July 2016





NCCOR Childhood Obesity Declines – New RWJF Signs of Progress Data

July 18, 2016, NCCOR

In 2013, NCCOR formed the Childhood Obesity Declines Workgroup, to better understand reported declines in childhood obesity. An expert panel convened to start assessing how U.S. cities and counties are developing and operationalizing obesity reduction interventions, initiatives, and strategies. Four communities were identified to be studied: New York City (NY), Philadelphia (PA), Granville County (NC), Anchorage (AK) in order to examine the reasons behind the change in obesity rates and exploring, more generally, how communities can address childhood obesity. The Site Summary Reports for the original NCCOR sites can be accessed on the Childhood Obesity Declines Project Page.

The number of communities charting declines continues to grow. In June, the Robert Wood Johnson Foundation (RWJF) released new stories and data from states, cities, and counties that have measured declines in their childhood obesity rates. Many of these places have made broad, far-reaching changes to help support healthy eating and regular physical activity. RWJF has updated its Signs of Progress map, which now includes more than 30 locations nationwide where childhood obesity rates are going down.

Sample data from “new” sites include:

  • CentraCare Health, a nonprofit healthcare system in St. Cloud, Minnesota, is working with the local government and community organizations to help school districts update their wellness policies and implement nutrition labeling in grocery stores and schools. The obesity and overweight rate fell from 17 percent in 2008 to 13 percent in 2015 among 12-year-olds, a 24 percent relative decline.
  • All YMCAs in Cherokee County, South Carolina, have adopted Healthy Eating and Physical Activity (HEPA) standards in their afterschool programs to help kids have healthy snacks and drinks and at least 30 minutes of physical activity. The obesity and overweight rate fell from 43 percent in 2012 to 34.3 percent in 2015 among first grade students, a 20.2 percent relative decline. Among third graders, the obesity and overweight rate fell from 51.5 percent in 2012 to 40.7 percent in 2015, a 21 percent relative decline.
  • Kaiser Permanente, the Safe Routes to School Partnership, and the National PTA are running a “Fire Up Your Feet” campaign in Southern California to encourage kids to walk or bike to school. The obesity rate fell from 19.1 percent in 2008 to 17.5 percent in 2013 among Kaiser Permanente members ages 2 to 19, an 8.4 percent relative decline.
  • The obesity and overweight rate fell from 22.9 percent in 2012 to 21.2 percent in 2015 among 2- to 4-year olds enrolled in the Colorado Special Supplemental Nutrition Program for Women, Infants and Children (WIC), a 7.4 percent relative decline.

Following are updates from the four sites originally studied as part of the NCOOR Childhood Obesity Declines Project:

  • Philadelphia, PA: The obesity rate fell from 21.7 percent in 2006–07 to 20.3 percent in 2012–13 among Philadelphia public school students in grades K–12, a 6.5 percent relative decline.
  • New York City, NY: 5.5 percent decline in obesity among children in grades K–8 between 2006–07 and 2010–11.
  • Granville, NC: 3.5 percent decline in combined overweight and obesity among children ages 2–18 in Granville Counties, respectively, between 2005 and 2009.
  • Anchorage, AK: 5.4 percent decline in combined overweight and obesity among children in grades K, 1, 3, 5, 7 between 2003–04 and 2013–14.

For more information on the NCCOR Obesity Declines project, see the Connect and Explore webinar from March 22, 2016, as well as the RWJF Signs of Progress Web page.

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Journal of Physical Activity and Health Publishes Special Issue on Youth Energy Expenditure

Since 2012, NCCOR has sponsored a Youth Energy Expenditure (YEE) workgroup to support research efforts to achieve consensus on methods and measures for establishing youth energy expenditure values. This is important for efforts to reduce childhood obesity because standardized measures to quantify the amount of energy children expend during physical activity have been lacking. These measures are vital for comparing the effects of physical activity interventions and for cost and benefit research.

Until recently, researchers studying children and adolescents have relied on the Adult Compendium of Physical Activities to translate the energy cost of various physical activities into standardized values. However, the energy costs of physical activity change as children grow and mature, making adult values inappropriate for youth.

To accurately establish values for younger ages, researchers need data on the energy expenditure of children and adolescents performing a wide variety of physical activities. To generate these data, the YEE workgroup issued a call for researchers to submit previously unpublished data on youth energy expenditure. The result is a special issue of the Journal of Physical Activity and Health, New Data for an Updated Youth Energy Expenditure Compendium, which was released July 11. The Journal is hosting a webinar on July 21 at 1:00 p.m. ET.

The special issue consists of 17 papers from four countries that each met rigorous requirements for measuring energy expenditure among the youth studied. The papers make an important contribution to the literature because they include youth from preschoolers to older teens, and they provide previously unavailable energy expenditure values across these ages and developmental stages. Another important contribution is that the papers include values for nearly 100 separate physical activities, substantially enriching knowledge about activities in which children and youth engage.

