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November 2018

SPOTLIGHT

PUBLICATIONS & TOOLS

CHILDHOOD OBESITY RESEARCH & NEWS

Spotlight

HHS Office of Disease Prevention and Health Promotion releases updated Physical Activity Guidelines for Americans

November 29, 2018, NCCOR

On November 12, the Department of Health and Human Services’ Office of Disease Prevention and Health Promotion released newly updated physical activity guidelines for Americans. This second edition is based on new scientific evidence showing that physical activity has even more benefits than previously known. Physical activity fosters normal growth and development, can reduce the risk of various chronic diseases, and can make people feel and sleep better. Many of the benefits take effect immediately after physical activity and even short time periods of activity can be beneficial.

The original guidelines contained physical activity recommendations for youth and adults to safely get the physical activity they need to maintain their health. Now, the updates include guidance for preschool-aged children for the first time. The guidelines also include evidence for even more health benefits of physical activity, discussion of sedentary behavior, and tested strategies for physical activity promotion. The 10-minute bout length requirement for a physical activity has been removed because new research shows that every little bit counts.

To read more and see the guidelines, click here.

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Publications & Tools

CDC and Springboard to Active Schools Share New Resources for Promoting Classroom Physical Activity

CDC and Springboard to Active Schools have developed new resources for educators to incorporate physical activity into the classroom. Physical activity can not only reduce obesity rates in children but it can help improve concentration in the classroom, behavior, engagement and grades.

Check out the resources on the CDC Healthy Schools website.

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Sustainable Diets, Food, and Nutrition workshop proceedings

On August 1 and 2, 2018, the Food Forum of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop in Washington, DC, on sustainable diets, food, and nutrition. The workshop objectives were to review current and emerging knowledge on the concept of sustainable diets within the field of food and nutrition; explore sustainable diets and relevant impacts for cross-sector partnerships, policy, and research; and discuss how sustainable diets influence dietary patterns, the food system, and population and public health. This publication, released this month, summarizes the key points made by the workshop participants during the presentations and discussions and is not intended to provide a comprehensive summary of information shared during the workshop.

Read the key points.

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Childhood Obesity Research & News

Largest pediatric study shows obesity increases asthma risk in children

November 26, 2018, Nemours Children's Health System

Ten percent of pediatric asthma cases could be avoided if childhood obesity were eliminated, according to research led by Nemours Children’s Health System. The research, published today in Pediatrics, the journal of the American Academy of Pediatrics, reported on the analysis of medical records of more than 500,000 children. The study is among the first to use the resources of PEDSnet, a multi-specialty network that conducts observational research and clinical trials across eight of the nation’s largest children’s health systems. PEDSnet is funded by the Patient-Centered Outcomes Research Institute (PCORI), a government-supported nonprofit.

“Pediatric asthma is among the most prevalent childhood conditions and comes at a high cost to patients, families and the greater health system. There are few preventable risk factors to reduce the incidence of asthma, but our data show that reducing the onset of childhood obesity could significantly lower the public health burden of asthma,” said Terri Finkel, MD, PhD, Chief Scientific Officer at Nemours Children’s Hospital in Orlando and one of three Nemours researchers participating in the study. “Addressing childhood obesity should be a priority to help improve the quality of life of children and help reduce pediatric asthma.”

In this retrospective cohort study design, researchers reviewed de-identified data of patients ages two to 17 without a history of asthma, receiving care from six pediatric academic medical centers between 2009 and 2015. Overweight or obese patients were matched with normal weight patients of the same age, gender, race, ethnicity, insurance type, and location of care. The study included data from 507,496 children and 19,581,972 encounters.

In their analysis, the researchers found that the incidence of an asthma diagnosis among children with obesity was significantly higher than in children in a normal weight range and that 23 to 27 percent of new asthma cases in children with obesity are directly attributable to obesity. Additionally, obesity among children with asthma appears to increase disease severity. Being overweight was identified as a modest risk factor for asthma, and the association was diminished when the most stringent definition of asthma was used. Other significant risk factors of an asthma diagnosis included male sex, age of under 5 years old, African-American race, public insurance.

With 6 to 8 million cases of pediatric asthma previously reported in the United States, the study’s data suggest that 1 million cases of asthma in children might be directly attributable to overweight and obesity and that at least 10 percent of all U.S. cases of pediatric asthma might be avoided in the absence of childhood overweight and obesity.

“This is the first study of its kind, looking at obesity and the risk of developing asthma entirely in a pediatric population, and is made possible through the PEDSnet data collaboration,” said Finkel. “The PEDSnet collaboration brings the power of Big Data to pediatric research and medicine–as well as the expertise to structure the data and understand how to extract the most meaningful points.”

