PUBLICATIONS & TOOLS
- NCCOR Toolbox: Measures Registry Learning Modules
- Promoting Equitable Expansion of SNAP Online Purchasing Pilot
- 2021 Breastfeeding Inspiration Guide
CHILDHOOD OBESITY RESEARCH & NEWS
- Study Finds Risk of Serious Complications from Youth-onset Type 2 Diabetes
- Ultraprocessed Foods Now Comprise 2/3 of Calories in Children and Teen Diets
- Physical Activity Protects Children from the Adverse Effects of Digital Media on Their Weight Later in Adolescence
- Preventing Childhood Obesity Requires Changes in Parents’ and Clinicians’ Early-life Care
Head Back to School with NCCOR during National Childhood Obesity Awareness Month
This September, NCCOR will recognize National Childhood Obesity Awareness Month (NCOAM) by featuring our best academic resources. Whether you are a graduate student, professor, or K-12 teacher, NCCOR can support your work this upcoming school year.
Elementary, middle, and high school teachers, visit the NCCOR website when you need to:
- Plan a class or program to encourage physical activity. Children need 60 minutes of moderate to vigorous activity a day. Have confidence that your programs are meeting this recommendation with NCCOR’s Youth Compendium of Physical Activities. This resource lists 196 common youth activities and the estimated energy cost associated with each. We also offer sample class plans and specific guidance for classroom and physical education
- Teach the components of a healthy diet and food system. NCCOR offers infographics based on the Healthy Eating Index. The first shows the elements of a healthy diet and is appropriate for all age groups. Older students can deepen their analytical skills by learning about the importance of a healthy food supply.
Graduate students in public health, nutrition, or kinesiology, NCCOR has the tools and resources you need to:
- Learn the foundations. If you are a new student or just want a refresher, NCCOR’s Student Resources Guide is essential reading. It provides case studies and step-by-step guidance on how to use NCCOR’s tools and will point you to additional training materials.
- Design a research project. When it comes time to complete your thesis, capstone project, or any large assignment, NCCOR can help you select the most appropriate measures and datasets. Use the Measures Registry, the Catalogue of Surveillance Systems, and the Youth Compendium of Physical Activities to conduct systematic reviews and meta analyses, develop childhood obesity interventions, analyze secondary data sets, and much more.
- Stay current in the field of childhood obesity prevention. Sign up for the quarterly Student Hub e-newsletter. Each issue connects you to childhood obesity events and free resources to support continued learning. Be sure to select “Student” when you sign up!
College and university professors, NCCOR can help you:
- Find new and engaging lecture content. NCCOR’s archive of Connect & Explore webinars features accomplished researchers and practitioners presenting their work. These hour-long sessions are perfect for asynchronous lecture content or to provide variety to your syllabus.
- Teach research methods. NCCOR provides a suite of free tools to help faculty demonstrate our signature tool, the Measures Registry. We offer free User Guides, case studies, and PowerPoint slides for classroom use. Learn more with our factsheet for professors.
- Stay connected. In addition to our monthly e-newsletter, NCCOR offers a quarterly publication for college and university professors. Sign up on our website and be sure to select “Professor.”
If you have used NCCOR resources in your classroom or research project, please let us know! You could be featured in our next case study to help others learn from your success.
Publications & Tools
NCCOR Toolbox: Measures Registry Learning Modules
Not sure where to start with selecting measures for your next research project? NCCOR’s Measures Registry Learning Modules are ideal for users newer to research and evaluation, or those who need a refresher on key research concepts. The Learning Modules walk you through measurement selection on your own time through 5 to 15-minute modules in the four major domains of the Registry: individual diet, food environments, individual physical activity, physical activity environment.
Promoting Equitable Expansion of SNAP Online Purchasing Pilot
Healthy Eating Research released an issue brief addressing how to improve utilization of the USDA Online Purchasing Pilot, which allows people who use SNAP benefits to shop and pay for groceries online. The research brief outlines policy recommendations to address structural, personal, and financial barriers to increase the utilization of online grocery shopping.
