International Journal of Obesity (2011) 35, S16–S23

& 2011 Macmillan Publishers Limited All rights reserved 0307-0565/11

www.nature.com/ijo

ORIGINAL ARTICLE
The IDEFICS community-oriented intervention
programme: a new model for childhood obesity
prevention in Europe?
S De Henauw1, V Verbestel2, S Mårild3, G Barba4, K Bammann5, G Eiben6, A Hebestreit5,
L Iacoviello7, K Gallois5, K Konstabel8, É Kovács9, L Lissner6, L Maes1, D Molnár9, LA Moreno10,
L Reisch11, A Siani4, M Tornaritis12, G Williams13, W Ahrens5, I De Bourdeaudhuij2 and I Pigeot5,
on behalf of the IDEFICS Consortium
1
Department of Public Health, Faculty of Medicine and Health Sciences, University Hospital, Ghent University, Ghent, Belgium;
2
Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;
3
Department of Paediatrics, Queen Silvia Children’s Hospital, University of Gothenburg, Gothenburg, Sweden; 4Unit of Epidemiology
and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy; 5Bremen Institute for Prevention
Research and Social Medicine, University of Bremen, Bremen, Germany; 6Department of Public Health and Community Medicine,
Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 7Laboratory of Genetic and
Environmental Epidemiology, Catholic University, Campobasso, Italy; 8National Institute for Health Development, Tallinn, Estonia;
9
Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary; 10Growth, Exercise, Nutrition and Development
Research Group, University of Zaragoza, Zaragoza, Spain; 11Copenhagen Business School, Copenhagen, Denmark; 12Research and
Education Institute of Child Health, Strovolos, Cyprus and 13Department of Philosophy, Lancaster University, Lancaster, UK

Background and objectives: The European UnionFas well as other parts of the worldFfaces a major challenge of increasing
incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate
action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There
is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to
counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable
health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-
induced health effects in children and infants) study developed and implemented innovative community-oriented intervention
programmes for obesity prevention and healthy lifestyle primarily in children aged 2–10 years in eight European countries:
Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus.
Materials and methods: The IDEFICS community-oriented intervention study mobilised an integrated set of interventional
efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall
programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main
focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their
(grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the
interventions were centrally developed and culturally adapted.
Results: So far, the following has been achieved: focus group research, literature review and expert consultations were done in
an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as
guide for structuring the intervention research. The overall intervention programme’s duration was 2 years, but a longer-term
follow-up programme is under development.
Conclusions: This large-scale European effort is expected to contribute significantly to the understanding of this major public
health challenge.
International Journal of Obesity (2011) 35, S16–S23; doi:10.1038/ijo.2011.31

Keywords: intervention programme; childhood obesity; healthy lifestyle; European children; sustainable health promotion

Correspondence: Professor S De Henauw, Department of Public Health,
Faculty of Medicine and Health Sciences, University Hospital, Ghent
University, 2BlokA, De Pintelaan 185, Ghent 9000, Belgium.
E-mail: stefaan.dehenauw@ugent.be
Introduction
The epidemic rise in the prevalence of overweight and
obesity in almost all populations around the world has been

