September 2016





NCCOR Tools Support Researchers and Practitioners

September 29, 2016, NCCOR

The Measures Registry and the Catalogue of Surveillance Systems are two free, online resources created by National Collaborative on Childhood Obesity Research (NCCOR) to help public health researchers and practitioners work more efficiently and effectively. Launched in 2011, these tools are a central repository of publicly available data resources that strengthen research and evaluation on the causes of childhood obesity.

In 2015, these two major NCCOR tools had over 15,000 total visits, with 5,535 visits to the Measures Registry and 9,890 visits to the Catalogue of Surveillance Systems. According to a recent survey, the Catalogue and Measures Registry helped researchers and practitioners identify datasets, evidence-based tools, and measures to support manuscripts, reports, and grant applications. The tools were used as classroom resources, in survey development, and to identify instruments and measures to evaluate the effectiveness of interventions. Initially, these resources were developed to support the work of researchers and practitioners within physical activity and nutrition sectors. Today, the Catalogue and Measures Registry have a broad reach and have become valuable tools for public health.

The tools are regularly updated and expanded. And with growing demand from users, NCCOR is now developing user guides specific to the four domains of the Measures Registry: individual diet, food environment, individual physical activity, and physical activity environment. These user guides, which will further enhance the usability of the Measures Registry, will be released in 2017.

Learn more about and access the Measures Registry at:

Learn more about and access the Catalogue of Surveillance Systems at:

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Publications & Tools

What is the state of obesity in America?

This year’s State of Obesity report is an urgent call to action for government, industry, healthcare, foundations, schools, child care and families around the country to redouble efforts to provide a brighter, healthier future for our children. Together we can build an inclusive Culture of Health in this country and ensure that all children and families live healthy lives.

View the Interactive Report

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School Fundraising Policies and Practices: A Shifting Landscape

The goal of this project was to examine the impact of Smart Snacks in School standards on fundraising practices in districts and schools in a sample of states that allow and do not allow fundraiser exemptions. This study used a series of interviews with key stakeholders to explore the successes, challenges, and financial aspects of implementing these new policies regarding fundraisers and the ways in which schools may or may not have succeeded in transitioning to non-food fundraising strategies. Participants included state-level child nutrition directors; district-level leadership; district food service directors; school-level leadership; and parents or leaders of local, regional, or state parent-teacher organizations. This report focuses on key themes that emerged through the interviews, including barriers and challenges, and ways of addressing them. Overall, interview results revealed that many schools have improved the school nutrition environment, but this has often come at a financial cost to schools and school districts. The factors that appear to be key to the successful implementation of healthier fundraising practices—whether in states that allow exemptions or in states that do not allow any exemptions—are time, patience, champions, and collaboration across multiple levels.

View the Report

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Childhood Obesity Research & News

How the Sugar Industry Shifted Blame to Fat

September 12, 2016, The New York Times

The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

“They were able to derail the discussion about sugar for decades,” said Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the JAMA Internal Medicine paper.

The documents show that a trade group called the Sugar Research Foundation, known today as the Sugar Association, paid three Harvard scientists the equivalent of about $50,000 in today’s dollars to publish a 1967 review of research on sugar, fat and heart disease. The studies used in the review were handpicked by the sugar group, and the article, which was published in the prestigious New England Journal of Medicine, minimized the link between sugar and heart health and cast aspersions on the role of saturated fat.

Even though the influence-peddling revealed in the documents dates back nearly 50 years, more recent reports show that the food industry has continued to influence nutrition science.

Last year, an article in The New York Times revealed that Coca-Cola, the world’s largest producer of sugary beverages, had provided millions of dollars in funding to researchers who sought to play down the link between sugary drinks and obesity. In June, The Associated Press reported that candy makers were funding studies that claimed that children who eat candy tend to weigh less than those who do not.

The Harvard scientists and the sugar executives with whom they collaborated are no longer alive. One of the scientists who was paid by the sugar industry was D. Mark Hegsted, who went on to become the head of nutrition at the United States Department of Agriculture, where in 1977 he helped draft the forerunner to the federal government’s dietary guidelines. Another was Dr. Fredrick J. Stare, the chairman of Harvard’s nutrition department.

In a statement responding to the JAMA journal report, the Sugar Association said that the 1967 review was published at a time when medical journals did not typically require researchers to disclose funding sources. The New England Journal of Medicine did not begin to require financial disclosures until 1984.

The industry “should have exercised greater transparency in all of its research activities,” the Sugar Association statement said. Even so, it defended industry-funded research as playing an important and informative role in scientific debate. It said that several decades of research had concluded that sugar “does not have a unique role in heart disease.”

The revelations are important because the debate about the relative harms of sugar and saturated fat continues today, Dr. Glantz said. For many decades, health officials encouraged Americans to reduce their fat intake, which led many people to consume low-fat, high-sugar foods that some experts now blame for fueling the obesity crisis.

