September 2017





NCCOR, The JPB Foundation strengthen alliance to support Measures Registry

September 28, 2017, NCCOR

Through a three-year grant from The JPB Foundation, NCCOR will continue to strengthen its landmark Measures Registry, a free, online, searchable database of diet and physical activity measures relevant to childhood obesity research. This new grant will promote the Measures Registry, support training in measures selection, examine adaptation of measures for distinct populations and communities, and define next steps in measurement science to accelerate progress in reducing childhood obesity.

In 2015, The JPB Foundation supported the development of Measures Registry User Guides, designed to help childhood obesity researchers and practitioners choose appropriate measures for their research and evaluation efforts. The User Guides help move the field forward by fostering more consistent use of measures, which allows for standardization, meta-analyses, and synthesis.

“Funding for work enhancing measures and measurement is not always easy to obtain. However, good measurement is fundamental to research and evaluation in public health and childhood obesity.” said Dr. David Berrigan, Program Director of the Health Behaviors Research Branch in the Division of Cancer Control and Population Science at the National Cancer Institute. “This funding from The JBP Foundation for further work on measures relevant to childhood obesity is a welcome boost to NCCOR efforts to provide the best possible tools to advance prevention and control of childhood obesity.”

This grant continues a strategic funding alliance between The JPB Foundation and NCCOR. Strategic funding alliances allow the Collaborative to engage with other funders in targeted efforts to advance the field of childhood obesity research. The JPB Foundation strives to enhance the quality of life in the United States through transformational initiatives that promote the health of our communities by creating opportunities for those living in poverty, enabling pioneering medical research, and enriching and sustaining our environment.

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NCCOR hosts National Childhood Obesity Awareness Month social media activities

September 28, 2017, NCCOR

In recognition of National Childhood Obesity Awareness Month, NCCOR hosted social media activities to share resources and support communities in their efforts to reduce childhood obesity.

On September 6, NCCOR launched a Facebook page! Through this new platform, NCCOR will engage diverse audiences and promote the latest information related to childhood obesity. Like the page and share with your colleagues:

On September 20, 108 organizations and individuals shared a Thunderclap message on Facebook and Twitter: September is National #ChildhoodObesityAwarenessMonth! Learn how NCCOR supports community efforts #NCOAM

The message reached more than 336,000 individuals. Some of our Thunderous supporters (supporters with the highest reach) included: National Institute of Health (NIH) National Heart, Lung, and Blood Institute; National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS); and The Obesity Society.

Finally, on September 27, NCCOR hosted a #childobesitychat on Twitter along with NCI DCCPS (@NCICancerCtrl); the NIH Office of Behavioral and Social Sciences Research (@NIHOBSSR); and the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity (@CDCObesity). The Twitter chat facilitated a discussion on community efforts to reduce childhood obesity. More than 100 individuals and organizations participated reaching more than 1.2 million people.

Thank you to all who participated!

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Publications & Tools

CDC-funded National Early Care & Education Learning Collaborative project case studies

For the last five years, Nemours and CDC worked with states and communities to integrate support for childhood obesity prevention into their early childhood systems. Using CDC’s Spectrum of Opportunities, state and community grantees receive technical assistance to encourage system changes that support best practices in childhood obesity prevention in child care, pre-kindergarten, and Head Start settings in centers, homes, and schools. Each case study highlight successes, challenges, and lessons learned. The case studies also point to the diverse paths and unique approaches that stakeholders are taking to ensure child health is an aspect of quality in all ECE settings.

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The 2017 U.S. Report Card on Walking and Walkable Communities

The National Physical Activity Plan Alliance released the first comprehensive national assessment of walking and walkability in the United States. The Report Card assesses the extent to which the U.S. population and U.S. communities meet selected standards for participating in walking and providing physical and social supports for walking behavior. Factors assessed include both individual- and community-level factors.

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The Differences in Characteristics Among Households With and Without Obese Children: Findings From USDA’s FoodAPS

Although the obesity rate for children in the United States has reached an unprecedented level, not all children face the same risk. Using data from USDA’s 2012 National Household Food Acquisition and Purchase Survey (FoodAPS), this study examines characteristics of households with at least one obese child (obese-child households) and without any obese children (nonobese-child households) to understand potential reasons behind the dissimilar risks. Children from obese-child households tend to live in a more disadvantageous household and food environment than children from nonobese-child households. Their parents are more likely to be unmarried, less educated, financially constrained, and obese. Obese-child households tend to be located in areas with lower access to healthful foods. Children from obese-child households eat breakfast less frequently than children from nonobese-child households; however, the difference in the nutritional quality of food acquired by the two household types is not statistically significant.

