January 2017





Getting to equity in obesity prevention: A new framework

January 18, 2017, National Academy of Medicine

By Shiriki Kumanyika

High obesity prevalence persists as a major issue for societies globally. Chronic overweight and obesity have high health, social, and economic costs, and the benefits of achieving and maintaining healthy weight for overall health and well-being are well established. Obesity in children and adolescents is of particular concern because it may compromise physical and psychosocial development and set the stage for early onset of adverse health effects that accumulate over a lifetime. Relevant to the topic of this discussion paper, obesity is also a health equity issue. Social disadvantage tends to intensify the exposure to obesity-promoting influences. The challenge of preventing and controlling obesity includes the need to assure that socially disadvantaged populations benefit from relevant public health interventions.

Population-wide obesity and its health consequences are linked to eating and physical activity patterns that have become ways of life in modern societies. This is a global problem, but one for which solutions must be tailored to national and subnational contexts. Human physiologic systems for regulation of food intake are well developed for responding to hunger but poorly developed for curbing overeating, and they evolved when routine physical activity levels were much higher than they are now. Thus, it is often said that from an evolutionary perspective widespread obesity reflects a natural response to an unnatural environment. On the energy intake side, this unnatural environment is characterized by ubiquitous, heavily advertised, and highly palatable high-calorie foods and beverages and large portions of restaurant meals; these all promote caloric overconsumption. On the energy output side, the unnatural environment is evident in residential areas where cars are a common form of transportation or where mobility depends on using a car, in sedentary work environments that limit physical activity, and where sedentary entertainment is readily available, affordable, and heavily promoted.

Original source: https://nam.edu/getting-to-equity-in-obesity-prevention-a-new-framework/

Full discussion paper: https://nam.edu/wp-content/uploads/2017/01/Getting-to-Equity-in-Obesity-Prevention-A-New-Framework.pdf

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Publications & Tools

Driving action and progress on obesity prevention and treatment: Proceedings of a workshop—in brief

The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on September 27, 2016, titled “Driving Action and Progress on Obesity Prevention and Treatment.” The workshop was designed to (1) review the progress that has been made in obesity prevention and treatment; (2) identify some of the levers that can drive significant future progress; and (3) discuss how gaps in the field can be filled. This Proceedings of a Workshop-in Brief highlights key points made during the presentations and discussions and is not intended to provide a comprehensive summary of information shared during the workshop.

Read the full report

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Review of WIC Food Packages: Improving balance and choice: Final report

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population.

Read the full report

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FDA issues two guidance documents on the Nutrition Facts Label and the Serving Size Final Rules

The U.S. Food and Drug Administration today issued two draft guidance documents related to the final rules on Nutrition Facts labeling and Serving Sizes to help industry comply with those rules.

The first draft guidance answers questions related to compliance, labeling of added sugars, rounding as it relates to the declaration of quantitative amounts of vitamins and minerals, and label format (thickness of lines and space between lines).

The second draft guidance provides examples of food products that belong to product categories included in the tables of Reference Amounts Customarily Consumed (RACCs) per Eating Occasion that are established in FDA’s serving size regulations. These examples will help industry identify the appropriate food categories for their products and, in turn, determine the serving size on a product’s Nutrition Facts label.

The final rules on the Nutrition Facts label and serving sizes published May 27, 2016. The compliance date is July 26, 2018, but smaller businesses with annual food sales that are less than $10 million have until July 26, 2019 to comply.

Draft guidance

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Childhood Obesity Research & News

Using school staff members to implement a childhood obesity prevention intervention in low-income school districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

January 12, 2017, Preventing Chronic Disease



Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts


The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability.


MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers.


Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.

Original source: https://www.cdc.gov/pcd/issues/2017/16_0381.htm?s_cid=pcd13e03_x

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Parents' physical activity associated with preschooler activity in underserved populations

January 9, 2017, EurekAlert

Preschool-age children from low-income families are more likely to be physically active if parents increase activity and reduce sedentary behavior while wearing movement monitors (accelerometers), according to a Vanderbilt study published today in the American Journal of Preventive Medicine.

