November 2016

Connect & Explore: Assessing Prevalence and Trends in Obesity: Navigating the Evidence

NCCOR, November 30, 2016

Understanding prevalence and trend estimates for childhood obesity is essential to informing research, policies, and interventions. However, different survey or measurement approaches can produce different prevalence rates and trends, painting a varying picture of the state of childhood obesity in America.

On December 5, NCCOR is hosting the next Connect & Explore webinar on Assessing Prevalence and Trends in Obesity: Navigating the Evidence. A consensus committee convened by the National Academies of Sciences, Engineering, and Medicine recently explored how reports on obesity prevalence and trends differ and what these differences mean for interpretation and application. This webinar, presenting insights from the resulting National Academies report, will provide an overview of the various data collection and analysis approaches that have been used in developing reports on the prevalence and trends in obesity across population groups, but particularly as they relate to children and adolescents.

Connect & Explore gives you the chance to hear from leading experts from the National Academies of Science, Engineering, and Medicine Committee on Evaluating Approaches to Assessing Prevalence and Trends in Obesity.

Join us on Monday, December 5, at 3 p.m. ET, for the one-hour event. Guest speakers include:

• Shari L. Barkin, M.D., M.S.H.S. (Chair), William K. Warren Foundation Chair and Professor of Pediatrics, Director of Pediatric Obesity Research in the Diabetes Center, and Chief of General Pediatrics at Vanderbilt University School of Medicine
• Lynn Blewett, Ph.D., Professor, Division of Health Policy and Management, School of Public Health, Director, State Health Access Data Assistance Center (SHADAC)
• Jackson P. Sekhobo, Ph.D., M.P.A., Director of Evaluation, Research, and Surveillance in the Division of Nutrition of the New York State Department of Health
• Cynthia L. Ogden, Ph.D, M.R.P, NHANES Analysis Branch Chief/Epidemiologist, National Center for Health Statistics, Centers for Disease Control and Prevention

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

Join the conversation! 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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Moving From Test Market to All Markets: Translating Food Purchasing Research into Evidence-based Strategies to Improve the Purchase of Healthier Items Workshop Recap

NCCOR, November 30, 2016

On October 17, 2016, NCCOR brought together interested researchers, food retailers, and practitioners working via the Supplemental Nutrition Assistance Program–Education (SNAP-Ed) and other public and private programs that promote healthy food purchasing by low-income consumers to participate in a workshop to engage in dialogue and form working relationships to enhance each other’s work.

The workshop began with opening presentations by Katie Wilson, MS., PhD., Deputy Under Secretary for Food Nutrition and Consumer Services, U.S. Department of Agriculture (USDA) and Mary Bohman, PhD., Administrator of the Economics Research Service, USDA. Following these opening presentations attendees listened to four sets of panels on topics covering the latest data from USDA’s National Household Food Acquisitions and Purchases Survey (FoodAPS), how retailers, researchers and practitioners can work together to achieve common goals, how healthy retail can be achieved under SNAP-Ed and other programs like Share Our Strength’s Cooking Matter’s at the Store, and additional resources and funding opportunities from various agencies and organizations.

Following the panel presentations, attendees came together to highlight their different perspectives and backgrounds to discuss how to move the dialog forward on research and its translation into evidence-based practice, promising opportunities for partnerships among researchers, retailers, and practitioners, as well as the value of partnerships to the retailers that make participating in research appealing.

Some takeaways from these small group discussions include:

• Researchers should co-create research questions with retailers to obtain cooperation needed to conduct studies
• Research questions and interventions need to be simple and straightforward in order for retailers to want to participate, (i.e. consider staff resources at the store)
• Researchers need to speak the same language as retailers, so talk about surveys that are being done with customers as market research, etc.
• Consider hosting a worksite wellness demonstration at a retail store as a way to begin to build a relationship with the retailer
• Sales and the bottom line are the most important aspect to engaging retailers in these efforts; emphasizing the marketing benefits of having these kinds of initiatives is also important (i.e., stores can market themselves as the healthy option in their community)
• Researchers/retailers need to be patient to see changes in sales data, as it can take about 6 months for a change in the store to demonstrate an outcome
• Sixty percent of shoppers do not even go in produce section, so retail outlets need to place produce in cross-merchandised areas
  • Examples: bananas by cereal aisle, avocados near meat, soup mix (veggies) near meat section, strawberries near milk—all of these have been shown to increase sales of both items

Learn more about the Healthy Eating Research/NOPREN Healthy Food Retail Workgroup

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CDC Reports Modest Drop in Obesity Among 2 to 4-year-old WIC Participants

34 states report a modest decrease in obesity among young children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) between 2010 and 2014.

