May 2017





NCCOR at the American College of Sports Medicine 64th Annual Meeting

May 25, 2017, NCCOR

NCCOR is traveling to Denver, Colorado, for the American College of Sports Medicine 64th Annual Meeting in May. More than 6,000 professionals from around the world will come together and share their latest research and innovations. The NCCOR booth (#125) will be in the exhibit hall throughout the conference. NCCOR will share new resources including the Measures Registry User Guides and teaching slides, highlights of our work on behavioral design, and a preview of the upcoming Youth Compendium of Physical Activities. Please follow us @NCCOR and use the hashtag #ACSM17 on Twitter to stay connected with NCCOR activities at ACSM.

NCCOR is also pleased to host a tutorial presentation at ACSM on Thursday, June 1, at 1:00 p.m. MT. David Berrigan, PhD, MPH, National Cancer Institute, along with Karin Pfeiffer, FACSM, PhD, Michigan State University, and Stephen Herrmann, PhD, Sanford Research—all members of the Youth Energy Expenditure Workgroup—will present Hot off the Presses: A Revised Youth Compendium of Physical Activities, a new NCCOR resource that will be released later this year.

The Youth Compendium of Physical Activities is a list of more than 200 common activities in which youth participate and the estimated energy cost associated with each activity. The Youth Compendium provides energy cost values for activities such as standing, doing household chores, playing active video games, playing and participating in games and sports activities, walking and running, and doing sedentary activities such as lying down or watching TV.

Heading to ACSM? Look for these presentations by NCCOR members:

D-21 Tutorial Lecture: Hot off the Presses: A Revised Youth Compendium of Physical Activities  
Thursday, June 1, 2017, 1:00-1:50 p.m. MT
David Berrigan, National Cancer Institute
Karin Pfeiffer, FACSM, Michigan State University
Stephen D. Herrmann, Sanford Research

D-58 Tutorial Lecture: Findings from the First National Survey of the Built Environment
Thursday, June 1, 2017, 4:25-5:15 p.m. MT
David Berrigan, National Cancer Institute
Susan A. Carlson, Centers for Disease Control and Prevention

E-04 Symposium: Device-Based Assessments of Physical Activity in Epidemiologic Cohort Studies: Early Findings  
Friday, June 2, 2017, 9:30-11:30 a.m. MT
Janet Fulton, FACSM, Centers for Disease Control and Prevention
John Jakicic, FACSM, University of Pittsburgh
Virginia Howard, University of Alabama at Birmingham
David Buchner, FACSM, University of Illinois at Urbana-Champaign
I-Min Lee, FACSM, Harvard Medical School

F-42 Tutorial Lecture: CDC’s Vision for Increasing Physical Activity Across the Nation: Looking Behind the Curtain
Friday, June 2, 2017, 3:15-4:05 p.m. MT
Janet Fulton, FACSM, Centers for Disease Control and Prevention
Ruth Petersen, Centers for Disease Control and Prevention
Susan A. Carlson, Centers for Disease Control and Prevention

F-48 Tutorial Lecture: The Perfect Storm: Catalysts for a U.S. Physical Activity Movement
Friday, June 2, 2017, 4:20-5:15 p.m. MT
Susan A. Carlson, Centers for Disease Control and Prevention
Janet Fulton, FACSM, Centers for Disease Control and Prevention
Russell R. Pate, FACSM, University of South Carolina

We look forward to seeing you there!

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Publications & Tools

Nutrition, Physical Activity, and Obesity: Data, Trends, and Maps

Data, Trends, and Maps is an interactive database that provides information about the health status and behaviors of Americans, state-by-state, via clickable maps, charts, and tables. Topics include obesity, breastfeeding, physical activity, and other health behaviors and related environmental and policy data from multiple sources. This interactive tool allows visitors to study information either nationally or by state. Visitors can also examine data for adults, teens, and children by demographics like sex and race/ethnicity.

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Combined built environment features help communities get active

The Community Preventive Services Task Force recommends combined built environment approaches to increase physical activity. These approaches combine new or enhanced transportation systems (e.g., pedestrian and cycling paths) with new or enhanced land use design (e.g., proximity to a store, access to a public park) to promote physical activity among residents. The Task Force finding is based on a systematic review of the evidence that showed combinations of activity-friendly built environment characteristics are associated with higher levels of transportation-related physical activity, recreational physical activity, and total walking. The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity.

