February 2017





NCCOR launches Measures Registry User Guides

Feb. 23, 2017, NCCOR

The National Collaborative on Childhood Obesity Research (NCCOR) has launched four Measures Registry User Guides to help childhood obesity researchers and practitioners choose appropriate measures for their research and evaluation efforts. The four User Guides focus on core areas of childhood obesity research: individual diet, food environment, individual physical activity, and physical activity environment.

The User Guides were created through a two-year grant from The JPB Foundation, NCCOR’s first strategic alliance partner. The project represents a continued commitment to encourage consistent use of high-quality, comparable measures and research methods across childhood obesity prevention research and evaluation efforts focused on diet and physical activity.

The User Guides build on NCCOR’s Measures Registry—a free, online repository of scientific articles about measures—widely recognized as a key resource that gives researchers and practitioners access to detailed information on measures in one easy-to-search location.

The User Guides provide an overview of measurement, describe general principles of measurement selection, present case studies that walk users through the process of using the Measures Registry and direct researchers and practitioners to additional resources and sources of useful information. The Measures Registry User Guides are available on the NCCOR website as easy-to-read webpages and downloadable PDFs. The Guides are written for both expert researchers and graduate students or practitioners who may be using nutrition or physical activity measures for the first time. The PDF versions can work as text for graduate-level classes, and teaching slides will soon be available.

“The NCCOR Measures Registry is a great resource, but the large number of measures can make it difficult for users to find what they want. The new User Guides are designed to improve the user experience through step-by-step directions,” said Jim Sallis, author of the Physical Activity Environment User Guide and member of NCCOR’s Expert Scientific Panel. “The goal is to help readers find—and use—measures suitable for their research or evaluation objectives.”

Each Guide was written by a team of leading experts. The Guides were also reviewed by expert panels in nutrition and physical activity.

“The User Guides provide in-depth discussions of each domain for researchers and practitioners. They will be enormously helpful to my doctoral students in making effective use of the variety of measures available in the Measures Registry,” said Alice Ammerman, a reviewer on the Nutrition Expert Panel. “The Guides will move the field forward by promoting more consistent use of measures, which will allow for more standardization and synthesis among domains.”

Stay Tuned! NCCOR will two host two webinars on March 29 and April 12, both at 2:00 p.m. ET, on the Measures Registry User Guides to provide an overview of each Guide and highlight key features.

Original source: https://www.nccor.org/nccor-launches-measures-registry-user-guides/

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Publications & Tools

Optimizing the process for establishing the Dietary Guidelines for Americans: The selection process

The Dietary Guidelines for Americans (DGA) is a report that provides nutritional and dietary information with the intention of promoting health and preventing disease, and serves as the basis for all federal nutrition policies and nutrition assistance programs, as well as nutrition education programs. This guidance is updated and presented every 5 years by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS). The complicated process of updating the report begins with an assessment of relevant scientific data by a federal advisory committee of nationally recognized experts, called the Dietary Guidelines Advisory Committee. When the 2015–2020 edition of the DGA was released, some of the content received criticism from different stakeholders leading to questions about the advisory committee’s composition and membership selection processes.

In response to such concerns, Congress mandated that the National Academies of Sciences, Engineering, and Medicine produce two reports evaluating the entire process used to develop the DGA. In this first report, Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process, the ad hoc National Academies committee examines how the Dietary Guidelines Advisory Committee selection process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints.

Read the full report

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Feeding guidelines for infants and young toddlers: A responsive parenting approach

Early life diet and feeding behaviors play an important role in establishing healthy food preferences and behaviors and are crucial for preventing childhood overweight and obesity. This report presents evidence-based recommendations for promoting healthy nutrition and feeding patterns for infants and toddlers from birth to 24 months, with an emphasis on dietary quality, portion sizes, and mealtime environment. Physical activity, soothing, and sleep are also discussed in the report, as they have also been shown to influence early life feeding behaviors and weight outcomes. These guidelines were developed by an expert panel convened by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation. They are based on current scientific evidence related to responsive parenting practices. The aim of the guidelines is to empower caregivers to address the nutrition and well-being of infants and toddlers by offering them healthier food and beverage options in response to their behavioral cues. The guidelines can be used by parents and caregivers in the home, as well as be applied in child-care settings where many infants and toddlers are served.

Read the executive summary

Read the full report

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Sugar-sweetened beverage consumption among U.S. youth, 2011–2014

Sugar-sweetened beverages contribute calories and added sugars to the diets of U.S. children (1). Studies have suggested a link between the consumption of sugar-sweetened beverages and dental caries, weight gain, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease in children (2–6). The 2015–2020 Dietary Guidelines for Americans recommend reducing added sugars consumption to less than 10% of calories per day and, specifically, to choose beverages with no added sugars (1). This report presents results for consumption of sugar-sweetened beverages among U.S. youth aged 2–19 years for 2011–2014 by sex, age, and race and Hispanic origin.