The percentage of obesity among 2-4 years olds participating in WIC decreased from 15.9 percent in 2010 to 14.5 percent in 2014.

All major ethnic groups saw modest improvements in obesity prevalence among young children enrolled in WIC.

These findings come from a new study from the Centers for Disease Control and Prevention (CDC) and the United States Department of Agriculture (USDA), published in today’s Morbidity and Mortality Weekly Report.

In 2013–2014, the overall obesity prevalence in all children in the US aged 2–5 was 9.4%. Childhood obesity is more prevalent among lower-income young-children.  These children are often disproportionately affected by barriers such as access to healthy, affordable foods and beverages and opportunities for low-cost physical activity.

Authors noted several factors may have contributed to the drop in obesity among WIC toddlers:

• WIC food package redesign: In 2009, the WIC food packages were redesigned to align with the U.S. Dietary Guidelines for Americans.
• National awareness: Obesity programs and reports such as Let’s Move! and the Institute of Medicine recommendations for childhood obesity prevention policies raised awareness of this issue.
• Federal support of state and local health agencies: CDC provides funding, training, and tools to all 50 states and D.C. to address childhood obesity prevention in Early Care and Education settings. 

Other factors that could be responsible for the forward progress are community and state/local partnerships. Focused investments by foundations and non-profits have played an important role in supporting communities to address childhood obesity across the nation. State and local leaders are partnering with civic leaders and child care providers to make community changes that promote breastfeeding, healthy eating and active living.

Read the Report

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ERS Makes FoodAPS Purchase and Nutrition Data Easier to Access

USDA’s Economic Research Service (ERS) has developed a unique treasure trove of data from a survey on food purchases and acquisitions by U.S. households – USDA’s National Household Food Acquisition and Purchase Survey FoodAPS. To protect individual survey respondents’ privacy, access to the data had been restricted to researchers from academic institutions and government agencies. Now, a modified version that aggregates information so individuals cannot be identified, but still provides valuable data for research and planning is available to everyone.

What can FoodAPS data tell us? USDA’s investment in FoodAPS was undertaken to fill a critical knowledge gap and encourage research that can support an evidence-based approach to Federal food assistance policies and programs. The data are being used to address a range of questions such as where households acquire food in a typical week, which foods they acquire, how much they pay for the food and how the acquired foods match recommendations for a healthy diet.

What makes FoodAPS data unique? FoodAPS is the first nationally representative survey of American households to collect data on food purchases and acquisitions from all sources, including grocery stores, restaurants, workplaces and schools as well as data on food acquired free of charge (e.g., food banks, friends). The nearly 5,000 sampled households include low-income households and participants in the Supplemental Nutrition Assistance Program (SNAP), making the data particularly valuable to policy makers and program managers. In addition, FoodAPS links food acquisitions with detailed information about the local food environment (e.g., number of food stores near respondents’ locations) and nutrients in the food acquired by the respondents over a seven-day period.

To broaden access to the FoodAPS data, ERS has posted pubic-use files on the ERS website that users can download in several file formats. To protect the identity of the surveyed households, identifying variables (like place names and specific locations) are removed and others are slightly modified (like categorizing a person’s age).

Who will find FoodAPS data useful? In addition to policy makers and academic researchers, potential users include nutrition advocacy organizations, state and local agencies that address food-related issues, and journalists covering nutrition and food security topics. We invite potential users to explore this unique dataset.

Download the Public-Use Data Files and Codebooks

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Nutrition and Marketing of Baby and Toddler Food and Drinks

Birth to two years is a critical period for developing healthy food preferences and eating habits and preventing childhood obesity. Baby Food FACTS provides a comprehensive analysis of the nutritional content of food and drink products marketed to parents for their babies and toddlers (up to age 3), the messages used to promote these products, and how well the marketing messages correspond with expert advice about feeding young children.

Read the Report

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Foods Typically Purchased by Supplemental Nutrition Assistance Program (SNAP) Households

The Food and Nutrition Service (FNS) awarded a contract to IMPAQ International, LLC, to determine what foods are typically purchased by households receiving Supplemental Nutrition Assistance Program (SNAP) benefits. This study examined point-of-sale (POS) food purchase data to determine for what foods SNAP households have the largest expenditures, including both SNAP benefits and other resources, and how their expenditures compare to those made by non-SNAP households.