documented extensively.1,2 Several international expert
organisations, such as the World Health Organization
(http://www.euro.who.int/obesity) and the International
Obesity Task Force (http://www.iotf.org), have called for
urgent concerted actions at the international, national,
regional and local levels. The scientific world, at large,
together with the public authorities, seems to face one of the
most difficult battles in the history of health care, the battle
against a seemingly inevitable and generalised drive towards
excessive fat deposition in the human body.
The mechanisms behind this epidemic rise seem to be
rooted in a complex interplay between genetic, behavioural
and environmental influences.3,4 Although there is still quite
some heterogeneity in the perceptions and viewpoints as
regards the locus of responsibility in this contextual drive
leading to obesity, there seems to be an increasing consensus
that the main emphasis should be on the societal and
environmental aspects of the process. Swinburn et al.5 and
other pioneers in this public health debate have coined the
term ‘obesogenic’ or ‘toxic’ environment to indicate the
important fact that the environment, which is defined as a
broad set of cultural, societal and economic ingredients
within a community organisation, is by far the major
responsible driver of the disruption of energy homoeostasis
on population level. Individuals’ defense mechanisms, both
biological and/or behavioural, for a countercurrent ‘obeso-
preventative’ or ‘antiobesogenic’ adaptation have only a
negligible significance and impact in the overall balance
against an overwhelming environmental pressure with
regard to energy and food availability and with regard to
individual engagement (or the lack of it) in physical activity.
Children deserve our special focus for many reasons. They
are shaping their nutritional physiology in the early years of
life and face the perspective of an extremely difficult
restoration of disturbed set points later in life.6 Moreover,
children have a much more restricted range of opportunities
for choice with regard to their environment and daily life,
and many of these factors lie beyond their understanding
and control. This imposes an immense responsibility on
policy makers around the world. The children of today will
be the adults of tomorrow, entitled to question retrospec-
tively the lack of action in the presence of so much evidence.
The available data on body composition in childhood and
the increasingly obesogenic environment indeed call for
urgent interventional actions at the community level.
However, the volume of relevant knowledge on effective
community interventions for overweight and obesity is still
limited. It is also known that, even if the prevalence of
overweight and obesity has increased universally, there is a
great variation within countries and between countries (see
for example, http://www.iotf.org).1,7 It is therefore of great
interest to study well-considered new intervention models
across different cultures and countries, and across different
settings with differences in prevalence of obesity, in (eating)
culture, infrastructure and social organisation. Such research
is of utmost importance for the purpose of establishing
IDEFICS community-oriented intervention
S De Henauw et al
S17
evidence-based recommendations and guidelines for policy
makers and other key societal actors.
The IDEFICS study is one of the largest cross-cultural
scientific efforts for childhood obesity prevention in Europe.
IDEFICS is the acronym for Identification and prevention
of dietary- and lifestyle-induced health effects in children
and infants. The IDEFICS study is a project funded by the
European Commission within the sixth Framework Pro-
gramme that aimed to understand more thoroughly (a)
aspects of aetiology of childhood overweight and obesity,
and (b) the opportunities for prevention of this problem. The
project took the paradigm of an ‘obesogenic environment’ as
its starting point as well as the main general driver for
unbalanced energy intake. From a public health point of
view, this essentially translated into creating a research
framework that examined this environment and analysed its
potential for change towards adoption of healthy lifestyles.
The project’s general design, field measurements and their
methodology have been described already in detail else-
where.8–10 This report focuses on the historical development,
the concepts and the main aspects of the operational
development of the IDEFICS community-oriented interven-
tion programme (COIP) in eight European communities.
Conceptual framework and objectives for the
IDEFICS intervention programme
Ecological approach
The IDEFICS intervention strategy was embedded within the
broader general concept of health as an ecologically
determined phenomenon. This has been elaborated by other
authors,5,11 and essentially refers to the notion that inter-
ventions implemented at any one level of the ‘health
ecosystem’ should consider what happens at other health-
influencing levels to avoid conflicting situations and to
reinforce cohesion and consistence across all health-enhan-
cing drivers. This theoretical framework of ecological health
approach has generally been recommended for the purpose
of elaborating childhood obesity prevention through com-
munity action.12–14
The ecological environment of a child includes the family
and the school, which are in turn embedded in larger social
and societal spheres influenced eventually by the commu-
nity at large and also by events and changes at the
global scale. Development of a childFboth physically and
mentallyFoccurs as a result of interactions within and
across all these layers. Individual characteristics of the child
interact with processes in the family and school, which in
turn are influenced by processes at wide ecological le-
vels.15,16 Changing the health behaviour in a context of
such complex interactions cannot be achieved by putting in
place simple manipulations at any of these levels, but
necessitates intervening and engineering at all levels in a
way that is consistent towards its targets and complementary
