August 2017





NCCOR helps communities evaluate their progress in reducing childhood obesity

August 31, 2017, NCCOR

Communities are at the forefront of implementing strategies and programs to reduce childhood obesity. NCCOR is accelerating progress by supporting efforts to learn from communities, sharing evidence and lessons learned, and creating resources and tools to advance community-level approaches.

To commemorate National Childhood Obesity Awareness Month in September, we will share various ways that NCCOR helps communities evaluate their progress in reducing childhood obesity. On September 27, NCCOR will host a Twitter chat and highlight the following projects.

The Childhood Obesity Declines project was started to better understand the possible drivers and contributors that may influence reported declines in childhood obesity rates and to explore how these may be related to health promotion efforts. In March 2016, NCCOR released community summary reports from four sites across the country: Anchorage, AK, Granville County, NC, New York, NY, and Philadelphia, PA.

A top priority for NCCOR is to encourage the consistent use of high-quality, comparable measures and research methods across childhood obesity prevention and research. To achieve this aim, NCCOR developed the Measures Registry and the Measures Registry User Guides. Each Guide includes case studies that walk users through the process of using the Measures Registry to select appropriate measures. The case studies include research questions that communities might have for measuring childhood obesity reduction efforts in their communities, such as the implications of changes to food offered in vending machines, starting a farmer’s market obesity treatment program, and improving streetscapes and parks around schools.

NCCOR also supported the Healthy Communities Study, which aimed to understand how diet, physical activity, and body mass index are related to aspects of community policies and programs. Researchers recruited 5,138 children and their families in 130 demographically diverse communities across the nation from 2013 to 2015. Initial study findings were published in the American Journal of Preventive Medicine in 2017.

NCCOR has worked closely with USDA to rapidly develop and update the SNAP-Ed Toolkit—a portfolio of evidence-based obesity strategies and actionable tools. The online toolkit offers a robust group of effective interventions designed and updated to help states and local communities implementing SNAP identify evidence-based and emerging obesity prevention programs and strategies. In addition, NCCOR collaborated with USDA’s Food and Nutrition Services, the Association of SNAP Nutrition Education Administrators, and more than 28 states to develop the SNAP-Ed Evaluation Framework: Nutrition, Physical Activity, and Obesity Prevention Indicators and Interpretive Guide.

Learn more about community efforts to reduce childhood obesity, and NCCOR projects and resources, during NCCOR’s Twitter chat on September 27, 2017.

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Publications & Tools

CDC Healthy Schools

CDC Healthy Schools has launched new web pages to share stories about successful school health programs made possible by CDC funding. Healthy Schools highlights the work states are doing to promote the well-being and healthy development of children and youth while they are in school.

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Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease

For decades, nutrient intake recommendations have been issued through the Dietary Reference Intakes (DRIs) established by consensus committees of the Institute of Medicine, and now the National Academies of Sciences, Engineering, and Medicine (the National Academies). For each nutrient (i.e., vitamins, minerals, water, electrolytes, carbohydrate, or protein) deemed essential, DRI committees reviews the scientific literature to help inform nutrition standards of adequacy and toxicity for groups of people of different genders and at different life stages. These DRIs are used for planning and assessing the diets of apparently healthy individuals and groups. The National Academies convened an ad hoc committee to determine guiding principles to support future DRI committees as they make decisions about recommending DRIs for specific nutrients or other food substances (NOFSs) that could ameliorate the risk of chronic disease. The resulting report, Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease, addresses conceptual and methodological challenges and offers recommendations and guiding principles to develop DRIs based on chronic disease endpoints.

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Improving Public Health through Public Parks and Trails: Eight Common Measures

This summary presents eight common measures that connect park and trail planning to public health goals. The data collected using these measures can be employed to evaluate, plan, and promote public parks and trails at the national, state, regional, and local levels. By using these measures, park and trail system planners, public health professionals, community leaders, and researchers can identify and quantify some of the public health impacts of parks and trails and compare those results across time and geographic levels.

