhood obesity and overweight, childhood impacts of childhood obesity and overweight, adult impacts of childhood obesity and overweight and the lifetime costs of childhood obesity.
In late 2015 / early 2016, the WP4 lead team conducted an email-based Local Mate

The main output achieved so far and their potential impact and use by target group (including benefits)

Summary of the main outputs (Technical activities)

The WP4 team worked on the deliverable 4.1 “Evidence paper and study protocols” which was submitted. The Evidence paper covers prevalence of childhood obesity, health and other impacts of this condition, healthcare and other costs, taking into account the availability and quality of data in the EU MS. It summarizes four International systematic reviews (“Irish studies”). WP4 members have also worked on the Study Protocols which identify the most appropriate methodology and modelling approach based on existing work and models; they have been tested in the scope of the Irish studies. The Deliverables 4.6 and “Lifetime Impacts & Costs of Childhood Obesity Overweight in Europe: Part 1: Modelling methodology; Data requirements; Results for the Republic of Ireland & Northern Ireland” and 4.7 “Part 2: Data & Data Documentation; Challenges & Lessons; Future Developments” were produced. They gave results for 2 countries (Ireland and Northern Ireland) and produced the data necessary to get results for the other countries (except Portugal). To achieve this objective, it is necessary to improve the tools and to make them largely available. Links with OECD which is working on the economy of obesity will allow in a near future to include the JANPA WP4 work in a global view.

Participating countries of WP5 collected information on existing monitoring systems of nutritional information and their use by nutritional policy managers. Countries also collected available data on the use and understanding of food information by families. In 3 countries where a pilot study took place - data were collected on the nutritional composition of two categories of food (breakfast cereals and sugary beverages) and were put into a harmonised database. The feasibility of such a system was already demonstrated in France (“Oqali”), and was tested in Romania and Austria. The main conclusion of the first part of the work (D5.1) is that a combination of different types of policy actions is necessary in order to improve the quality of the diet at the population level: information and education to increase the interest for nutrition, actions on the food environment in order to make the good choices easier, simplified food labelling systems to empower the families and give them the possibility to make the right choice when shopping, and food reformulation to improve the quality of the food supply. The main conclusions of the second part of the work (D5.2) is that: (i) a monitoring tool managed by public authorities and fed by industry is necessary to qualify the nutritional quality of the food offer and to follow up the impact of the nutrition policies deployed, and (ii) that it is absolutely necessary to work at the brand and at the country level because the offer varies depending of the country, but also because the composition of the products can be different from one country to another. Such a tool, based on the Oqali model, could easily be implemented in other European countries.

The WP6 team conducted desk research on existing definitions in health promotion and set up a working definition and criteria for good practices. WP6 worked on the collection and analysis of the collected good practices regarding integrated approaches in kindergartens and schools; 37 good practices were collected from 15 countries and all 13 WP6 members’ countries were sent country context forms to be completed. WP6 members also worked on assessing the existing capacities and resources for the prevention of childhood obesity; 187 web-based questionnaires from 13 countries were completed and 16 interviews were conducted. The final D6.2 “Compendium of Good Practices in Creating Healthier Environments in Pre-Schools and Schools” brings together diverse practices from 16 countries which were collected in a standardized way. It offers information on 39 different good practices, with the objective of making both a

Achieved outcomes compared to the expected outcomes

The outcomes have been achieved as planned though with some delays in the submission of some deliverables. Due to external constraints, the WP4 results were delayed and need a further development after the end of JANPA. However, the implemented methodology proved to be efficient.

Dissemination and evaluation activities carried out so far and their major results

Dissemination activities – WP2
Information about JANPA and its outputs have been largely disseminated both at national level and European level. The main target groups, including EC institutions (in particular DG SANTE), international organisations, topic-related projects, public national, regional and local authorities, educational body and schools, health communities, universities, NGOs, foundations, food economic actors etc., have been reached through both offline and online communication means. Most countries participating in the Joint Action have created a specific section on their organisation’s website or have disseminated information about JANPA through their newsletters or their websites. As of October 2017, JANPA Twitter’s account has 251 followers and 8 200 views, the Facebook account has been “liked” by 1 250 people and has reached 20 639 people or institutions so far. The information leaflet has been translated in the languages of the partners for a total of 19 languages. The main JANPA Deliverables, the Position paper and the Layman report have been printed and disseminated during the JANPA Final conference, as well as on the JANPA website. Factsheets of the main deliverables have also been prepared and disseminated through printed copies and the electronic channels. Six newsletters were prepared and sent to around 2 500 stakeholders working on local, regional, national and European levels. Also, JANPA has been presented in many conferences and meetings both at national and European levels (some of them are presented on the JANPA website).

Evaluation activities – WP3
In the beginning of JANPA, the evaluation activities have helped defining and setting up an evaluation mechanism as well as a relevant evaluation methodology for JANPA’s activities. Two interim evaluation reports (for internal use) have been issued in March 2016 and in June 2017 and gave an overview of the work achieved. The reports provided recommendations for WP leaders and the project’s partners in order to implement their future activities as initially expected. In addition, two yearly evaluation reports were prepared in the end of the first and the second year of the JA and included the evaluation of the three external evaluators, selected in the beginning of JANPA. In the end of JANPA, the Evaluation team prepared a final evaluation report on the basis of an on-line questionnaire sent to the JANPA stakeholders and aiming to evaluate the impact of the JA. A layman version of the final evaluation report is also available.
The global final evaluation of JANPA shows a high level of achievement of the various ambitious objectives given. It shows also that the many partners of JANPA in the participating countries were satisfied with the process. JANPA achieved its overall purpose. Finally, JANPA early assessment of impacts was positive: there were some cases of changes in policies, institutions, and regulations where positive JANPA impact was identified.