Several limitations of the study are noted, including the retrospective design using electronic health data, which prevent the researchers from drawing absolute conclusions regarding the causal nature of the association between obesity and asthma. Additionally, while the study includes data from a large, geographically diverse population of children, rural children may be underrepresented in the study results.

The research team hopes in the future to use PEDSnet’s capabilities to continue to gain new epidemiologic insights into the relationship between pediatric obesity and asthma, including measures of lung function, comorbidity, and medication data. Each PEDSnet member institution is able to map its own data onto the common data model, creating an enormous resource across the network with the power to produce findings relatively quickly.

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Kids in this community couldn't get to a playground. So the playground came to them.

November 14, 2018, Huffington Post

In a state with the fourth-highest rate of youth obesity in the nation, the Baton Rouge, Louisiana, parks and recreation agency wanted to lure kids away from their screens and into the parks to get moving.

But the low-income youths who needed exercise the most weren’t showing up at the parks, because, officials learned, they didn’t have transportation, and their parents were too busy working to take them. So they decided to take the parks to the kids.

With money donated in 2012 by corporate sponsors and a portion of their parish budget, the local parks and recreation agency, known as the Baton Rouge Recreation, or BREC, bought a box delivery truck, painted it with bright colors and filled it with scooters, hula-hoops, balls, slack lines, trampolines, sidewalk chalk and jump ropes.

“The idea came to us one day while we were watching a bunch of kids turn flips on an old mattress someone had discarded near the office,” said Diane Drake, who directs BREC’s playground on wheels. “We realized it wouldn’t take much to get kids moving if we put it right in front of them.”

Naming the mobile playground BREC on the Geaux (a Cajun play on words for go), the parks and recreation agency in 2013 started what would become a daily program by holding community events at housing complexes, churches, parks and schools in low-income neighborhoods.

If peals of laughter and swarms of activity are any indicator, BREC on the Geaux was an immediate success, Drake said. “Once word spread, children would come running out of their apartments as soon as we pulled into the parking lot. It was all we could do to unload the equipment before they grabbed it and ran off.”

A year after it began, BREC officials drove the mobile playground to Charlotte, North Carolina, to share their story with others at a 2014 meeting of the National Recreation and Park Association.

Since then, BREC has received dozens of emails and phone calls from other cities seeking advice on how to start a similar program, Drake said. Recreation officials in Knoxville, Tennessee, told Stateline in an interview that they plan to start a copy of BREC’s program next year.

Other imitators include Waynesville, North Carolina; Greenville, South Carolina; Mt. Pleasant, Michigan; and Alexandria, Louisiana.

Transporting the joy and the health benefits of play to kids in underserved neighborhoods isn’t a new idea. A concept called “Play Streets,” in which local volunteers work with police and health officials in urban neighborhoods to temporarily block traffic so kids can play, has been thriving for decades in places like London, Chicago, New York and San Francisco.

But the idea is only now starting to take root in small and medium-sized cities — and in a handful of rural towns — where it turns out that low-income children and adults are even more prone to obesity than in the nation’s urban centers, according to a June report from the U.S. Centers for Disease Control and Prevention.

Baton Rouge was not the first city to launch a mobile playground. “We stole the truck idea from Rochester, New York,” Drake said, having researched other cities after their initial idea. “But our concept was different because it was designed to combat obesity.”

Rochester’s “Recreation on the Move” program offers homework help, read-aloud programs, art and music, in addition to some sports and group games.

The oldest known mobile playground started in Sioux Falls, South Dakota, more than 70 years ago, and it’s still operating, Drake said. “They temporarily repurposed vehicles used to transport seniors one summer and the rest is history.”

In Winter Park, Florida, a decommissioned fire truck was converted to a playground on wheels in 2012. And in 1997, East Point, Georgia, started using an old police SWAT truck to take play equipment to a basketball park for kids whose parents couldn’t afford to send them to summer camp, Drake said.

Budget-Friendly
BREC started its mobile playground project with $110,000, half from the Blue Cross and Blue Shield of Louisiana Foundation and half from the parish budget.

That paid for the truck, play equipment and staff and sustained the project for two years, with funds left over. In the third year, the agency bought a second truck and hired more staff with new funding from Blue Cross and other donors.

A Play Streets project funded by the Robert Wood Johnson Foundation supported play events in four diverse low-income rural communities last summer — Warrenton, North Carolina; Talihina, Oklahoma; Oakland, Maryland; and Cameron, Texas — on a much smaller budget: $6,000 for a handful of community events.

Instead of shutting down a street, the communities held the events in parks, fields and other public spaces.

