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Epidemiology and Population Health

Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial

International Journal of Obesity volume 44, pages 895–907 (2020)Cite this article

Subjects

Abstract

Background

A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status.

Methods

PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13–18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion.

Results

A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (−0.11 [95% CI, −0.13 to −0.08]; p < 0.0001) and girls (−0.05 [−0.08 to −0.03]; p < 0.0001). No equivalence between LA.S.S and A.S groups was evidenced. For girls, the trend to superiority for LA.S.S was confirmed by the more favourable change (−0.06 [−0.11 to −0.01]; p = 0.01) observed on superiority analysis, with no differential change for boys (0.02 [−0.03 to 0.08]; p = 0.41).

Conclusions

A public health school-based intervention using the proportionate universalism principle may be effective in not worsening or even reducing overweight social inequalities in adolescents, especially for girls. Overcoming social barriers may help health professionals dealing with the burden and inequalities of overweight in adolescents.

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Fig. 1: Flow diagram of the study sample selection.
Fig. 2: Equivalence comparison of weight status change between LA.S.S and A.S adolescents.
Fig. 3: Equivalence comparison of diet, physical activity and perceived health changes between LA.S.S and A.S adolescents.

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Acknowledgements

Many people worked together selflessly and enthusiastically to make the PRALIMAP-INÈS trial a success. The PRALIMAP-INÈS trial group warmly acknowledges the students and their parents who participated in the measurements and interventions and the school professionals (nurses, teachers, administrative staff, and headmasters’ staff) who contributed to the recruitment of students and delivery of the interventions.

Participating schools: Le Chesnois high school, Bains Les Bains; Jean Lurcat high school, Bruyeres; Marcel Goulette high school, Charmes; Pierre Mendès France high school, Contrexeville; Pierre Mendès France high school, Epinal; Isabelle Viviani high school, Epinal; Claude Gellée high school, Epinal; Louis Lapique high school, Epinal; EREA middle and high school, Epinal; Pierre Gilles de Gennes high school, Gerardmer; Jean-Baptiste Siméon Chardin high school, Gerardmer; La Haie Griselle high school, Gerardmer; Jean-Baptiste Vuillaume high school, Mirecourt; Pierre et Marie Curie middle and high school, Neufchâteau; Louis Geisler high school, Raon L’Etape; Camille Claudel high school, Remiremont; André Malraux high school, Remiremont; Jules Ferry middle and high school, Saint-Dié-des-Vosges; Georges Baumont high school, Saint-Dié-des-Vosges; Jacques Augustin high school, Saint-Dié-des-Vosges; La Haute Mosellotte high school, Saulxure-sur-Mosellotte; Emile Gallé high school, Thaon Les Vosges; Fleurot D’herival middle school, Le Val-D’ajol; Fleurot D’herival middle school, Plombières; Charlet middle school, Remiremont; Le Tertre middle school, Remiremont; René Cassin middle school, Eloyes; Hubert Curien middle school, Cornimont; Les Boudieres middle school, La Bresse; Maurice Barres middle school; Charmes; Jean Montemont middle school, Rupt-Sur-Moselle.

We warmly thank Mrs Henry-Wittmann and her statistical team of Nancy-Metz Academy Board of Education for making the required student database available. We thank all administrative and technical staff of the Nancy National conservatory of arts and crafts (CNAM), the Nancy School of Public Health, the Lorraine University EA 4360 APEAMAC team and the epidemiology and clinical evaluation department of Nancy University Hospital for their contribution to data collection, data entry and management, activity reporting, and logistic and financial management.