This special issue is just one of several interrelated activities that the YEE workgroup is pursuing in its long-term goal of creating a Youth Compendium of Energy Expenditure Values. In 2008, an initial Youth Compendium was published, but it did not fully meet researchers’ needs because many of its values were based on values from the Adult Compendium. NCCOR recognized the importance of filling this gap and in 2012, it established the YEE workgroup. The workgroup has engaged in a number of interrelated tasks, in addition to the JPAH special issue:

  • Convening an expert group to chart a path forward. In 2012, an expert group met to begin preliminary planning for an updated Youth Compendium and to discuss ways of addressing methodologic challenges related to obtaining and calculating energy expenditure values from data on youth.
  • Determining the best metric to use for youth energy expenditure values. The workgroup has conducted several analyses to identify the best energy expenditure metric and determine ways to minimize potential confounders, such as age, sex, and physical characteristics. One analysis was published in PLoS One in June 2015, and a manuscript for the other analysis is under development.
  • Conduct a comprehensive literature search. This search was conducted to find newly published data on measured energy expenditure values for youth physical activities. This literature search is nearing completion.
  • Developing a website for the Youth Compendium of Energy Expenditure Values.This website is in the early development stage.

Read the JPAH special issue

Learn more about NCCOR’s Youth Energy Expenditure project

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Publications & Tools

Ag Committee Evaluates Effectiveness in SNAP-Ed

The House Agriculture Committee held a hearing to evaluate the effectiveness of nutrition education programs in promoting positive long-term health outcomes within the Supplemental Nutrition Assistance Program (SNAP). Members heard from a panel of witnesses who discussed the history and evolution of SNAP-Ed, various program models, how SNAP-Ed complements and works with other nutrition education programs, and the efforts currently in place to ensure dollars spent on the program are used effectively. This hearing is a continuation of the committee’s ongoing review known as the Past, Present, and Future of SNAP. (There is a discussion of the NEW SNAP-ED Evaluation Framework roughly 49 minutes into the archived session recording.)

View the archived session

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Philadelphia soda tax could help prevent diabetes, avert deaths

A three-cents-per-ounce tax on sugar-sweetened beverages proposed in Philadelphia could help 36,000 people per year avoid obesity, prevent 2,280 annual cases of diabetes, avert about 730 deaths over a decade, and save almost $200 million in health spending, according to an analysis from Harvard T.H. Chan School of Public Health.

Learn more about Sugar-Sweetened Beverage Taxes with this NCCOR Connect and Explore webinar

Read the full article about Philly’s tax

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The Role of Business in Multisector Obesity Solutions: Working Together for Positive Change—Workshop in Brief

On April 12, 2016, the Roundtable on Obesity Solutions convened a 1-day workshop in Washington, DC, to examine the role of the business sector in obesity solutions. The goal of the workshop was threefold: (1) explore why companies should be involved in obesity solutions and how to encourage them to do so; (2) identify reasons why businesses might be interested in being involved in obesity solutions; (3) identify ways in which business can be engaged in obesity solutions. Nico Pronk, vice president for health management and chief science officer at Health Partners Inc., started the workshop and referred to statistics that show the rapid growth in obesity prevalence among U.S. workers, from 15 to 30 percent over the past three decades. Pronk listed several ways that obesity in the workforce impacts both companies and individuals. He emphasized the bidirectional connection between healthy companies and thriving communities and put obesity into the context of the social determinants of health model, which predicts that only 20 percent of an individual’s health is related to what happens in the doctor’s office and the remainder to social and economic factors, behaviors, and the physical environment. He raised four questions for workshop participants to consider: (1) How can business be engaged? (2) How does business relate to other sectors in ways that may align efforts? (3) What are examples of partnerships between businesses and other community stakeholders? (4) What are opportunities and barriers to engaging business? This Workshop in Brief highlights key points made during the presentations and discussions and is not intended to provide a comprehensive summary of information shared during the workshop. The summary was released June 29, 2016.

Download the report

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Healthy Retail: A Set of Tools for Policy & Partnerships

The retail environment has a significant impact on community health. In many places, residents lack access to fruits and vegetables, but can find tobacco, non-nutritious foods and beverages, and alcohol all too easily. And perhaps not surprisingly, tobacco use, poor nutrition, and excessive alcohol use are among the leading causes of deadly illness in the United States.

Access the toolkit

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School District Wellness Policies: Evaluating Progress and Potential for Improving Children’s Health Eight Years after the Federal Mandate

This report provides the most comprehensive evaluation to date of the content of written school district wellness policies from school years 2006–2007 through 2013–2014, the first eight years following the required implementation date for the federal mandate. Using a nationally representative sample of school districts, this report, published in June 2016, details the characteristics of these districts as well as the individual components of wellness policies and related provisions.

