- NCCOR continues to expand its reach with the help of external advisors
- Systems science in childhood obesity and public health research: Pre-doctoral and post-doctoral opportunities at Johns Hopkins University
PUBLICATIONS & TOOLS
- Tax on sugary beverages projected to have broad health benefits
- U.S. Department of Agriculture releases new school meal nutrition standards
- Prevalence of obesity and trends in body mass index among U.S. children and adolescents, 1999-2010
CHILDHOOD OBESITY RESEARCH & NEWS
- New rules for school meals aim at reducing obesity
- Can online games influence what kids eat?
- Learning to be lean
NCCOR continues to expand its reach with the help of external advisors
February 2012, NCCOR
The National Collaborative on Childhood Obesity Research (NCCOR) has appointed a panel of external advisors to help the Collaborative expand its programs and areas of expertise. The NCCOR External Scientific Panel (NESP) will advise NCCOR on its overall direction and provide guidance and assistance on specific projects and initiatives.
“NCCOR has been very successful at becoming a national resource for childhood obesity,” said Terry Huang, NESP chair and a senior advisor to NCCOR. “It is now at a stage of growth where it can benefit from the help of external experts to grow its programs, both in terms of an expanded range of expertise and manpower capacity. This will allow NCCOR to continue to innovate and stay relevant to the broader community interested in addressing childhood obesity.”
The Panel will serve as a valuable liaison between NCCOR and the extramural community. It will inform the Collaborative on new science and ideas, and connections to extramural research, practice, and policy. Further, it will contribute to the ongoing refinement of NCCOR’s strategic plan, including helping to establish key performance indicators and other metrics associated with evaluating the impact of the Collaborative.
“I believe that NESP will increase NCCOR’s visibility and usefulness to the research community and the public,” said Huang. “NESP will also bring fresh ideas that will help NCCOR innovate and advance its strategic agenda.”
The NESP is composed of one chair and five to six panel members. The panel members are experts in a range of disciplines relevant to childhood obesity and are typically individuals familiar with the research and functions of at least one of the NCCOR funders-– the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Robert Wood Johnson Foundation (RWJF) and the United States Department of Agriculture (USDA).
In addition to Huang, NESP members serving in 2012 include:
- Ronette R. Briefel, DrPH, RD, a Senior Fellow at Mathematica Policy Research in Washington, DC. Dr. Briefel’s research includes evaluations of child nutrition programs, population-based studies of children and high-risk populations, and investigations of the home and school food environments and children’s diet and obesity.
- Ross C. Brownson, PhD, a Professor at Washington University in St. Louis. He is involved in numerous community-level studies designed to understand and reduce modifiable risk factors such as physical inactivity, obesity, and tobacco use. In particular, he is interested in the impacts of environmental and policy interventions on health behaviors and he conducts research on dissemination of evidence-based interventions.
- Amelie G. Ramirez, DrPH, is a Professor of Epidemiology and Biostatistics at The University of Texas Health Science Center at San Antonio, where she also is Founding Director of the Institute for Health Promotion Research, which researches health disparities. Over the past 30 years, Dr. Ramirez has directed many research programs focused on human and organizational communication to reduce chronic disease and cancer health disparities affecting Latinos, including cancer risk factors and genetics, clinical trial accrual, tobacco prevention and cessation, obesity prevention, and more.
- James F. Sallis, PhD, is a newly appointed Distinguished Professor in the Department of Family and Preventive Medicine at the University of California, San Diego. He is also Director of Active Living Research (ALR), a program of the Robert Wood Johnson Foundation (RWJF). His primary research interests are promoting physical activity and understanding policy and environmental influences on physical activity, nutrition, and obesity.
- Mary Story PhD, RD, is a Professor in the Division of Epidemiology and Community Health, and Senior Associate Dean of Academic and Student Affairs in the School of Public Health, and an Adjunct Professor in the Department of Pediatrics, School of Medicine, at the University of Minnesota. She is Director of the National Program Office for the Robert Wood Johnson Foundation (RWJF) Healthy Eating Research (HER) program that supports research on environmental and policy strategies to promote healthy eating among children and to prevent childhood obesity.
