June 2016





NCCOR Connect & Explore: Evaluating Health Care-Community Collaborations: Community-Based Programs

June 10, 2016, NCCOR

The health care sector is working toward engaging communities to directly address population health, including childhood obesity prevention. The Affordable Care Act of 2010 stipulates that non-profit hospitals and health systems must engage in activities to improve the health of the communities they serve. Exploring the integration of clinic-community programs is vital for moving childhood obesity prevention efforts forward.

This month, NCCOR is hosting a Connect & Explore webinar on “Evaluating Health Care-Community Collaborations: Community-Based Programs.” The webinar will feature two case studies highlighting strategies used by clinics to engage communities in addressing childhood obesity. Presenters will discuss efforts to assess the reach, effectiveness, adoption, impact, and maintenance of programs at the community level.

Connect & Explore gives you the chance to hear from renowned researchers and practitioners on this pressing issue. Learn how clinics can effectively engage in obesity prevention efforts and effective models for evaluating success.

Join us on Wednesday, June 22, at 1 p.m. ET, for the one-hour event. Guest speakers include:

  • Dr. Darcy Freedman, PhD, MPH, an Associate Professor of epidemiology, biostatistics, and social work at Case Western Reserve University; Associate Director of the Prevention Research Center for Healthy Neighborhoods; and Director of the Ohio Building Capacity for Obesity Prevention Research Network. Dr. Freedman will share her experience conducting a five-year CDC-funded study in rural South Carolina to examine the feasibility of integrating a farmers market into the operations of a federally qualified health center.
  • Dr. Elsa Keeler, MD, MPH, FAAP, a Pediatric Physician with HealthPartners and Ms. Marna Canterbury, MS, RD, Director of Community Health at Lakeview Health Foundation. Dr. Keeler and Ms. Canterbury will share their experiences working with PowerUp and Bear Power, two community-wide movements helping youth and their families eat well and be active.

Stay tuned! Later this summer, NCCOR will host two more Connect & Explore webinars to further explore how clinics, health care providers, and health systems engage communities in addressing the childhood obesity epidemic.

You must register to receive webinar access. The event is free, but attendance is limited, so tell a colleague and register today!

Register for the Connect & Explore Webinar: Evaluating Health Care-Community Collaborations: Community-Based Programs

Please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will also be live tweeting the event, so be sure to follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on www.nccor.org.

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USDA releases new guide for SNAP-Ed evaluation

Since 2012, NCCOR has worked with USDA to promote evidence-based and actionable tools consistent with the context and policies of the Supplemental Nutrition Assistance Program (SNAP). SNAP-Education (SNAP-Ed), the nutrition education and obesity prevention arm of the SNAP, aims to increase the likelihood that SNAP-Ed eligible households will make healthy diet and physical activity choices within a limited budget. SNAP-Ed is central to USDA efforts to improve nutrition and prevent or reduce diet-related disease and obesity among SNAP recipients. As a result of the Healthy, Hunger-Free Kids Act of 2010, changes in policies, systems, and environments (PSEs) were to be layered with direct nutrition education and marketing to enable, promote, and support healthy behaviors among low-income people and their communities.

States that are now implementing comprehensive programs with direct education, social marketing, and PSE changes do not have an established or streamlined mechanism to evaluate program effectiveness and report results to funders. Working together, NCCOR, USDA’s Food and Nutrition Services (FNS), the Association of SNAP Nutrition Education Administrators (ASNNA), and more than 28 states, contributed and developed theSupplemental Nutrition Assistance Program Education (SNAP-Ed) Evaluation Framework: Nutrition, Physical Activity, and Obesity Prevention Indicators.

The evaluation framework is an effort that began in 2013 by the USDA/FNS Western Regional Office, was updated in 2014, and finalized at the national level in 2016. The evaluation framework includes a focused menu of 51 evaluation indicators that align with the SNAP-Ed guiding principles and lend support to documenting changes resulting from multiple approaches for low-income nutrition education and obesity prevention. These approaches include individual, group, and family nutrition education and physical activity promotion and related interventions; comprehensive, multi-level interventions in environmental settings; and community and public health approaches that reach a large segment of the population.