Read the full report

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Childhood Obesity Research & News

Family Life, Activity, Sun, Health, and Eating (FLASHE) Study

June 29, 2016, National Cancer Institute, Division of Cancer Control & Population Sciences

The Family Life, Activity, Sun, Health, and Eating (FLASHE) study, sponsored by the National Cancer Institute, collected survey data on psychosocial, generational (parent-adolescent), and environmental correlates of cancer-preventive behaviors. The purpose of the study is to help researchers understand lifestyle behaviors that relate to cancer risk. The majority of the survey questions focus on diet and physical activity, with additional survey items about sleep, sun safety, and tobacco use. View the study’s conceptual model.

FLASHE is a cross-sectional, internet-based study that was conducted between April and October 2014. A parent/caregiver and his/her adolescent child (ages 12–17) were enrolled and then randomly selected to a Survey-Only group (e.g. group received the web-based survey instruments only) or a Motion Study group (e.g. received the same web-based surveys plus an accelerometer worn by the adolescent). View the study’s flow diagram. The sample, drawn from the Ipsos’ Consumer Opinion Panel, is similar to that of the general U.S. population in terms of sex, income, age, household size, and region.

Each parent and adolescent completed two web-based surveys. One survey asked participants about their diet-related behaviors and factors that may be related to those behaviors (known as correlates), while the other survey solicited responses on physical activity-related behaviors and correlates. The physical activity survey also included questions on other cancer-preventive health behaviors such as sleep, sun safety, and tobacco use. Participant survey order was determined by random assignment. FLASHE included demographic questions and questions related to general parenting style at the end of the first survey. FLASHE survey data are publicly available.

FLASHE was designed to support individual and dyadic analyses. For example, investigators can explore physical activity behaviors in adolescents using the adolescent physical activity survey. Or they can link data from adolescents and their parents to determine whether there is a relationship between parent and adolescent physical activity. To learn more about FLASHE and download the data, go to the data resource page. For more information on conducting dyadic analyses, go to the dyadic resource page or view aninstructional webinar.

Download FLASHE data

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First-Year Evaluation of Mexico’s Tax on Nonessential Energy-Dense Foods: An Observational Study

July 5, 2016, PLoS Medicine



In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES).

Methods and Findings

This study uses data on household packaged food purchases representative of the Mexican urban population from The Nielsen Company’s Mexico Consumer Panel Services (CPS). We included 6,248 households that participated in the Nielsen CPS in at least 2 mo during 2012–2014; average household follow-up was 32.7 mo. We analyzed the volume of purchases of taxed and untaxed foods from January 2012 to December 2014, using a longitudinal, fixed-effects model that adjusted for preexisting trends to test whether the observed post-tax trend was significantly different from the one expected based on the pre-tax trend. We controlled for household characteristics and contextual factors like minimum salary and unemployment rate. The mean volume of purchases of taxed foods in 2014 changed by -25 g (95% confidence interval = -46, -11) per capita per month, or a 5.1% change beyond what would have been expected based on pre-tax (2012–2013) trends, with no corresponding change in purchases of untaxed foods. Low SES households purchased on average 10.2% less taxed foods than expected (-44 [–72, –16] g per capita per month); medium SES households purchased 5.8% less taxed foods than expected (-28 [–46, –11] g per capita per month), whereas high SES households’ purchases did not change. The main limitations of our findings are the inability to infer causality because the taxes were implemented at the national level (lack of control group), our sample is only representative of urban areas, we only have 2 y of data prior to the tax, and, as with any consumer panel survey, we did not capture all foods purchased by the household.


Household purchases of nonessential energy-dense foods declined in the first year after the implementation of Mexico’s SSB and nonessential foods taxes. Future studies should evaluate the impact of the taxes on overall energy intake, dietary quality, and food purchase patterns.


Original source: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002057

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Proper maternal folate level may reduce child obesity risk

June 13, 2016, National Institutes of Health

Proper maternal folate levels during pregnancy may protect children from a future risk of obesity, especially those born to obese mothers, according to a study led by researchers funded by the National Institutes of Health.

“Maternal nutrition during pregnancy can have long-lasting effects on child health, as well as the health of a mother after pregnancy,” said the study’s principal investigator, Xiaobin Wang, M.D., M.P.H., Sc.D., from Johns Hopkins University, Baltimore. “Our results suggest that adequate maternal folate may mitigate the effect of a mother’s obesity on her child’s health.”