The study, which examined the impact of parent modeling of physical activity (PA) and sedentary behaviors in low-income American ethnic minorities, included data from more than 1,000 parent-child pairs. About 75 percent of the children were Latino and almost 10 percent, African-American. The participants live in metro areas of Minneapolis/St. Paul, Minnesota, and Nashville, Tennessee.

During the research period, each parent and child wore an accelerometer for an average of 12 hours a day, for a week. This is the first study to link the physical activity of parents and young children by objectively measuring that physical activity with such a long wear time for an accelerometer.

Researchers found that the preschoolers’ total physical activity was 6.03 hours per day with 1.5 hours spent in moderate to vigorous activity.

“This study highlights how important parents’ physical activity is to shaping their young children’s physical activity,” said principal investigator Shari Barkin, M.D., MSHS, William K. Warren Foundation Professor in Medicine, director of Pediatric Obesity Research, and chief of the Division of General Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“The good news is that increasing physical activity is not only good for parents’ health, it also helps set these behaviors in their young children as well. It’s doubly good for family health. Setting this habit early could impact good health not only in childhood but in adulthood as well.”

Physical activity is a critical factor for preventing childhood obesity and promoting good cardiovascular health. Recommendations call for preschoolers to obtain about three hours a day of total physical activity (light, moderate and vigorous) with at least one hour of moderate-to-vigorous physical activity (MVPA), but reports show that less than half of preschoolers actually achieve that recommendation.

In this study, about 60 percent of the children were normal weight, while 30 percent were overweight and 10 percent were obese. More than three-fourths of the parents were overweight or obese. During the period examined, parents and children wore the accelerometers more than 12 hours each day.

Researchers saw a strong association between parent and child sedentary behavior and mild physical activity. They also found that up to 40 minutes of moderate-to-vigorous physical activity by a parent correlated with their preschool-age child’s level of MVPA.

For every minute that a parent spent in sedentary behavior, the child’s sedentary behavior increased by 0.10 minutes. Similarly, for every minute a parent engaged in light physical activity, the child’s light physical activity increased by 0.06 minutes. Increasing parental physical activity and reducing sedentary behavior correlated with increased physical activity behaviors in children, the researchers concluded.

This study is part of Barkin’s ongoing research into childhood obesity.

“We are completing a three-year-long intervention for childhood obesity prevention, called the Growing Right Onto Wellness (GROW) Trial, that includes parents’ healthy lifestyle behaviors as well as their children’s healthy behaviors for more than 600 parent-child pairs. We will be able to examine how parents and children can utilize their existing built and social environments to maximize good health and to set and maintain healthy habits,” she said.

Original source: https://www.eurekalert.org/pub_releases/2017-01/vumc-ppa010917.php

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USDA announces retailer volunteers for SNAP online purchasing pilot

January 5, 2017, U.S. Department of Agriculture, Food and Nutrition Service

The U.S. Department of Agriculture (USDA) today announced the seven retail firms selected to take part in a pilot designed to enable Supplemental Nutrition Assistance Program (SNAP) participants to purchase their groceries online. The two-year pilot is slated to begin this summer.

“Online purchasing is a potential lifeline for SNAP participants living in urban neighborhoods and rural communities where access to healthy food choices can be limited,” USDA Secretary Tom Vilsack said. “We’re looking forward to being able to bring the benefits of the online market to low-income Americans participating in SNAP.”
Firms selected include:

Retailers – Pilot States

  • Amazon – Maryland, New Jersey, New York
  • FreshDirect – New York
  • Safeway – Maryland, Oregon, Washington,
  • ShopRite – Maryland, New Jersey, Pennsylvania
  • Hy-Vee, Inc. – Iowa
  • Hart’s Local Grocers – New York (based in Rochester)
  • Dash’s Market – New York (based in Buffalo)

The firms selected represent a variety of store types, including national online retailers as well as large grocery chains and smaller, regional networks to appropriately test online SNAP purchasing in different settings. Pilots will take place in seven states in both rural and urban areas, marking the next critical step in bringing the online purchasing option to SNAP clients.

While USDA has authorized SNAP online grocery ordering in a few locations, this pilot will test both online ordering and payment. Online payment presents technical and security challenges that will need to be examined and fully addressed before it is offered nationwide. As with the core program, SNAP participants will only be able to use their benefits to purchase eligible items online – not to pay for service or delivery charges. USDA is committed to maintaining the security of SNAP benefits for both the protection of SNAP participant accounts and to prevent and detect trafficking, so SNAP online purchases must have a higher level of security than most other online purchases.

