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Research Article
Description of the EUROBIS Program: A Combination of an Epode Community-Based and a Clinical Care Intervention toImprove the Lifestyles of Children and Adolescents withOverweight or Obesity 
Claudia Mazzeschi,
1
Chiara Pazzagli,
1
Loredana Laghezza,
1
Dalila Battistini,
2
Elisa Reginato,
1
Chiara Perrone,
1
Claudia Ranucci,
1
Cristina Fatone,
1
Roberto Pippi,
1
Maria Donata Giaimo,
3
 Alberto Verrotti,
4
Giovanni De Giorgi,
1
and Pierpaolo De Feo
1
󰀱
Healthy Lifestyle Institute, Centro Universitario Ricerca Interdipartimentale Attivit `a Motoria (C.U.R.I.A.MO.),University of Perugia, Via Giuseppe Bambagioni 󰀱󰀹, 󰀰󰀶󰀱󰀲󰀶 Perugia, Ital
󰀲
Department of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Specialty School of Psychiatry,University of Perugia, Piazzale Gambuli, 󰀱-󰀰󰀶󰀱󰀳󰀲 Perugia, Italy 
󰀳
Department of Health Prevention, Umbria Region, Via M. Angeloni, 󰀶󰀱-󰀰󰀶󰀱󰀲󰀴 Perugia, Ital
󰀴
Department of Medicine, Pediatric Clinic, University of Perugia, Piazzale Menghini, 󰀱-󰀰󰀶󰀱󰀲 Perugia, Italy 
Correspondence should be addressed to Chiara Pazzagli; chiara.pazzagli@unipg.itReceived 󰀷 December 󰀲󰀰󰀱󰀳; Revised 󰀱󰀳 June 󰀲󰀰󰀱󰀴; Accepted 󰀱󰀷 July 󰀲󰀰󰀱󰀴; Published 󰀴 August 󰀲󰀰󰀱󰀴Academic Editor: Jean-Michel BorisCopyright © 󰀲󰀰󰀱󰀴 Claudia Mazzeschi et al. Tis is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Te present paper describes the Epode Umbria Region Obesity Prevention Study (EUROBIS) and aims to implement theC.U.R.I.A.MO. model through the EPODE methodology. Te main goal o the EUROBIS is to change the pendency o slope o the actual trend towards the increase in the yearly rates o childhood overweight and obesity in Umbria and to improve healthy liestyles o children and their parents. Te project is the 󿬁rst EPODE program to be perormed in Italy. Te aims o the ItalianEUROBISstudyare:(󰀱)acommunity-basedinterventionprogram(CBP)carryingoutactivitiesinallprimaryschoolsotheUmbriaRegion and amily settings as 󿬁rst step, to reverse the current obesity trend on a long-term basis, and (󰀲) a clinical care programor childhood and adolescent by C.U.R.I.A.MO. model. C.U.R.I.A.MO. model is a multidisciplinary approach to improve threekey aspects o healthy liestyles: nutrition, exercise, and psychological aspects with the strategy o a amily-based approach. Tecommunity-basedinterventionandclinicaltrialprovideaninnovativevaluablemodeltoaddressthechildhoodobesitypreventionand treatment in Italy.