Read the data brief

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Strategies for recess in schools

The 2008 Physical Activity Guidelines for Americans recommends that children and adolescents engage in 60 minutes of physical activity each day.1 Being physically active can improve strength and endurance; help build healthy bones and muscles; help control weight; reduce anxiety, stress, and depression; improve academic achievement; and increase self-esteem for children and adolescents.1, 2

Recess can help students increase their daily physical activity and contribute to getting the recommended 60 minutes of physical activity each day.2-4 Recess also is an essential part of students’ school experience that contributes to their normal growth and development. Recess helps students practice social skills (e.g., cooperation, following rules, problem solving, negotiation, sharing, communication), positively engage in classroom activities (e.g., being on-task, not being disruptive), and enhance cognitive performance (e.g., attention, memory).2–4

This document, Strategies for Recess in Schools, describes strategies for planning and providing recess in schools to help increase participation in physical activity and improve academic achievement (e.g., performance, behavior, attention). The audiences for this document include state and school district leaders that provide technical assistance and professional development on recess, physical education teachers, classroom teachers, recess and playground supervisors, support staff, school administrators, parent-teacher organizations, school health coordinators, school health advisory councils, parents, and anyone interested in supporting recess in schools. While each of these representative groups may have different roles and responsibilities in garnering support for and implementing these strategies, involvement of all groups is important.

Read the full report

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Childhood Obesity Research & News

Can parental education improve effectiveness of school-based BMI screening?

Feb. 8, 2017, EurekAlert!

By Mary Ann Liebert, Inc., publishers

New Rochelle, NY, February 8, 2017—Parents of elementary school children who received body mass index (BMI) screening results together with educational material were significantly more likely to express their intent to change at least one obesity-related risk factor compared to parents who received only the BMI measure. Parental education may help improve the acceptance and utility of BMI screening in school-age children, a practice that has been controversial and largely ineffective at reversing the childhood obesity epidemic. The study is published in Childhood Obesity, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Childhood Obesity website until March 10, 2017.

Greg Welk, PhD, Iowa State University (Ames), Lisa Bailey-Davis, DEd, RD, Geisinger Health System (Danville, PA), and coauthors from University of Tennessee–Chattanooga and Iowa State University describe the educational information they provided to parents in the article entitled “Effects of Enhancing School-based Body Mass Index Screening Reports with Parent Education on Report Utility and Parental Intent to Modify Obesity Risk Factors.” Among the important findings of this study was that parents of children who were overweight or obese and who received the enhanced BMI information reported being more likely to plan a visit to a health care provider and an intent to limit sugar-sweetened drinks compared to parents of children who were not overweight.

“In the midst of the child obesity epidemic in the United States, there has been concern that parents are not well informed about what constitutes obesity or what they should do about it. It was thought that simply providing a “report card” with the child’s BMI would be enough provoke action,” says Childhood Obesity Editor-in-Chief Tom Baranowski, PhD, Baylor College of Medicine, Houston, TX. “Studies testing that method have encountered inconsistent results, with many showing no effect. Dr. Welk and colleagues took that intervention one step further and provided the parent with information on how to interpret the report card with guidance on what they could do. In this study, parents of overweight and obese children responded in a desired way. This study is important enough that it needs to be replicated in other samples and regions of the country. This will provide a firm foundation for formulating school policies to prevent the further development of child obesity.”

Original source: https://eurekalert.org/pub_releases/2017-02/mali-cpe020817.php

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The Healthy-Lifestyle Curriculum: At Perea Preschool in Memphis, Tennessee, lesson plans come with a heaping portion of nutrition

Feb. 5, 2017, The Atlantic

By Reyna Gobel

At Perea Preschool in Memphis, Tennessee, a teacher introduces mango to a circle of 16 4-year-olds for the first time. Another day, the children discover pumpkin during a play activity. Most of these children come from impoverished families where lettuce is considered a luxury item. According to Vicki Sallis Murrell, a professor of counseling, educational psychology, and research at the University of Memphis, parents are making tough choices between a $1 head of lettuce and five boxes of macaroni and cheese.

“In the middle of a food desert, grocery stores with reasonably priced, quality produce and fish are difficult to find,” Murrell said. But parents are making sacrifices to provide healthy food for their families because they know their kids want and need it. “If my kids didn’t go to Perea, they wouldn’t want to eat vegetables,” said Scharica Martin, a former Perea parent. But because all three of her children attended the school, healthy food is one of her family’s biggest budget items.

Perea is funded by a local health care organization, and nutrition is a key component of the curriculum. The school operates with the idea that students and their families do best when they know that good nutrition aids brain development—and ultimately, the development of cognitive skills. Enrollment has grown by more than 300 percent since the school was founded in 1999.

