March 2017





NCCOR’s 2016 Annual Report: Expanding Our Outreach

March 30, 2017, NCCOR

NCCOR’s recently released Annual Report 2016 explores how NCCOR has expanded its outreach in four areas: engaging new audiences; harnessing the expertise of members and advisors; convening experts from diverse fields; and creating tools and resources for researchers and practitioners.

Engaging new audiences

NCCOR reaches new stakeholders, researchers, practitioners, and health care providers through its highly successful Connect & Explore webinar series. These webinars provide information and insights on the latest developments and research findings in the field of childhood obesity research. In 2016, NCCOR held 11 Connect & Explore webinars—including in-depth multi-part webinars on topics such as Health Care Community Collaborations—and three livestreamed panels hosted by NCCOR during the Society of Behavioral Medicine (SBM) 37th Annual Meeting & Scientific Sessions.

Harnessing the expertise of members and advisors

NCCOR workgroups provide the structure for members to come together and work on issues of shared interest. The Engaging Health Care Providers and Systems workgroup was active in 2016 and continued its work reaching out to health care providers and health systems to better understand how research on childhood obesity prevention and control can be used in clinical settings. As a result of a 2015 workshop, the workgroup released a white paper, Evaluating Community-Clinical Engagement to Address Childhood Obesity: Implications and Recommendations for the Field. The white paper provides a background on the impetus for evaluation of community-clinical engagement models, describes workshop development, and captures the workshop findings and recommendations.

Convening experts from diverse fields

NCCOR convened a diverse group of experts on two occasions to examine two very different issues relevant to the field—how to create better environments that encourage active living and healthy eating and how to use retail markets to encourage healthy food purchases.

Creating tools and resources for researchers and practitioners

NCCOR continued to enhance the longstanding Measures Registry and Catalogue of Surveillance Systems and expand the Registry of Studies. A high point of 2016 was the completion of four User Guides to complement the Measures Registry. NCCOR also helped USDA develop the interpretive guide to the SNAP-Ed Evaluation Framework, and created a web-based Youth Compendium of Physical Activities that will be released in 2017.

To view the full Annual Report, visit

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NCCOR publishes new white paper on health, behavioral design, and the built environment

March 30, 2017, NCCOR

NCCOR released a new white paper on the use of behavioral design strategies and approaches to foster healthy eating and active living among children, teenagers, and their families.

Available on the NCCOR website, the white paper builds on a series of behavioral design meetings NCCOR hosted in 2015–2016 that brought together experts from a variety of fields, including architecture, environmental psychology, art, landscape architecture, human behavior, and philosophy and ethics. Meeting participants examined conceptual frameworks of behavioral design and their application to healthy eating and active living.

The white paper encourages childhood obesity researchers and practitioners to consider the role of behavioral design in their work and use it for research and practice. It examines how behavioral design is applied to the built environment and guides researchers and practitioners in using behavioral design methods to enable and promote healthy eating and active living among children. With this white paper, NCCOR plans to stimulate further discourse on the application of behavioral design.

Learn more! NCCOR is sponsoring a panel, “Healthy Places: Using Behavioral Design to Enhance Active Living and Healthy Eating,” featuring the authors of the white paper at The Environmental Design Research Association (EDRA) conference from May 31 through June 2.

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Publications & Tools

500 Cities: Local data for better health

The 500 Cities project is a collaboration between CDC, the Robert Wood Johnson Foundation, and the CDC Foundation. The purpose of the 500 Cities Project is to provide city- and census tract-level small area estimates for chronic disease risk factors, health outcomes, and clinical preventive service use for the largest 500 cities in the United States. These small area estimates will allow cities and local health departments to better understand the burden and geographic distribution of health-related variables in their jurisdictions, and assist them in planning public health interventions.

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Food Service Guidelines for Federal Facilities

The U.S. Department of Health and Human Services (HHS) and the U.S. General Services Administration (GSA) collaboratively released the first food service guidelines for federal facilities in March 2011 in an effort to assist employees in making healthier food and beverage choices and to create an efficient and environmentally beneficial food service system. Those guidelines, Health and Sustainability Guidelines for Federal Concessions and Vending Operations, have been updated and renamed, Food Service Guidelines for Federal Facilities.

