March 2016





NCCOR Connect & Explore Webinars: Promising U.S. and international strategies for reducing childhood obesity

March 10, 2016, NCCOR

While childhood obesity remains a global public health challenge, many communities around the world are showing signs of progress and demonstrating innovation in halting and reversing the childhood obesity epidemic. This March and April, NCCOR is hosting one regular and three special-event Connect & Explore Webinars to examine these promising strategies in the United States and abroad.

  • Connect & Explore Webinar – NCCOR’s Childhood Obesity Declines project: Exploring drivers of declines in the United States
    • Traditional NCCOR Connect & Explore Webinar
    • Tuesday, March 22, from 1:00 p.m. to 2:00 p.m. ET
    • Speakers: Nicola Dawkins-Lyn, ICF International; Tina Kauh, Robert Wood Johnson Foundation; Karol Fink, State of Alaska; Cathy Nonas, New York City Department of Health and Mental Hygiene; Amanda Wagner, Philadelphia Department of Public Health
  • Connect & Explore Special Event – Reducing childhood obesity disparities: Insights from global strategies to achieve health equity
    • Livestream from the Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions
    • Thursday, March 31, from 8:15 a.m. to 9:30 a.m. ET
    • Speakers: Vivica Kraak, Virginia Tech (Chair); Shiriki Kumanyika, African American Collaborative Obesity Research Network and Drexel University School of Public Health; Tim Lobstein, World Obesity Federation; Nicola Dawkins-Lyn, ICF International; and Karabi Acharya, Robert Wood Johnson Foundation (Discussant)
  • Connect & Explore Special Event – Learning from sugar-sweetened beverage tax evaluations in Mexico, South America, and the U.S. to reverse childhood obesity
    • Livestream from the Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions
    • Thursday, March 31, from 1:45 p.m. to 3:00 p.m. ET
    • Speakers: Lori Dorfman, Berkeley Media Studies Group (Chair); Lynn Silver, Public Health Institute; Shu Wen Ng, University of North Carolina at Chapel Hill; Steven L. Gortmaker, Harvard University School of Public Health; Mauricio Hernández-Avila, Mexican National Institute of Public Health (Discussant)
  • Connect & Explore Special Event – Importing, adapting and evaluating Open Streets & Cicloviá to increase physical activity levels
    • Livestream from the Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions
    • Friday, April 1, from 8:15 a.m. to 9:30 a.m. ET
    • Speakers: David Berrigan, National Cancer Institute (Chair); Olga Sarmiento, University of Los Andes; Michael Pratt, Emory University Rollins School of Public Health; J. Aaron Hipp, North Carolina State University; Gil Penalosa, 8-80 Cities (Discussant)

On Tuesday, March 22, NCCOR’s Connect & Explore Webinar will highlight the drivers of declines, particularly those that influence disparities. NCCOR’s Childhood Obesity Declines project studied four U.S. communities—Anchorage, Alaska; New York City; Granville County, N.C.; and Philadelphia, Pa.—to better understand which strategies may have influenced reported declines. During this one-hour webinar, listeners will hear the study authors and community leaders in Anchorage, Philadelphia, and New York discuss the study’s key findings and community perspectives on declines.

NCCOR will turn its focus internationally on March 31 and April 1 with Connect & Explore Special Events in which we livestream three panel sessions from the Society of Behavioral Medicine (SBM) 37th Annual Meeting & Scientific Sessions. This special event will offer exclusive access to presentations from internationally renowned scholars. Experts will discuss high-impact childhood obesity strategies from around the world including scalable physical activity interventions in Latin America; sugar-sweetened beverage taxes in Mexico, South America, and the United States; and approaches to eliminating health disparities among U.S. and international populations disproportionately affected by obesity. Each webinar, hosted in partnership with SBM, will provide an overview of the issue, key insights, and implications for childhood obesity research and policy. The SBM sessions will be view-only.

“NCCOR is at the center of understanding the drivers of declines and thinking innovatively about solutions to childhood obesity,” said Todd Phillips, Director of the National Collaborative on Childhood Obesity Research. “Exploring lessons learned from communities in the United States and abroad can play a critical role in spurring future research and action.”

Join us for these upcoming events! Each event is free, but attendance is limited, so register today to receive webinar access. And spread the word to colleagues.