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The CDC EvaluACTION is an award-winning tool designed to help evaluate public health programs and strategies.

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Childhood Obesity Research & News

Is childhood obesity a psychological disorder?

August 22, 2017, Children’s Hospital Los Angeles

Study uses fMRI to observe relationship between neurological activity and risk for obesity

A team of researchers, including senior investigator, Bradley Peterson, MD, director of the Institute for the Developing Mind at Children’s Hospital Los Angeles, used fMRI to investigate neural responses to food cues in overweight compared with lean adolescents. The team observed that food stimuli activated regions of the brain associated with reward and emotion in all groups. However, adolescents at an increasing risk for obesity had progressively less neural activity in circuits of the brain that support self-regulation and attention.

“This study establishes that risk for obesity isn’t driven exclusively by the absence or presence of urges to eat high-calorie foods, but also, and perhaps most importantly, by the ability to control those urges,” said Peterson, who is also a professor at the Keck School of Medicine at the University of Southern California.

The public health implications of childhood obesity are staggering. More than half of all adolescents in the U.S. are either overweight or obese. Children of overweight parents (2/3 of adults in the U.S.) already are or are likely to become overweight. Since excess weight has been linked to a myriad of health issues shown to limit human potential and add to the skyrocketing cost of healthcare, researchers are actively seeking novel approaches to understand better the causes of obesity and alter its trajectory. This study, recently reported in the journal NeuroImage, may offer such an approach.

“We wanted to use brain imaging to investigate a key question in obesity science: why do some people become obese, while others don’t?” said Susan Carnell, PhD, assistant professor of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine and first author on the study.

Of the 36 adolescents (ages 14 to 19 years) enrolled in the study, 10 were overweight/obese, 16 were lean but considered at high risk for obesity because they had overweight/obese mothers and 10 were lean/low risk since they had lean mothers. The adolescents underwent brain scanning using fMRI, while they viewed words that described high-fat foods, low-fat foods, and non-food items. Then they rated their appetite in response to each word stimulus. Following the activity, all participants were offered a buffet that included low- and high-calorie foods – to relate participants test responses to real-world behavior.

The investigators observed that after viewing food-related words, brain circuits that support reward and emotion were stimulated in all participants. In adolescents who were obese or who were lean but at high familial risk for obesity, they observed less activation in attention and self-regulation circuits.

Brain circuits that support attention and self-regulation showed the greatest activation in lean/low-risk adolescents, less activity in lean/high-risk participants and least activation in the overweight/obese group. Also, real world relevance mirrored fMRI findings – food intake at the buffet was greatest in the overweight/obese participants, followed by the lean/high-risk adolescents, and lowest in the lean/low-risk group.

“These findings suggest that interventions designed to stimulate the self-regulatory system in adolescents may provide a new approach for treating and preventing obesity,” said Peterson.

Additional contributors to the study include Leora Benson, Johns Hopkins University School of Medicine; Ky-Yu (Virginia) Chang and Allan Geliebter, Icahn School of Medicine; and Zhishun Wang and Yuankai Huo, Columbia University Medical Center. The study was supported in part by NIDDK (K99R00DK088360, R01DK074046 and DK080153).

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Lack of sleep tied to higher risk of diabetes in kids

August 15, 2017, Reuters

By Lisa Rapaport

Children who don’t get enough sleep may be more likely to develop diabetes than kids who typically get enough shuteye, a UK study suggests.

That’s because each additional hour of sleep children get at night is associated with a lower body weight, more lean muscle mass, and less accumulation of sugars in the blood, researchers report in Pediatrics. Obesity and elevated blood sugar are risk factors for type 2 diabetes, which happens when the body can’t properly use or make enough of the hormone insulin to convert blood sugar into energy.

