December 2017

CHOICES research predicts long-term risks of obesity in children

December 21, 2017, NCCOR

How does obesity in childhood affect weight status into adulthood? A recent article in the New England Journal of Medicine, “Simulation of Growth Trajectories of Childhood Obesity into Adulthood,” explores the long-term risks of obesity later in life given current weight and age.

The study, which is part of the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES), developed a simulation model to predict growth trajectories. The model pooled five existing U.S. data sets containing 176,720 observations of repeated height and weight information from 41,567 children and adults.

Results show that the majority (57.3%) of current U.S. children aged 2-19 years will be obese at 35 years of age. Furthermore, among obese children, the likelihood of being obese as an adult increases as obese children age. In children that are obese at 2 years, there is a 74.9% probability that they will still be obese at 35; the probability increases to 88.2% if the child is obese at 19 years. The authors suggest the results of this model support the need for increased efforts to develop and implement effective interventions for children who are already obese.

NCCOR’s projects identify, design, and evaluate practical and sustainable interventions, especially in high-risk populations and communities. Through these projects, NCCOR helps improve the ability of childhood obesity researchers and program evaluators to conduct research and evaluation. Some examples:

• NCCOR supported and helped design the National Institutes of Health–funded Healthy Communities Study and the Robert Wood Johnson Foundation–funded Childhood Obesity Declines project. The Healthy Communities Study assessed policies and programs designed to address childhood obesity rates in communities where those rates were the highest. The Childhood Obesity Declines project examined possible drivers and contributors that may influence reported declines in childhood obesity rates.
• NCCOR worked with the Supplemental Nutrition Assistance Program Education to incorporate evidence-based obesity prevention strategies into the existing SNAP-Ed Toolkit and to develop the SNAP-Ed Evaluation Framework.
• NCCOR’s Engaging Health Care Providers and Systems workgroup is starting a new project to develop a module-based, collaborative learning project to evaluate community-based healthy weight programs. The project is intended to promote sharing of experiences, resources, and lessons learned for practitioners to learn about evaluation practices from one another.

To read the full research article about the CHOICES research, visit: http://www.nejm.org/doi/full/10.1056/NEJMoa1703860

Original source: https://www.nccor.org/choices-research-predicts-long-term-risks-of-obesity-in-children

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Advancing Obesity Solutions Through Investments in the Built Environment: Proceedings of a Workshop—in Brief

The built environment—the physical world made up of the homes, buildings, streets, and infrastructure within which we all live, work, and play—underwent changes during the 20th and 21st centuries. These changes have contributed to a sharp decline in physical activity and affected access to healthy foods, adding to the weight gain observed among Americans in recent decades. As such, policies and practices that affect the built environment could affect obesity rates in the United States and improve the health of Americans. These proceedings highlight key points and discussions from the National Academy of Sciences’ September 12, 2017, workshop on this topic. The workshop brought together diverse partners to examine how the places where we live, work, and play influence obesity, health, and equity. Participants—including real estate developers, leaders from state, regional and local government, and innovative nonprofit organizations—discussed strategies to create more healthful and equitable built environments and outlined next steps.

Access the brief: http://nationalacademies.org/hmd/Reports/2017/advancing-obesity-solutions-through-investments-in-the-built-environment-proceedings-in-brief.aspx

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Voices for Healthy Kids 2017 Progress Report: Making Each Day Healthier for All Children

Voices for Healthy Kids, a joint initiative of the American Heart Association and Robert Wood Johnson Foundation, released its 2017 progress report. The report highlights program successes, including policy wins, and a behind-the-scenes look at campaigns to increase health equity, improve access to healthy foods and physical activity, and improve the places where families live, learn, work, and play.

Access the report: http://voicesforhealthykids.org/wp-content/uploads/2017/12/Voices-for-Healthy-Kids-2017-Progress-Report-final.pdf

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Strategies to Limit Sugar-Sweetened Beverage Consumption in Young Children: Proceedings of a Workshop

On June 21–22, 2017, the Food and Nutrition Board convened A Workshop on Strategies to Limit Sugar-Sweetened Beverage Consumption in Young Children: Evaluation of Federal, State, and Local Policies and Programs, in Washington, DC. The workshop had five objectives: provide an overview of current and emerging strategies to reduce consumption of sugar-sweetened beverages by young children 0-5 years of age and explore the evidence on effectiveness; contextualize the strategies by broadly considering patterns and trends in beverage consumption, and specifically sugar-sweetened beverage consumption, in U.S. children; examine current guidelines for beverage intake applicable to children 5 years of age and younger; explore the role of industry in sugar-sweetened beverage intake in young children; and identify where knowledge gaps and opportunities exist to inform future policies, programs, and strategies. These proceedings summarize the presentations and discussions that took place during the workshop.

Access the proceedings: http://nationalacademies.org/hmd/Reports/2017/strategies-to-limit-sugar-sweetened-beverage-consumption-in-young-children-proceedings.aspx

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Are measures derived from land use and transport policies associated with walking for transport?

December 14, 2017, Journal of Physical Activity and Health

Abstract

Background

There is growing urgency for higher quality evidence to inform policy. This study developed geographic information system spatial measures based on land use and transport policies currently used in selected Australian states to assess which, if any, of these measures were associated with walking for transport.

Methods

Overall, 6901 participants from 570 neighborhoods in Brisbane, Australia, were included. Participants reported their minutes of walking for transport in the previous week. After a review of state-level land use and transport policies relevant to walking for transport across Australia, 7 geographic information system measures were developed and tested based on 9 relevant policies. Data were analyzed using multilevel multinomial logistic regression.