Register for one or more events in the series, Connect & Explore: Promising U.S. and international strategies for reducing childhood obesity

We encourage you to share this information on your social networks using the hashtags #ConnectExplore and #SBM2016. 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 To learn more about SBM, visit

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Publications & Tools

The first 1,000 days: Childhood obesity risk factors and interventions

A recent review found several early-life risk factors for developing childhood obesity, but few effective early-life interventions for preventing childhood obesity. Risk factors ranged from prenatal tobacco exposure to high infant weight gain. Study authors noted that early-life interventions that focus on multiple risk factors and are delivered across a variety of settings may help reduce childhood obesity risk.


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Report: Minimum stocking levels and marketing strategies of healthful foods

A new report from Healthy Eating Research provides recommendations to improve the healthfulness of foods and beverages sold in a variety of small retail food stores. The report identifies basic, minimum stocking levels for healthful foods and beverages structured around food categories and nutrition guidelines in the Dietary Guidelines for Americans. Marketing strategies for product placement, promotion, and pricing that retail food stores should adopt to enhance sales of healthful foods are also highlighted.


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National Nutrition Month Toolkit

March is National Nutrition Month. The Academy of Nutrition and Dietetics’ National Nutrition Month Celebration Toolkit provides a variety of resources to highlight the importance of making informed food choices and developing sound eating and physical activity habits. The toolkit includes key messages, event ideas, and a presentation.


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Childhood Obesity Research & News

In pregnancy, eating too much fish can raise a child’s obesity risk, study says

Feb. 15, 2016, Los Angeles Times

By Melissa Healy

Newborns whose mothers ate fish more than three times a week during pregnancy grew faster in their first two years of life and were more likely to be overweight or obese at 4 and 6 years old than were babies born to mothers who ate little to no fish during pregnancy, a new study says.

In a large study conducted across several countries, researchers found that the weight-related effects of a mother’s high fish consumption was more pronounced when the offspring was female.

Researchers suggested two explanations for their finding: that the Omega-3 fatty acids found plentifully in fish might predispose fetal stem cells to differentiate into fat cells, or that pollutants found in fish disrupt fetal hormones related to metabolism and prompt greater fat storage. But they acknowledged that the possibility that contaminants are to blame for the effect is “speculative,” since the study’s authors had no measure of the persistent organic pollutants in the fish the women ate.

In July 2014, the Food and Drug Administration and the Environmental Protection Agency recommended that pregnant women eat two to three servings (8-12 ounces) of fish per week. The agencies’ advisory recommended that pregnant women steer clear of fish known to be contaminated with mercury (tilefish from the Gulf of Mexico, shark, swordfish and king mackerel, for example) and choose instead salmon, shrimp, pollock, light canned tuna, tipalia, catfish and cod.

The authors of the new study, published Monday in the journal JAMA Pediatrics, said their findings “are in line with” the EPA and FDA advisory.

The study tracked 26,184 pregnant women and their children, born between 1996 and 2011 in the United States and across Europe. They observed the growth patterns and weight status of the children up to the age of 6 years old. The pregnant women, who answered questionnaires about their food intake, reported they ate anywhere from less than half a serving of fish weekly (in the Netherlands, Belgium, and Ireland) to as many as seven servings of fish per week (in Spain and Portugal).

The Massachusetts women that made up the U.S. study cohort ate an average of one to two servings of fish per week.

At 4 and 6 years old, children born to women who had had the highest level of fish consumption during pregnancy were 14 percent and 22 percent more likely to be overweight or obese than were babies born to women who ate the least fish. In their first two years of life, the babies of heavy fish eaters were 22 percent more likely to have had a rapid increase in growth than were the babies of women who ate little fish in pregnancy.

Largely scared by reports of mercury poisoning, U.S. women have been eating little fish during pregnancy, and public health campaigns have urged them to consumer more. Omega-3 fatty acids, which are plentiful in many kinds of fatty fish, are critical building blocks for the development of the fetal brain and retinal tissues. These essential fatty acids may also help determine the length of fetal gestation and ward off a mother’s depression during pregnancy or after giving birth.

Women who eat at least 12 ounces of oily fish per week have been shown to give birth to children who have better childhood IQ scores, fine motor coordination, and communication and social skills, along with other benefits.

But, as a 2014 article on the subject noted, the U.S. government’s new advice on fish consumption is “complicated.” The new research findings are likely to make it even more so, underscoring the importance of not eating too little or too much.