“It was a very smart thing the sugar industry did, because review papers, especially if you get them published in a very prominent journal, tend to shape the overall scientific discussion,” he said.

Dr. Hegsted used his research to influence the government’s dietary recommendations, which emphasized saturated fat as a driver of heart disease while largely characterizing sugar as empty calories linked to tooth decay. Today, the saturated fat warnings remain a cornerstone of the government’s dietary guidelines, though in recent years the American Heart Association, the World Health Organization and other health authorities have also begun to warn that too much added sugar may increase cardiovascular disease risk.

Marion Nestle, a professor of nutrition, food studies and public health at New York University, wrote an editorial accompanying the new paper in which she said the documents provided “compelling evidence” that the sugar industry had initiated research “expressly to exonerate sugar as a major risk factor for coronary heart disease.”

“I think it’s appalling,” she said. “You just never see examples that are this blatant.”

Dr. Walter Willett, chairman of the nutrition department at the Harvard T. H. Chan School of Public Health, said that academic conflict-of-interest rules had changed significantly since the 1960s, but that the industry papers were a reminder of “why research should be supported by public funding rather than depending on industry funding.”

Dr. Willett said the researchers had limited data to assess the relative risks of sugar and fat. “Given the data that we have today, we have shown the refined carbohydrates and especially sugar-sweetened beverages are risk factors for cardiovascular disease, but that the type of dietary fat is also very important,” he said.

The JAMA Internal Medicine paper relied on thousands of pages of correspondence and other documents that Cristin E. Kearns, a postdoctoral fellow at U.C.S.F., discovered in archives at Harvard, the University of Illinois and other libraries.

The documents show that in 1964, John Hickson, a top sugar industry executive, discussed a plan with others in the industry to shift public opinion “through our research and information and legislative programs.”

At the time, studies had begun pointing to a relationship between high-sugar diets and the country’s high rates of heart disease. At the same time, other scientists, including the prominent Minnesota physiologist Ancel Keys, were investigating a competing theory that it was saturated fat and dietary cholesterol that posed the biggest risk for heart disease.

Mr. Hickson proposed countering the alarming findings on sugar with industry-funded research. “Then we can publish the data and refute our detractors,” he wrote.

In 1965, Mr. Hickson enlisted the Harvard researchers to write a review that would debunk the anti-sugar studies. He paid them a total of $6,500, the equivalent of $49,000 today. Mr. Hickson selected the papers for them to review and made it clear he wanted the result to favor sugar.

Harvard’s Dr. Hegsted reassured the sugar executives. “We are well aware of your particular interest,” he wrote, “and will cover this as well as we can.”

As they worked on their review, the Harvard researchers shared and discussed early drafts with Mr. Hickson, who responded that he was pleased with what they were writing. The Harvard scientists had dismissed the data on sugar as weak and given far more credence to the data implicating saturated fat.

“Let me assure you this is quite what we had in mind, and we look forward to its appearance in print,” Mr. Hickson wrote.

After the review was published, the debate about sugar and heart disease died down, while low-fat diets gained the endorsement of many health authorities, Dr. Glantz said.

“By today’s standards, they behaved very badly,” he said.

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JAMA Internal Medicine Study:

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US Food Industry Progress During the National Salt Reduction Initiative: 2009–2014

October 2016, American Journal of Public Health


Objectives. To assess the US packaged food industry’s progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years.

Methods. Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396).

Results. In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001).

Conclusions. National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest.

Public Health Implications. The US Food and Drug Administration’s proposed voluntary targets will be an important step in achieving more substantial sodium reductions.

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Obesity, violence hamper U.S. progress on U.N. health goals: study

September 21, 2016, Reuters

The United States performs poorly in U.N. rankings on progress towards global health goals due to its high levels of violence, alcohol abuse and childhood obesity, a study has found.

The research, published in The Lancet medical journal on Wednesday, offers the first assessment of 188 countries’ rankings against the United Nations’ Sustainable Development Goals (SDGs), which aim to boost health by improving the environment, food and water and by easing poverty.

More than 60 percent of the nations assessed have already met targets on reducing maternal and child death rates, the study showed, but none have met nine other targets including the elimination of tuberculosis and HIV or reducing prevalence of childhood obesity and violence.

The United States ranked 28th, below many other wealthier nations, due to its relatively high rates of death caused by violence, HIV, alcohol abuse, childhood obesity and suicide.

The United States also lagged among high-income countries on maternal and child mortality, reflecting large differences in the accessibility and quality of healthcare.

Iceland topped the rankings, followed by Singapore and Sweden, thanks to good sanitation and healthcare provision and to progress on tackling “rich-world” health problems such as obesity, chronic diseases, violence and road traffic injuries.

The Central African Republic, Somalia and South Sudan had the lowest scores.

The SDGs are targets set by the United Nations to tackle a range of pressing problems including food and water security, poverty and climate change up to 2030. They follow the Millennium Development Goals, which expired at the end of 2015 and were also focused on reducing poverty and improving health.

