December 2012





NCCOR member survey on research priorities shapes the Family Life, Activity, Sun, Health and Eating (FLASHE) Study

Nov. 11, 2012, NCCOR

By Kate McSpadden and April Oh

Last fall, the National Cancer Institute (NCI) worked with the National Collaborative on Childhood Obesity Research (NCCOR) to identify key priority areas and research gaps in childhood obesity research.

To identify these research priorities and perceived gaps in publically available data for childhood obesity researchers, an online survey was conducted of the NCCOR membership and others included on the NCCOR distribution list of 1,806 researchers, federal and local government, and practitioners. Data were collected for three weeks in October 2011 via an online survey. A total of 516 people responded.

Respondents were provided with a list of priority research domains in diet and physical activity research that were based on a scientific review of the literature. Respondents were then asked to rank these domains and identify scientific gaps in publically available data in adolescents.

Results showed that the top priority rankings related to diet related research (out of 8 domains) was the home food environment, the community environment, the school environment, psychosocial correlates of dietary behaviors, and finally parenting styles and practices related to diet behaviors.

In contrast, the highest priority for physical activity was the community environment, including neighborhood access and policy influences, followed by the school environment, the home environment, sedentary behaviors, and finally parenting styles and practices.

Respondents then reported the biggest gaps related to publically available data. The biggest gap was availability of survey data on the home environment followed by the community environment for both diet and physical activity.

Respondents were also asked to suggest additional gaps or priority areas not listed in the survey. Common themes submitted included health disparities, culture, media effects, food systems, and early childhood influences on diet and physical activity behaviors.

This NCCOR survey has strengthened the scientific content of the FLASHE Study by identifying research gaps not currently captured in publically available data, while also offering NCCOR members the opportunity to provide feedback and contribute to this survey, which will ultimately become a publically available dataset.

Using the results from this survey, the home and community environments were determined as priority survey domains and other research priority areas and survey items were identified for inclusion in the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Following collaboration with NCCOR partners, including NCI and the Centers for Disease Control (CDC), the FLASHE Study is currently in its second round of cognitive testing. A contract has been awarded for FLASHE data collection to Westat.

For more information, about FLASHE visit

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Publications & Tools

Out of balance: A look at snack foods in secondary schools across the states

The majority of our nation’s secondary schools do not sell fruits and vegetables in school stores, snack bars, or vending machines, according to a new report by the Kids’ Safe and Healthful Foods Project, a joint initiative of The Pew Charitable Trusts and the Robert Wood Johnson Foundation.

Key findings show:

  • Many states reduced the availability of low-nutrient, high-calorie snacks such as chocolate, other candy, or full-fat salty chips in secondary schools between 2002 and 2008, but progress has since stalled.
  • Hundreds of secondary schools sell less-healthy snack foods or beverages. In 36 states, more than a quarter of schools sold them in 2010.
  • The availability of healthy snacks, such as fruits and vegetables, in secondary schools is limited. In 49 states, fewer than half of secondary schools sold fruits and vegetables in snack venues in 2010.


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Food marketing to children and adolescents: What do parents think?

Food marketing contributes to poor diet and obesity among youth, and public health experts believe that the obesity crisis cannot be resolved without dramatic changes in food marketing to children and adolescents. Parents have the consumer power to insist that food and media companies improve their youth targeted marketing practices and the political power to demand government action.

The Rudd Center for Food Policy & Obesity at Yale University conducted a survey of 2,454 parents with children ages 2-17 living at home in June-July of 2009, 2010, and 2011. This research is the first to examine what parents really think about food marketing to their children.

Key findings:

  • Parents were as concerned about junk food marketing to children as they were about alcohol and tobacco use in the media.
  • In 2011, 65 percent of parents surveyed rated the food industry as a negative influence on their children’s eating habits, up from 59 percent in 2009.
  • The majority of parents surveyed expressed broad support for limiting unhealthy food marketing and other policies to help them encourage their children to eat healthy.
  • The policies that received the greatest approval included those that set nutrition standards for foods sold in schools (supported by 72 percent to 81 percent of parents), and policies that would promote healthy eating in children’s media (70 percent to 73 percent).