Presented in a logic model format, the framework has excellent potential for informing multi-year planning and evaluation when State SNAP Agencies and providers select short-term (ST), medium-term (MT), long-term (LT), and population-results (R) indicators that are related to each other through time. Practitioners can use the framework to identify indicators of success and inform program improvements when implementing multi-component programs with a focus on social marketing or PSE interventions included in the SNAP-Ed Strategies and Interventions: An Obesity Prevention Toolkit for States, as well as when reporting PSE changes and evaluating obesity prevention potential for interventions not yet included in the toolkit.

The interpretive guide to the SNAP-Ed Evaluation Framework identifies and explains the indicators, outcome measures, and preferred methodologies for tracking success and developing state- and local-level SNAP-Ed objectives and reporting program evaluation to FNS, other funders, and program stakeholders. The framework offers invaluable benefits to program implementers by offering a roadmap that monitors program effectiveness, informs continuous program improvement, and generates a consistent set of program outcomes of interest to stakeholders and funders, including Congress.

View the Evaluation Framework

View the Obesity Prevention Toolkit for States

Read the Interpretive Guide

Learn more about NCCOR’s SNAP-Ed project

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Publications & Tools

Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions: Workshop Summary

To explore what is known about effective and innovative interventions to counter obesity in young children, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Obesity Solutions held a workshop in Washington, DC, on October 6, 2015, titled, Obesity in the Early Childhood Years: Emerging Science and Implementation of Promising Solutions. The workshop brought together leaders from many sectors to describe the science of early childhood obesity, from its prevalence and trends to the influence of epigenetics and sleep. Speakers and participants also explored risk factors for children, effective cross-sector solutions, and opportunities for interventions in the many settings where children live, learn, and play. This summary, released June 1, 2016, describes what was discussed at the workshop.

Read the full report

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Healthy Corner Stores Making Corner Stores Healthier Places to Shop

In this guide, you will learn how to lay the groundwork for planning and implementing a successful program in your community. It’s important to note that all communities are different, and there is no “one-size-fits-all” corner store program that works for every state, city, or neighborhood. A number of case studies, resources, and best practice recommendations from organizations that have effectively maintained these programs are included for additional learning and support.

Access the Healthy Corner Store Guide

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Childhood Obesity Research & News

Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988–1994 Through 2013–2014

June 7, 2016, The Journal of the American Medical Association

Importance: Previous analyses of obesity trends among children and adolescents showed an increase between 1988–1994 and 1999–2000, but no change between 2003–2004 and 2011–2012, except for a significant decline among children aged 2 to 5 years.

Objectives: To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011–2014 and investigate trends by age between 1988–1994 and 2013–2014.

Design, Setting, and Participants: Children and adolescents aged 2 to 19 years with measured weight and height in the 1988–1994 through 2013–2014 National Health and Nutrition Examination Surveys.

Exposures: Survey period.

Main Outcomes and Measures: Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011–2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted.

Results: Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988–1994 and 2013–2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% (95% CI, 15.5%–18.6%) and extreme obesity was 5.8% (95% CI, 4.9%–6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%–8.8%) in 1988–1994 to 13.9% (95% CI, 10.7%–17.7%) (P < .001) in 2003–2004 and then decreased to 9.4% (95% CI, 6.8%–12.6%) (P = .03) in 2013–2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%–13.4%) in 1988–1994 to 19.6% (95% CI, 17.1%–22.4%) (P < .001) in 2007-2008, and then did not change (2013–2014: 17.4% [95% CI, 13.8%–21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988–1994 (10.5% [95% CI, 8.8%–12.5%]) and 2013–2014 (20.6% [95% CI, 16.2%–25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%–5.0%] in 1988–1994 to 4.3% [95% CI, 3.0%–6.1%] in 2013–2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%–3.9%] in 1988–1994 to 9.1% [95% CI, 7.0%–11.5%] in 2013–2014; P < .001). No significant trends were observed between 2005–2006 and 2013–2014 (P value range, .09–.87).