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Division of Nutrition, Physical Activity, and Obesity success stories

These highlights focus on grantees’ efforts to implement strategies that encourage healthy eating, increased physical activity, and breastfeeding.

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Childhood Obesity Research & News

Minimum stocking requirements for retailers in the special Supplemental Nutrition Program for Women, Infants, and Children: Disparities across US states

May 18, 2017, American Journal of Public Health

Objectives. To examine state variation in minimum stocking requirements for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)–authorized small food retailers.

Methods. We obtained minimum stocking requirements for 50 states and the District of Columbia in 2017 from WIC Web pages or e-mail from the state WIC agency. We developed a coding protocol to compare minimum quantities and varieties required for 12 food and beverage categories. We calculated the median, range, and interquartile range for each measure.

Results. Nearly all states set minimum varieties and quantities of fruits and vegetables, 100% juice, whole grain–rich foods, breakfast cereal, milk, cheese, eggs, legumes, and peanut butter. Fewer states set requirements for canned fish, yogurt, and tofu. Most measures had a large range in minimum requirements (e.g., $8–$100 of fruits and vegetables, 60–144 oz of breakfast cereal).

Conclusions. WIC-participating retailers must adhere to very different minimum stocking requirements across states, which may result in disparities in food and beverage products available to WIC recipients.

Public Health Implications. The results provide benchmarks that can inform new local, state, and federal program and policy efforts to increase healthy food availability in retail settings.

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Does sleep duration affect cardiac metabolic risk in young children?

May 15, 2017, Childhood Obesity

How many hours a day young children (1-3 years) sleep does not appear to affect their cardiometabolic risk (CMR) at ages 3-8, based on an assessment of factors including blood pressure and cholesterol and blood glucose levels. Most unexpectedly, less sleep was associated with increased levels of high density lipoprotein (HDL), the “good” form of cholesterol, as reported in a new study 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 June 15, 2017.

The article entitled “Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children” was coauthored by Lesley Plumptre, PhD, Catherin Birken, MD, and colleagues from The Hospital for Sick Children, University of Toronto School of Medicine and Dalla Lana School of Public Health, Toronto, and St. Michaels Hospital, Toronto, Canada, on behalf of the TARGet Kids! Collaboration.

The researchers collected sleep duration data for children 12-36 months of age. At a follow-up visit at age 36-96 months they determined a CMR score for each child by totaling the child’s age, standardized waist circumference score, systolic blood pressure, triglyceride measurement, blood glucose level, and the inverse HDL. The authors suggest that a relationship between sleep duration early in life and CMR could appear at a later age. Sleep quality could also have a greater effect on CMR than sleep duration.

“Recently, sleep duration has emerged as an influence on cardiometabolic risk factors and obesity in childhood and among adults using mostly cross-sectional analyses. It is not clear when this relationship starts,” says Childhood Obesity Editor-in-Chief Tom Baranowski, PhD, Baylor College of Medicine, Houston, TX. “Plumptre and colleagues conducted the first such analysis using a longitudinal design testing the relationship between sleep in early childhood (12 to 36 months) with a cardiometabolic risk score later in childhood (36 to 96 months), and found no such relationship. This important finding indicates that the relationship between sleep and cardiometabolic risk emerges later in childhood.”

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Tri-Ponderal Mass Index vs Body Mass Index in estimating body fat during adolescence

May 15, 2017, JAMA Pediatrics


Importance Body mass index (BMI) is used to diagnose obesity in adolescents worldwide, despite evidence that weight does not scale with height squared in adolescents. To account for this, health care providers diagnose obesity using BMI percentiles for each age (BMI z scores), but this does not ensure that BMI is accurate in adolescents.

Objective To compare the accuracy of BMI vs other body fat indices of the form body mass divided by heightn in estimating body fat levels in adolescents.

Design, Setting, and Participants Cross-sectional data from the 1999 to 2006 US National Health and Nutrition Examination Survey were analyzed between September 2015 and December 2016.

Main Outcomes and Measures Dual-energy x-ray absorptiometry and anthropometric data were used to determine changes in body fat levels, body proportions, and the scaling relationships among body mass, height, and percent body fat. To assess the merits of each adiposity index, 3 criteria were used: stability with age, accuracy in estimating percent body fat, and accuracy in classifying adolescents as overweight vs normal weight.

