January 2010





State Regulations for Child-Care Centers Fall Short in Preventing Childhood Obesity; Two Examples

Dec. 9, 2009, RWJF Childhood Obesity News Digest

Most states would get a failing grade if ranked according to model obesity prevention regulations governing child-care centers, according to a report released in early December 2009. However, improving such grades should be straightforward for most states because there is strong expert agreement on the model regulations that can best help child-care centers provide healthier foods and more opportunities for physical activity. The report was funded by the Robert Wood Johnson Foundation through its national program Healthy Eating Research.

Although the majority of states would have failed if compared to model regulations, most still performed at average or below-average levels even when compared to less stringent, less specific standards. When compared to those less than ideal standards the vast majority of states got an overall grade of a C. No states received an A, and just eight earned a B.


Concurrently, two states’ child-care physical activity shortcomings were critiqued in last month’s literature.

Majority of North Carolina centers not meeting 120-minute benchmark

Many young children in child-care centers are not getting as much active playtime as they should, according to new research from the University of North Carolina at Chapel Hill.

A study published in the December 2009 issue of the journal Pediatrics found only 13.7 percent of child-care centers in North Carolina offered 120 minutes of active playtime during the school day.

Researchers at the UNC Center for Health Promotion and Disease Prevention observed and reviewed physical activity and playtime practices and policies in 96 centers across the state. An earlier study by the same group developed the 120-minute benchmark as part of best practice guidelines for promoting healthy weight in young children.

“We think that our guidelines are a starting point for child-care centers looking to develop physical activity policies,” said Christina McWilliams, a research associate at the center and lead author of the study. “Unfortunately, a lot of the best practice guidelines are not being met in North Carolina.”

However, the study also showed positive signs. In 82 percent of the centers, children were not sitting for more than 30 minutes at a time and about 56 percent of centers had a written policy on physical activity.

The investigators began studying activity in child-care settings in response to the United States’ rapidly increasing rates of childhood obesity. Nationwide, the percentage of obese children aged 2 to 5 years increased more than 30 percent between 2001 and 2004.

“What happens in child-care centers is a very important indicator of preschoolers’ physical activity levels, since children spend on average 25 hours a week in such centers and physical activity protects against obesity during the preschool-age period,” said McWilliams. “More specific physical activity recommendations for centers will be a positive step in fighting childhood obesity.”

Study of Kansas child care indicates too much TV

A study of family child-care providers shows that most children ages 2 to 5 are not getting enough physical activity and are exposed to the television for most of the day.

Oregon State University’s Stewart Trost, an expert on childhood obesity issues, studied about 300 home-based child-care providers in Kansas. The findings are published in the December 2009 issue of the American Journal of Preventive Medicine.

Trost directs the obesity prevention research core at the new Hallie Ford Center for Healthy Children at Oregon State.

He said a big concern was television exposure in such a young age group. The providers surveyed were caring for young children up to age 5, and two-thirds of providers said they had the TV on most of the day.

The American Academy of Pediatrics recommends no more than two hours of television per day for children between the ages of 2 and 5, and discourages any television viewing for children younger than 2.

In addition, while 78 percent providers reported offering more than an hour of time for active play daily, 41 percent said children sat for extended parts of the day. Also of concern to the researchers: Sixty-three percent – a majority – restricted active play or exercise as punishment for kids.

“Would you withhold fruits and vegetables for kids who misbehave and negatively affect their health?” Trost said. “All the research shows that restricting physical activity makes children more, not less, likely to misbehave. So it’s not even an effective means of punishment.”

Trost said the most eye-opening result of the study was that less than half of the providers had received any training in physical activity.

Trost’s past research has shown that children in family daycare get an average of only seven minutes of physical activity per hour. Considering the 114 percent rise in childhood obesity in the last 30 years, Trost thinks it is time to act on this crisis facing American children.

He said providers did “pretty well” in supporting healthy eating habits. Few reported serving fried foods or high-fat foods, and a low percentage of providers served sweets or chips as snacks.