Conclusions and Relevance: In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011–2014 was 17.0% and extreme obesity was 5.8%. Between 1988–1994 and 2013–2014, the prevalence of obesity increased until 2003–2004 and then decreased in children aged 2 to 5 years, increased until 2007–2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.


Original source: http://jama.jamanetwork.com/article.aspx?articleid=2526638

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An 'Added Sugar' label is on the way for packaged food

May 20, 2016, National Public Radio

The new, redesigned “Nutrition Facts” label is coming. The Food and Drug Administration has announced that the new label will be required on most packaged food by July 2018.

The big change: The label will have a separate line showing how much sugar has been added to each food. The amount of “added sugar” will be expressed in grams and as a percentage of a “Daily Value” — an amount of sugar consumption that nutritionists think would be reasonable as part of a daily 2,000-calorie diet. The label also will display calories per serving, and serving size, more prominently.

As one example, a 20-ounce bottle of Coke could show 65 grams of added sugar, representing 130 percent of a recommended daily intake.

The change reflects increasing concern about the amount of sugar that Americans consume, and the amount of sugar that’s added to common foods.

Several advocacy groups cheered the FDA’s move. Michael Jacobson, founder of the Center for Science in the Public Interest, released a statement saying that the new labels will allow consumers to make more informed choices and “should also spur food manufacturers to add less sugar to their products.”

The FDA proposed including “added sugar” on the label last summer, and many food companies, such as General Mills, opposed it. The companies argued that from a health point of view, it doesn’t matter whether sugar is added or is already present naturally in ingredients such as fruit. The existing labels already show the amount of total sugars in packaged food, and food manufacturers argued that this already tells consumers what they need to know.

Now that the FDA has made its decision, however, the Grocery Manufacturers Association does not seem interested in continuing the fight. The GMA released a statement welcoming the FDA’s revised food label and calling for a “robust consumer education effort” to help explain it.

The Sugar Association, on the other hand, was outraged, calling the FDA’s decision a “dangerous precedent that is not grounded in science.”


Original source: http://www.npr.org/sections/thesalt/2016/05/20/478837157/the-added-sugar-label-is-coming-to-a-packaged-food-near-you

Original press release:http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm502182.htm

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Big Soda has lost a big fight against sugar warnings

May 18, 2016, Fortune

Big Soda has reportedly failed to stop a new San Francisco law requiring ads for sugary drinks to display warnings about the products’ possible negative health effects.

San Francisco passed the ordinance targeting sugary drinks last summer—and the beverage industry immediately pounced. But federal District Judge Edward Chen ruled against drink makers’ request to halt the law’s implementation on Tuesday, the Wall Street Journal reports, dismissing arguments that warning labels would present a threat to the industry’s free speech rights or excessively burden beverage companies.

The request for a preliminary injunction was brought forward by trade group, the American Beverage Association, who were then joined by allies, the California Retailers Association and the California State Outdoor Advertising Association.

With the complaint dismissed, the first-of-its-kind San Francisco law is slated to go into effect on July 25. Ads for drinks with added sugars, including billboards, will have to say, “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.”

The beverage industry has come under fire in recent years as public health advocates have turned their focus to additives such as sweeteners, including through proposed soda and sugar taxes. There is some debate about whether or not the taxes curb both sugary drink consumption and obesity, but recent evidence has shown Mexico’s new soda tax to be more effective than expected.

While beverage makers have fought such taxes and proposed FDA changes to nutritional labeling requirements, Big Three soda companies Coca-Cola, PepsiCo, and Dr. Pepper Snapple Group pledged in 2014 to cut public calorie consumption from drinks by 20% by 2025.