Updates to the Food Service Guidelines for Federal Facilities primarily include the following: 1) alignment of food and nutrition standards with the 2015 – 2020 Dietary Guidelines for Americans, 8th Edition 2) alignment with Executive Order 13693 (Planning for Federal Sustainability in the Next Decade) on energy efficiency and environmental performance; 3) additions of food safety standards aligned with the Food Code to ensure protection against foodborne illnesses; and 4) behavioral design strategies for encouraging selection of healthier foods and beverages.

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Childhood Obesity Research & News

Healthy Eating Index—Beyond the score

April 2017, Journal of the Academy of Nutrition and Dietetics

The Healthy Eating Index (HEI) is a measure of diet quality that is based on key recommendations of the Dietary Guidelines for Americans (DGA). The DGA as well as the HEI are a result of collaborations between nutritionists at the US Department of Health and Human Services and the US Department of Agriculture (USDA). The current version is HEI-2010, which reflects the 2010 DGA and includes component scores for total fruit, whole fruit, total vegetables, greens and beans, whole and refined grains, total protein foods, seafood and plant-based protein foods, sodium, and calories from solid fats, added sugar, and alcohol beyond a moderate level.

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Study underscores benefit of smartphone use to track children's health

March 20, 2017, KU Today

A new, wide-ranging review of available research shows parents and caregivers can improve health outcomes for kids by using mobile-phone apps and text messaging.

The research appears in the prestigious, peer-reviewed journal JAMA Pediatrics on March 20. Previous to this investigation, the only across-the-board review of mobile health (mHealth) effectiveness centered on childhood obesity alone.

“The take-home message is that a smartphone can help a child be healthier across a number of health care behaviors, like making sure they get vaccines or eat a healthy diet,” said Christopher Cushing, assistant professor of clinical child psychology at the University of Kansas, who co-authored the findings. “We have some idea that a smartphone and messaging can be a good way to go, but we also have a long way to go to optimize this kind of intervention.”

The researchers analyzed 37 unique studies of mobile health interventions, looking for statistical evidence of changes in health behavior or disease control in participants 18 years old or younger.

“Mobile health interventions appear to be a viable health behavior change intervention modality for youth,” the study concludes. “Given the ubiquity of mobile phones, mobile health interventions offer promise in improving public health.”

Cushing’s collaborators include lead author David Fedele as well as Alyssa Fritz and Adrian Ortega of the University of Florida, and Christina Amaro of KU’s Clinical Child Psychology Program.

According to lead author Fedele, the study suggests that health care providers should encourage mobile-phone-based tech for their patients.

“Findings from the current study indicate that mHealth interventions are a promising and potentially effective route for pediatric health care providers to use with patients and their family members,” he said.

Benefits could come with simple or more complex smartphone interventions, the researchers found. Their study looked at the benefits of all types of mHealth technology but didn’t find advantages of one kind over another.

“It’s worth using, and there a lot of different media that can be used,” Cushing said. “mHealth interventions can be as simple as text messages and as complicated as a dedicated app. You can go small and send text messages for vaccine reminders or build an app that allows for diet and physical activity tracking.”

For parents, Cushing said a key finding suggests they “be involved in the technology.”

“If they have a young child, they could opt into a scheduling program that would allow them to see those things that are due for the child like a vaccination,” he said. “For an older child, it’s appropriate for the child to take on some autonomy such as engaging with an app where they can set goals and get feedback. But the parent should be engaged in that system so they can use teachable moments. If a child isn’t sure about why they’re not meeting goals, a parent can use adult problem-solving to help find an answer.”

According to Cushing, the findings should be relevant to parents, caregivers and pediatricians but also should motivate the technology community. For instance, the research team found that interventions where parents were involved in mHealth technology revealed greater health benefits to children.

“If you’re designing technology, design it so parents and children interact around the technology,” he said. “You get a bigger bang for your buck.”

The ubiquity of mobile phones today contributes to the effectiveness of mHealth technology, according to the researchers.

“With an overwhelming percentage of individuals owning or having access to a mobile phone, mHealth interventions can have greater reach than in-person interventions,” Fedele said. “Furthermore, mHealth programs can collect dynamic health-related data and deliver intervention content to individuals in their natural environment, outside of a clinical encounter, at key times that have a higher likelihood of modifying behavior. An example could be collecting data on percentage of time an individual has spent in sedentary activity and then delivering an individually tailored message to their mobile device promoting them to engage in some sort of physical activity.”

The researchers hoped to follow up the investigation by discovering more about which behavior changes boost the effect of these types of interventions.

“We know that mHealth interventions can work and that parents should be involved, but we are left to guess at what specific strategies they should include,” Cushing said.