in the envisaged effects.5,12,13
International Journal of Obesity
 IDEFICS community-oriented intervention
S De Henauw et al
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Locus of control
As explained above, the starting paradigm for the conception
of the IDEFICS COIP was that overweight and obesity are
mainly socially and environmentally determined phenom-
ena. As such, they are historically rooted in a gradual
evolution in the overall exposure of populations to a variety
of mechanisms that appear in many different forms and
dimensions of everyday life, and that are ultimately related
to energy homoeostasis.
Such mechanisms are, beyond any doubt, related to food
and energy intake (food availability, food choices, portion
sizes, meal patterns, commensality aspects and so on) and to
physical activity patterns (how much physical activity
people engage in, the type of physical activity, frequency,
context and so on). Other mechanisms might also have a
role, such as exposure to modern forms of psycho-social
stress, the quality of sleep and environmental factors
influencing endocrine regulation.
The interesting common feature of most of these mechan-
isms is that they seem to be integral aspects of a global
process of environmental change, particularly in the eco-
nomics of food production, transport and infrastructure,
communication, marketing and leisure opportunities. These
are changes that largely lie beyond the control and
responsibility of individuals and yet affect individuals’ life
in a very prominent and insistent way. As we have stressed,
this is particularly true for children who are even more
conditioned in their choices related to food, physical activity
and their responses to incoming stress signals.
Formulating objectives
On the basis of these considerations, the IDEFICS COIP was
based on the premise that remedies for the obesity epidemic
should be integrated across all aspects from this multi-
dimensional causal space, should largely focus on changing
the environment and should make use of the best scientific
knowledge available. However, this theoretical framework
cannot be visualised nor quantified in all its dimensions;
instead, it constitutes a holistic, organic and qualitative
approach. Therefore, a more concrete operational strategy
and work plan had to be distiled from this theoretical
framework.
The objectives of the IDEFICS study were as follows:
(i) To develop culturally acceptable and integrated, sustain-
able, multicomponent COIP, targeting lifestyle and
behaviour determinants at the community, school,
household and individual level for the primary preven-
tion of overweight and obesity in children (aged 2–10
years) in different European countries.
(ii) To implement such COIP in a standardised way, yet
allowing for local adaptations, across eight areas in
Europe.
(iii) To evaluate different aspects of such multicomponent
intervention programme (its effect, sustainability, ac-
ceptability and so on) both at the level of the recipients
International Journal of Obesity
(children and their parents) and at the level of involved
actors in the field (school boards and personnel, school
medical staff, mass media, local authorities and so on).
Evaluation comprised development evaluation, process
evaluation and outcome evaluation.
For the purpose of achieving these objectives, the study
design and a broad battery of protocols, procedures and tools
were established (Figure 1). These have been outlined in
detail in several reports and standardised operation proce-
dures that are centralised and archived by the project
management, and that will be made available in the public
domain (http://www.idefics.eu) in the longer run.
Study design
A more detailed description of the IDEFICS study design is
given elsewhere in this supplement.10 In brief, eight pairs of
mutually comparable areas in eight European countries have
been allocated in each country to either control status or
intervention status. In most countries, these areas were
distinct cities or communities. Italy was to some extent
different from the other countries, as clusters of villages were
selected instead of urban areas both for intervention and
control area. Within each country, the intervention and
control areas were chosen on the basis of feasibility and
pragmatic considerations. However, comparabilities between
both areas in terms of overall population size, overall
socioeconomic level and its distribution over the population,
general infrastructure and preexisting health-enhancing
initiatives at the community level were carefully considered.
The list of intervention and control areas for each country is
given in Table 1. Between countries, areas differed consider-
ably in population size. Specific attention was also given to
avoid contamination between intervention and control area,
for example, by making sure that none of the local media
covered both intervention and control area.
In each area, B1000 children were examined on biologi-
cal, behavioural and sociodemographic characteristics at
baseline (school year 2007–2008) and again after 2 years of
follow-up (school year 2009–2010). Another follow-up
survey has been scheduled for the school year 2010–2011.
Power calculations that were performed in view of an
outcome evaluation indicated that a number of 1000
children (500 preschool and 500 primary school) in both
the intervention and control groups in each country would
offer a sufficient power of 80% to detect a true reduction in
overweight and obesity prevalence from 15 to 12%, stratified
by country and school level (preschool/primary school) with
a ¼ 0.05.
Immediately after the baseline survey, a COIP was
launched in the eight intervention areas, whereas no such
initiative was taken in the control areas. The intervention
teams in each intervention area were chaired by a so-called
‘intervention programme manager’ who operated with some
 IDEFICS community-oriented intervention
S De Henauw et al
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Figure 1 Overview of the IDEFICS geographical representation in Europe. Countries marked in light grey colours are contributing with the IDEFICS survey centres.