One area of nutritional concern was the use of whole milk and an over-reliance on fruit juice. More than 50 percent of providers reported serving juice every day, and less than 14 percent served low-fat milk regularly.

“There is a misconception that whole milk is what should be served to youngsters,” Trost said. “Low-fat or skim milk has just as much vitamins, and is much healthier. And fruit juice, even 100 percent juice, is mainly sugar and is not what we recommend.”

Trost and colleagues at OSU Extension Service, in response, have begun a four-year intervention study called the Healthy Home Child Care Project with family daycare providers in a five-county area from Portland to Eugene.

The largest intervention of its kind, this $1.2 million project is funded by the U.S. Department of Agriculture. It will collect data on what Oregon family care providers are doing, as well as seek to improve nutritional and physical activity standards through Extension-based training.

Still a nascent field

Meanwhile, a study published by the same group in the American Journal of Lifestyle Medicine found that research into finding effective ways to increase physical activity in child-care centers is still a new field.

The study, led by Dianne Ward, a research fellow at the center and a nutrition professor at the Gillings School of Global Public Health, is the first to systematically review research databases for such papers. Ward and her colleagues found that only nine studies, all conducted since 2003, have tested ways to help young children in child-care centers become more physically active.

Ward’s team recommended that researchers look at all areas of the child-care environment, not just the amount of time children are provided for play. For example, other areas that relate to physical activity at preschools include the physical environment (such as fixed and portable play equipment), sedentary environment (such as television viewing time and the presence of TVs and computers in classroom), staff training and behaviors (such as staff joining in active play and providing verbal prompts to increase active play) and a written physical activity policy.

Also, the Healthy Eating Research report authors encouraged states to adopt specific regulations for child care, using those developed by a team of experts and included in the report as a guide. They also said states should help support child-care facilities through adequate funding and technical assistance.


Original Sources:

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Publications & Tools

Sonneville KR, La Pelle N, Taveras EM, Gillman MW, Prosser LA. Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents. BMC Pediatrics, Dec. 21 2009; 9(81),1471-2431

Background: Parents are integral to the implementation of obesity prevention and management recommendations for children. Exploration of barriers to and facilitators of parental decisions to adopt obesity prevention recommendations will inform future efforts to reduce childhood obesity.

Methods: We conducted four focus groups (two English, two Spanish) among a total of 19 parents of overweight (BMI >= 85th percentile) children aged 5 to 17 years. The main discussion focused on seven common obesity prevention recommendations: reducing television watching, removing television from child’s bedroom, increasing physically active games, participating in community or school-based athletics, walking to school, walking more in general, and eating less fast food. Parents were asked to discuss what factors would make each recommendation more difficult (barriers) or easier (facilitators) to follow. Participants were also asked about the relative importance of economic (time and dollar costs/savings) barriers and facilitators if these were not brought into the discussion unprompted.

Results: Parents identified many barriers but few facilitators to adopting obesity prevention recommendations for their children. Members of all groups identified economic barriers (time and dollar costs) among a variety of pertinent barriers, although the discussion of dollar costs required prompting. Parents cited other barriers including child preference, difficulty with changing habits, lack of information, lack of transportation, difficulty with monitoring child behavior, need for assistance from family members, parity with other family members, and neighborhood walking safety. Facilitators identified included access to physical activity programs, availability of alternatives to fast food and TV which are acceptable to the child, enlisting outside support, dietary information, involving the child, setting limits, making behavior changes gradually, and parental change in shopping behaviors and own eating behaviors.

Conclusions: Parents identify numerous barriers to adopting obesity prevention recommendations, most notably child and family preferences and resistance to change, but also economic barriers. Intervention programs should consider the context of family priorities and how to overcome barriers and make use of relevant facilitators during program development.


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Nevada Professor Develops New Childhood Obesity Screening Tools

Dec. 3, 2009, This Is Reno

A University of Nevada, Reno professor who thinks the present weight management charts and screening tools for children are too difficult to understand and use has devised new, simpler charts that pediatricians and parents can use to help combat the increasing rates of obese and overweight children in the United States.