NESP members serving in 2013 include:
- Frank J. Chaloupka, PhD, is a Distinguished Professor at the University of Illinois at Chicago, where he has been on the faculty since 1988. He is currently Director of the UIC Health Policy Center and holds appointments in the College of Liberal Arts and Sciences’ Department of Economics and the School of Public Health’s Division of Health Policy and Administration. He is a Fellow at the University of Illinois’ Institute for Government and Public Affairs, and is a Research Associate in the National Bureau of Economic Research’s Health Economics Program and Children’s Program. Dr. Chaloupka is Director of the WHO Collaborating Centre on The Economics of Tobacco and Tobacco Control, Director of ImpacTeen: A Policy Research Partnership for Healthier Youth Behavior, and Co-Director of the International Tobacco Evidence Network.
- Shiriki Kumanyika, PhD, MPH, is a professor of epidemiology at the University of Pennsylvania Perelman School of Medicine. She is also the Associate Dean for Health Promotion and Disease Prevention at the University of Pennsylvania School Of Medicine, and was the founding Director of the University of Pennsylvania’s Master of Public Health program, a role that she served from 2002 until May 2007. In addition to her positions at Penn, Dr. Kumanyika is the founder of the African American Collaborative Obesity Research Network (AACORN), and has been a member of several national and international advisory boards and committees, including the Institute of Medicine, the International Obesity Task Force, and the World Cancer Research Fund Expert Panel on Diet, Nutrition and Cancer.
- Steven Gortmaker, PhD, is a Professor of the Practice of Health Sociology, part of the Department of Society, Human Development and Health at the Harvard School of Public Health. In addition to this position, Dr. Gortmaker also directs the Harvard Prevention Research Center (HPRC) at the Harvard School of Public Health. Through the HPRC, Dr. Gortmaker is contributing to several collaborative, including the Donald and Sue Pritzker Nutrition and Fitness Initiative, the Maine Youth Overweight Collaborative (MYOC), and the Healthy Care for Healthy Kids (HCHK) Collaborative. These projects involve research into activity levels for youth, as well as other factors in childhood obesity, such as children’s consumption of fruits and vegetables, and youths’ television viewing.
NCCOR is a collaboration among the NIH, CDC, RWJF, and USDA to accelerate progress on reversing the epidemic of childhood obesity in the United States. Through the collective efforts of these organizations, NCCOR aims to improve the efficiency and effectiveness of research on childhood obesity.
For information about NCCOR please visit www.nccor.org.
Systems science in childhood obesity and public health research: Pre-doctoral and post-doctoral opportunities at Johns Hopkins University
February 2012, NCCOR
The National Collaborative on Childhood Obesity Research (NCCOR)-supported and NIH-funded, Johns Hopkins Global Center for Childhood Obesity (JHGCCO) is recruiting qualified pre-doctoral and post-doctoral trainees from diverse fields (e.g. Public Health, Medicine, Engineering, Nursing, or Arts and Sciences) with a career interest in addressing childhood obesity, non-communicable chronic diseases, and related topics in public health using systems science theories and methods.
Applications are invited from exceptional individuals who will benefit from involvement with training and research activities and who will contribute to the Center and the field at large. Women and candidates from under-represented minorities are particularly encouraged to apply. Trainees will be provided with training in systems science and public health, research opportunities, and involvement in diverse Center activities. A traineeship including stipend will be provided.
Eligibility and requirements
The pre-doctoral candidates must have passed the admission requirements for a masters or doctoral program at one of the departments in the five Schools listed above. Postdoctoral candidates must have a doctoral degree in a relevant field.
To apply, please send curriculum vitae, three references, and a letter of intent to the Center’s Education and Training Core (ETC) Program Manager, Rosemary Mountain, firstname.lastname@example.org. The letter must be no more than 1000 words and should address the following points:
- What are your most important previous experiences that make you a good candidate for this training program?
- What are your long term career goals and how would this training program fit those goals?
- What do you want to focus on in your research and how does that fit with this training program? Please be specific about particular skills, knowledge or certification that are relevant to your future career. Please also mention if you prefer to work with a particular Center faculty member.
- Why are you interested in research about childhood obesity and systems approaches to public health?
Pre-doctoral candidates, please include a description of what Hopkins school, department and degree program you have applied to, or are currently enrolled in, and a clear statement of where you are in the process.