Table 1 IDEFICS intervention and control areas

Intervention area Control area Linear distance (km)

Belgium Geraardsbergen Aalter 46

Cyprus Strovolos Pafos 120
Estonia Tartu Tallinn 185
Germany Delmenhorst Wilhelmshaven 68
Hungary Pecs Zalaegerszeg 205
Italy Atripalda, Forino, Pratola Serra, Mercogliano Avellino, Lauro, Quindici, Minimum 5,
Volturara, Monteforte I maximum 43
Spain Huesca Zaragoza (district of) 72
Sweden Partille Alingsas/Mölndal 38/16

Abbreviation: IDEFICS, Identification and prevention of dietary- and lifestyle-induced health effects in children and infants.

assistants under the supervision of the IDEFICS principal committee was responsible for the standardised implemen-
investigator and his/her team. The intervention programme tation of the IDEFICS intervention in the different centres,
managers of all centres formed the ‘IDEFICS interven- for ad hoc trouble shooting, synchronising and developing
tion programme committee’. The intervention programme activities in the field and overall quality control. It also

International Journal of Obesity

 IDEFICS community-oriented intervention
S De Henauw et al
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coordinated the collection of data for the evaluation of the
COIP. The intervention programme committee has been
internationally connected through monthly telephone con-
ferences and regular meetings.
Development and implementation of the
community-oriented intervention
Theoretical framework and intervention scope
The overall elaboration of the IDEFICS COIP predominantly
followed the framework of the ‘intervention mapping
protocol’ developed by Bartholomew et al.17 This protocol
offers a methodological framework for the elaboration of a
tailored ‘road map’ for the development and evaluation of
public health promotion programmes and community
interventions, and is conceived as a stepwise process, starting
basically from an in-depth exploration of the problem
within a given community and a well-specified account of
the programme objectives. Relevant behaviours and their
determinants are thereby carefully dissected and integrated
into matrices for operational interventional actions, chosen
on the basis of existing evidence and/or supporting theore-
tical models for behaviour change. A comprehensive over-
view of the intervention mapping protocol can be found at
http://www.interventionmapping.com.
The IDEFICS COIP approach can be depicted as a tiered
and setting-based way of thinking and acting (Figure 2). Its
philosophy targets primarily young children, representing a
new generation for which maximum effort of primary
prevention needs to be applied. However, these children
are an integral part of a householdFthey can be ‘exposed’ to
obesogenic pressures if these are already active in the
Figure 2 The IDEFICS tiered approach for the development of the
community-oriented programme, including four levels and three dimensions
for tackling behavioural change in the community.
International Journal of Obesity
household. Furthermore, as households are exposed to and
in constant interaction with the broader ‘community-level’
obesogenic pressures and practices, the community at large
needs to be strongly involved in the prevention effort.
Last but not the least, as children spend most of their
active time at school or at the kindergarten, these settings are
a very attractive target for actions aimed at installing and
adopting healthy lifestyle in a sustainable way and a target
that has proven to offer potentially effective paths for
prevention already.
Within the tiered approach of the IDEFICS study, the
community is to form the solid basis, the driving force for
triggering and installing the necessary environmental ‘anti-
obesogenic’ changes in a sustainable way. The children are at
the top and symbolise the segment of the population that
can form a new generation protected from an obesogenic
environment, if action is swiftly taken.
In a recent review looking at the association between
social class and adiposity in children,18 it was concluded that
this association is predominantly inverse and that preven-
tion programmes should give highest priority to the higher-
risk profile of children from lower socioeconomic back-
ground. From the very beginning, the IDEFICS intervention
strategy has largely embraced this notion and integrated
specific actions aimed at penetrating the microenvironment
of children from low-income and underprivileged house-
holds, and experiencing societal hardship. For example,
special cooking events were offered especially targeting one-
parent families or families with low income to enable these
families to engage in a cheaper healthy way of cooking.
The overall aim of the IDEFICS intervention was to trigger
changes in behaviour as a basis for prevention of chronic
diseases in general and overweight and obesity in particular.
The behaviours targeted most emphatically through the
intervention efforts were diet, physical activity and ability to
cope with stress, further decomposed into six so-called key
messages (Table 2). These key messages constituted measur-
able outcome variables that were integrated in the IDEFICS
field-survey battery, as described more extensively else-
where.9,10
The final identification and elaboration of ‘axes for action’
within the interventional framework can be pictured in
terms of an intersection between the four-layered tiered and
setting-based approach with the three-dimensional beha-
vioural targets. Such grid analyses, in analogy with the
Analysis Grid for Environments Linked to Obesity framework
(a conceptual model for analysing the obesogenicity of
environments and prioritising research and intervention
tools) developed by Swinburn et al.,19 allows one to visualise
niches for development of specific tools or modules that can
be implemented as part of a larger overall programme, while
ensuring coherence and articulation with all other modules
of the intervention construction. This process has been
largely based on literature searches and expert consultation
(an ad hoc meeting for this purpose was organised in
Stockholm in June 2007) to identify relevant and effective
 IDEFICS community-oriented intervention
S De Henauw et al
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Table 2 IDEFICS key messages