In future research, the investigators aim to look at the efficacy of specific apps on the marketplace.

“Now that we know that these approaches can work, it would be a good idea to learn more about what features are valued by consumers and whether those features appear in commercially available apps,” Cushing said.

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Racial or ethnic and socioeconomic inequalities in adherence to National Dietary Guidance in a large cohort of US pregnant women

March 17, 2017, Journal of the Academy of Nutrition and Dietetics


The significance of periconceptional nutrition for optimizing offspring and maternal health and reducing social inequalities warrants greater understanding of diet quality among US women.


Our objective was to evaluate racial or ethnic and education inequalities in periconceptional diet quality and sources of energy and micronutrients.


Cross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort.

Participants and setting

Nulliparous women (N=7,511) were enrolled across eight US medical centers from 2010 to 2013.

Main outcome measures

A semiquantitative food frequency questionnaire assessing usual dietary intake during the 3 months around conception was self-administered during the first trimester. Diet quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy and micronutrients were the outcomes.

Statistical analyses

Differences in diet quality were tested across maternal racial or ethnic and education groups using F tests associated with analysis of variance and χ2 tests.


HEI-2010 score increased with higher education, but the increase among non-Hispanic black women was smaller than among non-Hispanic whites and Hispanics (interaction P value <0.0001). For all groups, average scores for HEI-2010 components were below recommendations. Top sources of energy were sugar-sweetened beverages, pasta dishes, and grain desserts, but sources varied by race or ethnicity and education. Approximately 34% of energy consumed was from empty calories (the sum of energy from added sugars, solid fats, and alcohol beyond moderate levels). The primary sources of iron, folate, and vitamin C were juices and enriched breads.


Diet quality is suboptimal around conception, particularly among women who are non-Hispanic black, Hispanic, or who had less than a college degree. Diet quality could be improved by substituting intakes of refined grains and foods empty in calories with vegetables, peas and beans (legumes), seafood, and whole grains.

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Study finds kids’ meals not improving much despite initiative

March 6, 2017, American Heart Association News

Parents frustrated with a barrage of unhealthy meal choices for their children when dining out were supposed to get a hand when the National Restaurant Association started an initiative six years ago to help cut calories, fat and sugar in kids’ meals.

But a recent report finds the program has been largely ineffective at boosting the nutritional value of menu items aimed at children. The findings come at a time when an increasing number of municipalities are taking matters into their own hands when it comes to helping kids eat more healthfully.

“Because there’s been so little progress in improving the nutritional quality of restaurant kids’ meals, a number of states and localities have passed or introduced kids’ meal policies,” said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest.

So far, only four jurisdictions have passed such rules, all in California. San Francisco and Santa Clara County adopted laws in 2010 setting nutrition standards for any restaurant kids’ meal that offered toys or prizes. In 2015, Davis passed an ordinance making water and milk the default options for any menu geared toward children. Stockton passed a similar bill last June.

But Wootan said city councils or state legislative bodies in Chicago, New York, Hawaii and Vermont and other cities have introduced or are considering similar measures.

“It’s well within the authority of a state or locality to pass measures to protect the public’s health, and this is a business practice that contributes to heart disease, diabetes and childhood obesity,” she said.

Such measures bolster recent findings that self-regulation within the restaurant industry isn’t working.

The new study examined U.S. chain restaurants that made voluntary pledges to improve the nutritional quality of their children’s menu, as outlined in the Kids LiveWell program launched in 2011 by the National Restaurant Association.

By 2015, more than 150 chains with 42,000 locations participated in the program, which requires restaurants to offer at least one healthy entrée and one healthy side on their children’s menus.

But the restaurants failed to make any significant reductions in calories, saturated fat or sodium in their kids’ menus during the first three years of participating in the program, according to the study’s researchers at the Harvard T.H. Chan School of Public Health.

The study also found that while soda gradually disappeared as drink options for kids, they were replaced by other sugary drinks and made up nearly 80 percent of beverage choices.

Dietician Alyssa Moran, the report’s lead author, described the Kids LiveWell program “as definitely a step in the right direction.”

“Their nutrition standards are actually quite strong,” she said, noting they include recommendations for more servings of fruits, vegetables and whole grains.

“Ideally, we’d like restaurants to adopt these standards across all of the menu items that they’re marketing to kids,” she said.

Her study noted, citing federal statistics, that in 2011 and 2012, more than one in three children and teens ate fast-food meals every day. Children offered one nutritional option among more popular, but less healthy, items often won’t make enough of a difference for kids dining out.