Overall, the study shows that parents’ concerns about food marketing and other negative influences on their children’s eating habits appear to be increasing. Parents rated the impact of nearly all specific types of food marketing higher in 2011 versus 2009, which indicates that they may be becoming more aware of food marketing issues. Parents’ ratings of most obstacles to healthy eating also increased from 2009 to 2011, as did the percent of parents who indicated that the food industry, government, and local communities were a negative influence in promoting healthy eating for their children. These changes may indicate a future increase in support of policy-related actions to reduce children’s exposure to unhealthy food marketing and create a healthier food environment for children.


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Effectiveness of intervention on physical activity of children

Physical activity interventions for children have minimal impact on overall activity levels and consequently the body fat and mass of children, a study published in BMJ suggests. Researchers analyzed 30 randomized controlled trials that took place between January 1990 and March 2012. All participants were aged 16 or younger and must have completed an intervention that lasted at least four weeks.

The review found that interventions achieved “small-to-negligible” increases in children’s total physical activity with small improvements in time spent in moderate-or-vigorous intensities (equal to four more minutes walking or running per day), which would have minimal impact on children’s BMI or body fat (equal to a reduction of 2mm in waist circumference). The authors suggest that the interventions could be replacing periods of equally intense activity, such as after-school activity clubs, that would usually be spent outdoors.


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Childhood Obesity Research & News

Physical education programs stalled by state loopholes: 2012 Shape Of The Nation Report

Nov. 14, 2012, Huffington Post

A report by the National Association for Sport and Physical Education and the American Heart Association has found that while nearly 75 percent of states require physical education in elementary through high school, over half of states permit students to substitute other activities for their required physical education credit, or otherwise fail to mandate a specific amount of instructional time.

According to the report, only six states — Illinois, Hawaii, Massachusetts, Mississippi, New York, and Vermont — require physical education at every grade level, from K-12. Just over half the country, 26 states, insist on some form of student assessment in physical education; branching off that, twice as many states now require physical education grades to be included in students’ grade point averages compared to 2010, when only 14 did so. Fitness assessments are only required in 27 percent of states.

Among the 33 states that allow students to substitute other activities in order to satisfy the physical education requirement, common allowances include Junior ROTC, interscholastic sports, marching band, cheerleading, and community sports. Twenty-eight states permit schools or districts to grant exemptions or waivers for physical education time or credit requirements, though these are not necessarily the same states that allow substitutions. Commonly cited reasons for exemptions include health, physical disability, religious beliefs, or early graduation.

There is no federal law that mandates physical education be provided to students in American schools, just as there are no incentives for states or schools to offer such programs. While states define guidelines and establish requirements, implementation is left up to individual school districts.

All but one state — Iowa — have adopted their own state standards for physical education, but according to the report, just 35 states of 46 survey respondents require local districts to comply with these standards.

“It is time to eliminate the ‘loopholes,’” NASPE President Mary Jo Sariscsany said in a statement. “We urge parents to join our efforts to be more proactive and effective advocates for physical education to ensure that their children’s schools and school districts are complying with required state physical education policies.”

In keeping with the physical activity guidelines set forth by the U.S. Department of Health and Human Services, NASPE recommends that schools provide 150 minutes per week of instructional physical education for elementary school children, and 225 minutes per week for middle- and high-school students throughout the school year. Currently, no states adhere to these nationally recommended guidelines at all grade levels.

“The fact that kids are being deprived of physical education in school is unacceptable, especially in a nation suffering from a childhood obesity epidemic,” American Heart Association CEO Nancy Brown said in a statement. “Making physical activity a part of the daily routine is critical to saving the next generation of Americans from heart disease, stroke, diabetes, and other serious problems.”

The report’s findings echo those of a study by University of Georgia kinesiology professor Bryan McCullick earlier this year that found only six states nationwide require the recommended 150 minutes of elementary school-based physical education. While public health reforms have emphasized school-based physical education as a means of combatting the childhood obesity epidemic, the study’s results found that courts typically do not interfere with state legislative decisions concerning curriculum. According to McCullick, a lack of firm requirements reduces the likelihood that schools will adhere to the guidelines.

Additionally, many schools are reducing or eliminating their physical education programs due to budget cuts, combined with a greater emphasis on academic performance.