Target behaviours

Diet Physical activity Stress, coping and relaxation

Measurable indicators of health Enhancing daily consumption of water Reducing TV viewing Spending more time together
behaviour (IDEFICS key messages)
Enhancing daily consumption of fruit Enhancing daily physical activity Ensuring adequate sleep
and vegetables duration

Abbreviations: IDEFICS, Identification and prevention of dietary- and lifestyle-induced health effects in children and infants; TV, television.

Table 3 Overview of ten IDEFICS intervention modules

Community level
Module 1: Involvement of community partners
Module 2: Long-term multimedia and public relations campaign
Module 3: Short- and a long-term perspective for the prevention of childhood obesity developed by local community members

School level
Module 4: Building partnerships
Module 5: Integration of the key behaviours in the classroom activities and providing related homework activities (curriculum based)
Module 6: Environmental changes related to physical activity: the active playground
Module 7: Health-related physical education curricula
Module 8: Environmental and policy changes related to water consumption
Module 9: Environmental and policy changes related to fruit and vegetable consumption

Family level
Module 10: Educational materials for parents, providing strategies to create health promoting family environments

Abbreviation: IDEFICS, Identification and prevention of dietary- and lifestyle-induced health effects in children and infants.

tools that could be adopted in the efforts of the IDEFICS
study. In addition, focus group research has been done in all
participating centres in specific target groups of the popula-
tion (children, parents, school teachers and local politicians)
and has revealed important information on barriers and
opportunities for implementing particular intervention
measures, as well as on the need for specific cultural
adaptations of the intervention modules. These focus group
results have been extensively reported.20
This overall process has ultimately led to the development
of 10 intervention modules of the IDEFICS study, 3 modules
to be deployed at community level, 6 at school level and 1 at
the level of the parents (Table 3). These modules were
elaborated at the central coordinating level and were then
transformed into ready-to-use modules for each local inter-
vention centre. This transformation includes language
translations and necessary modifications in view of specific
local context for implementation. A detailed description of
the 10 intervention modules, their theoretical framework
and implementation modalities will be published separately.
Most of these modules were implemented during the actual
period of ‘intervention adoption’ and ‘intervention imple-
mentation’ (see below) within the first 2 years of the project.
However, one set of proposals took a somewhat special
position in that it projects into the future and well beyond
the current timeline of the project. Under the general
umbrella of module 3 ‘Lobbying for community environ-
mental and policy interventions’, a perspective for long-term
community-based obesity prevention has been created
through a listing of potential policy initiatives that can be
initiated by the community platform at any point in time.
Examples of this are political decisions aimed at influencing
safe mobility of children within the area, creating green areas
and restricting publicity for unhealthy lifestyles.
Timeline for the IDEFICS intervention
The IDEFICS intervention has been conceived as a gradual
process in which three phases can be distinguished: adoption
phase (I), implementation phase (II) and dissemination
phase (III).
Phase I essentially encompassed the ‘installation’ of the
10 modules within their target infrastructural settings and
networks: community segments, schools/kindergartens,
health care institutes and households. It included the
‘marketing’ (contacting, explaining, negotiating, convincing
and so on) of the interventional product or module to the
key responsible actors in these different societal areas, such
as school head masters, mayors and their civil servants, and
managers of health care institutions. This adoption phase
was envisaged to last 1 year, long enough for the key
structures and procedures to start a process of ‘budding’ as a
first step of growth, with a perspective of creating new
dynamics in the intervention city. This phase made use also
of techniques of social marketing and public relation
building.