SNAP, administered by FNS, is the nation’s largest nutrition assistance program. In 2011, SNAP participants redeemed over $71 billion in SNAP benefits in more than 230,000 SNAP-authorized stores. Given the magnitude of SNAP, FNS has a sustained interest in understanding the effects of the program. To date, FNS has studied SNAP household food consumption and expenditures using national surveys that generally rely on consumers to recall what they ate or to report or scan every purchase. This previous research has shown that the similarities in food purchases, consumption patterns, and dietary outcomes among low-income families and higher-income households are more striking than the differences.

By using POS data to compare the purchases of SNAP households to those of non-SNAP households, the current study provides more detail on food expenditure patterns than previous studies. This study examines two major questions:

• What food items are purchased by SNAP households?
• How do foods purchased by SNAP households compare to food purchased by non-SNAP households?

Read the Report

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Is Nutritious Food Really Pricier, And, If So, Is That Really the Problem?

November 25, 2016, The Washington Post

Nobody disagrees: We Americans eat badly. We eat too many calories, too much highly processed food and not nearly enough vegetables.

Why is that? Ask the question, and you get a lot of answers, which is appropriate for a matter as complex as a country’s diet. But one of the answers that bubbles to the top almost every time is that nutritious food just costs more.

Does it?

There are two relevant questions here. The first is empirical: Is healthful food more expensive? The second is behavioral: Is cost what stands between people and a better diet?

By one very straightforward measure, healthful eating does indeed cost more. If you look at cost per calorie (a reasonable measure, since calories are the one thing all food has in common, and we all need about 2,000 of them every day), nutrient-dense vegetables and fruits cost far more, on average, than the ubiquitous, nutrition-sparse sources of calories: refined grains, sugar and vegetable oil.

The fact that vegetables are, on average, more expensive than, say, Doritos doesn’t mean you have to abandon the idea of healthful eating and head for the snack food aisle. Sugar-snap peas and asparagus may bring up the average price of produce, but there are inexpensive calories in the category, too. Think sweet potatoes.

An ordinary supermarket (the one I shop at on Cape Cod) offers a variety of affordably priced calories to meet the daunting challenge of making your daily menu come in at under $4 per person, the average benefit under the Supplemental Nutrition Assistance Program, informally referred to as food stamps. Sure enough, there are the usual suspects: the processed foods that are a microwave away from being a meal. Kraft Macaroni & Cheese comes in at 13 cents per 100 calories. Similarly, there was a frozen burrito for 14 cents, canned beef ravioli for 17 cents and hot dogs for 10 cents. But the rock-bottom-cheapest meal option was instant ramen, at 6 cents, a price point so irresistible that I almost bought some.

As inexpensive as it is, ramen isn’t the cheapest source of calories at the grocery store. That honor belongs to — drumroll, please — all-purpose flour and vegetable oil, both of which cost all of 2 cents per 100 calories. Sugar, at 3 cents, rounds out that trifecta of low-nutrition, calorie-dense staples of the American diet.

No matter how cheap the processed foods are, the raw materials that go into them are even cheaper. And, if those raw materials are so very cheap for us, imagine how cheap they are for Kraft. So cheap that the company can manufacture a food out of them, box it, ship it and market it, and still sell it for pennies. Even so, you almost always do better, cost-wise, when you buy the ingredients and cook them yourself, which is one of the reasons that upgrading to a decent diet may cost less than you think. A 2013 review of studies quantifying the price of a healthful vs. unhealthful diet found that the healthful version cost $1.48 more per person, per day.

Although $1.48 doesn’t sound like enough to make much difference in the quality of your diet, it can buy a variety of cheap, nutritious staples: peanut butter (at 7 cents per 100 calories), whole-grain pasta (7 cents), whole-wheat flour (3 cents), eggs (10 cents), rolled oats (7 cents), pearled barley (8 cents), corn flour (3 cents), brown rice (4 cents), dried black beans (10 cents) and unpopped popcorn (9 cents). (Of course, plain old price isn’t the only issue. Not everyone has access to an ordinary supermarket, but, from a policy standpoint, that’s not an affordability problem, it’s an access problem. Not everyone lives in a home with a proper kitchen, but that’s a housing problem.)