2021 Breastfeeding Inspiration Guide
The organization 1,000 Days has released a resource hub of unbranded, evergreen communication materials for National Breastfeeding Awareness Month. Users will find social media graphics and sample text for breastfeeding education campaigns. The inspiration guide, which is updated annually, is available for free to download and use on social media channels.
Childhood Obesity Research & News
Study Finds Risk of Serious Complications from Youth-onset Type 2 Diabetes
August 11, 2021, NIH
People with type 2 diabetes diagnosed during youth have a high risk of developing complications at early ages and have a greater chance of multiple complications within 15 years after diagnosis, according to results of the NIDDK-funded Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) follow-up study, called TODAY2. Findings from this study underscore the importance of early, intensive treatment for those diagnosed with youth-onset type 2 diabetes.
TODAY2 involved 500 original participants from the TODAY study, which began in 2004. TODAY was the first major comparative effectiveness trial for the treatment of type 2 diabetes in youth. Participants in TODAY2 were monitored annually for signs of diabetes complications, including heart disease, kidney disease, and diabetic foot complications, and to report other health events. Diabetic eye disease was assessed once during the study, at the 7-year study visit. The TODAY study’s diverse cohort is representative of U.S. youth diagnosed with type 2 diabetes. Study participants had regular, intensive diabetes management through the study at no cost during the original TODAY trial, which researchers noted may have actually lowered the rate of complications.
After following participants for 15 years, researchers found that 60% of participants had at least one diabetes-related complication, and nearly a third of participants had two or more complications.
“Compared to what we see in adults with type 2 diabetes, the participants in TODAY2 developed complications much earlier in their disease course and at a much faster pace over time,” said TODAY2 study chair Philip Zeitler, MD, PhD, professor of Pediatrics-Endocrinology at the University of Colorado School of Medicine. “This study shows the importance of treating youth-onset type 2 diabetes intensively from the beginning and using all available approaches to control blood glucose and prevent, delay, or aggressively treat developing complications.”
The hope is that the TODAY2 findings will help find improved prevention methods, and also lead to future discoveries of new and better treatments to manage type 2 diabetes in youth.
The results of this NIDDK-funded study were published in the New England Journal of Medicine. For more information about the study, read the full NIH press release.
Ultraprocessed Foods Now Comprise 2/3 of Calories in Children and Teen Diets
August 10, 2021, TuftsNow
The calories that children and adolescents consumed from ultraprocessed foods jumped from 61% to 67% of total caloric intake from 1999 to 2018, according to a new study from researchers at the Friedman School of Nutrition Science & Policy at Tufts University. Published August 10, 2021, in JAMA, the study analyzed dietary intake from 33,795 children and adolescents nationwide.
“Some whole grain breads and dairy foods are ultraprocessed, and they’re healthier than other ultraprocessed foods. Processing can keep food fresher longer, allows for food fortification and enrichment, and enhances consumer convenience,” said senior and corresponding author Fang Fang Zhang, nutrition epidemiologist at the Friedman School. “But many ultraprocessed foods are less healthy, with more sugar and salt, and less fiber, than unprocessed and minimally processed foods, and the increase in their consumption by children and teenagers is concerning.”
The largest spike in calories came from such ready-to-eat or ready-to-heat dishes as takeout and frozen pizza and burgers: from 2.2% to 11.2% of calories. The second largest spike in calories came from packaged sweet snacks and desserts, the consumption of which grew from 10.6% to 12.9%.
There was a larger increase in the consumption of ultraprocessed foods among non-Hispanic Blacks (10.3%) and Mexican Americans (7.6%) than non-Hispanic Whites (5.2%). Trends in other racial/ethnic groups were not assessed due to lack of sufficient data that allow for nationally representative estimates across survey cycles.
There were no statistically significant differences in the overall findings by parental education and family income. “The lack of disparities based on parental education and family income indicates that ultraprocessed foods are pervasive in children’s diets,” said Zhang. “This finding supports the need for researchers to track trends in food consumption more fully, taking into account consumption of ultraprocessed foods.”
Over the study period, calories from often healthier unprocessed or minimally processed foods decreased from 28.8% to 23.5%. The remaining percentage of calories came from moderately processed foods such as cheese and canned fruits and vegetables, and consumer-added flavor enhancers such as sugar, honey, maple syrup, and butter.