The authors of the current study — a team of researchers hailing from the 11 countries where women and their babies were participants — say the next step might be to try to better understand why a pregnant woman’s fish consumption, as well as other dietary patterns, appears to have different effects on a female baby than it does on a male child. They suggested that researchers should delve more closely into placental tissue to glean how intra-uterine factors such as diet could have sex-specific effects.


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The crippling thing about growing up poor that stays with you forever

Feb. 12, 2016, The Washington Post

By Roberto A. Ferdman

Poverty has a way of rearing its ugly head, slipping into the cracks in people’s lives when they’re young and then re-emerging later in life. Sometimes it happens in ways that are easily observable—what poor babies are fed, for instance, has been shown to alter what they crave as adults, creating life-long affinities for foods that might be better left uneaten. But sometimes the influences are hidden, and all the more insidious as a result.

A team of researchers, led by Sarah Hill, who teaches psychology at Texas Christian University, believe they have uncovered evidence of one such lingering effect. Specifically, Hill and her colleagues found that people who grow up poor seem to have a significantly harder time regulating their food intake, even when they aren’t hungry.

“We found that they eat comparably high amounts regardless of their need,” said Hill.

The researchers, interested in exploring why obesity is more prevalent in poorer populations, devised three separate experiments, which tested how people from different socioeconomic backgrounds behaved in front of food.

In the first, they invited 31 female participants into their lab, who were asked how long it had been since they had eaten, and how hungry they were. They were then given snacks (cookies and pretzels), which they were free to eat or leave be, as they pleased. When they were finished, Hill and her team measured the number of calories each consumed. The discrepancy between how the participants ate was alarming.

Those who grew up in higher socioeconomic households exhibited normal consumption behavior—eating when they were hungry, saying no thank you to the snacks when they were full. Those who grew up in lower socioeconomic households, meanwhile, ate no matter how hungry they were.

A single experiment, however, isn’t nearly enough to establish a convincing connection. So they took it a step further.

This time they invited 60 female participants, each of whom was asked to refrain from drinking or eating for five hours. Half of them were given Sprite, a caloric beverage, while the remaining half sipped on sparkling water, which has no calories. Then, they too were given snacks (cookies and pretzels), which they were free to eat or leave be, as they pleased. And, once again, what Hill and her team observed was eye-opening.

“It’s incredible, it’s as though the soda didn’t register for those whose socioeconomic status as a child was low,” said Hill. “It went down like water.”

Those who grew up in higher socioeconomic households ate far less when they had consumed a Sprite, while those who grew up in lower socioeconomic households ate regardless of the beverage they had been given.

In the third and final experiment, the researchers replicated the second, but added two tweaks. They invited 82 participants, which included men this time, and measured each participants’ blood glucose to see if their blood sugar levels mediated food intake as they should.

Yet again, only those who hadn’t grown up in poor households seemed to properly regulate their food intake.

“We expected to observe these differences, but not this clearly or consistently,” said Hill. “I think it points to how the conditions poorer children face when young could be leading them to behave in ways that promote things like overeating and obesity.”

Hill singles out childhood poverty, because she and her team asked participants not only for their socioeconomic statuses as children, but also their current socioeconomic statuses as adults, and, rather incredibly, the abnormal eating patterns only correlated with the former.

“I was very surprised by this,” she said. “We really thought there would be an association with both.”

The reason why people who grow up in poorer households seem to have trouble controlling how much they eat when they’re not actually hungry is not entirely clear. But there are likely a few things going on.

For one, Hill posits that growing up in poorer households, which tend to have less educated parents, could lead to less of an awareness of one’s body and the changes that it undergoes. “If they aren’t in tune with their bodies, they might not be in tune with their bodily needs,” she said. “And that’s kind of what the results suggest.”

There might also be a form of conditioning that’s tied to the actual circumstances in which poorer families encounter and experience food. For those who never had to worry about a meal, foregoing a snack is no big deal—it’s an afterthought. But for those who did, it could mean the difference between a good night’s sleep and hours awake in bed.

“When you grow up in these types of environments, you’re effectively being trained to eat when you can instead of when you’re hungry,” she said. “Something about that experience could be leftover.”

Traci Mann, who teaches psychology at the University of Minnesota and has been studying eating habits, self-control and dieting for more than 20 years, has a slightly different theory.

