December 2015





Connect & Explore: New Cost-Effectiveness and Impact Estimates for Childhood Obesity Interventions

Nov. 19, 2015, NCCOR

NCCOR’s Connect & Explore Webinar examines the latest research findings from the CHOICES project

On Wednesday, Dec. 9, NCCOR’s Connect & Explore Webinar will feature exciting new research on the cost effectiveness and impact of interventions to reduce childhood obesity. Steven Gortmaker, PhD, director of the Harvard Prevention Research Center, will explore the latest findings from the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) project, a collaborative modeling effort designed to evaluate the effectiveness, costs, and reach of interventions to reduce childhood obesity in the United States. Dr. Gortmaker is the lead investigator of the CHOICES project.

At a time of limited resources and constrained budgets, the evidence-base for choosing cost-effective interventions for childhood obesity is evolving, but remains limited. Understanding the approaches that offer the best value can play a critical role in the decision-making process by policymakers and public health practitioners.

Published in the November issue of Health Affairs, the latest paper from the CHOICES project examined seven interventions high on the obesity policy agenda — documenting their potential reach, comparative effectiveness, implementation cost, and cost-effectiveness. Researchers analyzed interventions separately and concluded that no single strategy on its own will be sufficient to reverse the obesity epidemic.

The upcoming webinar will provide insights into the study’s unique methods and explore how the latest findings impact childhood obesity research and policy.

“Policy makers, health care practitioners, researchers, and other experts are working tirelessly to reverse the childhood obesity epidemic,” said Dr. Gortmaker, who also serves as a Professor of the Practice of Health Sociology at the Harvard T.H. Chan School of Public Health. “The implementation of cost-effective preventive interventions can help us reach a larger percentage of our nation’s children and reduce long-term obesity prevalence in this country.”

Join us at 3 pm, Eastern, on Wednesday, Dec. 9, for the one-hour event. The webinar is free but attendance is limited, so tell a colleague and register to receive webinar access.

Register for Connect & Explore Webinar: New Cost-Effectiveness and Impact Estimates for Childhood Obesity Interventions

We encourage you to share this information on your social networks using the hashtag #ConnectExplore. We will also be live tweeting the event, so be sure to follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on


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Publications & Tools

Prevalence of Obesity Among Adults and Youth: United States, 2011–2014

From 1999 through 2014, obesity prevalence increased among adults and youth. However, among youth, prevalence did not change from 2003-2004 through 2013-2014, according to the latest data brief from the Centers for Disease Control and Prevention. The prevalence of obesity was more than 36 percent in adults and 17 percent in youth.


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Availability of Healthy Food Products at Check-out Nationwide, 2010-2012

Less than 25 percent of retail food stores carried bottled water or fresh fruits/vegetables at check-out, according to a recent study by Bridging the Gap. The study examined the availability of healthy food and beverage products at check-out in more than 8,000 retail food stores across the United States.


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Childhood Obesity Research & News

Obesity rises despite all efforts to fight it, U.S. officials say

Nov. 12, 2015, The New York Times

By Sabrina Tavernise

Despite years of efforts to reduce obesity in America, including a major push by Michelle Obama, federal health officials reported Thursday that the share of Americans who were obese had not declined in recent years, and had edged up slightly.

About 38 percent of American adults were obese in 2013 and 2014, up from 35 percent in 2011 and 2012. Researchers said the increase was small enough that it was not statistically significant. But to many in public health, it was surprising and disheartening.

“The trend is very unfortunate and very disappointing,” said Marion Nestle, a professor in the department of nutrition, food studies and public health at New York University. “Everybody was hoping that with the decline in sugar and soda consumption, that we’d start seeing a leveling off of adult obesity.”

And compared with a decade ago, the increase was significant: In 2003 and 2004, about 32 percent of adults were obese, said the report’s lead author, Cynthia L. Ogden.

Health experts had hoped that gradual improvements in the American diet in recent years might have moved the needle on obesity. Consumption of full-calorie soda has dropped by a quarter since the late 1990s, and there is evidence that calorie intake has dropped for adults and children. Obesity began rising in the 1980s, but the rate flattened in the 2000s, and declines among young children in some cities had lifted expectations that the epidemic might be easing.

Obesity among young people was unchanged in 2013 and 2014 from the previous period, the report found. Seventeen percent of Americans ages 2 to 19 were obese, the same as in 2003 and 2004. Experts pointed out that far more work had been done to fight obesity in children, including changes in school lunches and the removal of sugar-sweetened beverages from some school systems.