Publications & Tools
Tax on sugary beverages projected to have broad health benefits
Jan. 24, 2012, Amednews
By Carolyne Krupa
A nationwide penny-per-ounce excise tax on sugar-sweetened beverages would reduce consumption of the beverages by 15 percent and save an estimated $17 billion in medical costs over 10 years, says a study in the January Health Affairs.
During the same period, researchers project that the tax would mean 867,000 fewer obese adults between 25 and 64 years old, resulting in 95,000 fewer cases of coronary heart disease, 8,000 fewer strokes and 26,000 fewer premature deaths. New cases of type 2 diabetes would be reduced by 2.6 percent as more people opted for milk, juice, water and other beverages, the study said.
“The study shows that even modest reductions in sugar-sweetened beverage consumption could prevent thousands of cases of cardiovascular disease and diabetes, and save billions of dollars in medical costs,” said James S. Marks, MD, MPH, senior vice president and director of the Robert Wood Johnson Foundation Health Group, which helped fund the study with the American Heart Assn.
Forty states have sales taxes on soda, but they are too low to impact sales, said Dr. Y. Claire Wang (NCCOR Envision member), lead study author and assistant professor at Columbia University’s Mailman School of Public Health in New York. California’s tax is the highest at 7.3 percent. In many states, profits from the taxes are used to benefit health-related programs and low-income families.
“This has been on the political agenda in a lot of state legislatures over the last few years,” she said.
Unlike state sales taxes, an excise tax on beverage makers would affect the price on the front end, rather than at the cash register after the consumer has made the decision to purchase the product, Dr. Wang said.
Americans Against Food Taxes opposes such taxes, saying the country can’t tax its way to good health. “A tax on juice drinks and soda would further squeeze hardworking families already struggling to pay their bills and keep their health coverage,” Susan Neely, president and CEO of the American Beverage Assn., said in a statement on the Americans Against Food Taxes website. “With the economic downturn, there could not be a worse time to ask them to pay more for the simple pleasures they enjoy.”
The organization –a coalition of concerned citizens, beverage and food manufacturers, grocers associations, restaurant chains and other businesses –did not respond to requests for comments on the Health Affairs study.
Getting an excise tax on sugar-sweetened beverages passed at the national level would be difficult, Dr. Wang said. The beverage industry spent nearly $13 million to oppose an excise tax on sugar-sweetened beverages in New York state in 2010. But Dr. Wang said she thinks public sentiment may be shifting as more people learn about the nation’s high health care costs.
“Eventually, the public needs to see which part [of the debate] is to protect profit and which part is what policymakers should be paying attention to,” she said.
U.S. Department of Agriculture releases new school meal nutrition standards
The U.S. Department of Agriculture (USDA) has recently released updated nutrition standards for school meals. This marks the first update to meal nutrition standards in more than 15 years, the new standards will help schools provide healthier meals for millions of students. The standards will help ensure that school meals include more fruits and vegetables, more whole-grain breads and pastas, and more low- and non-fat milk. They also set limits for fat and sodium.
Prevalence of obesity and trends in body mass index among U.S. children and adolescents, 1999-2010
A recent paper explored trends in childhood obesity rates, and discovered that the prevalence of childhood obesity increased in the 1980s and 1990s but that there were no significant changes in prevalence between 1999-2000 and 2007-2008 in the United States. Two of the co-authors are NCCOR members Cynthia L. Ogden, and Brian Kit.
Childhood Obesity Research & News
New rules for school meals aim at reducing obesity
Jan. 25, 2012, The New York Times
By Ron Nixon
Hoping to combat the growing problem of childhood obesity, the Obama administration on Wednesday announced its long-awaited changes to government-subsidized school meals, a final round of rules that adds more fruits and green vegetables to breakfasts and lunches and reduces the amount of salt and fat.
The announcement came months after the food industry won a vote in Congress to block the administration from carrying out an earlier proposal that would have reduced starchy foods like potatoes and prohibited schools from counting a small amount of tomato paste on a slice of pizza as a vegetable. Under the latest rules, potatoes are not restricted, and tomato paste can qualify as a vegetable serving.
The rules were announced by Agriculture Secretary Tom Vilsack and Michelle Obama at Parklawn Elementary School in Alexandria, Va.
