September 2013





ObesityWeek preconference workshop will explore the impact of mobile health on child obesity research

Sept. 2, 2013, NCCOR

This November The Obesity Society is hosting a preconference workshop called “Mobile Health (mHealth) Boot Camp for Pediatric Obesity.” The workshop will introduce participants to the basics of mHealth and its potential to inform research and practice in pediatric obesity. The workshop is part of ObesityWeek, a scientific and educational conference for obesity health care professionals that combines both The Obesity Society (TOS) and American Society for Metabolic and Bariatric Surgery (ASMBS) annual meetings.

“Mobile health has so much potential for so many aspects of childhood obesity research,” said workshop co-organizer Erin Hennessey, a cancer prevention fellow at the National Cancer Institute (NCI) and member of the National Collaborative on Childhood Obesity Research (NCCOR). “There are more mobile devices in the world than toothbrushes, and even in the developing world – in places where people may not have consistent access to electricity or running water – people have access to mobile technology. So, the reach potential for mobile health is huge.”

The workshop will focus on how to use mHealth in pediatric obesity research. It will explore aspects like developing transdisciplinary teams; using sensor technologies to measure behaviors like activity, sleep, location, and social networks; making use of new and emerging research methodologies for collecting and analyzing large volumes of data (e.g., systems science); and developing flexible interventions that adapt to emerging behaviors and contexts in real time.

“From a measurement perspective, mobile technology allows for stealth data collection (e.g., through sensors, GPS) that requires almost zero participant burden and yields highly accurate data, ” said co-organizer Heather Patrick, health scientist at NCI and NCCOR member. “From an intervention perspective, engaging with people – parents, children and adolescents, educators, public health and medical practitioners – in the space where they already are has the potential to improve participant engagement and retention and the opportunity to develop adaptive interventions that address the needs of people operating at multiple levels within the childhood obesity landscape.”

The workshop is a collaboration between NCCOR, The Obesity Society’s Pediatric Section, and leading researcher in obesity prevention and treatment in minority youth: Dr. Donna Spruijt-Metz. Dr. Spruijt-Metz is an associate professor at Keck School of Medicine’s Department of Preventive Medicine University of Southern California and chair-elect of The Obesity Society e-Health/mHealth section (EMS).

“Donna was starting to work on an EMS-supported workshop, and it turned out to be a great opportunity for the three groups to collaborate and capitalize on our respective strengths in some really exciting ways,” said Hennessey.

The workshop will also feature NCCOR tools and resources such as the Measures Registry and infographics. Participants will have an opportunity to discuss ways to enhance and expand NCCOR’s resources to be more mHealth-friendly and advance pediatric obesity research.

The workshop is designed for researchers, practitioners, and program evaluators at all career levels and disciplines who are interested in learning more about how to modernize their intervention, prevention, and evaluation skill sets.

“We hope that participants come away from the workshop with a newfound appreciation for how mHealth can be used to address the central disadvantages of current surveillance, prevention, and treatment approaches in pediatric obesity research,” said Hennessey.

“Mobile health is by no means a panacea that will solve all of the challenges we face in pediatric obesity research, so we also want participants to have a broader understanding of the issues mHealth can address and the limitations that mHealth may present,” added Patrick. “We want participants to develop a better understanding of the opportunities that mHealth presents, the kinds of ideas that are truly novel and innovative in mHealth, the current state of the evidence, and where additional evidence is needed.”

The preconference workshop will be held in Atlanta, Ga., on Nov. 12 from 8 a.m.-5 p.m. Though the conference is part of ObesityWeek, participants DO NOT have to register for the conference to attend the workshop.

To learn more about the preconference, visit To register for the workshop, visit For questions, email

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Publications & Tools

New report shows childhood obesity rates have leveled off over the past decade

Childhood obesity rates in the United States have more or less stabilized over the past decade, according to a report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The report, titled “F as in Fat: How Obesity Threatens America’s Future 2013,” states that based on data from the Centers for Disease Control and Prevention, that rates of childhood obesity have remained statistically the same for the past 10 years, with the exception of the prevalence of obesity among boys (2 to 19 years old) which increased from 14 percent in 1999-2000 to 18.6 percent in 2009-2010. The report also states that despite this stabilization, the rates of obesity among children ages 2 to 19 are still far too high—more than triple what they were in 1980.


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New data on adult obesity prevalence shows no change in national obesity rate

The Centers for Disease Control and Prevention (CDC) recently released the 2012 obesity map from the Behavioral Risk Factor Surveillance System (BRFSS). Although the map shows several states moved between categories from 2011-2012, only Arkansas showed a significant change (increase) and there was no significant change in the national obesity rate overall.