The study, published online in JAMA Pediatrics, was funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Obesity in children and adults is a serious health issue in the United States, contributing to such conditions as heart disease, stroke and type 2 diabetes. During pregnancy (link is external), maternal obesity also increases the risk for a range of pregnancy complications, such as stillbirth, birth defects and preterm birth. Furthermore, babies born to obese mothers have long-term health risks, including a higher risk of obesity in childhood.

Folate, an essential B vitamin, reduces the fetus’ risk for neural tube defects, which are malformations affecting the brain, spine and spinal cord. The U.S. Centers for Disease Control and Prevention recommends that women of childbearing age take 400 micrograms of folic acid (link is external) (a synthetic form of folate) daily to reduce their children’s risk for neural tube defects. However, the role of maternal folate levels on a child’s future obesity risk was not known, especially among those born to mothers who are obese during pregnancy.

In their study, the researchers investigated the health outcomes of mothers and children (ranging from 2- to 9-years-old) in the Boston Birth Cohort, a predominately low-income, minority population with a high prevalence of maternal and child obesity. The study team analyzed health records from more than 1,500 mother-child pairs, including information that was collected before, during and after pregnancy. To gauge a mother’s folate level during pregnancy, the researchers measured folate from stored plasma samples that were collected two to three days after delivery.

The study team found a wide range of maternal folate levels, but observed an “L-shaped” relationship between maternal folate levels and child obesity. In other words, the lowest levels of folate correlated with the highest risk of child obesity. When folate levels reached approximately 20 nanomoles per liter (nm/L), which is within the normal range for adults, further increases in folate levels did not confer additional benefits, indicating a threshold or ceiling effect.

According to the researchers, this threshold is higher than the standard cutoff for diagnosing folate deficiency (less than 10 nm/L).

Obese mothers in the study tended to have lower folate levels than normal weight mothers. However, when the researchers examined obese mothers only, they found that children of obese mothers with adequate folate levels (at least 20 nm/L) had a 43 percent lower risk of obesity compared to children of obese mothers with lower folate (less than 20 nm/L). The children in the latter group had higher body mass index-for-age z-scores (BMI-z) — a measure of body fat in children.

According to the authors, establishing an “optimal” rather than “minimal” folate concentration may be beneficial for women planning a pregnancy, especially obese women.

“Folate is well-known for preventing brain and spinal cord defects in a developing fetus, but its effects on metabolic disorders, such as diabetes and obesity, is less understood,” said Cuilin Zhang, M.D., Ph.D., NICHD senior investigator and a study co-author. “This study uncovers what may be an additional benefit of folate and identifies a possible strategy for reducing childhood obesity.”


Original source: https://www.nih.gov/news-events/news-releases/proper-maternal-folate-level-may-reduce-child-obesity-risk

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Systematic Review of Factors Influencing Farmers’ Market Use Overall and among Low-Income Populations

July 2016, The Academy of Nutrition and Dietetics


Recent evidence indicates a widening gap in fruit and vegetable (F/V) consumption between high- and low-income Americans. This gap is related, in part, to decreased access to food retailers that sell fresh F/V in low-income communities. Farmers’ markets are identified as a strategy for improving F/V consumption by increasing access to these foods.


The aim of this systematic review was to examine literature published from 1994 to 2014 to identify facilitators and barriers of farmers’ markets use, particularly among low-income consumers.


Peer-reviewed literature was identified in Ebsco Host (Academic Search Complete). Inclusion criteria for abstract review was primary research focused on farmers’ market use identifying 87 studies for full-text review. Full-text review identified articles focused on facilitators and/or barriers of farmers’ market use resulting in 49 articles. At least two reviewers completed review of all articles.


Of the 49 articles, 39% specified inclusion of low-income consumers and fewer than 15% focused on racial and ethnic minorities. Few studies were guided by theory and/or used standardized metrics. Results indicate farmers’ market use is influenced by multiple economic, service delivery, spatial-temporal, social, and personal factors. Among studies that included low-income populations (n¼19), key barriers to farmers’ market use were perceptions that food assistance benefits were not accepted, belief that food variety at farmers’ markets was limited, lack of access to transportation, lack of racial/ethnic diversity in the market space, and mismatch between markets and personal lifestyles. There is wide variation in study design and reporting standards and infrequent use of standardized measures limiting comparisons across studies.


There is a need to establish valid and reliable metrics and reporting standards for evaluating farmers’ markets. Findings may inform interventions, programs, and policies to promote farmers’ market use.

Darcy Freedman, the lead author on the study, presented at the recent NCCOR Connect and Explore webinar.


Original source: http://ac.els-cdn.com/S2212267216001568/1-s2.0-S2212267216001568-main.pdf?_tid=7c2a3ad8-3fa6-11e6-a95d-00000aab0f6c&acdnat=1467389676_da4930efd25586a56f3737dae23999a9

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