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July 2019

SPOTLIGHT

PUBLICATIONS & TOOLS

CHILDHOOD OBESITY RESEARCH & NEWS

Spotlight

NCCOR’s Global Reach

July 23, 2019, NCCOR

The National Collaborative on Childhood Obesity Research has been providing resources, tools, and information to the field for the last 10 years across the United States but did you know that NCCOR’s tools are also used in other countries? With the rates of childhood obesity on the rise in many countries, it’s no surprise that researchers and practitioners are turning to NCCOR for research tools to help tackle this growing problem. Keep reading to learn more about how NCCOR tools are used all over the world.

The Measures Registry is a searchable database of diet and physical activity measures relevant to childhood obesity research. Since its launch in 2011, the Measures Registry has been visited more than 54,400 times by users in more than 41 countries. The Measures Registry User Guides have been visited more than 45,300 times. In 2019, 11% of page views on the Measures Registry were from outside the U.S. Australia has the second most Measures Registry Users.

The Youth Compendium of Physical Activities provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity. The Youth Compendium, launched in 2017, has been visited more than 37,600 times by people in more than 71 countries.

The Catalogue of Surveillance Systems provides one-stop access to more than 100 publicly available datasets relevant to childhood obesity research. Nine percent of the Catalogue of Surveillance System’s page views come from outside the U.S. Israel has the second highest number of viewers, after the U.S. The Catalogue of Surveillance Systems has been visited more than 86,500 times all around the world.

It’s not just NCCOR tools making international appearances either! Last month, at the International Society of Behavioral Nutrition and Physical Activity Annual Meeting in Prague, NCCOR members and researchers gave a presentation on the Measures Registry.

NCCOR hopes to continue providing helpful research and research tools that can be used on a global scale to make progress in the field of childhood obesity research for years to come.

The Measures Registry is a searchable database of diet and physical activity measures relevant to childhood obesity research. Since its launch in 2011, the Measures Registry has been visited more than 54,400 times by users in more than 41 countries. The Measures Registry User Guides have been visited more than 45,300 times. In 2019, 11% of page views on the Measures Registry were from outside the U.S. Australia has the second most Measures Registry Users.

The Youth Compendium of Physical Activities provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity. The Youth Compendium, launched in 2017, has been visited more than 37,600 times by people in more than 71 countries. It has also been translated into Chinese.

The Catalogue of Surveillance Systems provides one-stop access to more than 100 publicly available datasets relevant to childhood obesity research. Nine percent of the Catalogue of Surveillance System’s page views come from outside the U.S. Israel has the second highest number of viewers, after the U.S. The Catalogue of Surveillance Systems has been visited more than 86,500 times all around the world.

It’s not just NCCOR tools making international appearances either! Last month, at the International Society of Behavioral Nutrition and Physical Activity Annual Meeting in Prague, NCCOR members and researchers gave a presentation on the Measures Registry.

The Collaborative’s unique resources are certainly popular. NCCOR hopes to continue providing helpful research and research tools that can be used on a global scale to make progress in the field of childhood obesity research for years to come.

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Publications & Tools

Toolbox

Are you a professor preparing lessons for classes this fall? Check out these teaching slides for the Measures Registry User Guides to incorporate it into your curriculum.

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A Health Equity Approach to Obesity Efforts: Proceedings of a Workshop—in Brief

This workshop explored the history of health equity issues in demographic groups that have above-average obesity risk and considered principles and approaches to address these issues as part of obesity prevention and treatment efforts.

Read the publication here

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Commercial foods for infants and young children in the WHO European region

Baby food often contains too much sugar and is incorrectly advertised as suitable for infants under 6 months of age, according to this new World Health Organization report. This may raise the risk for obesity and diabetes later because it can wire young children to a lifelong preference for sweet foods.

Read the report

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Childhood Obesity Research & News

More U.S. teenagers are trying to lose weight than in years past. That may be reason for concern.