Specifically the map shows:

  • By state, obesity prevalence ranged from 20.5 percent in Colorado to 34.7 percent in Louisiana in 2012. No state had a prevalence of obesity less than 20 percent. Nine states and the District of Columbia had prevalence between 20 to 25 percent. Thirteen states (Alabama, Arkansas, Indiana, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia) had a prevalence equal to or greater than 30 percent.
  • Higher prevalences of adult obesity were found in the Midwest (29.5 percent) and the South (29.4 percent). Lower prevalences were observed in the Northeast (25.3 percent) and the West (25.1 percent).
  • It is important to note that several updates were made in 2011 to BRFSS methodology that impact estimates of state-level adult obesity prevalence. Because of these changes, data collected in 2011 and forward cannot be compared to estimates from previous years.


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CDC report shows progress in school health practices

Over the last several years, more schools nationwide have begun implementing nutrition and health policies and requiring physical education programs, according to a report released Aug. 26 from the Centers for Disease Control and Prevention (CDC).

Key findings include:


  • The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
  • Between 2006-2012, the percentage of districts that required schools to prohibit offering junk food in vending machines increased from 29.8 percent to 43.4 percent.
  • Between 2006-2012, the percentage of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55.1 percent to 73.5 percent.
  • Between 2000-2012, the percentage of districts that made information available to families on the nutrition and caloric content of foods available to students increased from 35.3 percent to 52.7 percent.

Physical education/physical activity

  • The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
  • More than half of school districts (61.6 percent) had a formal agreement, such as a memorandum of agreement or understanding, between the school district and another public or private entity for shared use of school or community property. Among those districts, more than half had agreements with a local youth organization (e.g., the YMCA, Boys or Girls Clubs, or the Boy Scouts or Girl Scouts) or a local parks or recreation department.


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CDC releases new website to address obesity disparities

The Centers for Disease Control and Prevention (CDC) Division of Nutrition, Physical Activity, and Obesity recently launched the Health Equity Resource Web Guide. This website is an instructional tool developed to complement the “CDC Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities,” released in August 2012.

In support of the toolkit, the guide:

  • Provides access to the “Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities”
  • Provides an overview of the toolkit content
  • Provides supplementary information, examples, and exercises to reinforce or expand upon toolkit content
  • Guides users in the most effective use of the toolkit sections


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Childhood Obesity Research & News

‘Fat letters’ take the stage in childhood obesity debate

Aug. 21, 2013, HealthDay

By Alan Mozes

If their kids are frequently tardy, truant, or failing to turn in homework, parents of U.S. schoolchildren expect to be notified. And in some districts, they might be contacted about yet another chronic problem: obesity.

The “fat letter” is the latest weapon in the war on childhood obesity, and it is raising hackles in some regions, and winning followers in others.

“Obesity is an epidemic in our country, and one that is compromising the health and life expectancy of our children. We must embrace any way possible to raise awareness of these concerns and to bring down the stigmas associated with obesity so that our children may grow to lead healthy adult lives,” said Michael Flaherty, a pediatric resident physician in the department of pediatrics at Baystate Medical Center in Springfield, Mass.

About 17 percent of U.S. teens and children are obese — three times the number in 1980, according to the Centers for Disease Control and Prevention. And one in three is considered overweight or obese. Being overweight or obese puts kids at risk of developing serious health problems, such as heart disease. Too much weight can also affect joints, breathing, sleep, mood, and energy levels, doctors say.

Massachusetts — which has had a weight screening program since 2009 — is one of 21 states that have implemented statutes or advisories mandating that public schools collect height, weight, and/or BMI (body mass index) information. Some states further require that parents receive confidential letters informing them of the results, advising that they discuss the findings with a health care provider.

But some parents in the Bay State and elsewhere consider such policies an unwelcome intrusion into private family matters. Other objectors say “fat letters,” as they are sometimes called, have the potential to trigger bullying or eating disorders among the very children they’re trying to help.

In Massachusetts, where parents are letter-informed of BMI results for students in grades one, four, seven, and 10, the state department of public health is currently debating a possible repeal of the letter portion of its screening protocol.

This would be a grave mistake, Flaherty believes. “The growing number of children and adolescents seen day in and day out in our clinics with hypertension, high cholesterol, diabetes, and musculoskeletal issues secondary to weight do not lie,” he said. Flaherty, a clinical associate at the Tufts University School of Medicine, outlines his thoughts in a “perspective” piece published online Aug. 19 in Pediatrics.

While acknowledging that the effectiveness of such programs remains to be determined, Flaherty notes that school screenings are nothing new, with many states having done so for many years. And in 2005, the U.S. Preventive Services Task Force determined that calculating a child’s BMI — a calculation of body fat based on height and weight — should be considered the “preferred measure” for tracking weight issues.

What’s more, he suggests that parental fears that BMI assessments may accidently identify healthy muscular children as overweight is a misplaced concern over a relatively rare phenomenon.