International Journal of Obesity

 IDEFICS community-oriented intervention
S De Henauw et al
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In phase II, which was the implementation phase and also
lasted 1 year, the key players from the societal stakeholders
were encouraged to gradually take over the responsibility for
the IDEFICS modules from the responsible research teams
without any substantial changes (unless dictated by quality
control) in the implementation follow-up or in the content
of the modules. This phase was critical, as it was a first test of
acceptance and sustainability for the IDEFICS intervention
construction as something that local actors can sustain in
their communities. This phase was also critical with regard to
the building of local capacity and necessary skills for the
intervention follow-up. During this phase, the intervention
programme managers were still available to the local teams
for trouble shooting and general support and advice.
Phase III was the dissemination phase and corresponded to
the consolidation of the self-perpetuating character of the
intervention that was hoped to gradually transform social
dynamics and alter the environment in a non-obesogenic
direction.
Interestingly, the timeline of the IDEFICS study envisaged
short, middle and longer-term actions to be effectuated at
the different interventional levels. This implied that for
some of the targets that were included within the scope of
the intervention, evaluation of the effects was only feasible
in the longer run.
Strengths and limitations of the IDEFICS
intervention
The IDEFICS community-oriented intervention has been
conceived in line with the best current scientific knowledge
with regard to the theoretical framing of development and
evaluation of interventions. It relied on a combination of
tools targeting individual behaviour and societal change in a
consistent way. It used evidence-based material whenever
available. In parallel, it aimed to develop new practices that
can be evaluated to build up new and complementary
evidence and knowledge of best practices. Although the
IDEFICS study has set its ambitions quite high, it also faced a
number of constraints and limitations.
An obvious and inherent constraint is related to the fact
that the very nature of the IDEFICS community-oriented
intervention approach implied that no attempts were made
to influence ‘obesogenicity’ at the ‘higher’Fregional or
nationalFpolicy-making level in the respective countries
(for example, national food policy, infrastructural changes at
national level, new taxes or subsidies and so on). In other
words, the external validity of the findings relating to
IDEFICS intervention only applies to the type of interven-
tion activities that are typically governed by local public
authorities. However, this does not mean that they are
irrelevant to national or regional policy; those policies
cannot be changed without evidence from local initiatives,
especially insofar as different levels of action are supposed to
reinforce one another in a dialectic process towards ‘obesity
International Journal of Obesity
preventative’ changes in societies. This constraint implies,
therefore, thatFif the interventions have positive out-
comesFthere will still be additional work involved in
elucidating how these can best articulate with or be
integrated in other dimensions for intervention open to
higher levels of public authority.
One important limitation was the duration of the inter-
vention. Within the current concept of projects funded by
the European Commission or other funding bodies that are
limited to a maximum of 5 years, long-term perspectives for
interventional research can hardly be adopted within the
study protocols, although this is very much needed for better
understanding of community-oriented interventions. For
this reason, additional initiatives have already been taken
with a view to long-term sustainability of the IDEFICS
intervention, mainly based on an intensified involvement of
the local political networks.
A second limitation of the IDEFICS type of intervention
was that any significant outcome in terms of obeso-
preventive results that will be measured as part of the
evaluation will not be linkable to any specific module, but
will rather have to be seen as outcome of the new dynamics
that have been created at different levels in the community.
In conclusion, this large-scale European effort on commu-
nity-oriented interventions for the adoption of healthy
lifestyle and childhood obesity prevention is expected to
contribute significantly to the overall body of knowledge
and understanding of this major public health challenge.
Conflict of interest
The authors declare no conflicts of interest.
Acknowledgements
This work was done as part of the IDEFICS study (http://
www.idefics.eu). We gratefully acknowledge the financial
support of the European Community within the Sixth RTD
Framework Programme Contract No. 016181 (FOOD) and
the grant support from EU for IDEFICS study. We thank the
children for their participation in the IDEFICS study.
Statement of ethics
We certify that all applicable institutional and governmental
regulations regarding the ethical use of human volunteers
were followed during this research. Approval by the appro-
priate ethical committees was obtained by each of the eight
centres engaged in the fieldwork. Participants were not
subjected to any study procedure before both the children
and their parents gave their consent for examinations,
collection of samples, subsequent analysis and storage of
personal data and collected samples. The participating

children and their parents could consent to single compo-
nents of the study while refraining from others.
The information in this document reflects the authors
view and is provided as is.
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