“As parents, we try to prepare decent meals, limit how much junk food our kids eat and ensure that they have a reasonable balanced diet,” Mrs. Obama said in a statement. “And when we are putting in all that effort the last thing we want is for our hard work to be undone each day in the school cafeteria.”
About 32 million children participate in school meal programs each day. The new rules are a major component of Mrs. Obama’s campaign to reduce the number of overweight children through exercise and better nutrition.
The rules are the first changes in 15 years to the $11 billion school lunch program. They will double the amount of fruits and vegetables children are served in school and will require that all grains served are whole grains. All milk served must be low fat, and for the first time the rules set limits on levels of salt and trans fats. They also set a minimum and maximum calorie intake per day based on student age.
The government estimates that the rules will add about $3.2 billion in costs to the program, about half the cost of the proposed rules that were blocked last year.
Nutrition experts praised the new standards.
“We applaud the U.S. Department of Agriculture (USDA) for issuing final guidance to help schools across the country serve healthier meals to students,” said Jessica Donze Black, project director for the Kids’ Safe and Healthful Foods Project, a joint project of the Pew Charitable Trusts and the Robert Wood Johnson Foundation. “The updated nutrition standards for school meals are now in line with the most recent Dietary Guidelines for Americans.”
Representatives of the food industry generally also approved.
“From our perspective, the new rules improve school nutrition, but at the same time give schools the flexibility to serve a variety of foods to meet the standards,” said Corey Henry, vice president for communications of the American Frozen Food Institute. “It’s a balanced approach that meets the goals of everyone involved.”
The National Potato Council, which had opposed the attempts to limit the serving of potatoes, said that it was pleased with the new rules but that it still had some concerns.
“Despite the fact that Congress said the USDA could not limit potatoes in school lunches or breakfast, we still feel like the potato is being downplayed in favor of other vegetables in the new guidelines,” said Mark Szymanski, a spokesman for the council. “It seems the department still considers the potato a second-class vegetable.”
Earlier versions of the proposal met with political opposition because they would have cut the amount of potatoes served, a move not popular with lawmakers from potato-growing states. It would also have required schools to put more than a quarter-cup of tomato paste on a slice of pizza for it to count as a vegetable serving, an idea food service companies opposed as unappetizing. And the rules would have halved the amount of sodium in school meals gradually over 10 years.
A group of farm state senators, led by Senator Susan Collins, Republican of Maine, blocked those earlier rules. Ms. Collins, who once worked on a potato farm, said the proposal to limit potatoes was overly restrictive.
The American Frozen Food Institute was concerned about the previous guidelines’ restrictions on sodium levels and the amount of tomato paste required to qualify as a vegetable serving.
The institute backed the latest rules, which continue to allow about a quarter-cup of tomato paste on a slice of pizza to count as a vegetable serving.
Still, Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, a nonprofit research group in Washington, said the rules would provide healthier meals and have a major impact in reducing childhood obesity rates.
“Despite Congress getting involved,” she said, “this is a very significant and comprehensive change that should improve the quality of school lunches.”
Can online games influence what kids eat?
Jan. 10, 2012, TIME
By Alice Park
Children are an advertiser’s dream, and if you have any doubt about that, just take a stroll through a toy store or your local grocer’s with one of these trusting, impressionable tykes in tow. You’ll know what I mean.
As if the ads on TV for the latest toy, fast food, sugary snacks and fat-laden meals weren’t bad enough, now researchers say you have to worry about another insidious way that manufacturers are appealing to the youngest among us — advergames.
That’s the term for the enticing and engaging online games that food makers are increasingly supplying on their web sites as a way to introduce children to their products. The companies’ logos and goods are unavoidable on these games, which also include inducements to buy the products in order to launch new features on the game.
Researchers led by Jennifer Harris, director of Marketing Initiatives at the Rudd Center for Food Policy and Obesity at Yale University found that children are increasingly accessing these advergames, and, more importantly, falling under their spell. In one of the two studies that the group published in the Journal of Children and Media, the scientists documented the number of children who visited company web sites that included advergames, and how long the youngsters stayed on the sites. The kid-friendly games included puzzles, arcade-like games, as well as avatars and drawing features in which children used candy to “paint.”