“These findings suggest increasing sleep duration could offer a simple, cost-effective approach to reducing levels of body fat and type 2 diabetes risk early in life,” senior study author Christopher Owen of St. George’s, University of London, said by email.

Type 2 diabetes used to be called adult-onset diabetes because it was so rare in children. But today, it’s a common childhood health problem, in large part because millions of kids worldwide are overweight or obese, don’t get enough exercise, and eat too many sugary and fatty foods.

For the current study, researchers examined survey data on sleep habits and lab results from tests of risk factors for diabetes in 4,525 UK children age 9 or 10.

On average, the kids slept 10.5 hours on school nights, although sleep duration ranged from 8 to 12 hours.

Children who got less sleep in the study were more likely to have a risk factor for diabetes known as insulin resistance, when the body doesn’t respond normally to the hormone.

Kids who slept less were also more likely to be extremely overweight or obese and have more body fat, the study also found.

Kids 6 to 12 years old should get 9 to 12 hours of sleep a night, according to the American Academy of Pediatrics. Not getting enough sleep is associated with an increased risk of injuries, high blood pressure, obesity, and depression.

The study wasn’t a controlled experiment designed to prove whether or how insufficient sleep might lead to diabetes in children. Researchers also relied on kids to accurately recall and report what time they went to bed and woke up, which might not accurately reflect how much sleep they really got.

Even so, it’s possible that insufficient sleep might negatively impact children’s appetites and ability to regulate blood sugar, said Stacey Simon, a pediatric sleep psychologist at the University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado.

“When kids are going to bed very late or sleeping on an irregular schedule, they may also be skipping meals, eating at irregular times, or be less likely to exercise during the day,” Simon, who wasn’t involved in the study, said by email.

Insufficient sleep can affect levels of hormones that control appetite, making kids hungrier and increasing cravings for sweet and salty snacks, said James Gangwisch, a psychiatry researcher at Columbia University in New York who wasn’t involved in the study.

“Getting enough sleep helps keep our appetite in check and is protective against insulin resistance,” Gangwisch said by email.

Beyond making sure kids have regular bedtime, parents should also focus on what’s known as sleep hygiene, said Femke Rutters of the VU University Medical Center in Amsterdam.

This can include things like limiting screen time before bed and making sure the bedroom is totally dark at night, Rutters, who wasn’t involved in the study, said by email.

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To deal with childhood obesity, researchers eye prenatal and generational factors

August 12, 2017, The Washington Post

By Paul Tullis

Although the public health community has been trying to address the childhood obesity epidemic for years, progress has been disappointing. Often, governments or schools will make a single policy change — more fruit in school lunches, no soda machines in parks — only to find no effect.

Matthew W. Gillman has some ideas why. He is a pediatrician, a former professor of nutrition at the Harvard T.H. Chan School of Public Health and is now the director of a seven-year, $1.15 billion study by the National Institutes of Health — a study named ECHO, for Environmental Influences on Child Health Outcomes. Research that Gillman and others have conducted over the past 15 years indicates that the origins of obesity lie as much in early childhood — even prenatally and intergenerationally — as it does in an individual’s current behavior. He spoke with The Post recently about what science can tell us about kids and obesity.

Q: Recent research seems to suggest that whether someone is obese may be determined even before they are born.

A: What happens at the earliest stages of human development — even before birth — has long-lasting, sometimes lifelong, sometimes irreversible consequences.

There are a number of things, prenatally and early postnatally, that predict obesity, and more in combination than they do singly. We think about the weight of the mom coming into pregnancy, about how much weight the mother gains during pregnancy, whether or not she develops gestational diabetes. We just published a paper in Pediatrics that showed that moms who consume larger amounts of sugar-sweetened beverages during the second trimester have kids with higher [body mass index, or BMI] at school age. Rapid weight gain in the first six months of life, early introduction of solid foods, the less sleep you get as an infant — all of these make it more likely you will be obese as a child.