“Additionally, no studies have shown any increased risk in bullying, eating disorders, or unhealthy dieting patterns,” Flaherty noted. “While these risks exist, they have not been proven in states where these programs have existed for several years.”

The very point is to have a “confidential way of mailing letters directly home to parents where these issues can be addressed in the privacy of the home without any other students being aware of other children’s BMI,” he said.

Other specialists are less enthusiastic about school BMI screenings.

Dr. David Dunkin, an assistant professor of pediatric gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City, cautions that simply legislating parental notification of school screening results will not help curb the obesity crisis without comprehensive and well-designed follow-up.

“While I feel that the intention is good [to] raise awareness among parents about their children being obese, and thus instilling motivation for behavioral changes or lifestyle modifications, this is unlikely to have effects in and of itself,” Dunkin said.

To bring about change, notifications should include referrals to programs that could help parents make lifestyle modifications for their children, he added.

But Dunkin would prefer to see weight issues addressed by a family’s pediatrician.

“I think it is the primary responsibility of the pediatrician to discuss obesity on a case-by-case basis with the child and the family, and try to help them with life changes,” he said. “As a pediatrician I often speak to the family about this, and can assist them with advice on what to do to improve their child’s health.”

While Flaherty agrees that pediatricians should measure a child’s BMI at every child’s well-care visit, he said these check-ups are only performed annually.

“Pediatricians have 15 to 20 minutes per year to deal not only with BMI, but a variety of other preventive health issues,” Flaherty said. “The public school system is a universal organization that has been used as a forum to reach children and parents for a variety of other issues: vaccinations, dental exams, and hearing and vision screening.”


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Michelle Obama's newest initiative: Using hip-hop to fight obesity

Aug. 5, 2013, U.S. News & World Report

By Elizabeth Flock

In June, first lady Michelle Obama appeared in a hip-hop music video that featured rapper Doug E. Fresh, singer-songwriter Jordin Sparks, and TV medical personality Dr. Oz. The catchy song urged kids to “work hard/eat right” and “tell somebody/it’s your body/c’mon.” The song was just the first of a 19-track album, the majority of which are hip-hop, to be released by the Partnership for a Healthier America, the anti-obesity nonprofit that launched in conjunction with Michelle Obama’s Let’s Move! anti-obesity campaign, and a New York-based group called Hip Hop Public Health.

The full album, which includes songs with names like “Veggie Luv” by Monifah and J Rome, “Hip Hop LEAN” by Artie Green, and “Give Myself a Try” by Ryan Beatty, will be released on Sept. 30.

Let’s Move! Executive Director and White House assistant chef Sam Kass says the White House is fully behind the initiative to use hip-hop – and other genres of music – as a tool to get kids to live healthier lives.

“Cultural leaders and visionaries in our country can give these messages to kids in a way that’s not preachy. Kids are going to be dancing and listening to the music,” he says. “I think hip-hop in particular – so many kids love hip-hop. It’s such a core part of our culture…and particularly in the African-American community and the Latino community which is being disproportionately affected by those health issues.”

African-American children are more than 50 percent more likely to be overweight or obese compared with white children, and Hispanic children are nearly 30 percent more likely, according to a 2008 study published in Journal of the American Board of Family Medicine.

If all goes according to plan, some 10 of the 19 songs on the new album will be made into music videos, much like the hip-hop video in which Michelle Obama appeared. Those music videos will then be distributed to schools across the nation – starting with 40 schools in New York City, and then to schools in San Antonio, Philadelphia, and Washington D.C. The hope is that teachers will use the videos during recess, physical education classes, or even passing periods to encourage kids to get moving.

Though the White House has only recently gotten behind using hip-hop to fight obesity, the initiative has been almost a decade in the making. Back in 2005, an academic neurologist at Columbia University in New York, Olajide Williams, started thinking and experimenting with how hip-hop music could be used to encourage his stroke patients to live healthier lives. His efforts seemed to work and so Williams, who has done extensive research on community-based behavioral interventions, founded Hip Hop Public Health to educate African-Americans and Latinos through hip-hop about the diseases plaguing their communities.

“We also started looking at the communities with obesity in New York, and a lot of these communities just happened to be poor communities, and happened to be African-American, Hispanic, Latino. We needed to develop an interventionary tool for the community,” says Williams. “Hip-hop was born as a platform to bring our interventions to the youth.”

By 2011, Kass, the White House chef, had noticed the program, and by 2012, Hip Hop Public Health was working with the Partnership for a Healthier America on the anti-obesity album.

If Thurgood Marshall Lower School in Harlem is any indication, making hip-hop part of the school day could put a dent in the obesity epidemic. In 2010, obesity was affecting more than one third of children and adolescents, according to the Centers for Disease Control and Prevention.