In that list, we find the crux of the issue. The healthful meals you can make at a price point that competes with ramen are anchored by rice, beans and whole grains. And, if you have time and skill — a really big “if” — you can combine those with foods that cost a bit more, such as chicken thighs (13 cents), sweet potatoes (38 cents), carrots (30 cents), frozen corn (25 cents), walnuts (30 cents), yogurt (36 cents) or frozen broccoli (63 cents), and eat pretty well for under $4 per day.

Before we go on, let’s spend a moment on subsidies. Although farm subsidies have certainly had an impact on the price of staples, that impact is dwarfed by the inherent costs of growing crops as different as corn and broccoli. In that particular case, broccoli costs 50 times what corn does to grow (per calorie).

It’s also important to note that the same commodity programs that affect corn and soy subsidize rolled oats, pearled barley, lentils, peanut butter and whole-wheat bread. Although I’m in favor of revamping those programs (What do we want? Crop-neutral insurance!), they can’t shoulder all the blame for ramen. [A rallying cry for a crop program that could change everything]

Back to our dinner of chicken, carrots and black beans, and to the single parent, on a very limited budget, who has the challenge of trying to carve out the time to make it, only to have her (and it’s probably her) kids complain that what they really want is instant ramen.

Adam Drewnowski, director of the University of Washington’s Center for Public Health Nutrition and a longtime researcher in this area, tells me in an email, “Obesity is almost entirely an economic issue, and the higher cost of healthier foods is THE main problem,” but he acknowledges that factors other than money come into play. He mentions two in particular: skill and time, which can feed you well if money is in short supply.” Cooking at home . . . is one way to eat better for less,” he says.

So, sure, it’s possible to make a healthful dinner on a SNAP budget, but the other resources required — time and skill — may be in short supply as well.

Tonja Nansel, a senior investigator at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (an NIH institute), points out that, if cost were the major barrier, we’d expect higher-income groups to eat much better than lower-income groups. “The difference in diet quality isn’t that big,” says Nansel, although it’s hard to determine exactly what the difference is because of the limitations of data based on people’s ability to remember what they ate yesterday.

A 2013 study that attempted to quantify that difference found that the lowest-income group did indeed eat less-nutritious diets than the wealthiest group, but if you compare the lowest with the next group up, the diets are extremely similar. It’s not until you get to five times the poverty level that diets improve, and even than it’s not a big jump.

If cost were the primary driver of poor diets, we’d expect a significant income boost to correspond to a significant improvement in diet, particularly since a meaningful improvement can be had for $1.48 per day.

Nobody I’ve talked to disputes that cost is an issue. Likewise, nobody disputes that convenience and preference are also issues. But it’s hard to say what’s most important. “Most people prefer the taste of ramen to brown rice. They prefer chips to kale,” says Nansel. “The fact that we would rather not have to look at some of those other reasons is part of reason cost gets so much traction.”

Food isn’t just nutrition. Food is pleasure, something very-low-income people have very few sources of, says Nansel. That doesn’t mean we shouldn’t tackle cost at a policy level, she adds. “If we can make healthful food more affordable and accessible, we ought to.”

Looking at cost (or access, or education, or time) as a barrier to eating well is much more comfortable than looking at preference, which smacks of blaming the victim. The idea that our lousy diet was perpetrated on us, with the poor as the most vulnerable, gets around that problem. But until we acknowledge that we — rich and poor — are complicit in our food supply, that we help shape it every time we buy food we want to eat, we’re unlikely to improve it.

Original source: https://www.washingtonpost.com/lifestyle/food/is-nutritious-food-really-more-pricey-and-if-so-is-that-really-the-problem/2016/11/23/91ed1026-adeb-11e6-977a-1030f822fc35_story.html

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Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities

November-December 2016, Journal of Nutrition Education and Behavior

Abstract

Objective: To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index.

Methods: Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages.

Results: Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02).

Conclusions and Implications: Future studies should examine associations between elements of the in-store food environment, purchases, and consumption.

Original Source: http://www.jneb.org/article/S1499-4046(16)30714-X/pdf

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Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012

November 2016, Journal of the Academy of Nutrition and Dietetics

Abstract

Background: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children.

Objective: To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children.

Design: Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey.

Participants/setting: A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall.

Main outcome measures: Population proportions of sodium intake from major food categories, places, and eating occasions.

Statistical analyses performed: Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups.

Results: Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children’s sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast.