The researchers started with companies who voluntarily pledged to tailor advertising toward healthier foods for kids under the Children’s Food and Beverage Advertising Initiative (CFBAI), sponsored by the Council of Better Business Bureaus. About 38 percent of the companies had created advergames, and children made up a larger proportion of these advergame-supported sites than sites from similar companies without the games. About 1.2 million youngsters visit company sites with advergames every month, and spend up to an hour each month playing the games. Children were 77 percent more likely to visit pages with advergames than other sites, and spent 88 percent more time on these sites than on other pages.
In the second part of the study, Harris and her colleagues chose two advergames featuring unhealthy foods, two featuring healthy foods, and two control games that didn’t include advertising for any products. They then asked 152 children aged seven to 12 years to randomly play two games, which were randomly assigned to them, with a snack break in between. The snacks included healthy grapes and carrots, as well as less healthy crackers, fruit snacks, cookies and chips. While they ate, the researchers recorded what they consumed. After eating, the children were asked to rate how much they liked the food and how healthy it was.
The children who played the healthy advergames designed by Dole ate as much of the unhealthy foods as the youngsters who played the unhealthy advergames, but they also ate 50 percent more grapes and carrots than the unhealthy game players. It was almost as if they were remembering the lessons from the games and thought they should eat the healthy foods too, says Harris.
The children playing the unhealthy advergames for PopTarts and Oreos, however, ate 56 percent more unhealthy snacks compared to those playing the healthy games, and 16 percent more compared to those in the control group. These youngsters also ate less fruits and vegetables than children playing either the healthy or control games. That implies that the advertising in the games was influencing the children to chose the unhealthy snacks while rejecting the healthier ones, says Harris.
The findings reinforce a growing body of evidence suggesting that children’s eating preferences are heavily influenced by what they see and hear around them, including advertising and the use of appealing cartoon characters. The CFBAI was created to motivate manufacturers to shift their advertising for children away from sugary, salty and fat-laden snacks, but, say experts that doesn’t seem to be happening, at least not in a demonstrable way.
Even more disturbing was the fact that some parents weren’t aware of how their children were being influenced by advergames. One third of the parents in the study didn’t know whether their children visited company websites to play advergames. “It’s not something currently on parents’ radar screens, but it should be,” says Harris.
That’s especially true since some advergames, such as the ones for healthy foods, can actually get kids to eat better. The message seems to be sinking in — but parents, and food makers, just need to be sure it’s the right one.
Learning to be lean
Jan. 16, 2012, The New York Times
By Reed Abelson
As one of the many outgrowths of the sweeping federal health care law, health insurers and employers must now pay the cost of screening children for obesity and providing them with appropriate counseling.
With about one in three children in the United States obese or overweight, according to government statistics, the need for such programs is clear. But, experts say, creating them will be challenging. Other than intensive hospital-based programs, few proven models exist for helping children and adolescents achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years. “If this were easy, if there were clear outcomes for success, we would be investing in these,” said Dr. Samuel R. Nussbaum, the chief medical officer for WellPoint, one of the nation’s largest health insurers.
While there are many community efforts aimed at getting every child to eat better and exercise more, including Michelle Obama’s Let’s Move initiative, there is also growing demand for programs that help children who are already seriously overweight. WellPoint and the UnitedHealth Group, another large insurer, are experimenting with new approaches, and even Weight Watchers says it is working to develop a program for children and teenagers. Drug companies and medical device makers are also testing some products on children.
Adults have a difficult enough time losing weight, and the issues are even more complicated with children and teenagers, experts say. Children are still growing, and the goal of any program may be to help them grow into a healthier weight rather than to actually lose pounds. Experts also say that to be successful, programs need to focus on the family as a whole, changing what everybody eats and how much time they are all active, not sitting in front of a computer screen or television.
UnitedHealth’s pilot program, aimed at these family dynamics, was conducted in partnership with the YMCA of the USA and the YMCA of Greater Providence, R.I. The sessions at the Y, with young children or teenagers talking about their struggles with food and exercise, are intended to be a friendlier, more cost-effective alternative to hospital programs.