Working with a local health department, an agricultural extension service, a church and a tribal health center from the various towns, Robert Wood Johnson researchers found that the Play Streets concept could be cost-effectively adapted for rural communities, said Keshia Pollack Porter, a health policy professor at Johns Hopkins University who worked on the project.

In addition to providing needed community interaction as rural residents traveled to town centers for the events, bouncy houses and other inflatable play equipment inspired kids and some adults to get moving. Strapping pedometers on kids who volunteered, researchers showed that physical activity among participating children was higher during the three- to five-hour events than it otherwise would have been.

In Baton Rouge, Louisiana State University’s Pennington Biomedical Research Center found that similar events sponsored by BREC resulted in kids getting about 50 percent more physical activity, as measured in FitBit steps, compared with weekdays and weekends without Play Street events.

“Play Streets are not a magic bullet,” said Jamie Bussel, a pediatric health expert at the Robert Wood Johnson Foundation. But combined with food and nutrition initiatives, and institutionalized by communities, including schools, day care centers and recreation departments, they can go a long way to tamping the nation’s obesity epidemic, she said.

Play Deserts
Just this week, a report from a Department of Health and Human Services committee published in JAMA noted that 80 percent of U.S. adults and adolescents are not active enough, and recommended that children and adolescents aged 6 through 17 should do an hour or more of moderate-to-vigorous physical activity each day.

Nationwide, the childhood obesity rate was nearly 16 percent in 2016-2017, CDC data shows. And obese children are more likely to continue to be obese as adults, which puts them at a higher risk of developing heart disease, type 2 diabetes, cancer and other conditions.

In addition, children with obesity are at a higher risk of developing chronic health conditions such as asthma, diabetes, sleep apnea, and bone and joint problems. They’re also more likely to be bullied and have depression, low self-esteem or social isolation, CDC data shows.

States vary widely in the rate of obesity among youths ages 10 to 17, according to the most recent National Survey of Children’s Health. Eight of the 10 states with the highest rates are in the South. Nine of the 10 states with the lowest rates are in the Northeast and West.

Mississippi has the highest rate at 26 percent and Utah has the lowest rate at 9 percent. The obesity rate in Louisiana is 19 percent.

One of the causes attributed to increased obesity in poor urban neighborhoods is a lack of affordable fresh food, sometimes called a “food desert.” But researchers say that many food deserts are also play deserts, where low-income children lack safe, stimulating outdoor play spaces.

In many low-income neighborhoods, parks are plentiful but tend to be poorly maintained and lack amenities such as up-to-date play equipment. They also might be in areas that are unsafe for children to walk to on their own, said Johns Hopkins’ Porter.

The Elm Grove community in Baton Rouge is one of them, Drake said. That’s why BREC on the Geaux parks there once a week to set up shop. “You can see the kids peeking out of their windows and doors as we pull up,” she said. “When they see our truck, they start running.”

Dee Taylor calls herself the grandmother and great-grandmother of Elm Grove, a subsidized apartment complex in Baton Rouge. “We didn’t have much of anything for the kids on the grounds.

“They stayed in their apartments and watched too much TV or played video games all day in the summer,” she said. “It was the only thing they knew to do.”

“So, when I heard about BREC on the Geaux, I made a call and they came.” Taylor put up a notice about the mobile playground’s schedule in the window of her apartment and another one on the door of the building’s management office. She told everyone she knew.

“A child needs that kind of physical activity to grow up in a wholesome way,” she said. “The more we can give them, the better their lives will be.”

BREC’s two play trucks visit dozens of housing complexes, elementary schools and parks in Baton Rouge every week. They show up at community gatherings on the weekend. During the Louisiana floods of 2016, BREC’s trucks made the rounds at local shelters, giving children a much-needed daily play break.

BREC on the Geaux had more than 100,000 participants in 2016, adults and children. “We may have been the hardest-working mobile play unit in the business,” Drake said. But since then, BREC was short on funds and had to curtail its schedule slightly. Based on demand, the program should be expanding, Drake said.

At Elm Grove, Taylor said she and her children wish BREC on the Geaux could visit more often. But she said she knows other neighborhoods need it too.

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Study suggests childhood obesity linked to poor school performance and coping skills

November 2, 2018, American Academy of Pediatrics

A new study suggests that childhood obesity, now at epidemic levels in the United States, may affect school performance and coping skills for challenging situations. The study abstract, “Childhood Flourishing is Negatively Associated with Obesity,” will be presented on Saturday, Nov. 3, during the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition.

Researchers analyzed responses from 22,914 parents and caregivers of children aged 10-17 years who participated in the 2016 National Survey of Children’s Health. The goal was to determine the independent association between body mass index (BMI) and five markers of “flourishing,” or overall well-being as it relates to the development of positive psychosocial and coping skills.