George Fernandez, Nevada professor of applied statistics and director for the Center for Research Design and Analysis, contends that the current charts are difficult to interpret and often require determination of Body Mass Index (BMI). … Charts are then used to show a healthy weight range, given a child’s height, sex and age.

Using advanced SAS graphical software, Fernandez has computed healthy and unhealthy weight limits that correspond to these BMI-for-age definitions and has made easy-to-read color charts for each gender and different age groups. …


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The Negative Impact of Sugar-Sweetened Beverages on Children’s Health

November 2009, Healthy Eating Research

Over nearly the past 30 years, U.S. children and adolescents have dramatically increased their consumption of sugar-sweetened beverages (SSBs), including soda, fruit drinks and punches, and sports drinks. Such consumption has been linked to less healthy diets and a number of other negative health consequences, including decreased bone density, dental decay, headaches, anxiety and loss of sleep. Interventions to lower SSB consumption have been linked to lower risk of overweight, and weight loss among overweight adolescents. This research synthesis examines the evidence regarding the various health impacts of SSB consumption, presents initial conclusions based on these studies, and identifies areas for further research.


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Childhood Obesity Research & News

House Hearing on Childhood Obesity

Dec. 18, 2009, RWJF Center to Prevent Childhood Obesity

The House Committee on Education and Commerce, Subcommittee on Health, held a hearing Dec. 16. “Innovations in Addressing Childhood Obesity,” examined innovative strategies to reduce obesity among children and adolescents. Witnesses included William H. Dietz, M.D., Ph.D., Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention; Terry Huang, Ph.D., M.P.H., Director, Obesity Research Strategic Core, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health; Ron Jaworski, Jaws Youth Fund, National Football League Play 60; Sandra Hassink, M.D., Chair, Obesity Leadership Workgroup, American Academy of Pediatrics; Jeremy Nowak, Ph.D., President and CEO, The Reinvestment Fund; Mary Sophos, Senior Vice President of Government Affairs, Grocery Manufacturers Association; and Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO, Robert Wood Johnson Foundation.


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General Mills to Reduce the Amount of Sugar in Popular Products

Dec. 11, 2009, WalletPop

By Gina Roberts-Grey

Breakfast in households with children (and adults who eat like kids) combine two of the biggest money makers in America – sugary cereal and obesity. And if cereal giant General Mills has its way, the latter will get a whole lot smaller.

Last month, Big G, the cereal division of General Mills and the makers of popular brands Lucky Charms, Cocoa Puffs and Trix, announced that it was reducing the amount of sugar in many of its most profitable brands that are marketed to kids.

The chopping block

Ten cereals in all will go on a diet, with the goal of reducing the sugar grams within to the mere single digits per serving. The reduction could prove substantial. For instance, the sugar in Cocoa Puffs could dip 25 percent lower than it was a few years ago.

“This is a significant development across some of our biggest and longest-term brands,” Jeff Harmening, president of the company’s Big G cereal division told the Associated Press.

But this isn’t the first time a cereal maker has taken steps to keep kids’ waists from growing to unhealthy sizes.

Kellogg’s perennial favorites Froot Loops and Apple Jacks cut 1 to 3 grams of sugar per serving. A move that went pleasantly unnoticed by many discerning palates (at least in my house). Post Food also reformulated its recipes, slashing 20 percent of the sugar from both Cocoa and Fruity Pebbles.

Rave reviews

Trimming the sugar has captured the attention of parents. “I won’t buy sugary cereals because I worry about my kid’s weight and teeth,” says mom of three, Jill Monroe. As a result, breakfast time is usually a battleground. “One doesn’t like oatmeal and another is allergic to eggs. Sometimes pouring a bowl of cereal [that’s healthy] would be a welcome change,” says Monroe.”And none of them like the high-fiber, all-bran healthy cereals.” So many days Monroe’s kids get left-overs or PBJs for breakfast.