The PRALIMAP-INÈS steering committee consists of Bastien AFFELTRANGER, Annik AMADEUF, Fanny BALLAND, Philip BÖHME, Emilie BONSERGENT, Serge BRIANÇON, Barbara BUCKI, Pascal ENRIETTO, Carla ESTAQUIO, Cécile GAILLARD, Françis GUILLEMIN, Johanne LANGLOIS, Rozenn De LAVENNE, Lydia LAMBOLEY, Marion LAURENT, Karine LEGRAND, Edith LECOMTE, Marie-José MARANGONI, Christelle MASSOT, Olivier MOLON, Laurent MULLER, Abdou OMOROU, Lydia PETER, Céline POURCHER, Marie-Hélène QUINET, Sophie RIVOT, Gilles ROBERT, Laura SAEZ, Elisabeth SPITZ, Brigitte TOUSSAINT, Anne VUILLEMIN. Special acknowledgements are addressed to Cécile GAILLARD and Rozenn De LAVENNE for their involvement in the project setting up.

The University of Lorraine (EA 4360 APEMAC – Nancy) stakeholders: Epidemiology

Team project leader: Serge BRIANCON, Professor of Public Health, Principal Investigator. Coordination and management: Emilie BONSERGENT, PhD; Marion LAURENT, Project Manager; Abdou OMOROU, PhD; Jeremy PLAINFOSSE, student license; SAEZ Laura, PhD student, Anne VUILLEMIN, Lecturer. Data collection: Anne HISLER, Nurse; Martin KOLLOP, public health resident; Diane PIVOT, public health resident; Nadia TORKI, Nurse; Véronique PIFFAUT, Secretary. Transversal activities: Véronique DEVIENNE, Secretary; Sébastien SAETTA, Lecturer; Oissila SAINDIZIER, Accounting Manager; Bruno TOUSSAINT, Administrative Officer; Serge RAMISASOA, M2 Sociology Student.

The CNAM stakeholders

Team project leader: Edith LECOMTE, PhD, Director Training pole. Coordination and management: Cécile GAILLIARD, Project Manager; Johanne LANGLOIS, PhD student, Project leader and speaker for the meetings and interviews in physical activity. Transversal activities: Cécile BRICE, Communication Manager; Damien BRIQUET, Financial Officer; WAGNER Alexandra, webmaster.

The University of Lorraine (EA 4360 APEMAC – Metz) stakeholders: psychology

Team project leader: Elisabeth SPITZ Professor of Health Psychology. Coordination and management: Barbara BUCKI PhD; Laurent MULLER, lecturer; Lydia PETER, Lecturer. Animation of motivational interviewing: Alice CHARLES COHN, Psychologist; Julie CROUZIER, Psychologist; Emeline DAUTEL, Psychologist; KRIER Cécile MARTIN, Psychologist; Mathilde MOSSON, Psychologist.

The Clinical Investigation Centre - Clinical Epidemiology (CIC-1433 EC) stakeholders

Team project leader: Francis GUILLEMIN, Professor of Public Health. Coordination and management: Karine LEGRAND Project Manager. Data manager and statistical analysis: Julie AKKOYUN-FARINEZ, Statistician; Adélie BAERTSCHI, Statistician; Isabelle CLERC – URMES, Biostatistician; Ziyad MESSIKH, Biostatistician; Marc SOUDANT, Biostatistician; Jean Marc VIRION, Biostatistician. Data collection: Benjamin BETHUNE, public health resident; Catherine CAMPAGNAC, Clinical Research Nurse; Gaelle DALMOLIN, Nurse; Christelle DUJON, Technician seizure; Jonathan Epstein, AHU; Valerie ESCBACH, Clinical Research Nurse; Nicole FISCHER, Technician seizure; Sandrine Gerset, Clinical Research Nurse; Johanne GUICHARD AMOYEL, Clinical Researcher; Najet JUDAS, nursing student; Nicole KOEBEL, Technician seizure; Clotilde LATARCHE, delegate Doctor; Samia MAHMOUDI, Technician seizure; Philippe Melchior, Input Technician; Isabelle PETITGENET, Clinical Research Nurse; Nathalie PIERREZ, Clinical Research Nurse; Laurie RENAUDIN, public health resident; Maurice TANGUY, AHU; Sandrine TYRODE, Clinical Research Nurse; Nadine VALENTIN, Clinical Researcher; Maxime WACK, public health resident. Transversal activities: Adeline DAZY, Secretary; Laurence EMPORTE, Secretary; Emilie JACQUOT, Secretary; Nadine JUGE, Quality Manager; KLEIN Sylvie, Health Framework; Karine PRUD’HOMME, Secretary; Laetitia ROBELIN, Secretary.