Q: Could the same thing be causing obesity and other health problems in kids?

A: That’s an open question. For instance, obesity is related to asthma. It could be that one environmental factor is causing asthma and another is causing obesity, and certain kids are susceptible to both. It could be that some of the same pathways, like inflammatory pathways, lead to both. It’s also true that obesity causes asthma, probably both from inflammatory factors and that you’re just squeezing the lungs. And it may also be that asthma causes obesity because kids with asthma get less physical activity. So you’ve got common underpinnings, you’ve got separate underpinnings, and you’ve got one causing the other. And that’s another thing we’re trying to do in ECHO is tease apart some of these complexities. That can also tell you the best time and maybe the best ways to intervene, or at least to test interventions.

Q: What do we know about the effect on a fetus of developing in a low-nutrition environment, or a high-stress environment, and how that might be related to later obesity?

A: There are some great animal models — baboons and rats — but only hints in humans. Kids born at lower birth weights because of low fetal growth who then gain more weight in childhood have worse cardiovascular outcomes. While they don’t have higher BMI than those born larger, they may have more fat in the wrong places. Maternal smoking is related to both lower fetal growth and to obesity in childhood.

Q: So how does obesity become an intergenerational issue?

A: Sometimes [when we talk about intergenerational effects] we mean mother-to-child, but oftentimes we mean mother to a child who grows up to be a mother and passes her mother’s influences to her own child, the grandchild. If a woman comes into pregnancy at a high weight, she may develop gestational diabetes, and if she does, her offspring are more likely to be obese. If that’s a girl, then she’s more likely to be overweight if she gets pregnant. So you get into these intergenerational vicious cycles. Interventions during school age and adolescence could interrupt that by allowing women to come into pregnancy at closer to an ideal weight.

Q: How do you get kids and adolescents to lose weight when their prenatal or early life experience is what’s making them obese?

A: That’s a really, really good question. Once obesity is present, it resists treatment. It’s also behavioral: We have entrenched behaviors and they’re hard to break, and we have cultural things and environmental things like food systems and physical activity systems that tend to resist weight loss. So we think early prevention is really the key. Early life factors set people on a more unhealthful trajectory; then, because of all these resistance factors, it’s hard to turn around.

Q: What has been shown to work?

A: On an individual basis, working with families and working directly with kids — especially if there’s a multidisciplinary approach — can work. There are also whole-community interventions that show promise. Shape Up Somerville, a program results of which were published close to 10 years ago, was changing the large- and medium-scale environment in Somerville, Mass., for school-age kids. They lost more relative weight than kids did in neighboring communities. That was clearly multifactorial. The health-care system, the schools, community groups, local government — each one did something a little bit different: Schools changed what they served. The local government made it easier to get physical activity.

In each age group, you can think about different sectors that can be involved. I think that’s the way of the future. A project I was working on before I came to [the National Institutes of Health] was using computational approaches to try to figure out which communities might be ready and which kind of interventions to implement in different communities.

Q: So even when kids are predisposed to obesity, there’s hope?

A: Sometimes we look for the magic bullet. We say, “This is the thing with obesity, so we’re going to do away with it.” There’s not one thing: This obesity epidemic has been a long time coming, and it’s multifactorial. It involves everything from macro policy down to family and individual behaviors, and biology. The thought with these community interventions as well as some of the more individual interventions is you have an attack on multiple fronts

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Bike trains shown to increase physical activity among children

August 10, 2017, Seattle Children’s

By Evan Koch

The path to healthier living for children could be the same one they take to school.

Children who participated in adult-supervised group bicycle rides to and from school increased their moderate-to-vigorous physical activity by 21 minutes per day and daily cycling commutes by 45%, according to a pilot study recently published in the American Journal of Preventive Medicine.

The additional exercise study participants gained from riding in the groups, known as bike trains, accounted for 35% of the 60 minutes of physical activity recommended daily for children.