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L.A. Unified student stores feed appetite for alternative lunches

Nov. 19, 2012, Los Angeles Times

By Marisa Gerber

On the menu at the Miguel Contreras Learning Complex cafeteria on a recent Friday was petite beef patties on whole wheat buns, a cup of roasted potato wedges, an apple, and a carton of 1 percent milk. Together, the carefully portioned and paired foods amounted to about 730 calories — safely below a recently implemented 850-calorie cap for high school lunches.

But walk out of the cafeteria, through the circle of giggling cheerleaders and the huddle of boys eyeing them, to the long line of students snaking around a corner and you’ll find another option: the student store.

With a few crumpled bills and a smile at the woman running it, a sophomore makes off with an alternative lunch: a bag of cheese balls; a bottle of pineapple, peach and mango juice; three packages of brown sugar Pop-Tarts; and a strawberry ice cream bar. The items equated to 1,200 calories.

Unlike the Los Angeles Unified School District’s cafeterias, which are managed by its food services department, the more than 160 student stores on middle- and high-school campuses have a bit more autonomy. For students, the stores provide an alternative to the cafeteria food one sophomore described as “meh” and a junior called “crazy healthy.” For the schools, the stores provide a much-needed cash supplement for their slashed budgets. Proceeds pay for such things as athletic uniforms, school dances, and graduation decorations.

At Miguel Contreras, Marisol Morataya is the snack bar czar.

The 20-year-old started working at the student store her junior year and was hired to stay on as an office assistant after graduating.

“Gimme two fishies,” a boy said.

Morataya laughed as she handed him two bags of Goldfish crackers with her left hand and his change with her right. “Next,” she said.

A dark-eyed boy barked his order — a school beanie and a bottle of water — over the music blaring out of his earphones. Morataya took a $50 bill from him and squinted her eyes at it. “Yup, he’s real.”

When things get busy, Luke Shen mans the store’s second window.

On a recent Friday, the school’s financial manager ran his left hand through his hair as he tallied snack sales on a calculator. So far this year the school has made about $7,300 a month on drink and snack sales, he said, but there’s still never enough money to go around.

Shen also patrols the school’s vending machines. The companies that stock them usually stick to district-approved items, he said, but not always. Last year, for example, he spotted Flamin’ Hot Cheetos behind the glass and had them removed.

“They want the business,” Shen said. “But we say, ‘If it’s not on the list, it’s not going to happen.”

Despite a seven-year-old district policy requiring that snacks meet nutritional standards, the stores end up selling snacks that are “kind of hit-and-miss,” said David Binkle, the district’s interim director of food services.

“People don’t know the rules,” Binkle said. “Some student stores go to Costco and buy whatever the kids will eat.”

Faced with an onslaught of complaints from students about the new healthful food options last year, L.A. Unified scaled them back a bit. Instead of quinoa, for example, burgers are back — albeit without the cheese.

So far the changes seem to be paying off, Binkle said, noting that more students are eating in cafeterias this year than last. The nation’s second-largest district serves about 650,000 meals a day. But for Amilcar Martinez, the cafeteria’s changes aren’t enough. “The cafeteria food is meh,” the sophomore said as he shoved his hand into the 50-cent bag of Cinnamon Toast Crunch cereal from the student store.

Campus stores aren’t the only way around the nutrition requirements. Crafty students sell prohibited items while others get food from off-campus fast food joints.

On a recent day at Roosevelt High School, for example, a baseball player hawked Flamin’ Hot Cheetos for a buck a bag and a group of juniors had a friend’s mom bring them food from off campus — a pile of tortilla chips drenched with liquid cheese, sour cream, and a heaping serving of carne asada.

The district, meanwhile, is attempting to market its food options as best it can. A few weeks ago, for example, officials invited a group of elementary school students and their parents to a meal — served on china — with former White House chef Walter Scheib. If they can convince young students that healthful options are cool, the district reasons, perhaps the message will catch.

Before asking the group to pledge to curb junk food and eat more healthfully, Scheib acknowledged how hard it can be.

“It’s like stopping smoking,” he said. “It’s an ugly and brutal process.”