Time, July 17, 2019

By Jamie Ducharme

Recent years have ushered in a wellness movement that emphasizes body positivity and holistic health over thinness and crash diets. But new federal data suggest that messaging hasn’t fully changed behavior yet. In fact, the report shows that more American teenagers are trying to lose weight than in years past.

From 2013 to 2016, almost 38% of American adolescents ages 16 to 19 said they had tried to lose weight during the past year, according to a report from the U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. That’s up from about a quarter of adolescents who said the same a decade ago, according to previous research.

Rising childhood and adolescent obesity rates likely play a part in the increase, especially since the NCHS data showed that more than three-quarters of adolescents with obesity tried to lose weight. But weight-loss attempts outpaced increases in adolescent obesity, according to CDC data. Obesity rates among adolescents ages 12 to 19 climbed from 18.4% to almost 21% from 2009-2010 to 2015-2016.

Far more girls than boys reported trying to lose weight in the latest report: around 45%, compared to 30% of boys. Hispanic teenagers of both genders were more likely to say they had tried to lose weight compared to black, white and Asian youths.

Dr. Sarah Armstrong, an associate professor of pediatrics who researches adolescent obesity at the Duke University School of Medicine, says the increase suggests that despite cultural efforts to de-emphasize weight loss in favor of overall wellness, “there has really not been a shift in the social stigma and weight bias against people who are heavy,” Armstrong says. “Teenagers experience this, maybe even more so than adults, because they are still developing their image of self.” A study published July 16 in Obesity Science and Practice supports that theory, finding that younger people, and especially those who began struggling with their weight early in life, were more likely than others to internalize weight bias and stigma, which can damage health and self-esteem.

When teenagers try to lose weight, they mostly rely on traditional tactics, the NCHS data show. More than 83% said they had exercised in hopes of losing weight, followed by about 50% each who said they had consumed more water and less food.

But, Armstrong points out, the continuing rise in youth obesity rates suggests “the increased efforts to lose weight is not translating to weight loss. It should be a clear signal to all of us that we need to think about the systems and environmental-level drivers of obesity, and recognize that individuals won’t solve the problem alone.” Meaningful reductions in adolescent obesity will likely require better physical activity and nutrition programs at schools, more moderate use of technology, and substantive efforts from the food industry to improve nutrition and food quality, Armstrong says.

In addition, Armstrong cautions that even seemingly healthy behaviors, like working out and cutting back on calories, can quickly spiral into unhealthy territory, especially for teenagers. Eating disorders are thought to be most common among adolescents, and the American Academy of Pediatrics suggests that doctors and families avoid focusing on weight issues in teenagers, because doing so can promote disordered eating.

“An increased focus on being healthy is a good thing,” Armstrong says. “But what we know, particularly in teenagers, is that their focus on weight and particularly weight loss tends to be in an unhealthy way. A focus on trying to be healthier and get to a healthier weight is important, but I worry about the methods.”

Original source: https://time.com/5626717/adolescent-weight-loss/

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Latin America’s war on obesity could be model for U.S.

Washington Post, July 16, 2019

By Laura Reiley

There is something Chilean kids won’t see anymore. As of June 27, cinemas and televisions no longer screen advertisements for foods high in calories, added sugar, sodium and saturated fat between 6 a.m. and 10 p.m., under new laws aimed at reducing childhood obesity in Chile.

It is one of the most recent efforts in the campaign against obesity that Latin American countries have been fully engaged with — and winning — for some time.

One country and one strategy at a time, the region has pushed back against sugary beverages and ultra-processed foods in an effort to escape the obesity epidemic that has overtaken the United States. Infectious diseases are still the leading causes of death in developing countries, but as economies grow, Western lifestyle factors such as smoking, high-fat diet, obesity and lack of exercise are emerging public health problems.

In Chile, the Senate passed strict food labeling laws. Mexico imposed a tax on sugary drinks and junk food, and Brazil opted for voluntary measures that have proved effective.

“The obesity epidemic is relatively new in Latin America,” says Camila Corvalán, a nutrition professor at the Institute of Nutrition and Food Technology at the University of Chile, who was on the expert panel that helped the Ministry of Health develop the new policy. “But we knew exactly where we would end up. We have all the figures and numbers from the United States.”