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RWJF Signs of Progress collection

In recent years, some cities, counties, and states have started to see their childhood obesity rates go down. Places reporting declines have implemented a wide range of strategies to make healthy foods available and encourage physical activity in schools and communities. In this collection, RWJF shares these communities’ unique approaches. While no single local strategy is directly linked with declining childhood obesity rates, the collective effect of their far-reaching changes may be helping to support healthier choices and behaviors among kids and families.

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School Health Policies and Practices Study (SHPPS)

SHPPS is a national survey conducted periodically to assess school health policies and practices at the state, district, school, and classroom levels. Results and data for 2016 are now available.

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Preventing Childhood Obesity in Latin America: An Agenda for Regional Research and Strategic Partnerships supplement

This supplement—  an outcome of the NIH Fogarty International Center, Center for Global Health Studies’ project on preventing childhood  overweight and obesity in Latin America —addresses the state of the science, pressing research questions, models for translating evidence into policy and programs, and research capacity-building priorities.

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Childhood Obesity Research & News

Food reluctance of preschool children attending daycare centers is associated with a lower body mass index

September 14, 2017, Journal of The Academy of Nutrition and Dietetics



Food reluctance can present as fussiness, picky eating, slowness in eating, and high satiety responsiveness. It can be associated with inadequate weight gain during early childhood. Although a majority of preschoolers attend daycare centers, associations between their eating behaviors at daycare and their body composition have not been studied.


Our aim was to develop an estimate of food reluctance and to assess the relationship between food reluctance at daycare and body mass index (BMI) and waist circumference of preschoolers.


We conducted a cross-sectional secondary analyses. Food reluctance was estimated using weighted digital plate waste analysis. Intra-rater, inter-rater, and test−retest reliability and convergent validity of the food reluctance score were tested. The food reluctance score was then compared to preschool children’s BMI and waist circumference.


Participants included 309 children aged 3 to 5 years in 24 daycare centers across the Canadian province of New Brunswick.

Main outcome measures

Preschool children’s waist circumference and age-adjusted BMI derived from objectively measured height and weight were analyzed.

Statistical analyses performed

Intraclass correlations were used to determine the reliability of the new estimate. Spearman correlation was used to compare the estimate with parental report of food reluctance. Multivariate linear regressions were used to examine the relationship between food reluctance and waist circumference and age-adjusted BMI.


The estimated food reluctance score demonstrated excellent inter- and intra-rater reliability (intraclass correlation>0.97; P<0.0001) and good test−retest reliability (intraclass correlation=0.72; P<0.0001). It also provided evidence of convergent validity through correlation with reluctance-related subscales of the Child Eating Behavior Questionnaire (ρ=.53, P<0.0001). Greater demonstration of food reluctance at the daycare center was associated with a lower age-adjusted BMI (adjusted β −1.41; 95% CI −.15 to −2.67), but was not associated with children’s waist circumference (adjusted β −.60; 95% CI −2.06 to .86).


Signs of food reluctance can be observed in daycare and relate to lower BMI among preschoolers.

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Obesity prevention in the supermarket—choice architecture and the Supplemental Nutrition Assistance Program

September 13, 2017, American Journal of Public Health

As obesity-related health care costs in the United States reach nearly $210 billion annually, policymakers, health experts, and antihunger advocacy groups debate whether the government should pay for sugar-sweetened beverages (SSBs) and other unhealthy foods with food assistance programs. The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is the largest federal food assistance program; it provides 44 million low-income Americans with $66 billion in food assistance annually. A significant portion of this spending is on SSBs. A recent US Department of Agriculture analysis of sales from a national supermarket chain found that soft drinks were the number one purchase by SNAP households. Although health and nutrition groups advocate restricting the purchase of SSBs with SNAP benefits, antihunger groups object that these restrictions are stigmatizing and discriminatory. To move beyond this stalemate, we propose a SNAP “choice architecture” policy that would balance the major health risks of consuming SSBs and other unhealthy foods with freedom of choice by making unhealthy foods less convenient and less visible at the point of purchase.