Results

Greater levels of walking for transport were associated with more highly connected street networks, the presence of public transport stops, and having at least 2 public transport services per hour. Conversely, neighborhoods with shorter cul-de-sac lengths had lower levels of walking for transport. There was no evidence of associations between walking for transport and street block lengths less than 240 m or traffic volumes.

Conclusions

These findings highlight the need for urban design and transport policies developed by governments to be assessed for their impact on transport-related physical activity.

Original source: https://doi.org/10.1123/jpah.2016-0693

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Indoor and outdoor context-specific contributions to early adolescent moderate to vigorous physical activity as measured by combined diary, accelerometer, and GPS

December 14, 2017, Journal of Physical Activity and Health

Abstract

Background

The distribution of adolescent moderate to vigorous physical activity (MVPA) across multiple contexts is unclear. This study examined indoor and outdoor leisure time in terms of being structured or unstructured and explored relationships with total daily MVPA.

Methods

Between September 2012 and January 2014, 70 participants (aged 11–13 y) from 4 schools in Edinburgh wore an accelerometer and global positioning system receiver over 7 days, reporting structured physical activity using a diary. Time spent and MVPA were summarized according to indoor/outdoor location and whether activity was structured/unstructured. Independent associations between context-specific time spent and total daily MVPA were examined using a multivariate linear regression model.

Results

Very little time or MVPA was recorded in structured contexts. Unstructured outdoor leisure time was associated with an increase in total daily MVPA almost twice that of unstructured indoor leisure time [b value (95% confidence interval), 8.45 (1.71 to 14.48) vs 4.38 (0.20 to 8.22) minute increase per hour spent]. The association was stronger for time spent in structured outdoor leisure time [35.81 (20.60 to 52.27)].

Conclusions

Research and interventions should focus on strategies to facilitate time outdoors during unstructured leisure time and maximize MVPA once youth are outdoors. Increasing the proportion of youth engaging in structured activity may be beneficial given that, although time spent was limited, association with MVPA was strongest.

Original source: https://doi.org/10.1123/jpah.2016-0638

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Simulating the impact of sugar-sweetened beverage warning labels in three cities

December 14, 2017, American Journal of Preventive Medicine

Introduction

A number of locations have been considering sugar-sweetened beverage point-of-purchase warning label policies to help address rising adolescent overweight and obesity prevalence.

Methods

To explore the impact of such policies, in 2016 detailed agent-based models of Baltimore, Philadelphia, and San Francisco were developed, representing their populations, school locations, and food sources, using data from various sources collected between 2005 and 2014. The model simulated, over a 7-year period, the mean change in BMI and obesity prevalence in each of the cities from sugar-sweetened beverage warning label policies.

Results

Data analysis conducted between 2016 and 2017 found that implementing sugar-sweetened beverage warning labels at all sugar-sweetened beverage retailers lowered obesity prevalence among adolescents in all three cities. Point-of-purchase labels with 8% efficacy (i.e., labels reducing probability of sugar-sweetened beverage consumption by 8%) resulted in the following percentage changes in obesity prevalence: Baltimore: −1.69% (95% CI= −2.75%, −0.97%, p<0.001); San Francisco: –4.08% (95% CI= −5.96%, −2.2%, p<0.001); Philadelphia: −2.17% (95% CI= −3.07%, −1.42%, p<0.001).

Conclusions

Agent-based simulations showed how warning labels may decrease overweight and obesity prevalence in a variety of circumstances with label efficacy and literacy rate identified as potential drivers. Implementing a warning label policy may lead to a reduction in obesity prevalence. Focusing on warning label design and store compliance, especially at supermarkets, may further increase the health impact.

Original source: http://dx.doi.org/10.1016/j.amepre.2017.11.003

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Racial discrimination and low household education predict higher body mass index in African American youth

December 6, 2017, Childhood Obesity

Abstract

Objective

The purpose of this study was to examine the relationships between environmental factors, including household education, community violence exposure, racial discrimination, and cultural identity, and BMI in African American adolescents.

Methods

A community-based sample of 198 African American youth (120 girls, 78 boys; ages 11–19 years) from Washtenaw County, Michigan, were included in this analysis. Violence exposure was assessed by using the Survey of Children’s Exposure to Community Violence; racial discrimination by using the Adolescent Discrimination Distress Index; cultural identity by using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents; and household education by using a seven-category variable. Measured height and body weight were used to calculate BMI.

Results

Racial discrimination was positively associated with BMI, whereas household education was inversely associated with BMI in African American adolescents (discrimination: β = 0.11 ± 0.04, p = 0.01; education: β = −1.13 ± 0.47, p = 0.02). These relationships were significant when accounting for the confounding effects of stress, activity, diet, and pubertal development. Significant gender interactions were observed with racial discrimination and low household education associated with BMI in girls only (discrimination: β = 0.16 ± 0.05, p = 0.003; education: β = −1.12 ± 0.55, p = 0.045). There were no significant relationships between culture, community violence exposure, and BMI (all p’s > 0.05).

Conclusion

Environmental factors, including racial discrimination and low household education, predicted higher BMI in African American adolescents, particularly among girls. Longitudinal studies are needed to better understand the mechanisms by which these environmental factors increase obesity risk in African American youth.

Original source: https://doi.org/10.1089/chi.2017.0218

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Effectiveness of a kindergarten-based intervention for preventing childhood obesity

December 1, 2017, Pediatrics

Abstract

Background and Objectives

Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness.

Methods

This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese.

Results

By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of –0.31 (95% CI –0.47 to –0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status.

Conclusions

Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.

Original source: https://doi.org/10.1542/peds.2017-1221

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