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Americans fighting fat, but odds stacked against them

Nov. 6, 2012, USA TODAY

By Nanci Hellmich

If you look hard enough, there are signs that Americans are finally getting the message about how heavy and out-of-shape they are. Consumption of diet drinks is increasing, and the calories Americans consume from regular sodas are on the way down.

More than half of Americans (55 percent) say they are trying to drop some weight, up significantly from 43 percent in 2011, according to a recent survey conducted for the International Food Information Council Foundation.

But while the concern about obesity may have hit the national consciousness, it hasn’t really shown up on the bathroom scale for most Americans yet.

The reality is that the nation is now entering a fourth decade of weight gain. The obesity rate — those who are 30 or more pounds over a healthy weight — stayed fairly level at 15 percent from 1960 to 1980. Since then it climbed to 36 percent in 2010, an all-time high. If it continues to grow, about 42 percent of Americans may end up obese by 2030, according to a projection from researchers with RTI International, a non-profit organization in North Carolina’s Research Triangle Park.

“If you go with the flow in America today, you will end up overweight or obese, as two-thirds of all adults do,” says Thomas Frieden, director of the Centers for Disease Control and Prevention. Obesity is “one of the few things that has gotten worse quickly,” he says. “It really is a very serious health problem.”

Obesity takes a huge toll on people’s health. “Obesity is not just a cosmetic problem. It contributes to a long list of serious health problems — diabetes, cardiovascular disease, liver problems, degenerative joint disease, and even cancer,” says Francis Collins, director of the National Institutes of Health.

Those extra pounds rack up billions of dollars in weight-related medical bills. It costs about $1,400 more a year to treat an obese patient compared with a person at a healthy weight, Frieden says. It costs $6,600 more a year to treat someone with diabetes, he says.

So where did we go wrong, and what will it take to reverse the trend?

National obesity experts say that over the past three decades, Americans’ eating habits have changed dramatically. Food marketers, manufacturers, and restaurants are selling us more food in bigger portions — and we’re happy to wolf down much more than we used to. The culprit behind the epidemic is that “we are eating significantly more calories now” than 30 years ago, Frieden says. “At its most basic level, obesity is a problem of calories.”

A number of observers cite a litany of changes that have reshaped food consumption: Fast-food chains are pushing bigger hamburgers, beverages, and servings of french fries; restaurants have doubled the portion sizes of their meals.

Meanwhile, jobs put fewer physical demands on workers, and physical education has been squeezed out of many schools.

These and many other changes, big and small, have led to “the perfect storm that has caused the obesity rate we have today,” says James Hill, executive director of the Anschutz Health and Wellness Center at University of Colorado.

States, cities, and communities have taken action across the country to reverse the trend. Schools are being pushed to offer healthier foods to kids, and programs such as first lady Michelle Obama’s Let’s Move! are trying to get them to exercise more. In one of the most high-profile efforts, New York City is putting a 16-ounce cap on sweetened bottled drinks and fountain beverages sold at city restaurants, delis, movie theaters, sports venues, and street carts.

Though many people consider sugar one of the big villains, it doesn’t bear sole responsibility, Hill says. “I’m not here to defend sugar,” but the causes of obesity are more complex than just sugar intake, he says. Many Americans are following high-fat, high-calorie diets, and they are not moving nearly as much as they should, he says. “There’s a lot we don’t know about obesity,” Frieden adds. “I don’t think we can blame our genes, because we have basically the same genetic makeup we had 40 years ago. It’s not that we have gotten less self-disciplined. What has happened is the structure of our society has changed in ways that make it difficult to maintain a healthy weight.”

Surrounded by food

So how much more are we eating?

Research suggests different amounts. It’s in the “ballpark” of maybe 200 to 400 more calories a day than 20 years or so ago, says Marion Nestle, a nutrition professor at New York University and co-author of “Why Calories Count.”

Collins says it’s not hard to consume just 100 calories more each day than you need, but for an average person that would result in a 10-pound weight gain over a year.

Where people eat has changed significantly as well. They now gobble meals and snacks at the desk, in the car, standing up, in food courts at malls, in gas stations, says Kelly Brownell, director of Yale University’s Rudd Center for Food Policy & Obesity. There are more grab-and-go foods everywhere you turn.