Results Participants included 2285 non-Hispanic white participants aged 8 to 29 years. Percent body fat varied with both age and height during adolescence, invalidating the standard weight-to-height regression as the way of finding the optimal body fat index. Because the correct regression model (percent body fat is proportional to mass divided by heightn) suggested that percent body fat scales to height with an exponent closer to 3, we therefore focused on the tri-ponderal mass index (TMI; mass divided by height cubed) as an alternative to BMI z scores. For ages 8 to 17 years, TMI yielded greater stability with age and estimated percent body fat better than BMI (R2 = 0.64 vs 0.38 in boys and R2 = 0.72 vs 0.66 in girls). Moreover, TMI misclassified adolescents as overweight vs normal weight less often than BMI z scores (TMI, 8.4%; 95% CI, 7.3%-9.5% vs BMI, 19.4%; 95% CI, 17.8%-20.0%; P < .001) and performed equally as well as updated BMI percentiles derived from the same data set (TMI, 8.4%; 95% CI, 7.3%-9.5% vs BMI, 8.0%; 95% CI, 6.9%-9.1%; P = .62).

Conclusions and Relevance The tri-ponderal mass index estimates body fat levels more accurately than BMI in non-Hispanic white adolescents aged 8 to 17 years. Moreover, TMI diagnoses adolescents as overweight more accurately than BMI z scores and equally as well as updated BMI percentiles but is much simpler to use than either because it does not involve complicated percentiles. Taken together, it is worth considering replacing BMI z scores with TMI to estimate body fat levels in adolescents.

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Survey: Nutrition information abounds, but many doubt food choices

May 5, 2017, International Food Information Council Foundation

Americans are consuming food information from more sources than ever before, yet our nutritional literacy is sorely lacking—and our health may be suffering as a result. Those are among the findings of the International Food Information Council Foundation’s 12th Annual Food and Health Survey.

“As in previous years, the Food and Health Survey has shown that Americans feel overwhelmed by conflicting food and nutrition information,” said IFIC Foundation CEO Joseph Clayton. “But this year, we’re finding troubling signs that the information glut is translating into faulty decisions about our diets and health.”

“As policymakers work to revise the Nutrition Facts panel and define ‘healthy’ on food labels, it’s more crucial than ever before that we empower consumers with accurate information based on the best available science, in terms they can easily understand and put into action.”

Food Confusion

The vast majority of consumers—eight in 10 (78 percent)—say that they encounter a lot of conflicting information about what to eat/avoid. More than half of those (56 percent) say the conflicting information makes them doubt the choices they make.

Almost all consumers (96 percent) seek out health benefits from what they eat and drink (the top benefits being weight loss, cardiovascular health, energy, and digestive health), but out of those, only 45 percent could identify a single food or nutrient associated with those benefits.

For example, while sources of omega-3 fatty acids such as fish oil can contribute to heart health, just 12 percent made an association between them.

In addition, while people are interested in getting energy benefits, less than 5 percent could name caffeine as providing those benefits.

The “Social Network”: Family and Friends As Nutrition Advisers

So why are we confused? For one, despite their best intentions, the people we’re closest to might actually be leading us astray. In short, consumers paradoxically rely heavily on information from individuals—family and friends—for whom there is little trust.

About three-quarters of consumers (77 percent) say they rely on friends and family at least a little for both nutrition and food safety information, which tops other sources including health professionals, news, and the internet. But only 29 percent actually have high trust in family or friends as information sources, far behind sources such as Registered Dietitian Nutritionists, other health or fitness professionals, and health-related websites.

Meanwhile, six in 10 consumers (59 percent) rated family and friends as the top influencer on decisions about their eating patterns or diets. Personal healthcare professionals were cited by 55 percent of consumers, while all other sources rated only in the single digits.

The Health Halo Effect

The Food and Health Survey also suggests that consumers might be paying too much or making flawed decisions about nutrition because of non-health factors—or mental shortcuts—that drastically alter our perception of what is healthful.

These factors include the form of the food (fresh, frozen, canned), place of purchase (e.g., convenience store vs. natural food store), the length of the ingredient list, and price, among others —and they drive perceptions of healthfulness even between two foods with identical nutrition information.

For example, even with nutritionally identical products, consumers are almost five times as likely to believe a fresh product is healthier than canned and four times as likely to believe a fresh product is healthier than frozen. Consumers also are more likely to believe a product that costs $2 is healthier than an otherwise identical product that costs 99 cents.