The school isn’t unusual. As brain science has evolved and more attention has been paid to the link between health and education, more preschools across the country seem to be focusing on providing not only academic and social support, but health education, too. Educare, which operates a network of schools across the country, focuses on health and nutrition. Recently, Priscilla Chan, a philanthropist married to the Facebook founder Mark Zuckerberg, helped launch a school for low-income children that is partnering with a health center to holistically educate children and their families.

Most physical brain development occurs before age 5 or 6 when the brain reaches 90 percent of its adult size, Murrell said. “The intake of healthy fat is particularly important for the process of myelination. Myelin is like the grease that coats the synaptic connections, making the transfer of information faster. Without proper nutrition both in utero and after birth, the brain cannot develop as it should.” In other words, a lifetime brain map for social, emotional, and cognitive functions is formed during preschool and kindergarten.

Play is the best way to influence behavior and teach lessons about health in early years, according to Murrell. For example, Perea never introduces a food by having a cafeteria employee plop a scoop on a plate—there is always an explanation or exploration, Alicia Norman, the school’s principal, said. During a pumpkin-centered activity, children see a raw pumpkin before seeds are roasted or pies are made. They’re encouraged to stick their hands in and feel the texture of both the seeds and the pumpkin meat. If they want to try raw pumpkin, that natural curiosity is indulged.

A child that graduates from Perea can explain the health benefits, taste, and texture of every food they’ve been introduced to, Norman said. The preschool’s philosophy is that while pie itself isn’t the epitome of nutritional perfection, the concept of food not coming from cans encourages the use of fresh ingredients and the avoidance of preservatives. Talking to the children about foods instead of making them eat new foods without a choice or explanation is why her students want to eat healthy while other schools have had trouble achieving similar results, she said.

Preschools like Perea that have adopted health as a focus don’t just cover physical wellness and nutrition. They often cover the emotional side of wellness, too. For instance, if a school serves students who already have parents providing and encouraging nutritious meals, teachers may focus more on emotional regulation and cognitive functions. For Perea students, emotional regulation is part of every lesson. “You can’t get to the root of any problem, nutrition or otherwise, without exploring emotional regulation and getting the child to explain what problems they are having,” Murrell said. “We can understand problems and get clues of the overall health of the child when we ask how they are feeling.”

To further focus on emotional growth, Perea has developed an approach where teachers and administrators become part of the students’ extended families. Teachers do at least one home visit per year. The home visits help them see what a child’s family life is like, and they also help the children trust their instructors. A child might show her teacher her Spiderman, Dora, and princess toys. When tough lessons are taught in school, such as conflict resolution, kids are more likely to remember their teacher played with them at home and then listen to their advice and guidance at school.

A big part of conflict resolution is helping kids learn to express their feelings instead of resorting to violence or anger. Gender roles are untaught at Perea, Murrell said. Girls are traditionally taught it’s okay to be sad, happy, or scared, while boys are traditionally taught it’s not okay to show fear or sadness, but it is okay to be angry or happy. Perea students are taught that all emotions are okay as long as they’re expressed calmly, which helps them learn to regulate their emotions, she said.

Perea knows that to help students develop emotionally and physically, it needs to work with parents to ensure that the adults in students’ lives are physically and mentally healthy, too. This means providing supportive resources for parents.

Martin saw firsthand how much the school cared about her family when her child’s teacher helped her after a job loss. “I was walking around depressed, and she went home and talked to her husband to see what they could do to help me,” Martin said. “They paid my light bill and helped me find a new job. I’ll never forget her, and we still keep in touch. My children refer to her as if she were an aunt.”

The help Martin received from Perea wasn’t rare. Perea has a parent liaison that connects parents with community resources for employment, getting their GED, and enrolling in or returning to college. Some parents say they have a stronger support system than they’ve ever had through the friends and teachers they meet at Perea.

Martin’s Perea story started when she volunteered there with her cousin before she even had a child in the preschool. She said she was so impressed that she wanted to send her children there. Her cousin was fulfilling part of the 30-hour annual parent volunteering and engagement requirement. Parent engagement isn’t just volunteering in the classroom; it’s also taking parenting classes.

“Parents tend to parent as they were parented,” Murrell said. “With education, Perea parents learn different tactics to take with our children. For example, we teach parents that punishment is not effective for long-term behavioral change, and can, in fact, promote avoidance behaviors and secrecy.” Instead, parents are taught about other ways to deal with problem behaviors, such as refocusing attention and talking with their children about their emotions. The purpose is to help the children develop the cognitive processes required to self-regulate. But if the parents don’t know about their options, then they can’t make change.

Perea’s been so successful with parenting training that it created a parenting center the community will soon have access to. The center will educate parents about how to provide a healthy environment for children, including about the importance of nutritionally balanced meals.