Choice architecture and public health

“Choice architecture” refers to the context in which people make choices. Behavioral science research has shown that people’s choices can be highly influenced by features like accessibility, salience, colors, information, and ordering of items. Subtle aspects of choice architecture can have significant effects on public health; if bottles of soda are easily accessible and highly salient (e.g., located at the checkout counter rather than the middle of a supermarket aisle), people are more likely to choose them. Having a background in which people make choices is inevitable, and so the question is how to design the best choice architecture, not whether to have one. Good choice architecture can help advance public health by influencing small health-related decisions that cumulatively lead to chronic disease.

One example is restaurant calorie labeling, required by the Affordable Care Act, which places calorie information at the point of purchase rather than buried in a pamphlet or Web site. Another example is state and local policies that restrict the placement of tobacco products (e.g., behind the counter placement, elimination of “power walls”) to discourage sales of cigarettes. Both calorie labeling requirements and tobacco placement restrictions increase the likelihood of healthier behaviors—consuming fewer calories or not smoking—while maintaining people’s freedom to make the less healthy choice.

Supermarket choice architecture

Supermarkets and other food retailers have long enlisted choice architecture to maximize sales and profits. For example, buying milk is one of the most common reasons for going to the grocery store, and it is purposely placed at the back of the store so that shoppers have to travel farther through the store to get it, increasing the likelihood they will make other, unplanned purchases. More generally, supermarkets are designed with the knowledge that most shoppers prefer to move counterclockwise around the perimeter of the store and make only short trips up and down the aisles. The end of the aisle (endcap) displays face in three different directions, and products located in endcap or other free-standing displays account for 40% of all supermarket sales. Almost half of all supermarket sales of chewing gum, candy, and soft drinks are selected in the checkout aisles.

Existing supermarket choice architecture is designed to sell products, but it comes at a steep cost to Americans’ health. Endcap and checkout counter displays are designed to encourage impulse purchases and are stacked with SSBs, candy, salty snacks, and sweetened baked goods. Research has shown that higher exposure to these marketing techniques is associated with a higher body mass index. A study of a UK supermarket showed that carbonated beverages located in end of the aisle displays had 51% higher sales than did sales of the same beverages located in the middle of aisles, even after accounting for number of display locations, price, and weekly promotions. Despite widespread knowledge about the risks of an unhealthy diet, many Americans purchase SSBs, sweets, and unhealthy snacks at high rates in the supermarket. More than half of adult’s and children’s calories from SSBs are consumed in the home,6 and reducing supermarket purchases would likely reduce consumption.

Healthy choice architecture and policy

By contrast, placing healthy items, such as fruits and vegetables, in prominent positions and placing unhealthy items in less prominent positions lead to healthier choices. In 2014, the US Department of Agriculture concluded that product placement is a promising approach for promoting healthier food choices by SNAP participants and recommended further research in this area ( But there is no reason to delay implementation of empirically supported policies to replicate research that scientists and the grocery industry have already conducted.

Ideally, of course, supermarkets would change the choice architecture on their own, and some have taken steps to do so. But evidence about retailer practices makes it reasonable to assume that most supermarkets are unlikely to move in the direction of healthier choice architecture without being required to change. We believe that a SNAP choice architecture policy should be implemented that would restrict placement of certain accessory food items, such as SSBs, desserts, candy, and salty snacks, from endcap, free-standing, and checkout counter displays in stores participating in the program. Although these items would remain available for purchase in the store aisles, they would be out of view from the highest traffic areas; thus, both adults and children would see them less, leading to fewer unplanned purchases.

SNAP benefits are redeemed at approximately 260 000 food stores nationwide, and 81% of benefits are spent at supermarkets and superstores. National and state policies that restrict the placement of SSBs and other unhealthy items in stores participating in the SNAP program would have a positive impact on the US food shopping environment and could significantly reduce unhealthy purchases among households that shop at these stores, whether they are participating in the SNAP program or not. From the perspectives of both public health and individual liberty, SNAP choice architecture policy is a win–win. Choice architecture does not discriminate: SNAP and non-SNAP households would have similar access to healthy and unhealthy choices. Choice architecture policy would also complement other established programs, particularly the SNAP education program, by helping to reduce unhealthy, impulsive purchases in the supermarket.

Anticipated arguments

A choice architecture policy might lead some stores to not participate in SNAP because the anticipated loss of profit from SSBs and other foods would be greater than would the loss of SNAP customers. To reduce this risk, particularly for smaller stores, the US Department of Agriculture might consider a minimum choice architecture requirement—such as for SSBs and candy—and provide financial incentives to encourage stores to participate in other categories. Larger supermarket chains and superstores could—and should—find creative ways to promote healthy choices while maintaining profits.