1. Introduction
Te prevalence o overweight and obesity in children andadolescentsisincreasingrapidlywithdramaticconsequencesor health [󰀱]. A study o the prevalence and determinantso pediatric overweight and obesity in European coun-tries reveals that the highest values are ound in Italy.Italian boys and girls show higher age-speci󿬁c values o body mass index (BMI), body circumerence, waist/hip, andwaist/height ratios when compared with other countries [󰀲].In Italy, pediatric obesity is one o the major public healthemergencies: 󰀲󰀵% o subjects aged between 󰀰 and 󰀱󰀸 years(average)areoverweight,withapeakrecordedinthe󰀹-to󰀱󰀱-year age group, in which 󰀲󰀳% o the population is overweight
Hindawi Publishing CorporationBioMed Research InternationalVolume 2014, Article ID 546262, 8 pageshttp://dx.doi.org/10.1155/2014/546262
 
󰀲 BioMed Research Internationaland 󰀱󰀳% is obese. Speci󿬁cally, the Umbria Region has aprevalence o overweight (󰀲󰀶%) and obesity (󰀹%) above thenational mean [󰀳].Pediatric obesity is a complex phenomenon. Its develop-ment and maintenance are in󿬂uenced by a complex array o actors, genetic predisposition, metabolic and neurobi-ological actors with liestyle aspects, eating and physicalactivity habits, and psychological-psychosocial actors [󰀴󰀶]. Although genetic and biological risk actors are receivingsigni󿬁cant research attention, among psychosocial actors inthe last decade there has been an important shif by consid-ering individual actors, to ocus on environmental actors,given the evidenced systemic associations between adiposity and amilial and parental unctioning [󰀷]. Obesity runs inamilies [󰀸] and a series o amilial variables, connected tothe multiactorial nature o children overweight, have beenidenti󿬁ed [󰀹󰀱󰀳]. Tere are evidences that liestyle behaviors have their roots early in lie and recent studies emphasize theimpactoparentalandamilialvariablesasriskactorsonthedevelopment and maintenance o childhood overweight andobesity [󰀱󰀴].TepurposeothispaperistodescribetheEpodeUmbriaRegion Obesity Prevention Study (EUROBIS), an innovativeprogram based on a community-based approach (EPODE,
Ensemble Pr ´evenons l’Ob´esit ´e des Enfants
) combined with aclinical intervention in order to prevent and treat overweightand obesity in childhood. EUROBIS is twoold: (󰀱) it is tobe intended as a community-based intervention program(CBP) to reduce childhood obesity prevalence carrying outactivities in all primary schools o the Umbria Region andamily settings as 󿬁rst step, and (󰀲) it has a clinical care pro-gram by the mean o C.U.R.I.A.MO. (Centro UniversitarioRicerca Interdipartimentale Attivit`a Motoria) model to treatchildhood and adolescence overweight and obesity througha amily-based approach. Te model is based on a multi-disciplinary approach, already experimented or adulthoodobesity [󰀱󰀵󰀱󰀷] and tailored or developmental needs. Te present paper describes a strategy that combines a strongprevention approach with a strong management approach.Combining these kinds o interventions into one program is very important and innovative and i successul could meana breakthrough in combating the obesity epidemic.
2. Study Design: The Combination of Preventive and Curative Action
EUROBIS is one o the EPODE programs. EPODE is acoordinated, capacity-building approach that aims to reducechildhood obesity through a social process in which localenvironment, childhood settings, and amily norms aredirectedandencouragedtoacilitatetheadoptionoahealthliestyle in children [󰀱󰀸].Within the ramework o the EPODE methodology, inItaly EUROBIS is based on a combination o preventiveand curative strategies. Relying on the preexisting Healthy Liestyle Institute o the region, EUROBIS aims to overcomethe division between prevention and health care.In accordance with the EPODE philosophy, it is basedon multiple components, including a positive approach intackling obesity, with no cultural or social stigmatization;step-by-step learning; and an experience o healthy liestylehabits, tailored to the needs o all socioeconomic groups.EPODE target groups are children, amilies, local stakehold-ers, and decision makers working in the different sectors o thesocietyinvolvedinenvironmentcausesanddeterminantso childhood obesity. Te our EPODE pillars (politicalcommitment, social marketing, mobilization o resourcesincluding public-private partnerships, and evidence includ-ingamultidisciplinaryevaluation)havebeensubdividedintoten EPODE implementation principles, which describe theEPODE methodology.(󰀱) Each country (or region) commits to a central coor-dination support/capacity.(󰀲) Each local community has a ormal political commit-ment or several years rom the outset.(󰀳) Each local community has a dedicated local projectmanager with sufficient capacity and cross-sectoralmandate or action.(󰀴) A multistakeholderapproachisintegralto thecentraland local structures and processes.(󰀵) An approach to action is planned and coordinatedusing social marketing. Tis is speci󿬁cally to de󿬁nea series o themed messages and actions, inormed by evidence, rom a wide variety o sources, and in linewith official recommendations.(󰀶) Local stakeholders are involved in the planning pro-cesses and are trusted with sufficient 󿬂exibility toadapt actions to local context.