For years, some influencers have driven home messages conflating nutrition with non-health values, and now consumers are paying the price—literally, or at the expense of other desired factors such as convenience or shelf life.

Boomers and Older Americans: The Health-Driven Generations

As people age, their nutrition needs and dietary preferences change. But few have examined the shopping habits and eating patterns of Americans ages 50-plus—the country’s fastest-growing demographic.

That’s why the IFIC Foundation, in collaboration with AARP Foundation, conducted an oversample of respondents ages 50–80 for the 2017 Food and Health Survey to help uncover insights into the diets and health of older Americans.

Compared with other segments of the population, those age 50–80 …

  • … are more confident in their choices. While 80 percent of all consumers say there’s a lot of conflicting information about what to eat and what to avoid, only 47 percent of those 50 – 80 say it makes them doubt the choices they make, compared to 61 percent of those ages 18 – 49.
  • … use fewer information sources when deciding which foods to eat or avoid. Consumers age 50 – 80 also are less likely than millennials to use friends and family as a common information source (23 percent vs. 40 percent).
  • … are more likely to adopt and maintain healthy eating behaviors. Among the most significant differences, Americans age 50 – 80 are more likely than those age 18 – 49 to be:
    • Cutting back on foods higher in saturated fat more than younger Americans (75 percent vs. 57 percent)
    • Cutting back on foods higher in salt (71 percent vs. 59 percent)
    • Eating more foods with whole grains (70 percent vs. 62 percent)
    • Consuming smaller portions (68 percent vs. 59 percent)
    • Comparing sodium in various foods (63 percent vs. 52 percent)
    • Cutting back on full-fat dairy or replacing it with low- or no-fat alternatives (60 percent vs. 50 percent)
  • are more likely to be able to connect specific foods with the health benefits they seek. Of those who named a desired benefit, 49 percent of older Americans could associate it with a food or nutrient source, versus only 40 percent of younger Americans.

Meanwhile, Americans’ interest in getting weight-loss benefits from food and nutrients falls dramatically with age. Weight loss and management are far and away the most desired benefit, at 40 percent among those 18 – 34 and 38 percent from 35 – 49, but that drops to 23 percent from age 50 – 64 and 28 percent from 65 – 80.

The desire for foods and nutrients with cardiovascular benefits increases with age, from 11 percent ages 35 – 49 to 23 percent ages 50 – 64.

Confidence in the safety of the food supply increases significantly with age, with 55 percent from 18 – 49 saying they’re confident, 66 percent from 50 – 64, and 76 percent from 65 – 80.

Other Survey Highlights:        

  • If Americans had an extra four hours per week, 46 percent would use that time to be physically active. That number is virtually tied with those who would spend more time with friends and family, while other priorities trail far behind.
  • If Americans had an extra $100 per month, 25 percent say they would spend it on groceries—second only to “saving or investing” (57 percent) when given a list of priorities.
  • Many Americans are overestimating their health status: While 59 percent say their health is very good or excellent, one-third of those people are either overweight or obese.
  • About one in five (19 percent) of Americans say they occasionally read scientific studies for information about what to eat and what to avoid. That’s slightly more than news articles or headlines (17 percent) and also ahead of sources such as health or fitness professionals on TV or social media, bloggers, food companies, and government agencies.
  • Products’ brand names ranked last among factors that impact our food and beverage purchasing decisions. From a list of six factors, 35 percent said that brand was a driver of their purchases, behind taste (84 percent), price (66 percent), healthfulness (63 percent), convenience (49 percent), and sustainability (38 percent).
  • Consumers overwhelmingly shop for food at supermarkets (80 percent), followed by super-stores (45 percent), warehouse/discount clubs (35 percent), farmers’ markets (19 percent), natural foods stores (17 percent), convenience stores (14 percent), and drug stores (11 percent).
  • About six in 10 (58 percent) of consumers use nutrition information at least sometimes to decide what to have when eating away from home.
  • Topping the list of specific components considered to be healthful by consumers is vitamin D (88 percent), followed by fiber (87 percent), whole grains (84 percent), protein from plant sources (72 percent), and omega-3 fatty acids (71 percent).
  • Six in 10 (61 percent) Americans are at least somewhat confident in the safety of the food supply, down from 66 percent in 2016 but unchanged from 2015 (61 percent).