Conclusions: With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren’s sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

Original source: http://www.andjrnl.org/article/S2212-2672(16)31142-X/abstract

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Children's Health and Privacy at Risk from Digital Marketing

November 4, 2016, Eureka Alert

For the first time, researchers and health experts have undertaken a comprehensive analysis of the concerning situation in the World Health Organisation European Region regarding digital marketing to children of foods high in fats, salt and sugars.

The World Health Organisation (WHO) has published the report, which calls for immediate action by policy makers to recognise and address the growing issue of targeted marketing to kids through digital media.

Dr Emma Boyland, from the University’s Institute of Psychology, Health and Society, in collaboration with The Open University, WHO, University of Melbourne and Flinders University, produced the report which examines trends in media use among children, marketing methods in the new digital media landscape and children’s engagement with such marketing.

In the absence of effective regulations for digital media in many countries, children are increasingly exposed to persuasive and individually-tailored marketing techniques through, for example, social media sites and advergames. This trend persists, despite the stubbornly high rates of childhood obesity found almost universally in the WHO European region.

Food marketing has been identified by the scientific community as an important contributor to the so-called ‘obesogenic’ environment, where foods high in fats, salt and sugars are promoted extensively, are more visible, as well as cheaper and easier to obtain than healthy options. Food marketing has been consistently demonstrated to influence children’s food preferences and choices, shaping their dietary habits and increasing the risk of becoming obese.

Digital marketing offers a loophole for marketers, as there is currently little or no effective regulation and minimal efforts to control it. Furthermore, due to the ability to tailor adverts online to a specific audience, marketing online is potentially much more powerful and targeted to the individual child and their social network.

Often, parents do not see the same advertisements, nor can they observe the online activities of children and many therefore underestimate the scale of the problem.

Dr Emma Boyland, said: “The food, marketing and digital industries have access to an enormous amount of information regarding young people’s exposure to HFSS food marketing online and its influence on children’s behaviour, yet external researchers are excluded from these privately held insights, which increases the power imbalances between industry and public health.”

To address the challenges the report suggests a number of recommendations. These include States acknowledging their duty to protect children from HFSS digital marketing with statutory regulation, the extension of existing offline protection online and existing regulation of internet content being drawn on to compel private Internet platforms to remove marketing of HFSS foods.

Dr Boyland adds: “Children have the right to participate in digital media; and, when they are participating, they have the right to protection of their health and privacy and to not be economically exploited.”

Original source: https://www.eurekalert.org/pub_releases/2016-11/uol-cha110416.php

Full report: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2016/tackling-food-marketing-to-children-in-a-digital-world-trans-disciplinary-perspectives-2016

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Children Gain Weight Faster Over Summer Break Than in School

November 2, 2016, National Public Radio

Despite the lure of Halloween candy and Christmas treats, elementary school children actually gain weight faster over the summer, a study finds.

If you remember your childhood summers as filled with running around outside and doing cannonballs off the diving board, that may sound improbable. But a study published in Obesity on Wednesday is only the most recent research to show that the summer vacation is the danger zone for childhood obesity, suggesting that interventions need to move beyond what goes on during the school day.

The latest study looked at a nationally representative sample of 18,170 kids and tracked the changes in their body mass index, or BMI, from the start of kindergarten in 2010 through the end of second grade. Researchers found that over that period, the prevalence of obesity increased from 8.9 percent to 11.5 percent, and the prevalence of overweight increased from 23.3 percent to 28.7 percent.

All of that increase occurred during the two summer vacation periods, not during the three school years. Previous national and local studies point to the same trend.

“It really doesn’t appear that schools were ever the problem,” says Paul von Hippel, an associate professor of public affairs at the LBJ School of Public Affairs at the University of Texas at Austin, and an author of the study. Yet the conversation about combating childhood obesity often centers on schools, from cafeteria lunches to physical education to vending machine snacks.

There are a lot of possible reasons, though no definitive data, for why summers are when kids gain too much weight, says Jennette Moreno, a clinical psychologist at the Children’s Nutrition Research Center at the Baylor College of Medicine who wasn’t involved with the study but has researched the issue. For example, it’s not clear whether kids eat more in the summer, get less physical activity, or some combination of both.

It does seem that kids sleep less during the summer or have more irregular sleep-wake patterns, and disrupted sleep is associated with higher BMI. “My hypothesis is that without the structure of school, kids are going to bed at irregular times and parents are more relaxed about enforcing bedtimes. As a result, children’s sleep and circadian rhythms are disrupted,” says Moreno.

Kids often spend more time on video games and other screens in the summer, which a recent technical report from the American Academy of Pediatrics says is linked to a higher risk of obesity starting in early childhood.