Some opponents of SNAP choice architecture might claim that the policy represents government intrusion on personal freedom and puts undue burdens on supermarkets and other food stores. However, use of choice architecture would not regulate the attributes of the food or beverage items; it would preserve people’s ability to purchase the products that they like.


No single food policy can be a panacea, but healthy choice architecture in the supermarket is an easy and cost-effective way to reduce a substantial proportion of SSB and other unhealthy food purchases among low-income families. Preferably, movement in this direction would be voluntary. To the extent that it is not, we should move forward with this policy, which would improve Americans’ health while fully preserving freedom of choice.

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Fruit and vegetable intake influences obesity risk in Mexican-American children

September 12, 2017, Penn State News

Potential disparities in fruit and vegetable intake in Mexican-American children may be placing them at greater risk for obesity and related health problems, new research suggests.

Ravindranath Duggirala, professor in the South Texas Diabetes and Obesity Institute at the University of Texas Rio Grande Valley, and Jairam K. P. Vanamala, associate professor of food science in Penn State’s College of Agricultural Sciences, are the corresponding authors of the study, published in a recent issue of the American Journal of Clinical Nutrition.

Childhood obesity is a major public health issue that disproportionately affects Mexican-Americans. To assess childhood obesity and its related cardio-metabolic traits in Mexican-American children and adolescents from San Antonio, Texas, and surrounding areas—and to determine how those traits affect risk for future disease—Duggirala designed the San Antonio Family Assessment of Metabolic Risk Indicators in Youth (SAFARI) project. The family-based study enabled Duggirala and his colleagues to determine the relative roles of genes and environmental factors such as diet and physical activity in determining obesity-related traits in Mexican-American youth.

As part of SAFARI, obesity-related data were obtained from 670 nondiabetic children and youth, aged 6-17 years, from large, predominantly lower-income, Mexican-American families at increased risk of diabetes, adult members of which had previously participated in one of three community-based genetic epidemiologic studies in San Antonio. Vanamala’s laboratory then measured provitamin A carotenoids—serum α- and β-carotenoid concentrations—in 570 of these children.

Serum carotenoids are associated with dietary fruit and vegetable intake. These carotenoids are the plant pigments that are responsible for the vibrant orange, yellow and green colors of cantaloupe, carrots, sweet potato, sweet red peppers, broccoli and green leafy vegetables.

Duggirala and Vanamala, working with first author Vidya S. Farook, of the South Texas Diabetes and Obesity Institute, found that α- and β-carotenoid concentrations were inversely correlated with obesity measures and triglyceride levels and positively correlated with HDL-C (good cholesterol) levels.

Since the SAFARI data were obtained from families, the researchers were able to characterize the genetic determinants of α- and β-carotene concentrations in the children and adolescents participating in the study. In addition, the investigators found that the inverse correlations between β-carotene and obesity-related traits and the positive correlation between β-carotene and HDL-C levels may themselves be influenced by genetic factors.

The researchers said the findings show the importance of fruit and vegetable intake for minimizing risk for obesity, while signifying potential disparities in fruit and vegetable intake in Mexican American children and a corresponding risk for obesity in these children.

The ultimate goal of the research is to find better ways to prevent or delay childhood obesity and associated cardio-metabolic risk. “The purpose of the SAFARI study is to identify genetic and environmental factors that influence childhood obesity risk,” said SAFARI Principal Investigator Duggirala.

“It is important to identify genetic, environmental and lifestyle contributors to childhood obesity, which is associated with obesity and related conditions in adulthood,” he said. “Our findings provide critical insights into the complex genetic architecture underlying the association between serum carotenoids and cardio-metabolic risk, and they highlight the need for culturally sensitive and family-based, early-life dietary interventions to combat the burden of obesity and its associated cardio-metabolic risk in Mexican American children and youth.”

Vanamala noted that a plant-based diet—one that involves higher consumption of foods coming from plant sources such as fruits, vegetables and herbs as opposed to animal-based foods—decreases cardio-metabolic disease risk.

“However, the role of a plant-based diet, rich in α- and β-carotenes, in reducing the risk of developing obesity in children has not been well studied,” he said. “Our current findings lend support to promoting fruit and vegetable consumption to reduce obesity as well as cardio-metabolic disease burden and to facilitating development of dietary interventions.”

The research was funded primarily by the National Institute of Child Health and Human Development, a division of the National Institutes of Health, with additional support from Voelcker Foundation (Max and Minnie Tomerlin Voelcker Fund), and the USDA National Institute for Food and Agriculture.

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