Thanks, Treena.
I'm Margaret Cargo, I'm a researcher with the Douglas Hospital Research Centre, which is affiliated with McGill University. I'm just going to pick up where Treena left off.
The effectiveness of KSDPP intervention was evaluated in two ways: an impact evaluation assessed the short-term effects of the intervention and an outcome evaluation assessed the long-term effects. The impact evaluation assessed behaviour change in two specific areas, physical activity and dietary practices. We compared the health practices of elementary school children in 2004 to children in baseline in 1994. We found no change in children's physical activity levels. However, we did see a reduction in television watching during school days, which was good. We also saw an overall decrease in the consumption of soda, chips, and french fries and increased consumption of low-fat milk and whole-wheat bread.
However, these modest changes in behaviour did not translate to changes in anthropometric outcomes, which are measures of body composition. So despite the intervention efforts in the community that were ongoing for about ten years, mean body mass indexes changed from 1994 to 2004. Mean subscapular skinfold thicknesses also increased. In addition, the prevalence of those who were overweight and obese increased from 31% in 1994 to 47% in 2004.
I want to put the findings of the KSDPP intervention in context, in that they are consistent with the majority of other evaluated interventions in childhood obesity prevention. Most studies result in modest changes in behaviour, but these changes in behaviour aren't sufficient to lead to changes in body composition. This was the basic finding of the most recent scientific review by the Cochrane Collaboration. That review included 22 studies, and only four studies had a positive effect on body composition, although the majority of those studies were successful in changing behaviour. One of the best-evaluated interventions was Pathways; it was implemented in several North American Indian communities in the United States, and their results were very similar to KSDPP.
We've learned a number of lessons from the KSDPP experience, and we'll share four of these lessons with you today. I'll talk about two, then Treena will talk about the other two.
The first lesson is that our most recent results suggest approximately half the children entering grade one are already overweight or obese. That suggests we need to refocus our intervention efforts on preschoolers, infants, families, and even pregnant moms, and that waiting until grade one may be too late. There's a parallel here to the smoking prevention interventions of the 1980s.
Also, if you want to see positive outcomes in healthy body weight, we need to consider the contextual factors influencing front-line workers who carry the responsibility for implementing a primary prevention mandate. Through a CIHR-funded study, we have interviewed over 35 front-line workers in aboriginal communities, first nations, Inuit, and even some Métis communities who have come to Kahnawake to receive training in the KSDPP model.
Many of these workers returned to their communities with the best of intentions, but they don't have enough time in their job to do the work. There are competing health issues, mental health issues in the community, and they don't have support within their organization, or even the political leadership, so it's very difficult for them to prevent childhood obesity or to implement their mandate.
We're short-sighted if we're looking at the outcome without looking at supporting the front-line workers and situating diabetes prevention, obesity prevention, in the context of competing community issues and putting conditions in place within their organizations to allow them to do their work.
Thank you.