“They see the hamburgers and French fries and chicken tenders, maybe next to one or two healthy options,” Moran said. “And it’s difficult for parents, when they have a kid pestering or nagging them for something less healthy, to make that more nutritious, healthy choice.”

The National Restaurant Association responded to the study’s findings in a statement.

“We have recently received this study and are currently reviewing it,” said Leslie Shedd, vice president of communications. “Kids LiveWell was started to promote healthy eating among children, and we welcome any opportunity to encourage children to make healthy choices.”

Wootan said part of the problem is that restaurants have failed to adjust their menus to reflect the fact that more people, especially families with young children, eat out far more often than they used to.

“It has become a way of life, and restaurants haven’t adjusted to that. Their menus still look as if we eat out very occasionally,” she said. “They’re full of high-fat, high-calorie splurges, when many times, it’s a Tuesday night when you have to work late, or your kid has soccer practice and you’d like to rely on a restaurant to feed your family. But too often it’s so difficult to find healthy options.”

That’s why she, like Moran, would like more Kids LiveWell restaurants to go far beyond offering the minimum one healthy menu option. Cities are looking for local laws to make a difference as well.

“It’s not enough to just have one grilled chicken breast amongst a minefield of fat, sugar and salt,” she said. “Because if your kid doesn’t like grilled chicken breast, you’re out of luck at a restaurant. Often times, there are no other healthy options.”

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Obesity study aims to learn what kids would rather do than eat

March 1, 2017, Jacobs School of Medicine and Biomedical Sciences

Researchers in the Department of Pediatrics are using a $2.8 million National Institutes of Health (NIH) grant to study if providing more non-food alternatives could help prevent childhood obesity.

Gauging Role of Non-Food Options in Weight Control

Children who are overweight aren’t necessarily more interested in food than their slimmer peers, but past research shows they are typically less interested than peers in non-food activities, such as sports or imaginative play.

“The goal is to identify whether motivation for non-food alternatives protects against weight gain over time,” says Katelyn Carr, PhD, postdoctoral researcher in the Behavioral Medicine Laboratory of the Department of Pediatrics.

“We want to find out whether a child’s motivation to participate in what we call a non-food alternative, whether it be practicing a musical instrument, doing homework or playing with a friend, will compete with their motivation to eat,” she says.

If it does, then one way to prevent childhood obesity would be to make more of those activities more readily available to children.

Socioeconomic Status May Also Be Contributing Factor

“Our thought is that if children only have food in their environments, then eating is what they’ll do,” Carr says. “But the question is: If other enjoyable activities are available, even if they’re already motivated to eat, will they choose to do those other things?”

She noted that watching television, technically a non-food activity, is considered a complement, not an alternative, to eating.

According to Carr, past research has found that the more alternatives individuals have in their environment, the less likely they are to use or abuse substances, whether it’s food, cigarettes or drugs.

It is also known that there are usually fewer non-food alternatives in homes and communities at the lower end of the socioeconomic scale. For that reason, the study will also examine the availability of non-food alternatives in relation to socioeconomic status.

Laboratory-Based Computer Games to Aid Study

The researchers plan to recruit approximately 300 Western New York children, ages 6 to 9, and visit them in their homes to see what kinds of foods and activities are available to them. With the help of their parents, the children will fill out questionnaires about activities they like to participate in.

During the next two years, each child will then make three visits to the Behavioral Medicine Laboratory on the UB South Campus, where they will play computer games to earn points.

This activity will tell the researchers how much work the child is motivated to do for food, known as food-reinforcement, versus how much they are motivated to work for a specific activity.

Once they have earned a sufficient number of points, the children will then be able to snack or participate in a non-food activity that is either social; formal or informal sports activity; self-improvement, such as homework; or cognitively enriching, such as writing a story or engaging in imaginative play.

Grant Led by Internationally Recognized Expert in Field

The researchers are interested in finding out which non-food activities are more likely to be selected by children who do not gain weight. The next potential step, Carr explains, would be to add an intervention.

“As anyone who has been on a diet knows, it’s really difficult to restrict food intake,” she says. “We want to know if just by adding new activities into a child’s environment, is it possible to prevent overeating?”

Carr is study coordinator on the grant led by Leonard H. Epstein, PhD, SUNY Distinguished Professor of pediatrics and chief of behavioral medicine. Epstein is an internationally recognized expert on childhood weight control and family intervention.

The five-year NIH grant is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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