“It’s better than fighting with them to eat the so-called “healthy” grain cereal,” Monroe says. Experts agree; food fights aren’t productive.

But parents need to be clear: General Mills isn’t slashing its sugar content out of the goodness of its heart. As with most things these days, this move is all about the marketing.

The Rudd Center for Food Policy and Obesity recently published a study that found the least-healthy breakfast cereals are the most frequently and aggressively marketed directly to children. It also found that General Mills, the maker of six of the 10 least healthy cereals, markets to children more than any other cereal company.

Health experts have long cautioned against excess sugar consumption, one of the leading causes of obesity. And since these cereals are marketed to – and frequently consumed by – children, it’s not a stretch to link them to the rising rates of childhood obesity. According to the National Center for Chronic Disease Prevention and Health Promotion, obesity among children aged 6 to 11 has more than doubled in the past 20 years, going from 6.5 percent in 1980 to 17 percent in 2006. The rate among adolescents aged 12 to 19 more than tripled, increasing from 5 percent to 17.6 percent.

The ballooning sizes of kids is one reason analysts speculate obesity-related health care costs will cost Americans about $344 billion in expenses by 2018. …


Original Source: http://www.walletpop.com/blog/2009/12/11/

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Tax Snacks to Raise Money for Obesity Prevention, Report Says

Dec. 24, 2009, Maryland Gazette.Net

By Erin Cunningham

Even though advocates are pushing for a snack tax to fight obesity, Maryland lawmakers say the idea is so unpopular they do not expect it to be introduced in 2010 — an election year.

The state had a tax on snack foods from 1992 to 1997, and since its repeal several lawmakers have tried to reinstate it — one as recently as this past session.

If lawmakers approve a snack tax, Maryland would be the only state to impose such a levy, said Jim McCarthy, president of the Snack Food Association, based in Arlington, Va.

But a health ranking — released jointly in November 2009 by the American Public Health Association, Partnership for Prevention and United Health Foundation — showed obesity in Maryland increasing 122 percent in just two decades.

The Committee on Childhood Obesity, an advisory group that included experts from the health field, released a December report with 12 recommendations on how to prevent childhood obesity.

Some of the report’s recommendations include making healthy food more available, increasing enrollment in government-funded nutrition assistance and education programs, improving nutrition and health education in the schools and increasing public awareness about nutrition and physical activity.

The report also recommends a statewide surveillance system to monitor nutrition, physical activity and related health behaviors of children.

And to pay for it all, the report recommends a “tax levy such as a tax on snack foods.”

Audrey Regan, with the Maryland Department of Health and Mental Hygiene’s Office of Chronic Disease Prevention, said one way that states can qualify for more federal stimulus money for health programs is by taxing snacks and sodas.

That was one of about 60 possible ways for states to be eligible for the funds, she said.

Taxing sodas and snacks can raise revenue for obesity prevention and encourage people to refrain from purchasing unhealthy food and drinks.

However, critics say that it is not good policy to enact a sin tax to change behavior, because if the tax proves successful the revenue source will dry up.

A recent report from the Johns Hopkins Bloomberg School of Public Health showed that a similar tax on alcoholic beverages — at 10 cents per drink — would raise $214.4 million in revenue. The tax increase also would reduce consumption, according to the report.

Sen. David C. Harrington (D-Dist. 47) of Cheverly is the most recent lawmaker to propose a snack tax. His bill, introduced in 2009 session, could have raised $23.5 million.

The tax was expected to cause a 6 percent decline in snack food purchases.

Harrington’s bill did not make it out of committee. “The climate for this was not a welcoming one,” he said.

Harrington said the snack food industry lobbied intensely against the bill, which he said was an effort to address the health problems caused by obesity.

McCarthy said his organization has “consistently opposed very arbitrary snack taxes.” The taxes often bring in little revenue and create public confusion and anger, he said.

Harrington has no plans to introduce the bill again in the 2010 session.

“Taxes are not the ‘in’ thing right now,” he said. “The climate is just not one that would be conducive to putting forth something like this. Down the road, as the economy does improve, perhaps it’s something we should think about.”