Local school office of the Nancy-Metz academy

Team project leader: Marie-Hélène QUINET, MD, Technical Adviser of the Rector. Coordination and management: Annik AMADEUF, IPR EPS; Rozenn DE LAVENNE, Nurse Technical Advisor of the Rector; Marie-José MARANGONI, MD, technical advisor to the Dasen des Vosges; Christelle MASSOT, Pralimap-Inés corresponding for schools; Céline POURCHER, Nurse technical advisor to the Dasen des Vosges; Brigitte TOUSSAINT, Nurse technical advisor to the Dasen des Vosges. Transversal activities: Leon FOLK, Dasen; Marie-Véronique HENRY-WITTMANN, Chief of the Division of Management and Statistical Analysis; Xavier PAPILLON, IPR EPS; Serge RAINERI, Director UNSS Regional Service; Mathieu SCHAFFAUSER, Director Departmental Service UNSS; Michèle WELTZER, Dasen.

The Lorraine Regional Health Agency stakeholders

Funding of the coordination of hospital specialised obesity management: Elise BLERY-MASSINET, referring physician; Annick DIETERLING, Director of Public Health; Simon KIEFFER, Director, Access to Health and Community Care.

The AVRS stakeholders

Leader: Gilles ROBERT, MD, Pediatrician. Data collection: Octave ALTIERI, MD, GP; Marc LESTRAT, MD, GP. Animation of group sessions: Christelle BRUST, Psychologist; Evelyne CAMUS, Psychologist; Sara CESARI, Dietician; Anita CHENOT, Dietician; Aline CHER, Dietician; Maria Elena COLLOT, Psychologist; Berenice DECHAZEAUX, Dietician; Geraldine DESTRIGNEVILLE, Dietician; Anabelle HECTOR, Dietician; Nathalie MARQUIS, Psychologist; Elsa OLIVIERI, Dietician; Eva REGENWETTER, Dietician; Francine BONTEMPS, Psychologist; Suzanne COLUMEAU, Psychologist; Beatrice DONNAY, Psychologist; Carole LANGLOIS, Psychologist; Anne LEMAIRE, Psychologist; Catherine RAFFENNE, Psychologist.

The Vosges Primary Health Insurance Fund stakeholders

Leaders: Pascal ENRIETTO, Director; Olivier MOLON, Deputy Director; Lydia LAMBOLEY, Manager customer relationship management; Sophie RIVOT, Manager Customer relationship management. Adolescents’ solicitation: Nicole BERTRAND; Sarah HADDADI; Ludivine JEANROY; Isabelle LHUILLER; Camille REQUENA.

Obesity Specialised Center (Nancy University Hospital) stakeholders

Leader: Philip BOHME, MD, PhD student. Associates: Jean-Marc DOLLET, MD; Pascal MATTEI, MD; Olivier ZIEGLER, MD, PhD.

Partnerships:

The Vosges Departmental Directorate of Social Cohesion and Protection of Population: Fanny BALLAND, sports activities Advisor. Decathlon: Cédric CARRETTE, Director; Mathieu IMBERT, customer service manager. The National Cancer Institute (INCA): Bastien AFFETRANGER, Geographer; Carla ESTAQUIO, Epidemiologist. Profession Sport Animation: Joffrey HUMBERT, Sport educator; Céline MICHEL, Sports Educator; Pierre BERTHE; Sylvie BOULASSEL, Management Assistant. Saphyr: Emilienne BARBAUX, sports educator; Martine DECHASEAUX, sports educator; Stephanie GERARD, sports educator; Julien BERNIER, sports teacher; Céline FAUCHERON, sports educator; Lionel LEDOCQ sports teacher; Grazia MANGIN, Director. TNL Marketing: Atika ANKI; Stephanie BIBIANNE; Christophe PERIN; Sandrine PERIN.