Original source: http://fortune.com/2016/05/18/san-francisco-warnings-soda-ads/

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No link between late-night eating and child obesity: study

May 18, 2016, CNBC

A team of researchers from Britain and the Netherlands examined data from a large survey of eating habits among adults and children in the United Kingdom, called the National Diet and Nutrition Survey Rolling Programme.

They looked at the eating habits of 1,620 children split into two groups—768 children were 4–10 years old, and 852 children were 11–18 years old. The surveys were collected between 2008 and 2012. Six percent of the boys ate their meals after 8 p.m., as did nine percent of the girls surveyed. The group of late-evening eaters was relatively small, but still, the researchers found that the children in both groups who eat dinner between 8 p.m. and 10 p.m. were no more likely to be overweight than children who eat before 8 p.m. They published their findings this week in the peer-reviewed British Journal of Nutrition.

These findings seem to fly in the face of several previously published studies—and they even contradict the hypothesis the researchers had when they began this study.

The team noted in their paper, “our results do not support our original hypothesis that children with a later evening meal time have a greater risk of being overweight and/or obese, have higher daily intakes of energy and have poorer quality of diet.”

The researchers also noted that their study highlights the need for more research into how the timing of meals affects weight.

“Alongside changes in dietary quality and levels of physical activity, meal timing is one of many possible factors that has been suggested as influencing the trends in weight gain seen in children in the UK,” said study co-author Gerda Pot, a researcher at both King’s College London and Vrije Universiteit Amsterdam. “However, the significance of its role is under-researched.”

Studies published in 2009, 2011, and 2013, among others, all suggested that eating later in the day may lead to weight gain or inhibit weight loss. The exact reasons for that are unclear, but there are some theories.

One notion holds that people who eat later in the day have less time to burn off the meal before going to bed. Other theories revolve around the body’s natural rhythms. It is possible that eating late at night might throw the body out of sync with a daily rhythm, known as the Circadian rhythm, as NPR reported in 2015.

But as Vox reported in February, “science on timing of meals is still pretty preliminary and limited.”

This current study has a few important limitations of its own. First, it’s a study of children—results could differ among an adult population. Second, because it was a survey, there is the possibility that participants did not accurately report what children were eating.

The researchers said they plan next to study how sleep patterns and breakfast choices affect overall dietary quality, and weight.


Original source: http://www.cnbc.com/2016/05/18/no-link-between-late-night-eating-and-child-obesity-study.html

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Association between artificially sweetened beverage consumption during pregnancy and infant body mass index

May 9, 2016, JAMA Pediatrics


Importance: The consumption of artificial sweeteners has increased substantially in recent decades, including among pregnant women. Animal studies suggest that exposure to artificial sweeteners in utero may predispose offspring to develop obesity; however, to our knowledge, this has never been studied in humans.

Objective: To determine whether maternal consumption of artificially sweetened beverages during pregnancy is associated with infant body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]).

Design, Setting, and Participants: This cohort study included 3033 mother-infant dyads from the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a population-based birth cohort that recruited healthy pregnant women from 2009 to 2012. Women completed dietary assessments during pregnancy, and their infants’ BMI was measured at 1 year of age (n = 2686; 89% follow-up). Statistical analysis for this study used data collected after the first year of follow-up, which was completed in October 2013. The data analysis was conducted in August 2015.

Exposures: Maternal consumption of artificially sweetened beverages and sugar-sweetened beverages during pregnancy, determined by a food frequency questionnaire.

Main Outcomes and Measures: Infant BMI z score and risk of overweight at 1 year of age, determined from objective anthropometric measurements and defined according to World Health Organization reference standards.