There was good news: Calories from sugar-sweetened beverages dropped from 10.8% to 5.3% of overall calories, a 51% drop.
“This finding shows the benefits of the concerted campaign over the past few years to reduce overall consumption of sugary drinks,” said Zhang. “We need to mobilize the same energy and level of commitment when it comes to other unhealthy ultraprocessed foods such as cakes, cookies, doughnuts and brownies.”
“In additional analyses, we compared the composition of ultraprocessed foods to non-ultra processed foods using data from the 2017-2018 period. We found that ultraprocessed foods contain a substantially higher percent of calories from carbohydrates and added sugars, and higher levels of sodium, but also had less fiber and a lower percentage of calories from protein,” said the study’s first author, Lu Wang, a postdoctoral fellow at the Friedman School.
“Food processing is an often-overlooked dimension in nutrition research. We may need to consider that ultraprocessing of some foods may be associated with health risks, independent of the poor nutrient profile of ultraprocessed foods generally,” concluded Zhang.
Ultraprocessed foods are ready-to-eat or ready-to-heat items often high in added sugar, sodium, and carbohydrates, and low in fiber, protein, vitamins, and minerals. They typically contain added sugars, hydrogenated oils, and flavor enhancers. Examples include packaged sweet snacks and desserts, sugary breakfast cereals, French fries, fast food burgers, and some lunchmeats such as bologna and salami. When consumed in excess, these foods are linked with diabetes, obesity, and other serious medical conditions, such as certain cancers.
This new study is part of a series led by Friedman School researchers investigating patterns and trends in diet quality among U.S. adults and children. The study characterized trends in ultraprocessed food consumption among U.S. children aged 2-19 years from 1999 to 2018, overall and among population subgroups, using data from 10 consecutive cycles of the National Health and Nutrition Examination Survey (NHANES). It further assessed major ultraprocessed food subgroups consumed by U.S. children in the latest cycle of NHANES (2017-2018) and associated nutrient profiles. The average age of participants was 10.7 years and was roughly equally divided between boys and girls. It relied on 24-hour dietary recall interviews conducted by trained personnel; older children and teens directly reported on the foods they ate while parents and caregivers did so for younger children. The percentage of calories consumed by participants was determined using the NOVA food classification system developed by researchers at the University of Sao Paulo, Brazil.
This study was supported by the National Institutes of Health’s National Institute on Minority Health and Health Disparities (award R01MD011501) to Fang Fang Zhang, and the São Paulo Research Foundation (FAPESP) awarded to co-author Eurídice Martínez Steele. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. For conflicts of interest disclosure, please see the study.
Physical Activity Protects Children from the Adverse Effects of Digital Media on Their Weight Later in Adolescence
August 9, 2021, EurekAlert!
Children’s heavy digital media use is associated with a risk of being overweight later in adolescence. Physical activity protects children from the adverse effects of digital media on their weight later in adolescence.
A recently completed study shows that six hours of leisure-time physical activity per week at the age of 11 reduces the risk of being overweight at 14 years of age associated with heavy use of digital media.
Obesity in children and adolescents is one of the most significant health-related challenges globally. A study carried out by the Folkhälsan Research Center and the University of Helsinki investigated whether a link exists between the digital media use of Finnish school-age children and the risk of being overweight later in adolescence. In addition, the study looked into whether children’s physical activity has an effect on this potential link.
The results were published in the Journal of Physical Activity and Health.
More than six hours of physical activity per week appears to reverse adverse effects of screen time
The study involved 4,661 children from the Finnish Health in Teens (Fin-HIT) study. The participating children reported how much time they spent on sedentary digital media use and physical activity outside school hours. The study demonstrated that heavy use of digital media at 11 years of age was associated with a heightened risk of being overweight at 14 years of age in children who reported engaging in under six hours per week of physical activity in their leisure time. In children who reported being physically active for six or more hours per week, such a link was not observed.
The study also took into account other factors potentially impacting obesity, such as childhood eating habits and the amount of sleep, as well as the amount of digital media use and physical activity in adolescence. In spite of the confounding factors, the protective role of childhood physical activity in the connection between digital media use in childhood and being overweight later in life was successfully confirmed.