People, she says, begin life perfectly capable of starting and stopping to eat when they are hungry and when they are full. “Babies can do it—breast feeding babies do that exactly (as long as the mom doesn’t mess it up)—and small kids as well.”

As the years go by, we tend to lose this ability to some extent, forcing us to rely on other cues—like memory. Certain people, however, lose the ability faster and more broadly than others. A perfect example are people Mann calls “chronic dieters,” who are constantly restraining what they eat. By depriving themselves of calories, they end up triggering biological changes in their bodies that actually make it harder for them to resist food. And this, she says, is likely what’s happening with those born into lower socioeconomic statuses.

“It’s not terribly surprising that a childhood of caloric deprivation (due to financial issues) would lead to the same long-term problems that you see among chronic dieters,” she said. “Essentially, eating when not hungry.”

However similar the pattern of behavior, the implications are still unsettling.

If there is such a gap between how poor and rich children interact with food that carries over to rest of their lives, it complicates our understanding of why here in the United States, contrary to international trends, poor people are far more prone to obesity than their wealthier counterparts. Many have posited that it’s not how much poorer households are eating, but what they are eating that has caused this trend. And there is plenty of reason to believe there is truth to this—studies have shown, after all, that lower income families choose substantially less healthy foods than others. The harms of unhealthier diets, however, are all the more nefarious when they’re coupled with a fractured ability to regulate eating.

Hill warns that her team’s findings are still preliminary. “We don’t know exactly what the mechanism is, or how self-aware the people who eat even when they aren’t hungry are,” she said. “We need to pursue more research to figure out what is causing these troubling patterns of behavior.”

She also says that just because the pattern exists, doesn’t mean it’s not something we can change

“There’s no reason to think we can’t help them override this.”

But the fact that the patterns exists steepens what we already know to be an uphill climb for those born into poverty in the United States. The tentacles of poverty touch many different aspects of people’s lives. Food is a particularly apt example—food inequality, whereby America’s wealthiest people eat well, while the country’s poorest eat, well, poorly, is not only real, but worsening—but it’s hardly the only one. Poverty has, for instance, been shown to shackle those who are born into it, severely limiting their ability to succeed in society—socially, academically, and financially.

Increasingly, it seems the key to breaking the cycle of poverty might lie in understanding that the gap begins to grow at a very early age, cementing itself in ways that make it very difficult to untangle. And there are few things as stark as the difference between how poor and rich kids develop relationships with food.


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American teenagers are eating better: Study

Feb. 9, 2016, TIME

By Alice Park

A study finds that adolescents are starting to make better food choices, but we shouldn’t be so quick to credit the dietary guidelines.

Lately, the news about children and obesity hasn’t been good. That’s because the numbers have been trending in the wrong direction; for years, obesity rates have inched upward, and while they haven’t yet started to drop, they have begun to plateau. But other signs of health trouble, including diabetes, hypertension, and heart disease, are also on the rise.

Yet in a study reported in the journal Pediatrics, researchers led by Dr. Marc DeBoer, associate professor of pediatrics at the University of Virginia, found encouraging news about some of these obesity-related health conditions. They analyzed data involving about 5,000 teens for signs of metabolic syndrome, a condition that increases risk of heart disease and includes obesity, high blood sugar, high levels of triglycerides (which mostly come from starches and carbohydrates), high blood pressure, and low levels of the good cholesterol HDL. Overall, DeBoer found that severity of metabolic syndrome—or how deeply entrenched these risk factors were for the teens—declined between 1999 and 2012, even while their BMI, a measure of height and weight, increased.

The decline in metabolic syndrome could be an encouraging trend for this generation of teens as they become adults. Addressing factors like high blood pressure, cholesterol, and weight can significantly lower the risk of heart disease and diabetes later in life.

When the scientists dissected the data more carefully, they found that the decrease in metabolic syndrome could be traced mostly to rises in HDL levels and drops in triglycerides. But does that mean that teens are eating less red and processed meats, which contain lots of saturated fat, and adding more fish and vegetables to their diet, which are high in the heart-healthier HDLs? Are their lower triglyceride levels due to cutting out processed and refined foods, like chips, that are high in carbohydrates?

