• Objectives

• 1. To examine the behavioral, body fatness/weight and nutritional risk for childhood obesity and associated complications (MetS, T2D, and CVD) at baseline and 2-year follow-up changes in the sentinel sample that is exposed to multi-level Whole-of-Society transformation (i.e., PAG and WHA resolution for Quebec sample; IUI and WHA resolution in India). (Individual-level BtS Diagnostic)
  2. To examine the direct impact of individual differences in genetic and neuro-cognitive predisposition for responsiveness to lifestyle-shaping environmental exposure conditions (i.e., endophenotype for environment responsiveness) on behavioral, body fatness/weight and nutritional risk for childhood obesity (MetS, T2D, and CVD) and their moderating role on contextual differences in such environmental exposure conditions. (Individual-level BtS Diagnostic)
  3. To proceed to foundational (qualitative and quantitative) work for subsequent computational systems science modelling (systems dynamic) of the relationships between aggregate-level measures of lifestyle-shaping environmental exposure conditions prevailing in communities (where sentinel samples live) and the organizational and collective choices made by community-level stakeholders (including health, social, and economic inputs, processes, outcomes and underlying mechanisms and feedbacks) involved in focal WoS interventions in Canada (PAG) and India (IUI). (Societal-level BtS Diagnostic)
  4. To proceed to foundational work for subsequent computational systems science modelling (systems dynamic) of the relationships between aggregate-level measures of the caloric and nutritional quality of food supply, demand and consumption, and changes in agriculture and food systems practices, strategies and policies in relation to both the national WoS transformation in Canada (PAG) and India (IUI), as well as in the global WHA resolution A63/12 (recommendations on the marketing of foods and non-alcoholic beverage to children). (Societal-level BtS Diagnostic)

• Timeline 

• Location

India: Palwal, Haryana (with four sub-divisions: Palwal, Hodal, Hasanpur and Hathin)            Total Nine (9) villages divided into 3 clusters are selected for the study

1. 1. Cluster 1 villages: Ratipur, Durgapur, Jodhpur
   2. Cluster 2 villages: Sarai, Khatela, Nangla Eshanpur
   3. Cluster 3 villages: Bahin, Kot, Pahari

Canada: Montreal, Quebec Province

• Methods

Study population: 612 Indian children and 612 Canadian children of 6-12 years of age distributed equally gender wise into 6 one year age bands i.e 17 males and 17 females in each age band from every cluster. These children are being recruited from 9 villages in India and 9 urban clusters in Canada.

Follow up: for 2 years

• Expected Outcomes

1. Primary outcomes:  
   1. Change in food related behavior – dietary intake
   2. Change in body weight & fatness – anthropometry

1. Secondary outcomes:
   1. Change in Nutritional risk for childhood obesity and associated complications – Biological risk markers – Heart rate, blood pressure, lipid profile, fasting insulin, glucose, HbA1c, hs-CRP
   2. Change in proximal environmental exposures – Household environment, social network, education, built environment and physical activity status
   3. Biologic exposure – genetic predisposition, neuro-cognitive predisposition, eating pattern phenotype

1. Societal Level Diagnostic –
   1. Change in Health promoting / hindering opportunities and constraints existing at aggregate level
   2. Change in aggregate community specific responses – Food demand, purchase, consumption; mobility patterns & opportunities, Health & Economic outcomes; Psycho-social status
   3. Aggregate change in society system – Agriculture; food system & supply chain; Marketing including influences of local communities; Media & communication policy changes; NGOs & other stakeholders