Dawn Decosta, principal of the elementary school, says before partnering with Hip Hop Public Health, the school relied on just one aide to encourage the kids to get moving at recess time. When the weather was bad, the kids often didn’t move at all.

Today, it’s a very different story, with half of the school’s cafeteria transformed into a space for physical activity, a student advisory board that meets weekly to talk about making the school more healthy, and a recess that involves dancing to hip-hop music – rain or shine.

“We probably don’t have one family [in the school] that doesn’t have a member touched by diabetes or obesity,” Decosta says. “But now, if the weather is good, bad or whatever, we have physical activity every day. We have conversations about what to eat. And we have kids walking around with pedometers, and they want to have more activity, because they want to be recognized as having more steps.”


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Mississippi school lunches among healthiest in United States

Aug. 18, 2013, Clarion Ledger

By Jasmine Aguilera and Deborah Barfield Berry

Two years ago, the Hattiesburg School District removed deep fryers from its schools, eliminating fried foods from the lunch menu.

“We wanted to offer our students healthier meal options at school,” said Jas N. Smith, a spokesman for the school district. “Schools kind of have a unique situation. We have, for lack of a better word, a captive audience.”

It was one of many efforts by school districts across the state to offer students healthier lunches.

Today, more than 80 percent of Mississippi school districts are meeting federal regulations for serving healthy lunches to students, according to the U.S. Department of Agriculture (USDA).

Regulations issued under the Healthy, Hunger-Free Kids Act of 2010 require schools to increase portions of fruits and vegetables and limit meat and grains per age group. Fat-free milk must be served, and the regulations bar trans fats.

In Mississippi, 83.4 percent of school districts meet the regulations, according to March data. The state has received $2.8 million from USDA based on a formula that sends states $0.06 cents per lunch for school districts in compliance.

“We took charge by starting regional training sessions,” said Scott Clements, director of healthy schools and child nutrition at the Mississippi Department of Education. “We made it a priority to make sure they had what they needed.”

As of March, Mississippi’s compliance with the regulations ranked the state number two behind South Carolina, where 92.6 percent of school districts meet the standards.

State agriculture officials in Florida said 100 percent of schools there had met the regulations as of July 22. Federal agriculture officials didn’t know how many other states may have attained 100 percent since March.

“The schools have realized that we have an obligation to our students to try to educate them about healthy eating, about healthy choices,” Smith said. “… And they are taking it seriously and they’re following through on it.”

Clements credits the Healthy Students Act that Mississippi enacted in 2007 with helping the state meet the regulations at a faster rate than most states. The act gave school districts a head start transitioning to healthier menus, but Clements said the process hasn’t been easy.

“The reason Mississippi is only at 82 percent instead of 100 is because school districts are very small, which makes it harder to manage,” Clements said. “There are also shelters, juvenile detention facilities, and some private schools that participate in the school lunch program. Those have a more difficult time meeting federal standards.”

Mary Hill, executive director of Jackson Public Schools Food Services, said officials have made several changes, including offering students fruits and vegetables as snacks throughout the day. “I think we have caused them to think a little more about what they are eating,” she said.

Hattiesburg school officials have implemented district-wide changes, including removing some vending machines. In some schools, beverages such as soda have been replaced with water, sports drinks, and juice. The district also changed the way meals are prepared, checks menu items for calorie counts and offers more fruits and fresh vegetables.

In some schools, deep fryers have been replaced with a combi oven — a combination convection oven and steamer.

“We had a good response,” Smith said. “Students were able to get the familiar texture of (fried) foods, which is big for students especially younger kids . . . without all of the bad side ramifications.”

The efforts come at a price. The combi ovens are so expensive the district has only put them in a few schools so far, Smith said. “It’s a slow process, that’s why we don’t have a combi oven in every school, but we are working on it.”

Districts are relying on grants from the USDA and other federal aid to help implement changes.

Officials at Jackson Public Schools were unable to provide a dollar amount for how much the district has been reimbursed, but Hill said the money will be used to continue providing more nutrition options. Data from the Centers for Disease Control and Prevention show almost 40 percent of children ages 10 to 17 are overweight in Mississippi, a problem Clements said the state is trying to solve through the Healthy Students Act and the Healthy, Hunger-Free Kids Act.

The national rate is 31 percent, according to the Kaiser Family Foundation, a national research group. Mississippi and Louisiana have the highest rates in the country, data show.

“That’s always in the back of our mind,” Smith said. “We’re fighting kind of an uphill battle.”

Earlier this year, first lady Michelle Obama visited Mississippi to tout its successful efforts to reduce childhood obesity. Obama teamed with celebrity chef Rachael Ray in Clinton to talk about the importance of serving nutritious foods in school.


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