Von Hippel says summer camps and summer learning programs may provide an opportunity to reduce obesity prevalence. Moreno says schools might address obesity in the same way they address the summer learning loss, with programs or challenges aimed at lowering risk factors.

Meantime, parents should try to “keep things as consistent as possible in terms of sleep and meal patterns,” says Moreno. Provide healthy food choices for your kids, give them plenty of opportunity for physical activity, and set limits on screen time, she advises.

The study’s authors say it’s plausible that the same risk factors are affecting kids after school and on weekends, though this research wasn’t designed to answer that question.

Original source: http://www.npr.org/sections/health-shots/2016/11/02/500269563/children-are-most-likely-to-gain-weight-in-summer-not-winter

Published Study: http://onlinelibrary.wiley.com/doi/10.1002/oby.21613/full

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To Fight Childhood Obesity, Task Force Recommends Screening All Kids Starting at Age 6

November 1, 2016, The Los Angeles Times

In a draft recommendation, the U.S. Preventive Services Task Force says all children ages 6 and older should be screened for obesity.

The fight against childhood obesity should begin in doctors’ offices with routine weight screening for all kids ages 6 and up, according to fresh advice from health experts.

Draft guidelines from the U.S. Preventive Services Task Force urge pediatricians and other clinicians to check the body mass index of children and adolescents to identify patients who would benefit from weight counseling programs. These “comprehensive, intensive behavioral interventions” have been shown to help participants change the trajectory of their weight gain, cutting their odds of a lifetime of obesity.

For kids, the official definition of obesity is having a body mass index in the top 5% for one’s age and gender, based on official growth charts. Ideally, that means only 5% of children and teens are obese. But in America today, 17% of kids have a BMI high enough to fit that description. (Another 32% are overweight, with a BMI that puts them between the top 5% and 15% on growth charts.)

Children who are obese suffer health problems such as asthma, sleep apnea, high blood pressure, insulin resistance and orthopedic issues. They are also more likely to develop psychological and mental health problems, according to research reviewed by the task force.

Reducing childhood obesity would reduce the incidence of these medical issues. But the larger goal of screening is to make a dent in the number of obese children who become obese adults. Most obese teens — nearly 80%, according to long-term tracking studies — are on track to be obese when they grow up.

Overall, childhood obesity has stabilized in the United States. But rates are still climbing for certain groups of kids, such as Latino boys and African American girls. The task force also noted that the proportion of obese kids who qualify as severely obese is growing.

The authors of the proposed guidelines are under no illusion that universal obesity screening will be a silver bullet. Even the best programs to modify kids’ behavior resulted in only a “moderate” benefit, they wrote. But the downside risks of screening are “small to none,” they wrote.

The types of programs that work involve at least 26 hours of counseling over several weeks or months. The more hours involved, the better the results.

Successful programs reviewed by the task force included counseling sessions not just for children who were obese but for parents and other family members as well. They taught patients how to improve their eating habits, including the importance of reading labels on packaged foods. They showed patients ways to exercise safely. They taught kids to keep tempting treats out of sight (and out of mind). And they helped them learn how to set goals for themselves, and monitor their progress toward reaching them.

In 16 clinical trials that tested these programs, most participants gained no more than 5 pounds while growing in height, leading to lower BMIs. Meanwhile, patients assigned to control groups gained up to 17 pounds.

On the psychological side, the programs resulted in small improvements in self-esteem, mental health and quality of life. The changes were too small to be statistically significant.

The task force also considered the pros and cons of two medications — metformin and orlistat — that are sometimes prescribed to help kids lose weight. In clinical trials, both drugs helped patients lose a little weight. But the amount — on the order of 5 to 7 pounds — was too small for doctors to be sure it would make a real difference for patients.

Against that modest benefit, studies found that orlistat (sold under the brand names Xenical and Alli) frequently caused side effects such as abdominal pain, cramps, oily stools and fecal incontinence.

In the end, the task force decided to recommend only behavioral interventions for weight loss. The panel did not consider bariatric surgery, noting that any patient heavy enough to be a candidate could be identified without screening.

The proposed guidelines were released Tuesday. Members of the public may comment on them until Nov. 28.

Original source: http://www.latimes.com/science/sciencenow/la-sci-sn-childhood-obesity-screening-20161101-story.html

Read the Draft Evidence Review: https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review156/obesity-in-children-and-adolescents-screening1

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