However, he is sponsoring legislation to limit licenses of fast-food restaurants in areas where health disparities are the highest.

In case lawmakers do not implement a tax on sodas or snack foods to pay for the committee’s recommendations, Regan said the department has applied for $13 million in stimulus money for obesity prevention.

She said officials should hear about the status of that request by the end of February. The funds could help implement at least some of the committee’s plan to tackle the state’s growing obesity problem, she said.


Original Source: http://www.gazette.net/stories/12242009/prinnew154554_32557.php

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NIH Launches Program to Develop Obesity Prevention Strategies

Dec. 11, 2009, RWJF News Digest

The National Institutes of Health (NIH) has announced plans to launch a $37 million research effort that seeks to identify more effective strategies to reduce obesity, AHA News Now reports. The Translating Basic Behavioral and Social Science Discoveries into Interventions to Reduce Obesity program is led by the NIH’s National Heart, Lung, and Blood Institute, in partnership with the National Institute of Diabetes and Digestive and Kidney Diseases, the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Office of Behavioral and Social Sciences Research. The program will fund research efforts at seven sites, including an effort by a researcher at the State University of New York at Buffalo who is translating research on reduced response to food after repeated exposure to identify strategies to reduce intake of high-calorie foods among children. Meanwhile, a study by a researcher at Weill Medical College of Cornell University in New York City will seek to develop and refine a mindful eating strategy aimed at producing small, sustainable changes in eating behavior among overweight or obese African-American and Latino adults. Other research sites receiving funding include Wayne State University in Detroit; Rush University Medical Center in Chicago; Miriam Hospital in Providence, R.I.; University of California, San Francisco; and Claremont Graduate University in California. Calling obesity a “significant public health challenge,” the director of the NIH noted that the program effort differs from previous large clinical trials of behavioral interventions to reduce obesity “by placing new emphasis on applying findings from basic behavioral and social sciences to improve behavioral strategies” (AHA News Now, 12/11/09; NIH release, 12/10/09).


Original Source: http://www.rwjf.org/publichealth/digest.jsp?id=26609

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Decrease in Smoking Extends Lifespan, but Obesity May Curb Gains

Dec. 3, 2009, CNN Health.com

By Sarah Klein

Although fewer people are smoking – and therefore less likely to die from cigarette-related causes – the obesity epidemic may negate any gains in lifespan, according to a new study.

By 2020, the typical 18-year-old will gain 0.31 years due to the drop in smoking rates (above and beyond lifespan increases caused by other factors). But the increase in obesity rates during the same period will reduce life expectancy by 1.02 years, the researchers say.

During the next 10 years, in other words, we’ll lose 0.71 years of our lifespan, time that we would have gained if so many people weren’t overweight, according to the estimates published in an early December issue of the New England Journal of Medicine.

In addition, the increase in quality-adjusted life expectancy — a measure that takes into account levels of disability and other quality-of-life factors — will be reduced by 1.32 years. If all U.S. adults were nonsmokers of normal weight, life expectancy would increase by 3.76 years, or 5.16 quality-adjusted years, according to the study.

“Life expectancy is not going to decline,” says the study’s lead author, Susan T. Stewart, Ph.D., a researcher at the National Bureau of Economic Research, in Cambridge, Massachusetts. “But it could have risen by that much more if it weren’t for the increases in obesity.”

Stewart and her colleagues forecast life expectancy through the year 2020 using national survey data. Smoking, a major risk factor for lung disease, heart disease, and cancer, has decreased by 20 percent in the United States in the past 15 years, according to the study.

Over the same period, obesity has increased by 48 percent. Obesity contributes to a host of serious health problems, including heart disease, diabetes, joint problems, stroke, and some sleep disorders.

By 2020, the report predicts, smoking will decrease by 21 percent, but 45 percent of the population will be obese.

Prior research has examined the effects of obesity on longevity, but this study is the first to examine the combined effects of obesity and smoking.