Activity according to recommendations
“The effect of physical activity on the association between digital media use and being overweight has not been extensively investigated in follow-up studies so far,” says Postdoctoral Researcher Elina Engberg.
Further research is needed to determine in more detail how much sedentary digital media use increases the risk of being overweight, and how much physical activity is needed, and at what intensity, to ward off such a risk. In this study, the amount of physical activity and use of digital media was reported by the children themselves, and the level of their activity was not surveyed, so there is a need for further studies.
“A good rule of thumb is to adhere to the physical activity guidelines for children and adolescents, according to which school-aged children and adolescents should be physically active in a versatile, brisk and strenuous manner for at least 60 minutes a day in a way that suits the individual, considering their age,” says Engberg. In addition, excessive and extended sedentary activity should be avoided.
Preventing Childhood Obesity Requires Changes in Parents’ and Clinicians’ Early-life Care
July 29, 2021, EurekAlert!
Rates of childhood obesity are at historically high levels in the U.S., yet there are few interventions that promote healthy weight gain in children from infancy to age two—a critical period for the development and prevention of childhood obesity. A new study published in Pediatrics found that fewer infants gained excess weight when low-income pregnant women received individualized health coaching in tandem with clinicians in community health centers and public health programs systematically changing how they delivered care to women and their infants.
“Most interventions to prevent obesity in children attempt to change the behavior of the child’s parent or family,” explains lead author Elsie Taveras, MD, MPH, chief of the Division of General Academic Pediatrics at Massachusetts General Hospital (MGH). “But a child’s health is also influenced by how well clinical and public-health systems interact with families and provide care targeted to reducing the risk of obesity.”
The novel intervention, called the First 1,000 Days program, has the potential to have a much broader impact on childhood obesity because it reaches all women and infants. “We can be so much more effective at preventing childhood obesity if all obstetricians pay close attention to a woman’s excess weight gain in pregnancy and if all pediatricians are trained in identifying problematic weight gain in infants, for example,” says Taveras, a professor of Pediatrics at Harvard Medical School (HMS). The First 1,000 Days program is also unique in combatting obesity starting in the first trimester of pregnancy and in focusing on low-income families, who have the highest risk for childhood obesity.
The investigators compared infants’ weight outcomes in women and infants who received the intervention and those who received usual care. The intervention group included 995 pregnant women in their first trimester and their infants receiving care at two community health centers affiliated with Mass General Brigham. The comparison group consisted of 650 pregnant women and their infants who received usual care at two other community health centers serving low-income patients.
The intervention had two goals: to promote the adoption of healthy behavior in the women and their infants and to make systematic changes in the clinical care the women and infants received. The systems-level component of the intervention included, for example, standardizing obesity-prevention training for pediatric clinicians and staff, close tracking of infants’ weight gain, screening pregnant women for adverse health behaviors and social determinants of health, and providing educational materials and text messages to families that promoted healthy feeding and sleeping behaviors of their infants. In addition, women in the intervention group received individual support and coaching during pregnancy and the first six weeks postpartum on diet, physical activity, sleep and stress reduction.
Infants in the intervention group had 54% lower odds of being overweight at six months and 40% lower odds of being overweight at 12 months compared with infants who received usual infant care. The researchers will continue to follow the children through age two. Mothers at the intervention sites had modestly lower, but clinically insignificant, weight retention at six weeks’ postpartum compared with mothers receiving usual care. But more women in the intervention group had a postpartum visit with a primary care clinician than the women who received usual care. “The first six weeks after delivery are very important for positively influencing a woman’s health trajectory, so we may need a more robust intervention to achieve postpartum weight reduction,” says Taveras.
Making changes in systems of care holds the promise to improve the health of all women and their babies at community health centers and public-health programs, Taveras adds. “We believe we can create a sustained reduction in childhood obesity by moving beyond simply modifying individual behaviors and risk factors, one parent at a time.”
The next steps for the research are to find the best approaches to disseminate the intervention to other health systems that care for low-income families and to train frontline clinicians in how to implement the program for preventing childhood obesity into their practices.
Major funding for this research was provided by the Boston Foundation and the National Institutes of Health.