Noting that obesity rates did not rise for youth, Ms. Obama’s office said the focus of the first lady’s efforts has been childhood obesity. Federal figures from last year even showed a decline among the youngest children, said Debra Eschmeyer, executive director of Let’s Move, Ms. Obama’s anti-obesity campaign. “It is more than encouraging to see in today’s CDC report that childhood obesity rates are no longer rising,” she said.

The figures are from the National Health and Nutrition Examination Survey, the gold standard for federal health data, released every two years. For smaller slices of the American population — for example, women or blacks — researchers used four years of data, from 2011 through 2014, for the most reliable results.

Some of the most striking numbers were among minorities. About 57 percent of black women were obese from 2011 to 2014, the highest rate of any demographic. Next highest were Hispanic women, at 46 percent, and Hispanic men, at 39 percent. About 36 percent of white women were obese, and 34 percent of white men. The prevalence of obesity was lowest among Asians, who had a combined rate of about 12 percent.

Dr. Walter Willett, the chairman of the nutrition department at the Harvard School of Public Health, cautioned that the modest improvements nationwide were extremely unevenly spread, with most of them happening among more educated Americans. A paper he helped write, published this month in Health Affairs, found that Americans’ diets had improved in quality from 1999 to 2012 — with a reduction in trans fats, small increases in fiber and less soda consumption — but that most of those advances were not happening among lower-income, less educated Americans.

“In general, there’s been a big gap” between rich and poor, Dr. Willett said. “When we take the U.S. average, we are hiding a lot of detail.”

There were a few other surprises. Men had more or less caught up to women in obesity prevalence in recent years, but the new numbers showed that women had edged ahead again, Dr. Ogden said. About 38 percent of adult women were obese from 2011 to 2014, the report found, compared with 34 percent of men.

Middle-aged Americans were hardest hit. Adults ages 40 to 59 had the highest rate of obesity, 40 percent, followed by people 60 and over, 37 percent of whom were obese. About 32 percent of 20- to 39-year-olds were obese.

Kelly D. Brownell, the dean of the Sanford School of Public Policy at Duke University, said the new figures were a reminder that many risks, such as the prevalence and inexpensiveness of junk food, had not gone away, and a sign that policy makers needed to redouble their efforts to, for example, impose a tax on soda.

“The emergency flag has gone up,” he said. We are not doing nearly enough.”


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YouTube kids app faces new complaints over ads for junk food

Nov. 24, 2015, The New York Times

By Cecilia Kang

Visit YouTube Kids and typically it will not be long before promotions for junk food appear. The advertisements regularly show up in the form of funny contests and animated stories.

In complaints filed to federal officials on Tuesday, two prominent consumer advocacy groups argued that those ads were deceptive, particularly for children. The two complaints, made to the Federal Trade Commission, expand on the groups’ filings to the agency in April and could increase pressure on federal officials to intervene in the fast-growing online video market.

The groups, the Campaign for a Commercial-Free Childhood and the Center for Digital Democracy, argue in the complaints that online video aimed at children is too commercialized and is not held to the same standards that apply to cable and broadcast television. The complaints call for an investigation of food marketers, video programmers and Google, which owns YouTube, as well as for a broad examination of advertising of such food to children online.

“You have digital natives consuming content simultaneously with the growth of powerful marketing at children at the earliest ages,” said Jeffrey Chester, executive director of the Center for Digital Democracy. “The agencies are lagging and the companies are emboldened.”

Google introduced YouTube Kids in February as a mobile app “built from the ground up with little ones in mind,” according to a blog post by the company. The app is geared for children of preschool age and older. After downloading the app on a mobile device, parents are guided through a tour of how to set safety features, like the option to block searching. The videos on the platform are selected from the main YouTube site through algorithms set to pick child-related content.

The groups expand on their April complaints by asking the F.T.C. to examine the advertising practices of food companies, and by citing new evidence of junk food ads on the app. In the new complaint, the groups argue that more than a dozen food companies have fallen short of their own promises to abstain from marketing junk food to children on YouTube Kids. The groups say that brands like Burger King, Coca-Cola, ConAgra Foods and American Licorice have commercials on the app for products including potato chips and chocolate bars.

While the groups direct blame toward marketers, they also criticize YouTube for not enforcing its own policies. YouTube restricts paid advertising of food and beverages on its children’s app, but the groups said their review of the app found many examples in which food companies used their own branded channels to show promotional videos. The groups asked for an investigation into uploaded TV commercials from unknown YouTube Kids accounts to determine whether there were connections between the food companies and those channels.

The Federal Trade Commission has been reviewing the April complaint, according to a person with knowledge of the investigation who spoke on the condition of anonymity. The F.T.C. usually accepts complaints and begins at least a preliminary review process.