Perea hopes that by equipping parents with the tools teachers use in class, what children learn at school will be reinforced at home and vice versa. While Martin sees children she knows getting into physical fights in middle school, her eldest is not only avoiding physical fights, but he is also quoting his Perea teachers about how to correctly handle disagreements by talking to resolve conflicts.

Without conflict-resolution skills, students can fall prey to toxic stress as they get older, according to Murrell. Toxic stress is stress that is so severe because of childhood trauma that it leads to “physical health issues that manifest later in life because of stress that is strong, frequent, and prolonged in the absence of protective relationships,” she said.

In a study of more than 17,000 people conducted in the mid-1990s by the Center for Disease Control and Kaiser Permanente, children with four or more adverse childhood experiences, such as an incarcerated parent, neglect, or physical abuse, “were much more likely to have hepatitis, chronic obstructive pulmonary disease (emphysema or chronic bronchitis), depression, auto-immune diseases, and one or more sexually-transmitted diseases,” Murrell said.

“We have a short time to reach both kids and parents,” Murrell said. “As children enter middle childhood, they tend to become more interested in other kinds of play, such as rule-based games. They become less influenced by what adults think or want. By adolescence, many kids will do the opposite of what an adult expects or wants, just to test boundaries. That makes introducing new concepts, including conflict-resolution tactics, learning approaches, and foods early important.“

“Children leave Perea confident and knowing they have a voice in the world,” Norman said. “Parents leave knowing the same.”

Original source: https://www.theatlantic.com/education/archive/2017/02/the-healthy-lifestyle-curriculum/515622/

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Establishment of the Pediatric Obesity Weight Evaluation Registry: A national research collaborative for identifying the optimal assessment and treatment of pediatric obesity

Feb. 1, 2017, Childhood Obesity


Background: Prospective patient registries have been successfully utilized in several disease states with a goal of improving treatment approaches through multi-institutional collaboration. The prevalence of youth with severe obesity is at a historic high in the United States, yet evidence to guide effective weight management is limited. The Pediatric Obesity Weight Evaluation Registry (POWER) was established in 2013 to identify and promote effective intervention strategies for pediatric obesity.

Methods: Sites in POWER provide multicomponent pediatric weight management (PWM) care for youth with obesity and collect a defined set of demographic and clinical parameters, which they regularly submit to the POWER Data Coordinating Center. A program profile survey was completed by sites to describe characteristics of the respective PWM programs.

Results: From January 2014 through December 2015, 26 US sites were enrolled in POWER and had submitted data on 3643 youth with obesity. Ninety-five percent were 6–18 years of age, 54% female, 32% nonwhite, 32% Hispanic, and 59% publicly insured. Over two-thirds had severe obesity. All sites included a medical provider and used weight status in their referral criteria. Other program characteristics varied widely between sites.

Conclusion: POWER is an established national registry representing a diverse sample of youth with obesity participating in multicomponent PWM programs across the United States. Using high-quality data collection and a collaborative research infrastructure, POWER aims to contribute to the development of evidence-based guidelines for multicomponent PWM programs.

Original source: http://online.liebertpub.com/doi/full/10.1089/chi.2016.0060

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Physical activity and changes in adiposity in the transition from elementary to middle school

Feb. 1, 2017, Childhood Obesity


Objectives: This study examined the longitudinal associations of objectively measured physical activity, sedentary behavior, and diet quality with two measures of adiposity and a measure of weight status.

Methods: A total of 658 children from 21 elementary schools (45.1% boys; 40% white, 33% black, 9% Hispanic, and 18% other race/ethnicity) were assessed at least twice in fifth, sixth, and/or seventh grade. Fat mass index (FMI), percent body fat (PBF), and BMI were calculated from body weight, standing and seated heights, and bioelectrical impedance (BIA) measured each year.

Results: At follow-up, both FMI and PBF decreased among boys and increased among girls, while BMI increased in both boys and girls. After controlling for race/ethnicity, parent education, and maturity offset at baseline, growth curve analyses showed that moderate-to-vigorous physical activity (MVPA) was significantly and negatively associated with FMI, PBF, and BMI for both boys and girls. After forming tertiles of fifth grade MVPA, least-square means for FMI, PBF, and BMI were examined by grade and gender. For both boys and girls, higher MVPA was associated with lower FMI, PBF, and BMI at all three grade levels. The relationships between sedentary behavior and diet quality and FMI, PBF, and BMI were not consistent for boys or girls.

Conclusions: As boys and girls transitioned from elementary to middle school, children who participated in higher levels of MVPA maintained more favorable levels of two indicators of adiposity and a measure of weight status. These findings support the need for interventions to help children meet current public health guidelines for physical activity.

Original source: http://online.liebertpub.com/doi/full/10.1089/chi.2016.0103

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