The results are derived from an online survey of 1,002 Americans ages 18 – 80, conducted March 10 to March 29, 2017. Results were weighted to ensure that they are reflective of the American population, as seen in the 2016 Current Population Survey. Specifically, they were weighted by age, education, gender, race/ethnicity, and region. The survey was conducted by Greenwald & Associates, using Research Now’s consumer panel.

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Modest increases in kids’ physical activity could avert billions in medical and other costs

May 1, 2017, Johns Hopkins Bloomberg School of Public Health

Even getting in just a little more can reduce obesity and related illnesses in adulthood

Increasing the percentage of elementary school children in the United States who participate in 25 minutes of physical activity three times a week from 32 percent to 50 percent would avoid $21.9 billion in medical costs and lost wages over the course of their lifetimes, new Johns Hopkins Bloomberg School of Public Health research suggests.

The findings, published May 1 in Health Affairs, suggest that just a small increase in the frequency of exercise among children ages 8 through 11 would also result in 340,000 fewer obese and overweight youth, a reduction of more than 4 percent. If all current 8- through 11-year-olds in the United States exercised 25 minutes a day, three times a week, the researchers suggest that $62.3 billion in medical costs and lost wages over the course of their lifetimes could be avoided and 1.2 million fewer youths would be overweight or obese.

These numbers represent cost savings for one cohort of 8-to-11 year olds, so every year that children in this age group reach those levels of physical activity, over $60 billion more would be saved.

“Physical activity not only makes kids feel better and helps them develop healthy habits, it’s also good for the nation’s bottom line,” says study leader Bruce Y. Lee, MD, MBA, executive director of the Global Obesity Prevention Center at the Bloomberg School. “Our findings show that encouraging exercise and investing in physical activity such as school recess and youth sports leagues when kids are young pays big dividends as they grow up.”

Studies have shown that a high body mass index (BMI) at 18 is associated with a high BMI throughout adulthood and increases the subsequent risk of developing maladies such as diabetes and heart disease associated with being overweight or obese, which can lead to high medical costs and productivity losses due to illness. In recent decades, there has been a growing epidemic of obesity in the United States.
For the study, Lee and his colleagues, including team members from the Bloomberg School and the Pittsburgh Supercomputing Center at Carnegie Mellon University, developed a computational simulation model utilizing their VPOP (Virtual Population for Obesity Prevention) software platform to represent the current population of U.S. children and to show how changes in levels of physical activity could affect them throughout their lifetime and the resulting economic impact. The model relied on data from the 2005 and 2013 National Health and Nutrition Examination Survey (NHANES) and on information from the National Center for Health Statistics. The medical costs and the lost wages were calculated in the second model, which looked at the lifetime effects of physical activity.

The researchers also looked at various levels of healthy physical activity, starting with the current average of 32 percent of children 8 to 11 who exercise for 25 minutes a day, three days a week, up to 100 percent doing so. That is a guideline developed by the Sports and Fitness Industry Association. The researchers found that maintaining the current level of physical activity would result in 8.1 million of these youths being overweight or obese by 2020, which would cost $2.8 trillion in additional medical costs and lost wages over their lifetimes. An overweight person’s lifetime medical costs average $62,331 and lost wages average $93,075. For an obese person, these amounts are even greater.

“Even modest increases in physical activity could yield billions of dollars in savings,” Lee says.

The costs averted are likely an underestimate, he says, as there are other benefits of physical activity that don’t impact weight, such as improving bone density, improving mood and building muscle.

Lee says that the spending averted by healthy levels of physical activity would more than make up for costs of programs designed to increase activity levels.

“As the prevalence of childhood obesity grows, so will the value of increasing physical activity,” he says. “We need to be adding physical education programs and not cutting them. We need to encourage kids to be active, to reduce screen time and get them running around again. It’s important for their physical health – and the nation’s financial health.”

“Modeling the Economic and Health Impact of Increasing Children’s Physical Activity in the United States” was written by Bruce Y. Lee; Atif Adam; Eli Zenkov; Daniel Hertenstein; Marie C. Ferguson; Peggy I. Wang; Michelle S. Wong; Patrick Wedlock; Sindiso Nyathi; Joel Gittelsohn; Saeideh Fala-Fini; Sarah M. Bartsch; Lawrence J. Cheskin; and Shawn T. Brown.

The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01 HD086861, R01 HD08601301 and U54HD070725) and the Agency for Healthcare Research and Quality (R01HS023317).

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