“People tend to consume whatever they find in a bag, bottle, or box, and the sizes of all these things have increased dramatically,” Brownell says.

Lisa Young, an adjunct professor of nutrition at New York University and author of “The Portion Teller Plan,” has spent years studying the trends. The serving sizes of foods sold in stores and restaurants — from candy bars to burgers and sodas — have become much bigger since the early 1980s, Young says.

Over the past three decades, food companies and restaurants competed by offering consumers larger portions and thus more calories for their money. And studies show that when you give people more food, they consume more, Young says.

“Portion sizes at restaurants are marketed in a way that makes you want to supersize for just pennies more, when in reality, it’s adding on hundreds more calories and sometimes even thousands,” says Heather Burczynski, 37, an administrative assistant in Nashville.

Adds Nestle, “There were enormous changes, and of course, they happened without anyone realizing it because they came in one by one.” Nestle and Young are convinced that these bigger portions account for much of the weight gain over the past 30 years. “I don’t think you need anything more than larger portions to account for the increase in obesity. It is sufficient,” Nestle says. “Larger portions have more calories.”

But Sean McBride of the Grocery Manufacturers Association, a group that represents the food and beverage industry, says its member companies “want to make sure they are providing consumers with the product choices they need for their changing preferences and lifestyles.”

“Parents don’t want to be told what they should or shouldn’t buy, they want information and options, and that’s what we’re working to provide them,” says Susan Neely, president of the American Beverage Association.

Registered dietitian Joy Dubost, director of nutrition for the National Restaurant Association, adds: “Just to blame obesity on portion size is shortsighted. It gives people a false sense of security that if they just cut portions they are going to lose weight. “It’s about how much you eat and how much you burn. The exercise portion of the equation has been missed in the debate of what caused obesity.”

It’s not only food that is to blame, Hill agrees. “If we were as active as we were in the 1950s, I don’t think we’d have nearly the problem with obesity, even with our current food environment.”

Kevin Fowler, 53, of Farmington, Minn., a safety director at an electric company, has seen the problem even in the way kids get to burn off energy: “I don’t see the all-day-long kid-organized pickup baseball and football games at the park anymore like we used to do as kids. Those kinds of opportunities to be active every day not only gave us great memories, but they helped to develop habits that can last a lifetime. Instead, kids’ sports today are too structured, too specialized, and too expensive for a lot of families.”

More sitting, less moving

Tim Church, director of preventive-medicine research at the Pennington Biomedical Research Center in Baton Rouge, points out that work-related physical activity also has decreased dramatically over the past 40 years.

He and colleagues analyzed data from the U.S. Bureau of Labor Statistics from the 1960s to 2008 and found that today’s workers are burning an average of 120 to 140 fewer calories a day at their jobs than workers in the 1960s. Men burn an average 142 fewer calories a day at work; women burn an average 124.

The lower activity level is the result of a dramatic drop in the number of active jobs in manufacturing and farming and an increase in office jobs that are mostly sedentary, Church says. “We have transitioned from the 1960s, when most Americans were essentially exercising at work to now, where almost everyone sits the majority of the workday.”

In a recent government study, about 48 percent of people in 2010 said they were meeting the government’s physical activity guidelines — at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking, a week. The finding was based on their self-reports about how active they are. But researchers with the National Cancer Institute, using actual motion sensors, found that less than 5 percent of adults in the United States get at least 30 minutes a day of moderate intensity physical activity in bouts of at least 10 minutes.

“I am convinced that activity levels have declined, and personally I am convinced that declining physical activity may be the key factor underlying the obesity epidemic,” says Russell Pate, an exercise researcher at the University of South Carolina.

Hill says society has “engineered activity out of our lives. How many remote controls do you have in your house? Most people are so sedentary that their energy balance regulation system doesn’t work very well.”

“Now we know that being sedentary is another risk factor for premature death,” Hill says. In one recent study, Pennington researchers found that if most people spent less than three hours a day sitting, it would add two years to the average life expectancy in the United States. Scientists believe that what’s called “sitting disease” is a risk factor for early death, on par with smoking.

Says Hill: “It’s a fallacy to think you could change one thing and fix obesity. Many things need to change to turn this problem around.”


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