Results: The mean (SD) age of the 3033 pregnant women was 32.4 (4.7) years, and their mean (SD) BMI was 24.8 (5.4). The mean (SD) infant BMI z score at 1 year of age was 0.19 (1.05), and 5.1% of infants were overweight. More than a quarter of women (29.5%) consumed artificially sweetened beverages during pregnancy, including 5.1% who reported daily consumption. Compared with no consumption, daily consumption of artificially sweetened beverages was associated with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk of infant overweight at 1 year of age (adjusted odds ratio, 2.19; 95% CI, 1.23-3.88). These effects were not explained by maternal BMI, diet quality, total energy intake, or other obesity risk factors. There were no comparable associations for sugar-sweetened beverages.

Conclusions and Relevance: To our knowledge, we provide the first human evidence that maternal consumption of artificial sweeteners during pregnancy may influence infant BMI. Given the current epidemic of childhood obesity and widespread use of artificial sweeteners, further research is warranted to confirm our findings and investigate the underlying biological mechanisms, with the ultimate goal of informing evidence-based dietary recommendations for pregnant women.


Read the full article: http://archpedi.jamanetwork.com/article.aspx?articleid=2521471

Read the editorial: http://archpedi.jamanetwork.com/article.aspx?articleid=2521469

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As early as first grade, children with severe obesity are more likely to be ostracized

May 25, 2016, Society for Research and Social Development

Childhood obesity has almost quadrupled among 6- to 11-year-olds since 1980. Today, approximately one in 20 children in the United States is severely obese and this public health threat costs the U.S. government billions of dollars annually. A new study has found that as early as first grade, severely obese children are more likely to be withdrawn and show signs of depression. They are also less liked by their peers, and more often picked on, teased, and made fun of than their classmates of healthy weights.

The study was conducted by researchers at Oklahoma State University, the University of Arkansas for Medical Sciences, the University of North Carolina-Greensboro, and West Virginia University. It appears in the journal Child Development. While most prior research has used stories about hypothetical obese peers to determine how obese children are treated, this study collected information from multiple sources about real children in different weight groups.

In this study, children were considered overweight if they had a body-mass index (BMI) for their age at or above the 85th percentile, obese if they had a BMI for their age at or above the 95th percentile, and severely obese if they had a BMI for age at or above the 99th percentile. Children were considered to be of healthy weight if their BMI for age was between the 5th and 85th percentile.

“Severe obesity is a clear psychosocial risk for children, even as early as 6 years old,” notes Amanda W. Harrist, professor of child development at Oklahoma State University, who led the study. “Children who are ostracized, as occurred with the severely overweight children in our study, suffer great harm, with feelings of loneliness, depression, and aggression, and these children are more likely to skip school and drop out later.”

Researchers looked at 1,164 first graders from 29 rural schools in Oklahoma to examine the social and emotional lives of obese children. Children lived in 20 towns in eight counties with adult obesity rates of 28% to 41% and came from mostly low-income, White families; about a fifth of the students were from American Indian families.

The more overweight the children were, the worse the consequences, the study found. Severely obese children were teased more than overweight children. The study found that obese children weren’t mentioned by peers when children were asked whom they liked to play with most and least. Severely obese children were actively rejected by their peers; they were frequently mentioned as their least favorite playmates and rarely mentioned as the most favorite. In terms of emotional health, severely obese children had more symptoms of depression than children who were overweight and of healthy weights. Furthermore, compared with overweight children, both severely obese and obese children had more physical symptoms (e.g., complaints of pain and visits to the school nurse) that may have been the result of stress or psychological concerns.

The study’s authors say that being teased and rejected by peers and being depressed as a result may exacerbate children’s struggles with weight over time. For example, obese children engage in emotional eating to deal with the pain of rejection, or they may avoid physical play with peers to avoid teasing, both behaviors that would lead to additional weight gain.

“Intervention or prevention efforts should begin early and target peer relationships,” suggests Glade L. Topham, associate professor of marriage and family therapy at Oklahoma State University, a coauthor of the study. “Interventions addressing the behavior of peer groups can limit exclusion and teasing, and help students form friendships.”


Original source: http://www.eurekalert.org/pub_releases/2016-05/sfri-aea052016.php

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