Any investigation of the previous complaint and the new filings would not be public, said Jessica Rich, director of the Bureau of Consumer Protection at the F.T.C. “We welcome and we review carefully all such complaints submitted to us,” she added.

The Children’s Food and Beverage Advertising Initiative, a coalition of major food and beverage companies that is mentioned in the complaint, said it had complied with its commitments. The organization said the companies did not place food ads on YouTube Kids, but it had seen how their ads could appear via the search function. The group said it had asked Google to find a technology fix to prevent the ads from appearing there.

The group’s “participants are not purchasing advertisements on the YouTube Kids app, even for foods that meet C.F.B.A.I.’s nutrition criteria,” it said in a statement.

For children’s television programming, there are clear rules that limit the length of commercials, as well as restrictions on product placement and on the promotion of products by TV hosts and characters. The Children’s Food and Beverage Advertising Initiative, formed in 2006, promised not to advertise any products that did not meet certain nutritional standards to children under 12 on TV or online.

YouTube Kids states in its parental guide that it cannot be responsible for user-generated content by branded channels or third parties.

YouTube said last week that the app had been downloaded more than 10 million times and had received strong ratings in app stores.

The company said parents could turn off the search function to help block content they do not want to reach their children. YouTube said on Tuesday that it had not seen the complaints, but a spokeswoman said, “We are always open to feedback and are committed to creating the best experience for families.”

The lines between marketing and advertising are often blurred, the groups said in their complaint. They asked the F.T.C. to investigate what appeared to be promotional videos by YouTube creators and said the agency should enforce its disclosure rules on paid sponsorships.

“There is just so much commercial content, and more of it all the time,” said Angela Campbell, a professor at Georgetown Law School and an author of the complaints. “And if they are trying to sell something, they aren’t making it obvious even to an adult. So to a kid, that is fundamentally unfair.”


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Are junk food habits driving obesity? A tale of two studies

Nov. 16, 2015, NPR

By Maria Godoy

More than 36 percent of American adults and 17 percent of youth under 19 are obese, according to the latest figures from the Centers for Disease Control and Prevention.

Scientists still don’t fully understand what got us here. And sometimes, the answers they’ve come up with turn out to be wrong. Consider the changing advice on fat, which has been amended of late from its days as a dietary demon.

By now, it would seem that the link between the obesity epidemic and the consumption of high-calorie, low-nutrition foods like sodas, cookies and fries is well-established. But as two recent studies show, researchers are still probing the mechanics of that connection.

Broadly speaking, both studies explore the connection between junk food and weight — though they do so using different data sets from two different populations (adults and kids).

Let’s start with the finding that seems most counterintuitive: For most of us, junk foods may not be what’s driving weight gain. That’s what behavioral economist David Just and his colleagues at the Cornell University Food and Brand Lab concluded in a paper in the journal Obesity Science & Practice.

The researchers looked at data collected in 2007-2008 from a nationally representative sample of roughly 5,000 U.S. adults as part of the National Health and Nutrition Examination Survey (NHANES), including information on weight, height and eating habits. Junk food was defined as fast food, soda and sweets.

Some of that data set had been used in a 2013 CDC study that found that heavier Americans were indeed getting more of their daily calories from fast food. But the Cornell researchers wondered what would happen if they excluded the people on the extreme ends of the weight spectrum—those who are clinically underweight and the very morbidly obese.

And they found that once those groups were eliminated, there was no association between body mass index and how much fast food, sugary sodas and sweets people consume.

The finding, which applies to 95 percent of the population, “was really counterintuitive — not what we expected at all,” Just tells The Salt.

But if fast food isn’t driving the obesity epidemic, what is? “I suspect we’re eating too many calories from all foods,” Just says. He points to data from the USDA’s Economic Research Service showing that Americans, on average, now eat 500 calories more daily than they did around 1970, before the obesity epidemic took off.

To be clear, Just isn’t saying that you can eat all the junk food you want with no consequence. “You increase your consumption of these things, yeah, you’re going to put on weight,” he says. “But that’s not to say that is the differentiator between those who are overweight and those who aren’t.” And if that’s the case, Just says, instead of targeting junk foods in the war against obesity, maybe we should be preaching the gospel of moderation and portion control with all foods.

Sure, that’s good advice in general — but it may not mean we can let junk foods off the hook.

Eric Finkelstein, an associate professor at the Duke Global Health Institute at Duke University, notes that the data the Cornell researchers used is only a snapshot of what a cross-section of Americans were eating at a single moment in time. So it’s possible, for example, that the overweight and obese people included in the study reported eating less junk foods because they were trying to lose weight.

“I’d lend a lot more credence to studies that follow change [in eating habits and weight] over time,” Finkelstein tells The Salt.