As the pilot proceeds and USDA confirms the system is operating as required, we anticipate being able to add additional retailers. Eventually, our goal is for this to be a national option for SNAP participants, once the pilot phase is complete and USDA can incorporate lessons learned into program rules.

USDA has taken many steps in the last several years to strengthen SNAP and increase access to healthy foods. Recently, USDA announced a purchase and delivery pilot, which is designed for non-profits and government entities to improve access to groceries solely for homebound elderly and disabled SNAP participants. USDA also provided funding to incentivize participants in SNAP to purchase more healthy fruits and vegetables through the Food Insecurity Nutrition Incentive Program, increased farmers market participation in SNAP to improve access to fresh and nutritious food, and announced final changes to increase access to healthy food choices for SNAP participants by requiring authorized retail establishments to offer a larger inventory and variety of healthy food options.

As the nation’s first line of defense against hunger, SNAP helps put food on the table for millions of low income families and individuals every month and has never been more critical to the fight against hunger. SNAP is a vital supplement to the monthly food budget of more than 43 million low-income individuals. Nearly half of SNAP participants are children, 10 percent are over 60 and more than 40 percent of recipients live in households with earnings.
Original source: https://www.fns.usda.gov/pressrelease/2017/fns-000117

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Parental obesity linked to delays in child development, NIH study suggests

January 3, 2017, National Institutes of Health

Children of obese parents may be at risk for developmental delays, according to a study by researchers at the National Institutes of Health. The investigators found that children of obese mothers were more likely to fail tests of fine motor skill — the ability to control movement of small muscles, such as those in the fingers and hands. Children of obese fathers were more likely to fail measures of social competence, and those born to extremely obese couples also were more likely to fail tests of problem solving ability.

“…our results suggest that dad’s weight also has significant influence on child development.” —Edwina Yeung, Ph.D., Investigator, NICHD, Division of Intramural Population Health Research

The study, appearing in Pediatrics, was conducted by scientists at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

“The previous U.S. studies in this area have focused on the mothers’ pre- and post-pregnancy weight,” said the study’s first author, Edwina Yeung, Ph.D., an investigator in NICHD’s Division of Intramural Population Health Research. “Our study is one of the few that also includes information about fathers, and our results suggest that dad’s weight also has significant influence on child development.”

Dr. Yeung and her coauthors cited research indicating that about 1 in 5 pregnant women in the United States is overweight or obese.

In the study, authors reviewed data collected from the Upstate KIDS study, which originally sought to determine if fertility treatments could affect child development from birth through age 3. More than 5,000 women enrolled in the study roughly 4 months after giving birth in New York State (excluding New York City) between 2008 and 2010. To assess development, parents completed the Ages and Stages Questionnaire (link is external) after performing a series of activities with their children. The test isn’t used to diagnose specific disabilities, but serves as a screen for potential problems, so that children can be referred for further testing.

Children in the study were tested at 4 months of age and retested 6 more times through age 3. When they enrolled, mothers also provided information on their health and weight — before and after pregnancy — and the weight of their partners.

Compared to children of normal weight mothers, children of obese mothers were nearly 70 percent more likely to have failed the test indicator on fine motor skill by age 3. Children of obese fathers were 75 percent more likely to fail the test’s personal-social domain — an indicator of how well they were able to relate to and interact with others by age 3. Children with two obese parents were nearly three times more likely to fail the test’s problem solving section by age 3.

It is not known why parental obesity might increase children’s risk for developmental delay. The authors note that animal studies indicate that obesity during pregnancy may promote inflammation, which could affect the fetal brain. Less information is available on the potential effects of paternal obesity on child development. The authors added that some studies have indicated that obesity could affect the expression of genes in sperm.

If the link between parental obesity and developmental delays is confirmed, the authors wrote, physicians may need to take parental weight into account when screening young children for delays and early interventional services.

Original source: https://www.nih.gov/news-events/news-releases/parental-obesity-linked-delays-child-development-nih-study-suggests

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