By 2012, a quarter of schoolchildren and a third of Chile’s adult population were obese. Chile’s figures were not anomalous. In the United States, the percentage of obese children and adolescents has more than tripled since the 1970s, according to the Centers for Disease Control and Prevention. The rates of obesity among adults is no better: In 2007, 33.7 percent of American adults were obese. The most recent estimates approach 40 percent, according to the American Medical Association.

In July 2012, the Chilean Senate approved the law of food labeling and advertising, which went into effect in 2016 with comprehensive food-regulation policy in three, increasingly stringent phases. Spearheaded by Guido Girardi, a physician and senator, the law included front-of-package warnings, restrictions on marketing unhealthful foods directly to children, and limits on what foods could be sold in schools and day-care facilities.

“The situation was producing an increase in noncommunicable chronic diseases and deaths from cancer, heart attacks, diabetes [and] hypertension,” Girardi wrote in an email. “And we have the conviction that this true tsunami of diseases affected the poorest who have a 160 percent higher risk of obesity, 380 percent higher risk of hypertension and 320 percent higher risk of diabetes and more than 100 percent [higher risk] of a heart attack … than people of high income.”

Foods high in added sugar, saturated fats, calories and added sodium must display black stop signs on front-of-package labels. Nothing with black stop signs can be sold or promoted in schools or included in child-targeted television ads or marketing strategies aimed at children (no characters, toys or celebrities like Tony the Tiger or the Trix rabbit).

There was pushback.

“There was a very hard lobby,” Girardi explains. In an episode that went viral on social media in Chile, a fast-food entrepreneur confronted Girardi on a Latam Airlines flight yelling, “You are the most nefarious thing that has happened to this country.”

The country’s leading business lobby also weighed in, threatening to withhold money for sports teams and disabled citizens. “They did a real campaign of terror saying that chaos and thousands of unemployed people would be generated,” Girardi said.

Chilean President Sebastián Piñera moved to veto the law. Girardi says that a citizen scientific coalition eventually defeated the lobby but that an association of food companies including Carozzi and Nestlé broadcast ads with celebrities and athletes maligning the law.

“There were lots of arguments that it would cost too much money and be impossible to implement,” remembers Corvalán. “The Ministry of Health is very happy with the results so far. In our studies, we have seen that consumers understand the regulation very well, that more logos means less healthy foods.”

Carozzi did not respond to emailed request for comment.

Francisco Frei, a spokesman for Nestle in Chile, said the company was complying with the new regulations and had reformulated its products to reduce sugars, salt and saturated fats. “For example, since 2015, we have been able to reduce more than 3000 tons of sugar in our products,” he said in an email.

Barry Popkin, a professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, has been involved in policy formulation for Mexico, Chile, Brazil and Colombia and helped evaluate the initiative.

He says the program resulted in a 25 percent reduction in the purchase of sugary beverages and a 9 percent decrease in the purchase of sugar-sweetened breakfast cereals. Many packaged foods have been reformulated with lower levels of sugar and sodium in an attempt to avoid the black stop sign labels.

The changes have also put children in a central role in guiding family eating patterns, he says.

“Low-income mothers reported their kids were coming home from school and saying, ‘You can’t buy these foods with the warning labels,’ ” Popkin says. “We saw large declines in the purchase of junk food.”

Uruguay and Peru have also approved warning labels similar to those in Chile.

“We have to get rid of the unhealthy food before we get people to eat the healthy food,” Popkin says. “Many of these countries have state health plans, so the financial burden of unhealthy diets and obesity is felt by the governments very quickly.”

MEXICO

Chile is ranked as a high-income economy by the World Bank. Popkin says different strategies — such as a tax on sugary beverages — have proved effective in countries such as Mexico, which has a larger percentage of low-income citizens.

Between 1989 and 2006, sugary drink consumption increased by 60 percent in Mexico. With death rates that are among the highest in the world for lifestyle-related chronic diseases such as diabetes, Mexicans drank more soda per person than residents of nearly any other country.