“Regular physical activity can help build muscle and bone strength, raise energy levels, and help reduce the risk of conditions like obesity and heart disease,” said Seattle Children’s researcher Dr. Jason Mendoza, who served as the principal investigator for the study.

Mendoza has also led and collaborated on research studying walking school buses, where adults supervise groups of children as they walk to and from school.

“Several studies have looked at the health benefits of walking to and from school. This is the first study that examines a bike train program,” Mendoza said.

Finding the time for physical activity

As rates of childhood obesity have skyrocketed across the country, most children need to look outside of a school setting to find rich sources of exercise.

Only 3.6% of public and private elementary schools require daily physical education for all students, according to Healthy People 2020, a health-focused initiative from the United States Department of Health and Human Services. Less than 60% of elementary schools require daily recess periods.

“Overall, schools are placing more emphasis on classroom instruction and less on physical education classes and recess periods than they used to,” Mendoza said. “Kids need time to exercise their bodies as well as their minds and release their physical energy in a healthy way.”

Other research has shown that early morning exercise positively impacts children’s academic performance, behavior and attitude.

Pedaling into the past to address an issue in the present

A drastic shift from active commuting to school by walking or biking to passive commuting, like riding in a car or bus, has coincided with rates of childhood obesity tripling over the last four decades. Nearly half of all children in the U.S. were active commuters in 1969. Forty years later, less than 13% of children actively commuted to school. Currently, only 1% bike to school.

“Previous research suggests losing sources of exercise like biking to school could be a contributing factor to drops in physical activity and increased rates of obesity in children,” Mendoza said.

Mendoza and his colleagues hypothesized that introducing a bike train program would increase rates of cycling to and from school and hopefully encourage long-term adoption of cycling as a means of transportation—eventually leading to increased physical activity.

Putting the bicycle train program into action

For the study, 54 fourth- and fifth-grade students from four inner-city Seattle schools that enroll lower-income families were equipped with bicycles, bike helmets and other safety gear.

“Lower-income children from diverse backgrounds are often left out of this type of research and have among the lowest rates of physical activity and highest rates of obesity,” Mendoza said.

Most participants lived less than 2 two miles from their school and all could keep the bikes and equipment following their voluntary participation in the study.

Bike Works donated and helped maintain the bikes. Cascade Bicycle Club provided a 2- to 3-hour safety course for all of the children prior to participation. The program also followed National Center for Safe Routes to School (SRTS) bike train guidelines.

Two of the schools were randomly chosen to receive the bike trains, and Seattle Children’s staff members rode with participants to and from school for the duration of the study. The bike trains arrived 25 to 30 minutes before school started so riders could participate in school breakfast programs.

“I had a good time and I was able to get a lot of exercise,” said Jann Isabel Adajar, who participated in the study as a fifth-grader. “It was helpful to have the instructors there to encourage us when it became hard to ride up some of the hills.”

Adajar, who now lives too far from her current school to bike, still has her bike three years after the study began and uses it after school, when time permits.

The next step in bike train research is to recruit for larger and longer-term studies that involve parents, community members, school staff and other responsible adults.

Starting a Bike Train

There are several resources for those who wish to start a bike train in their community. The Safe Routes to School (SRTS) bike train planning guide focuses on planning a route and ride schedule; safely equipping and preparing riders and leaders; and extensive safety checklists applicable to bike riders of all ages.

The Pedestrian and Bicycle Information Center provides links to cycling resources in every state, including state-specific cycling laws, cycling plans, and contact information for state bicycle and pedestrian coordinators.

“Engaging daily in a fun, safe activity such as biking, is an important way we can increase physical activity to ensure optimal child development and health,” Mendoza said. “There is a long way to go, but we will continue to research and help children, families and schools, especially those who are socioeconomically disadvantaged, to tap into and re-discover ways to live the healthiest life possible.”

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