Accompanied by a parent, the children meet for 16 hourlong sessions, initially once a week. Led by a coordinator who has been trained at a Y or other community setting, the children and parents learn about what foods they should favor, why children may be overeating and how to balance what they eat with how active they are.
In Rhode Island, parents like Dana Morel said the program was appealing because there were few other options. “There really wasn’t anything like this,” said Ms. Morel, who enrolled her son, Ryan, after hearing about it from her local Y. “That’s why we jumped on this.”
Ryan, now 11, said he was initially reluctant to go to the meetings but was won over by the woman leading the group and the promise of $150 in gift cards if he filled out the paperwork (The use of gift cards was limited to the study.)
Ryan, who weighed 122 pounds, lost 30 of them as he learned to make better choices about what he ate and to recognize that he sometimes ate because he was bored. He learned to limit his portions and substitute turkey burgers for cheeseburgers.
Already active in sports like soccer, the leaner Ryan said he has become a better player. “I’m faster,” he said. “I don’t lose my breath as quickly. I can run.”
The early results of UnitedHealth’s efforts are promising, according to the insurer, which said that 84 percent of the 155 children and teenagers completed the program and had an average 3.5 percent reduction in weight after six months. Parents also lost weight, according to UnitedHealth. The insurer says it is expanding the program, even as it continues to study its longer-term impact.
Raytheon, a military contractor, started offering the sessions to its employees in Massachusetts and Rhode Island as part of a pilot program. “We are always seeking out innovative ways to help our employees and their families live healthy lifestyles,” Keith J. Peden, a Raytheon executive, said in a statement.
UnitedHealth is now working with Texas and Louisiana to offer a similar program this year for children enrolled in Medicaid under the insurer’s Medicaid plans.
“There’s not a lot of programs, especially programs that children are interested in participating in,” said Dr. Rodney Wise, the medical director for Louisiana’s Medicaid program. The state, which suffers from one of the country’s highest rates of obesity, is asking all the health plans serving Medicaid to address the problem.
In another experiment aimed at teenagers obsessed with videogames, UnitedHealth said it was studying whether Microsoft’s Kinect for Xbox 360 could help children become more fit by playing fitness games at home.
Now that insurers and employers must pay for child obesity services, “the market will respond” with more treatment options, said Dr. Deneen Vojta, a pediatrician and UnitedHealth executive. But some of those treatments may not prove effective, she said.
Early results may be misleading, agreed Karen Miller-Kovach, the chief scientific officer of Weight Watchers International.
Weight Watchers, which runs a weight-loss program for adults that involves group meetings as well as a Web-based program, had to abandon one approach after discovering children were regaining their weight after a year, with some even gaining more than they might have had they not participated.
Weight Watchers has not given up, however. Departing from the early program, it is now trying to develop ways of engaging the whole family to eat better. The new efforts focus less on counting “points” for foods.
Children, especially teenagers, can rebel under an overly strict regime, said Ms. Miller-Kovach, and programs need to focus on making smaller, sustainable changes in their lifestyle.
Many of the most established treatment programs for childhood obesity are based at hospitals or academic medical centers, and experts say they may not be well suited to a child who is overweight but has not yet developed a serious medical condition like diabetes and is not an appropriate candidate for bariatric surgery. Parents are also often reluctant to take their child to a hospital for treatment.
“There’s a big gap” between what is available for children and what is needed, said Gary D. Foster, the director of the Center for Obesity Research and Education at Temple University in Philadelphia, who serves as a consultant to UnitedHealth on its program.
WellPoint is trying a different approach, working through pediatricians. Because many pediatricians lack the background to help children who are overweight and have nowhere to refer them, WellPoint provided training to 100 doctors and linked them with dietitians in Virginia. The health plan pays for four visits to the doctor and four visits to the dietitian, whose sessions are aimed at improving the diet of the entire family.
WellPoint is already planning to expand its efforts to customers in California and Wisconsin this year as soon as it is able to identify dietitians who can work with the pediatricians.
Experts say it is critical to take the long-term view. “What we’re learning about treating childhood obesity is that there is no magic bullet in dropping weight in kids,” said Dr. Colleen Kraft, a pediatrician in Roanoke, Va., who worked with WellPoint there.
Success may be achieved when an overweight child does not become an obese adult. “It’s going to be a generation return on investment,” she said.