“We had been aware of undernutrition problems and were starting to see reductions of those, but the levels of obesity came as a shock,” Juan Rivera, director of the National Institute of Public Health of Mexico, said recently by phone. “On average, Mexicans were consuming 25 percent of all their calories from junk food and sugar-sweetened beverages.”

The reasons are interesting. Rivera says that in the 1990s, Mexico had had a cholera epidemic and consumers were leery of drinking tap water. People started buying bottled water — but if soda was even cheaper than bottled water, why not opt for the more flavorful beverage?

He says there had also been a long tradition of mothers putting a little sweet juice in baby bottles of water. It wasn’t a big leap to introduce baby bottles of Coca-Cola to children under 12 months old. Between 1995 and 2005, Rivera says, Mexico became the largest consumer of Coca-Cola (Vicente Fox, who was president from 2000 to 2006, had previously been president of Coca-Cola Mexico).

“Suddenly we realized that if we had to take one single regulation, the perfect candidate would be sugar-sweetened beverages to overcome obesity,” Rivera says.

Ben Sheidler, director of external communications at Coca-Cola, said 45 percent of the company’s products in Mexico are now low- or no-sugar. “We have reduced the calorie content of our portfolio by more than 20% within the last decade,” he said in an email.

In 2012, Rivera and regulators began exploring the idea of a soda tax. They found that increasing the price by 10 percent reduced consumption by 12 percent. Industry countered: This would unduly hurt low-income people, and besides, sugar-sweetened beverages are part of the Mexican food basket. The way to reduce obesity, they said, was more physical activity.

But public health groups fought back with ads and billboards featuring a photo of 12 teaspoons of sugar, the amount in a 600-milliliter (about 20 ounces) bottle of soda, and the questions: “Would you give your child this much sugar? Then why would you give them a soda?”

A 10 percent tax went into effect in January 2014 for junk food (snacks, candy, nut butters, cereal-based prepared products and foods considered “non-essential”) and sugar-sweetened beverages. While it’s too early to assess obesity levels, Rivera says, low-income Mexicans have decreased their sugary beverage consumption by 12 percent. For those with higher incomes, it is a 5 percent reduction.

Rivera says that the food industry has tried to have the tax repealed every year but that the revenue has become important for the country, raising 23.2 billion pesos (about $1.2 billion) from sugar-sweetened beverages and 18.3 billion pesos ($967 million) from junk food.

BRAZIL

In Brazil, changing citizens’ nutritional behaviors has taken a voluntary route, which has also proved effective. The Dietary Guidelines for the Brazilian Population of 2015 contains strong, straightforward guidance on how to eat: “Always prefer natural or minimally processed foods and freshly made dishes and meals to over-processed foods.”

The guidelines also consider the impact of foods on the environment. The United States, in contrast, backed away from adding sustainability guidelines in 2015, bowing to pressures from the food industry. (Sustainability is also off the table for the 2020 U.S. dietary guidelines, which are being revised right now.)

“Brazil’s guidelines are simple but radical,” says Neena Prasad, of the Bloomberg Philanthropies, which has funded and provided technical assistance for obesity prevention programs in Mexico, Colombia, Brazil, Chile and Peru. “It’s a really sensible approach. Choose whole, minimally processed foods, cook those foods yourself, and eat those foods with other people.

The whole view of human rights is very different in Latin America. It’s built into constitutions, and often those frameworks include food and beverage. They could still go back to their traditional diets and eating whole, healthy foods, and avoid where the U.S. has gone.”

Original source: https://www.washingtonpost.com/business/2019/07/16/latin-americas-war-obesity-could-be-model-us/

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The influence of preschoolers' emotional and behavioral problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial

Pediatric Obesity, July 9, 2019

Background

Few studies have explored the influence of preschoolers’ behavioral problems on obesity treatment.

Objectives

To assess emotional and behavioral problems before and after an obesity intervention and examine relationships between changes in child behavior and changes in weight status.