(󰀷) Te “right message” is de󿬁ned or the whole com-munity. However, getting the message “right” meanstailoring or different stakeholders and audiences.(󰀸) Messages and actions are solution oriented anddesigned to motivate positive changes and not tostigmatize any culture or behaviors.(󰀹) Strategies and support services are designed to besustainableandbackedbypoliciesandenvironmentalchanges.(󰀱󰀰) Evaluation and monitoring are implemented at var-ious levels. Tis is achieved through the collectiono inormation on process, output, and outcomeindicators and inorms the uture development o theprogram.An approach to action is planned and coordinated usingsocial marketing. Local stakeholders are involved in theplanning processes. Strategies and support services are de-signed to be sustainable and backed by policies and enviro-nmental changes. Evaluation and monitoring are imple-mented at various levels. EUROBIS, similar to the Epode-like program in the Netherlands (JOGG) (http://www.ep-ode-international-network.com/programes/jogg), has add-ed a 󿬁fh pillar to the ones o EPODE methodology, “link-ing prevention and healthcare,” and proposes a structured
 
BioMed Research International 󰀳
Family-based approach- Pediatricians refer families with most difficult obese children to the clinical care program- Te results of the clinical intervention are used to implement the communication of the bene󿬁ts of CBPComponents of the clinical careprogram (CURIAMO):- Te nutritional intervention- Te psychological intervention- Te exercise interventionAction plan in CBP:- Intervention in primary school forchildren and parents- Intervention with family pediatricians- Intervention with sport societies- Intervention in daily shopping places- Intervention for outdoor families activities- Intervention through mass and socialmedia
F󰁩󰁧󰁵󰁲󰁥 󰀱: Diagram describing the action plan o the community-based program (CBP) and the clinical care program (C.U.R.I.A.MO.) andthe interaction between the preventive and the curative strategies.
combination o preventive and curative actions. In linewith the EPODE methodology to mobilize local resources,the added 󿬁fh pillar concerning mental health reers tothe Healthy Liestyle Institute o Perugia University. Temodel is based on a multidisciplinary approach, already experimented or adulthood obesity [󰀱󰀵󰀱󰀷, 󰀱󰀹], tailored or children and adolescents. Te intervention programdiffers or children and adolescents and it is 󿬁nalized inimproving three key aspects o healthy liestyle: nutrition,exercise, and psychological wellbeing, using a amily-basedapproach.TeC.U.R.I.A.MO.modelorpediatricoverweightor obesity involves the ollowing health care proessionals:pediatricians,endocrinologists,psychologists,dieticians,andexercise physiologists.AsillustratedinFigure 󰀱,thepediatricianshaveakeyrolebetween the two approaches (CBP and C.U.R.I.A.MO.) bothacilitating amilies with overweight or obese children inreerringtotheclinicalcareprogramandcommunicatingtheresults o the clinical intervention in order to implement thebene󿬁ts o CBP.AcommonperspectiveobothCBPandC.U.R.I.A.MO.isthe amily-based approach with an active involvement o theparentsintheprojectochanging.Temainaimistoactively involve both the child/adolescent and the two parents (as aras possible) in order to mobilize amily resources to improvethe efficacy o the program. In this model, the objective isto involve the parents in order to improve their skills andcon󿬁dence. Working with general and speci󿬁c parental skillsconnected to child’s care and health, it is possible to teach theparents to recognize the child’s needs, manage child’s dietary and activity patterns, and promote a healthy liestyle in theamily and consequently in the child. In adolescence it is alsonecessarytoimproveparentalskillsinrecognizingtheimpacto overweight/obesity in the sel-esteem o the youth.Te characteristics o CBP and C.U.R.I.A.MO. modelswillbediscussedindetailseparately,outliningevaluationandmonitoring strategies.
3. The Community-Based InterventionProgram (CBP)
Inordertomobilizestakeholdersatalllevelsacrossthepublicand private sectors through a local steering committee andlocal networks, the Umbria Region (the President and the vice-PresidentoUmbriaRegionandtheregionalassessorso health, welare, and agriculture and local ood), the Directoro the Health Prevention Department, the local university,amily pediatricians, local private associations, the RegionalOlympic Committee, the Regional Federation o Industries,promoters o treks and urban walking activities, the majorlocal companies o ood distribution, vending machines,the regional media channel, and web journal all actively collaborate with EUROBIS.
󰀳.󰀱. Action Plan in CBP.
 According to the Council Recom-mendations o the European Commission (http://ec.europa.eu/sport/library/documents/c󰀱/com-󰀲󰀰󰀱󰀳-󰀶󰀰󰀳-󿬁nal-coun-cil-recommendation-hepa en.pd ), the plan o action coversdifferent sectors (health, sport, school, and environment)in order to include a series o actions. In order to promotea healthy liestyle among children and their amilies, theactions planned include many contexts:

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