School professionals:

Marie-Colette ABDON; Amélie ABEL; Christophe ALBERT; Marylène AMET; Lydia ANIKINOW; Carole ARNOULD; Catherine BAGUET; Pascal BARET; Céline BAUMGARTNER; Pierre BEAUBIER; Laurent BELIN; Dominique BIANCHI; Sandrine BOETSCH; Johanna BOILLOT COUSIN; Xavier BONNAMOUR; Philippe CELLEROSI; Philippe CASTLE; Myriam CHRISTIAN; Sylvie CLAUDEL; Odile CLAUDON FISHING; Laurence COLLIN; Pierre COLSON; Francis CONSTANTIN; Marie-Béatrice COURTY; Jacques DAIZE; Charline DASSE; Thierry DECKER; Geneviève DIDIER; Christine DIDILLON; Virginia DIEUDONNE; Séverine DIVOUX; Stephanie DOFFAGNE; Séverine DONA; Michel FAIVRE; Marie-Pierre FAYSELER; Dominique WILL; Jean-Paul FERY; Lise FILLIEUX-SENCIER; Anne FLEITZ; Marcel FONTAN; Mireille BRUCKER FONTAN; Alice FOUCHER; Myriam FREYSSINEL; Christelle GEORGEL; Christine GEORGES; Antonio GOMES DO VALE; Christine GRAICHE; Sophie GRASSETTIE; Christian GRUNENWALD; Valérie HALLER; Patrick HAMAN; Eric HEU; Laetitia HOPFNER; Marcellin HOUMBADJI; Mylène JACQUINOT; Jean-Paul JACQUOT; Brigitte JACQUOT; Stéphanie JACQUOT; Thierry JANY; Denis JEANJACQUOT; Elisabeth JENNY; Sandrine JITTEN; Christine KERN; Hélène KIEKEN; Bernard KRID; Joël LAMOISE; CLEAN Isabelle; Nathalie LECLERE; LECOMTE Fabrice; Jean LEFEBVRE; Thérèse LEIBEL; Jean-Pierre LELARGE; Denis LEMONIER; Sylvain Hugues LETHEUX; Christine LIOTARD; Dominique LOUIS; Elodie MACERA; Philippe MAILLET; Mireille MARLIER; Elodie MARTIN; Pascal MASSONIE; Christelle MASSOT; Pauline MATHIOT; Marie-Claire MAURE; Gérard MICHEL; Joëlle MOUGEL; Nathalie MULLER; Sandra MUNIER; Frank NOURDIN; Olivier ODILLE; Rachel PARMENTIER; Sylvie PELLIS; Berengère PERNOT; Jean-Philippe PERRIN; Damien PETITJEAN; Virginia PETITJEAN; Paule PETITJEAN; Xavier PICHETTI; Cynthia CAPTAIN PIERRE; Christine PIERSON WICKMANN; Eric POLUS; Céline POURCHER; Louise QUARESEMIN; Martine RAGONDET; Bernadette RAKOTONDRAZAKA; Hélène REMY; Sabine RICHAUME; Max RINGENBACH; Françoise RINGENBACH; Alain RODRIGUES; Corinne RONECKER; Marie-José RONIN; Gilles ROQUIN; Sébastien SCHAL; Odile SCHERLEN; Florence SIBILLE; Marie-Catherine SONTOT; Marie STROTZ; Bertrand THIBOUT; François THIEBAUT; Florence THIERY; Pascal THOMAS; Marie-Josée THOMAS; Séverine THOUVENIN; Emmanuelle TRASCHLER; Ludmilla TRIOPON; Alain VAUTHIER; Sandrine VAUTRIN; Pascal VILLEMIN; Delphine VINCENT; Philippe VONTHRON; Claude VUILLAUME; Nathalie WOLLMANN; Hamid-Kylan YAHIAOUI; Pascal BRUNCHER; Caroline DESROZIERS; Sophie GATEL HENNAQUIN; Chantal LECOMTE; Marie-José MARANGONI; Jocelyne MARTIN DESCHANET; Anne-Lise SZTERMER; Marie VOGELWEITH.