Method

The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children’s heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children’s behaviors (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioral problems. Changes in child behavior during treatment were examined through paired samples t tests; the influence of child behavior on treatment effects was examined through linear regressions.

Results

Child emotional and behavioral problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behavior, Externalizing Behaviors, Oppositional Defiant Problems, and Total Problems. Child behavior significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviors, and a higher number of behavioral problems predicted decreasing BMI z‐scores.

Conclusions

Child behaviors at baseline influenced treatment results. Child emotional and behavioral problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

Original source: https://onlinelibrary.wiley.com/doi/full/10.1111/ijpo.12556#accessDenialLayout

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Neighborhood Food Environment and Physical Activity Among U.S. Adolescents

American Journal of Preventative Medicine, July 2019

Introduction

Few U.S. adolescents meet physical activity guidelines. Although several neighborhood characteristics influence physical activity, the role of food-related features as potential drivers of adolescent physical activity remains understudied. Using representative U.S. data, authors examined the effect of the neighborhood food environment on adolescents’ out-of-school physical activity.

Methods

The Family Life, Activity, Sun, Health, and Eating (FLASHE) study was conducted in 2014. Secondary data analysis occurred in 2018. Multinomial logistic regression models examined associations between neighborhood availability of (1) convenience store; (2) supermarket; (3) farmer’s market; (4) fast food; (5) non–fast food restaurant and adolescent out-of-school physical activity (tertile-based, low as referent). An additional association between a total aggregate neighborhood food environment score was assessed.

Results

Final analytic sample was 1,384 adolescents (mean age=14.5 years, SD=1.6). Controlling for free/reduced-price lunch, age, sex, race/ethnicity, and neighborhood physical activity and social environments, the aggregate food environment score was significantly associated with high physical activity (versus low tertile; OR=1.2, 95% CI=1.1, 1.3). Most individual categories of food retail outlets were significantly and directly associated with out-of-school moderate- to vigorous-intensity physical activity in the single food environment variable models. However, when fully adjusting for all food retail outlet categories plus confounders, they were no longer significant.

Conclusions

The availability of a diverse combination of retail food destinations within walking distance from home may provide opportunities for adolescents to achieve more physical activity, likely because of transport-based physical activity. Pending future research, these findings suggest that the role of the food environment on health extends beyond its influence on dietary behaviors to other health behaviors like physical activity.

Original source: https://www.ajpmonline.org/article/S0749-3797(19)30042-X/fulltext

 

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Childhood obesity and the associated roles of neighborhood and biologic stress

Preventative Medicine Reports, June 2019

Abstract

Exposure to violence and obesity continues to be growing epidemics, particularly among children. Our objective was to increase our understanding of the association between neighborhood violence exposure and children’s weight and how biologic stress may mediate this relation. A matched, community-recruited cross-sectional study of 90 children, ages 5–16 years, from 52 neighborhoods took place in the greater New Orleans, LA area between 2012 and 2013. Children were matched on their propensity for living in a high violence neighborhood and previous exposure to Hurricane Katrina. Primary neighborhood exposure included violent crime, operationalized as crime rates within specific radii of children’s home. Rates of exposure within 500, 1000 and 2000 meter radii from the child’s home were calculated. Primary outcomes were body mass index (BMI) and waist circumference, and the primary mediator was telomere length (TL), a marker of cellular aging. Significant variation in obesity and TL was observed at the neighborhood level and violent crime was significantly associated with weight status, with an increase of 1.24 units in BMI for each additional violent crime in the child’s neighborhood and a significant mediated or indirect effect of TL in the crime-BMI relation (0.32, 95% bootstrapped CI = 0.05, 0.81; 32% total mediated effect). Findings strengthen existing evidence linking neighborhood violence to childhood health and identify biologic stress, indexed by TL, as one mechanistic pathway by which neighborhood violence may influence childhood obesity. Neighborhood violence may be an important target for interventions focused on reducing obesity and other stress related health outcomes in children.

Original source: https://www.sciencedirect.com/science/article/pii/S2211335519300348

 

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