The aim of the SDG assessment is accountability on progress towards the targets, to give policymakers, aid groups and health workers an overview of gaps and priorities in health care.

“(It is) a starting point for further investigation on how and why countries are under-performing or performing well,” said Stephen Lim, a professor of global health at the Institute for Health Metrics and Evaluation (IHME) at Washington University which led the assessment.

“This will be an annual effort to ensure progress is maintained and lessons from successes are learned and rapidly transferred to other countries,” he said.

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More evidence of a link between C-sections and childhood obesity

September 7, 2016, Reuters

Children born by cesarean delivery appear to have higher odds of developing obesity than their peers who experienced vaginal births, a U.S. study suggests.

Women who had surgical deliveries known as C-sections were also more likely to be overweight, or to develop complications like diabetes and high blood pressure during pregnancy, than women who had vaginal births, the study found.

After these maternal factors were taken into account, delivery by C-section was still linked to a 15 percent increase in the risk of obesity by the time babies reached adolescence and early adulthood.

“I was expecting that after controlling for these factors the association between cesarean birth and childhood obesity would completely disappear,” said senior study author Dr. Jorge Chavarro, a public health and nutrition researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston.

“That was not the case,” Chavarro added by email.

Even within families, children born by C-section were 64 percent more likely to be obese than their siblings born by vaginal delivery, researchers report in JAMA Pediatrics.

Children born by vaginal birth to women with a previous cesarean delivery were 31 percent less likely to be obese than kids born to women with repeated cesarean deliveries, the study also found.

While cesarean deliveries are often necessary to save lives and prevent injuries, they may also leave babies vulnerable to chronic health problems such as asthma, diabetes and obesity, some previous research suggests.

To explore the connection between C-section deliveries and obesity in particular, Chavarro and colleagues examined data on 22,068 children born to 15,271 women, including 4,921 born by cesarean delivery.

From 1996, when the kids were between 9 and 14 years old, through 2012, when most participants were in their mid-to-late 20s, the researchers tracked their weight and height.

One limitation of the study is that researchers lacked data on why women had C-sections or other aspects of labor and delivery, the authors note.

The study also didn’t show why C-sections might make obesity more likely, though the authors say it’s possible babies delivered this way may not be exposed to good bacteria in the birth canal that help build the immune system and ward off obesity and other diseases.

Still, the findings offer the strongest epidemiologic evidence to date that C-sections may cause obesity, said Dr. Jan Blustein, a health policy researcher at New York University who wasn’t involved in the study.

“When cesarean is indicated, it can save lives,” Blustein said by email. “But experts agree that too many cesareans are performed without clear indication.”

Ideally, no more than 15 percent of deliveries should be C-sections, according to the World Health Organization. That’s the approximate proportion of births that require surgical intervention to protect the mother or infant in situations such as prolonged labor, fetal distress or a breech baby.

In the U.S. and many other developed nations, however, C-section rates are more than double what WHO recommends.

While the study doesn’t show why C-sections may be associated with obesity, women should still aim to maintain a healthy weight before getting pregnant and keep weight gain to a healthy range during pregnancy, said Dr. Amos Grunebaum, director of obstetrics at New York-Presbyterian Hospital Weill Cornell Medical Center.

“Because of increased risks, mostly to the mother, cesareans should be done only for proper indications,” Grunebaum, who wasn’t involved in the study, said by email.

Still, these deliveries have their place, he emphasized.

“The speculative future risk of obesity in the offspring should never be a good enough reason to not do a cesarean, especially when it’s done to save the baby’s or mother’s life,” Grunebaum said.

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The U.S. Is Now Eating and Wasting Twice as Much Food as It Did in 1975

August 30, 2016, The Atlantic

Americans ate an average of 1,999 calories per day in 1975. That’s according to the USDA, which released updated data this month that says we’re now up to 2,481.

That increase has come with soaring rates of cardiovascular disease and diabetes, the fiscal cost of which is inordinate.

The greater threat to our health as a population, though, may be the fact that the total U.S. food supply (the amount available, both produced and imported) is now 4,000 calories per person per day, also according to the USDA. This means that close to half of that food supply is going to waste. At the same time, none of these numbers is growing as quickly as the total number of people. Between 1975 and today, the American population increased from 213 million to 319 million.

So not only are we individually increasing in mass, but our numbers are soaring. The combined result is that over the past four decades, the amount of food being produced in order to feed the U.S. population (including what goes to waste) has nearly doubled.

Agriculture is a major source of greenhouse gas emissions—not simply by ways of the methane emitted by cattle, but through the deforestation of land necessary to grow the feed for the animals, and the actual process of growing that feed. Barring a radical cultural shift away from such abundance or a re-conception of what we consider to be food, this growth does not seem to be environmentally sustainable in any humane way. Gains made by the common approaches to environmental consciousness (organic farming, local sourcing, et cetera) seem to be chipping at the periphery of the problem.

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