PRALIMAP-INÈS trial group

Philip Böhme5, Serge Briançon1, Rozenn De Lavenne4, Cécile Gailliard3, Johanne Langlois3, Edith Lecomte3, Karine Legrand1,2, Laurent Muller1, Abdou Y. Omorou1,2, Céline Pourcher6, Marie-Hélène Quinet4, Laura Saez1, Elisabeth Spitz1, Brigitte Toussaint6

Funding

The PRALIMAP-INÈS trial is funded by the French National Cancer institute (Institut National du Cancer). It also received support from the public sector (Conseil Régional de Lorraine and Agence Régionale de Santé). All trial steps, design, data collection, analysis, write-up, and reports are and will be performed independently of any funding or sponsoring agency.

Author information

Authors and Affiliations

  1. University of Lorraine, EA 4360 APEMAC, Nancy Metz, France

    Serge Briançon, Karine Legrand, Laurent Muller, Laura Saez, Elisabeth Spitz, Abdou Y. Omorou, Serge Briançon, Karine Legrand, Laurent Muller, Abdou Y. Omorou, Laura Saez & Elisabeth Spitz

  2. CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France

    Karine Legrand, Abdou Y. Omorou, Karine Legrand & Abdou Y. Omorou

  3. National Conservatory of Arts and Crafts, Nancy, France

    Johanne Langlois, Edith Lecomte, Cécile Gailliard, Johanne Langlois & Edith Lecomte

  4. Local school office of the Nancy-Metz academy, Nancy, France

    Marie-Hélène Quinet, Rozenn De Lavenne & Marie-Hélène Quinet

  5. Department of endocrinology, diabetology and nutrition, Nancy University Hospital, Nancy, France

    Philip Böhme & Philip Böhme

  6. Vosges Departmental School Board Inspectorate, Épinal, France

    Céline Pourcher & Brigitte Toussaint

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  4. Johanne Langlois
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  5. Laura Saez
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  6. Elisabeth Spitz
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  7. Marie-Hélène Quinet
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  8. Philip Böhme
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  9. Edith Lecomte
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  10. Abdou Y. Omorou
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Consortia

and the PRALIMAP-INÈS trial group

  • Philip Böhme
  • , Serge Briançon
  • , Rozenn De Lavenne
  • , Cécile Gailliard
  • , Johanne Langlois
  • , Edith Lecomte
  • , Karine Legrand
  • , Laurent Muller
  • , Abdou Y. Omorou
  • , Céline Pourcher
  • , Marie-Hélène Quinet
  • , Laura Saez
  • , Elisabeth Spitz
  •  & Brigitte Toussaint

Contributions

SB is the principal investigator for the PRALIMAP-INÈS trial. EL is interventions head manager. AO, KL, JL, EL, LM, LS, PB and SB are outcomes and process evaluation managers. AO and SB are statistical managers. AO and SB drafted the manuscript. All authors read and approved the final manuscript. SB is the paper guarantor.

Corresponding author

Correspondence to Serge Briançon.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the PRALIMAP-INÈS trial group are listed below Acknowledgements.

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Briançon, S., Legrand, K., Muller, L. et al. Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial. Int J Obes 44, 895–907 (2020). https://doi.org/10.1038/s41366-020-0520-z

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  • DOI: https://doi.org/10.1038/s41366-020-0520-z

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