And, over time, he says, the evidence suggests strongly that even modest increases in the consumption of certain foods will result in long-term weight gain. He points to a 2011 study in the New England Journal of Medicine that looked at data gathered over decades on 120,000 U.S. adults. Over a four-year period, an extra daily serving of potato chips was associated with weight gain of 1.69 pounds, the study found. That may not sound like much, but for most adults, that’s how the pounds add up — gradually, over time, at an average rate of about a pound a year.

And problem foods will pack on the pounds for kids, too. Last week, Finkelstein and his colleagues published a similarly detailed breakdown of the links between weight gain and certain foods in children. The researchers turned to data on more than 4,600 kids from the Avon Longitudinal Study of Parents and Children, an ongoing study in the U.K. that has tracked the same set of children — with records on their height, weight, and food intake — since their birth in the early 1990s.

Once again, potato chips raised red flags.

As the researchers reported in the journal Health Affairs, over a three-year period, every 25-gram serving of potato chips (a little under an ounce) that kids ate daily was linked to about a half-pound of excess weight gain. (Basically, that’s defined as weight beyond what a child should weigh for his or her height and age.)

Again, half a pound doesn’t sound alarming, “but if you’re also getting an extra half a pound from burgers, and half a pound from french fries, these things add up. And some kids are eating more than a serving” daily, Finkelstein says.

Other foods the study linked to excessive weight gain included “kid food” staples — like breaded and coated fish and poultry (think fish sticks and chicken nuggets) and french fries — and processed meats, butter and margarine, desserts and sweets.

That’s important, because some 31 percent of American and 38 percent of European kids are now overweight or obese — and the pounds we gain as kids often stay with us through adulthood.


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Obese kids as young as 8 show signs of heart disease

Nov. 10, 2015, HealthDay

By Alan Mozes

Obese children can develop signs of heart abnormalities as young as age 8, which might drive up their risk for early death as adults, new research suggests.

“It is both surprising and alarming to us that even the youngest obese children in our study who were 8 years old had evidence of heart disease,” said study lead author Linyuan Jing, a postdoctoral fellow with Geisinger Health System in Danville, Pa.

“Ultimately, we hope that the effects we see in the hearts of these children are reversible,” Jing added. “However, it is possible that there could be permanent damage.”

For the study, Jing’s team conducted MRI scans of 40 children between 8 and 16 years old. Half were obese; half were of normal weight.

The obese kids had an average of 27 percent more muscle mass in the left ventricle region of their heart, and 12 percent thicker heart muscle overall. Both are considered indicators of heart impairment, Jing said.

Also, among 40 percent of the obese children, scans showed thickened heart muscle had already translated into a reduced ability to pump blood. Kids with this reduced heart capacity were deemed to be at “high risk” for adult cardiac strain and heart disease.

“This should be further motivation for parents to help children lead a healthy lifestyle,” Jing said.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, called the findings “alarming.”

He and Jing said the structural heart changes detected by the scans are associated with more complicated health conditions in adulthood as well as early death in adults.

The changes in heart muscle mass “suggest a significant increase in risk of heart failure, arrhythmia [irregular heartbeat] and premature cardiovascular death in children with obesity,” said Fonarow, who was not involved with the study.

Jing said the study results suggest obese children even younger than 8 years old likely have signs of heart disease, too. “Understanding the long-term ramifications will be critical as we deal with the impact of the pediatric obesity epidemic,” she said.

Obesity among 6- to 12-year-olds in the United States more than doubled over the last three decades and quadrupled among teens, according to the U.S. Centers for Disease Control and Prevention. As of 2012, more than one-third of children between ages 6 and 19 were either overweight or obese.

Some of the obese children in the study were struggling with health complications often associated with excess weight, including asthma, high blood pressure and depression, the researchers said. But none displayed customary warning signs of heart disease such as fatigue, dizziness or shortness of breath, Jing said.

Given that the study excluded kids with diabetes and those too large to fit inside the MRI scanning machine, the study may actually underestimate the extent of the problem, she said.

Jing said parents have a responsibility to help their children maintain a healthy weight. They should buy healthy foods instead of cheap fast food and fruit juice, “which is high in sugar but low in fiber,” she said.

Parents should also limit TV, computer and video game time, while encouraging more outdoor activities, she said.

“In addition, schools and communities need to do a better job at educating both the parents and children about the health risks of overweight and obesity,” said Jing.

Fonarow agreed, adding that “substantially increased efforts are needed to prevent and treat childhood obesity.”

The findings were scheduled for presentation Tuesday at the annual meeting of the American Heart Association in Orlando, Fla. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.


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