“Childhood obesity is one of the biggest public health challenges we face today,” said Natasha Gill, MD, FAAP, a Pediatric Emergency Medicine Fellow at the Alpert Medical School of Brown University and Hasbro Children’s Hospital. “We know that children with obesity are at a greater risk for long-term health conditions that can last into adulthood, and we wanted to see whether obesity affects a child’s immediate well-being as it relates to development of psychosocial skills and other signs of flourishing.”

Adjusting for several confounding variables, including gender, child depression status, average sleep hours per night, average digital media exposure per day, highest parental education level, and household poverty status, Dr. Gill and her colleagues analyzed parents’ responses to questions about whether their child:

“Shows interest and curiosity in learning new things”

“Works to finish tasks he or she starts”

“Stays calm and in control when faced with a challenge”

“Cares about doing well in school”

“Does all required homework”

Researchers found that only 27.5 percent of children with obesity, defined as a BMI at or above the 95th percentile for children and teens of the same age and sex, were reported to have all five flourishing markers. This compares with 36.5 percent of those in the overweight range, with BMI at or above the 85th percentile, and 39 percent of children with normal BMI.

“The negative relationship between obesity and flourishing markers suggests that when compared to children with a normal BMI, obese youth may be less likely to develop healthy relationships, positive attitudes, a sense of purpose and responsibility, and interest in learning,” Dr. Gill said. “Individual markers of flourishing have been shown to stay the same over time like a person’s personality,” she said, “so it may be important to monitor these markers in childhood to ensure optimal development into adulthood.”

“We want all children to reach their maximum potential,” she said. “If we can intervene early enough, we can promote positive physical, mental, and social development for these at-risk children and help them become responsible, hard-working members of society.” She said her study’s findings support the need for focused and coordinated efforts and resources from schools and health care providers that target obesity to improve overall well-being.

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Understanding correlates of physical activity in American Indian families: The Healthy Children Strong Families-2 Study

November 2018, Journal of Physical Health and Activity

Background: Little is known about factors contributing to physical activity (PA) in American Indian (AI) populations. Addressing this gap is paramount as sedentary activity and obesity continue to increase in this population. The purpose of this study was to determine factors associated with PA among AI families with young children.

Methods: Height and weight of both adult (n = 423) and child (n = 390) were measured, and surveys assessed demographics, PA, stress (adult only), sleep, and screen time. Separate multivariate logistic regression models were constructed for adults and children (reported as adjusted odds ratios, aORs).

Results: For adults, age (aOR = 0.952; P ≤ .001), television viewing (aOR = 0.997; P = .01), and computer use (aOR = 0.996; P = .003) decreased the odds of being active. For children, high adult activity (aOR = 1.795; P ≤ .01), longer weekday sleep (aOR = 1.004; P = .01), and family income >$35,000 (aOR = 2.772; P = .01) increased the odds of being active. We found no association between adult PA with stress or adult sleep or between child PA with body mass index and screen time.

Conclusions: Given the complexity of the factors contributing to obesity among AI families, multigenerational interventions focused on healthy lifestyle change such as decreasing adult screen time and increasing child sleep time may be needed to increase PA within AI families.

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Rates of obesity and obesogenic behaviors of rural Appalachian adolescents: How do they compare to other adolescents or recommendations?

November 2018, Journal of Physical Health and Activity

Background: To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations.

Methods: This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearson’s correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted.

Results: Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages.

Conclusion: Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern.

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The impact of residential segregation on obesity

November 2018, Journal of Physical Health and Activity

Background: This study examined the association between residential segregation and obesity for Whites, African Americans, Hispanics, and Asians. This study considered 3 dimensions of residential segregation, isolation, dissimilarity, and concentration.

Methods: By combining individual-level data from the Behavioral Risk Factor Surveillance System and county-level data from the County Health Rankings and Roadmaps, the total sample size was 204,610 respondents (160,213 Whites, 21,865 African Americans, 18,027 Hispanics, and 4,505 Asians) from 205 counties in the United States. Two-level logistic regression models were performed.

Results: African Americans and Hispanics in counties with high levels of isolation, dissimilarity, and concentration were more likely to be obese; these relationships did not hold true for Whites and Asians. Counties with a higher percentage of populations with the income below the poverty line and a higher percentage of fast food restaurants in the county were associated with a higher likelihood of obesity for all racial/ethnic groups. African Americans and Hispanics with low levels of education and income were more likely to be obese.

Conclusions: Residential segregation had a contextual influence on weight status, and the context of counties influenced racial/ethnic groups differently. Obesity reduction programs should consider the contextual influence on minority populations and target subgroups living in highly segregated areas.

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