Maybe, says DeBoer. “There was a consistent drop in the total number of calories consumed among adolescents,” he says. “And there was a consistent drop in the percentage of calories consumed that were carbohydrates, and an increase in the percentage of calories consumed that were from unsaturated fat. All of this is in the direction of recommendations from dietitians and shows that adolescents are starting to move in the right direction of consuming fewer calories, less carbohydrates, and more unsaturated fat,” he says.

But before you think that teens have suddenly become docile students of nutritional information, it’s worth noting that the study still doesn’t directly prove that changes in dietary advice in the 2000s have definitely changed teen eating habits. DeBoer notes, for example, that in that same time period, adolescents (and adults) have become more sedentary, so it’s not surprising that they might be consuming fewer calories overall since they aren’t as active. That could explain why teens are eating fewer calories but their BMIs are still climbing upward. The researchers tried to see if exercise levels had any correlation to the metabolic syndrome measures, but the teens were only asked about physical activity during the later years of the study. With the data he did have, DeBoer didn’t see a significant relationship between minutes spent exercising and metabolic syndrome.

But while the government’s concerted effort to promote healthier eating habits by encouraging people to eat more plants, vegetables, and fish may not be entirely perfect, it could be having some effect on improving the diets of young people, he says. “I would like to use the data to empower teenagers to tell them this study suggests that lifestyle changes you can make will help your metabolic syndrome severity,” he says. “I hope this motivates adolescents toward a healthier lifestyle.”


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Is more physical education at school linked to higher student math scores?

Feb. 9, 2016, The Washington Post

By Perry Stein

The amount of time students spend doing physical activity in school appears to be linked to higher standardized math scores in D.C. schools, according to a new American University study that examined the success of the city’s Healthy Schools Act and found that schools offering more physical activity had significantly better math success.

The law, passed in 2010, requires D.C. public and public charter schools to adhere to requirements for what food must be served and how much physical activity should be built into each school week. The schools received funding as part of the legislation and were required to report how they implemented the program.

“This finding demonstrates that students’ academic performance improves when there’s a balance between time spent on physical education and time spent on learning,” said Stacey Snelling, dean of American University’s School of Education.

Since the Healthy Schools Act was passed, the District’s schools have been required to incrementally increase the amount of physical education offered to elementary and middle school students each year. In the 2014-2015 school year, elementary school students should have received an average of at least 150 minutes per week, while middle school students should have received an average of at least 225 minutes.

Schools across D.C. struggled to meet those targets for physical education, but those that provided about 90 minutes each week saw higher standardized math scores, according to the report.

The study divided the city’s elementary schools into four groups based on how much physical education they offered: the lower 25 percent, lower-middle 25 percent, upper-middle 25 percent and upper 25 percent.

The researchers then took the average DC CAS math proficiency score from the 2012-2013 school year for each of these four groups and found that schools offering more physical activity posted higher math scores. The upper 25 percent had an average of 151 minutes of physical education and saw an average math proficiency rate of 56.66. The lower 25 percent had an average of 29 minutes of physical education per week and an average math proficiency rate of 47.53. Some of the findings also were published in the academic journal Appetite.

Sarah Irvine Belson, one of the authors of the report, said schools offering the most amount of physical education time are distributed relatively evenly throughout the District and are not clustered in wealthier ­neighborhoods.

Researchers graded each school on how it implemented various aspects of the legislation — including building school gardens, serving healthy lunches, and offering ample physical education time — on a 33-point scale. They found that, despite socioeconomic differences, there were no significant variations in how schools performed on the 33-point-scale across the District’s eight wards.

The researchers said there are limitations to the findings: The data is based on schools’ self­-reporting, which leaves room for error, and many schools have opened and closed during the five-year study period, yielding some data inconsistencies.

The D.C. Healthy Schools Act was passed to combat the area’s obesity rate, which varies greatly by ward. In Ward 3 — a wealthier area in the upper northwest part of the District — there was an obesity rate of 11.8 percent in 2012, according to government data. In Ward 7, a poorer ward east of the Anacostia River, the obesity rate was more than 36 percent.

D.C. Council member Mary M. Cheh (D-Ward 3), who authored the original 2010 legislation, applauded the report’s findings Tuesday, adding that although schools effectively provided more nutritious lunches, there is still more room for more physical ­activity.

“When children are fed and they are not hopping all around because their hungry, they’re better learners, and that’s translated throughout,” Cheh. “I was impressed with the findings.”


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