“No one ever has really done quite this linkage between smoking and obesity,” says S. Jay Olshansky, Ph.D., a professor of epidemiology and biostatistics at the School of Public Health at the University of Illinois at Chicago. “Some people have suggested we’re on the verge of dramatic increases in life expectancy because of reductions in smoking, but these authors are saying, ‘Hold on a minute; the negative effect of obesity is much greater.’”

The extent of obesity’s impact on lifespan “might be a real eye-opener,” says Stewart.

Many people will question how a sedentary lifestyle can be as unhealthy as a deadly habit such as smoking, she says, adding that this is exactly why she and her colleagues believe this research is important. “We wanted to bring attention to the health of a population [that] is already not as healthy as it could be, and will continue and worsen,” she says.

The study does have limitations. The authors based their projections on a steady rate of change in obesity, for instance.

However, “childhood obesity has been rising dramatically, so the trends in the future are going to change by how long people have been obese,” says Olshansky, who did not participate in the current research, but projected similar obesity trends in a 2005 paper in the NEJM. “Younger generations are going to carry the obesity with them much longer,” leading to additional or more serious weight-related health risks, he says.

“If we don’t intervene, we are in trouble,” Olshansky adds.

Reversing the obesity trends reported in the study will likely require a concerted public health campaign similar to the one that has reduced smoking rates.

“There are larger social issues to be addressed in combating the roots of obesity,” Stewart says. “These roots include sedentary lifestyles, widespread availability of high-calorie food in large portions, and reduced time for at-home food preparation.”

“Fixing obesity is going to require a change in our modern relationship with food,” Olshansky says. “I’m hopeful that we [will] begin to see a turnaround in this childhood obesity epidemic.”

The smoking trends used in the study were based on data from the National Health Interview Survey, and the body-mass index (BMI) trends were derived from the National Health and Nutrition Examination Survey. BMI levels were classified according to the World Health Organization’s guidelines for obesity.


Original Source: http://www.cnn.com/2009/HEALTH/12/03/obesity.smoking.lifespan/

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School Receive Tools to Fight Childhood Obesity Epidemic

Dec. 29, 2009, Digital Journal

By Sandy Sand

It’s no secret that childhood obesity has reached epidemic proportions, has tripled since the 1980s and is seen everywhere across all ethnic and economic lines. But one group wants to reverse this dangerous trend.

Project Fit America (PFA), a national nonprofit agency, is trying to take a bite out of childhood obesity by donating fitness equipment to schools across the country.

Working with sponsors and groups such as kid tool for fitness, PFA installs horizontal bars, climbing poles, pull-up stations and other fitness equipment in private and public schools. Students are encouraged to swing, slide and sweat in a effort to burn calories.

“Fitness is a primary goal for physical education in the United States. Many schools don’t have the equipment to allow youngsters to practice those skills,” said Craig Cunningham, a vice president who works out of the group’s Van Nuys, California, office. “This equipment provides that.”

Since its inception in 1990, PFA based in Sonoma, California, has pumped $9.7 million into fitness programs at more than 700 schools, encourages physical fitness, and promote self-esteem.

While obesity rates for children have tripled over the past 30 years, physical fitness programs in schools have been slashed because of school district budget shortfalls and the need to drop such programs along with others considered extraneous or extracurricular.

“It hurts the child academically,” said Stacey Cook, the group’s executive director. “You can’t expect a child to sit in a classroom all day long and not burn off that energy.”

Every year PFA awards grants to about 200 schools from the several thousand that apply for grants, Cunningham added.

Upon receiving the grants, PFA installs seven articles of exercise equipment in areas of school yards that average in size of 45-feet by 60-feet. Teachers and other school personnel are trained in the use of the equipment as well as how to implement the program, incorporate it into the physical education curriculum, and includes urging the use of the equipment during recess, Cunningham said.

“You can set trends and attitudes and fitness patterns at a younger period of life,” Cunningham said. “You want to build values early, and that’s the place to start.”


Original Source: http://www.digitaljournal.com/article/284651

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