December 2020





NEW from NCCOR: “Advancing Measurement of Environmental and Policy Influences on Childhood Obesity”

NCCOR, December 2020

This month, NCCOR released the third and final white paper based on a series of workshops on advancing measurement for childhood obesity. The white paper, titled “Advancing Measurement of Environmental and Policy Influences on Childhood Obesity,” describes the workshop held on February 27–28, 2020. The workshop series was funded by The JPB Foundation.

Leading research and practice experts were convened to (1) illustrate current challenges, needs, and gaps in measurement of environment and policy related to diet and physical activity and (2) discuss current practices used to adapt existing measures and develop new measures of environment and policy.

This whitepaper highlights recommendations for actionable steps to address short-term (1–3 years) and medium-term (3–5 years) measurement needs in these areas. Some recommendations include: (1) identify measures, methods, and approaches for collecting data where little information exists; (2) create new approaches for optimizing measurement, incorporating measures into existing sources of data and disseminating them widely; and (3) work across disciplines and sectors to synthesize measurement approaches that have been well-developed in other sectors and identify measures from other sectors that are appropriate for community health. The white paper can be accessed on the NCCOR website at

The first two white papers—”Advancing Measurement of Individual Behaviors Related to Childhood Obesity” and “Advancing Measurement for High-Risk Populations and Communities Related to Childhood Obesity”—are also available on the NCCOR website. These papers stem from a series of three workshops that aimed to define next steps in measurement needs to accelerate progress in reducing childhood obesity. From its inception, a key priority for NCCOR has been to promote the more common use of high-quality and standardized measures and methods across childhood obesity prevention and research, surveillance, and interventions. Use of such measures enhances the potential for comparison of results across different studies and the rapid advancement of progress against childhood obesity.

In addition, NCCOR plans to publish a synthesis of findings and recommendations from the three workshops in the scientific literature. Priority areas from these workshops will help advance the development of improved measures that can be used across a range of research, surveillance, and intervention activities related to childhood obesity by addressing the many levels of influences, such as policies and environmental factors, that impact the onset and progression of childhood obesity.

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Publications & Tools

NCCOR's Toolbox

This supplement, published in Childhood Obesity, highlights findings from a novel taxonomic meta-analytic method for childhood obesity. Read it here!

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Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020

Evidence-based hospital practices supporting breastfeeding have sometimes conflicted with COVID-19 infection prevention and control measures. During summer 2020, hospitals implemented a variety of practices intended to balance evidence-based maternity care with infection prevention and control. Because of the pandemic, 17.9% of hospitals reported that in-person lactation support had decreased, and 72.9% reported discharging mothers and their babies <48 hours after birth.

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Timing of Introduction of Complementary Foods

This study assessed the timing of introducing complementary foods to children aged 0–5.

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Food Over Fear: Overcoming Barriers to Connect Latinx Immigrant Families to Federal Nutrition and Food Programs

This report sheds light on why many immigrant families are forgoing vital assistance from federal nutrition and food programs and lifts up recommendations aimed at ensuring that all families and individuals, regardless of immigration status, are nourished and healthy.

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AAP interim guidance addresses healthy lifestyles, obesity management during pandemic

Two new interim AAP guidance documents can help pediatricians support children struggling to access nutritious food and engage in physical activity during the COVID-19 pandemic, including those who have obesity.

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Childhood Obesity Research & News

Kids gain weight when new convenience stores open nearby

EurekAlert!, December 10, 2020

A new study in the Journal of the Academy of Nutrition and Dietetics, published by Elsevier, found that changes in the food environment around low-income and high-ethnic/racial minority populations over time impact childhood obesity. Increased availability of small grocery stores selling a selection of healthy items in close proximity to children’s homes improves their weight status over time, whereas increased availability of convenience stores selling predominantly unhealthy foods is likely to be detrimental.

“Childhood obesity has a complex multifaceted etiology. In this study we found that community food environment, particularly small neighborhood stores, can significantly influence children’s weight status. Our findings are useful for designing future interventions and public policies,” explained lead author and co-director of the research, Punam Ohri-Vachaspati, PhD, RD, Professor, College of Health Solutions, Arizona State University, Phoenix, AZ, USA.

One of the few prospective longitudinal studies examining the influence of key elements of a comprehensive set of food outlets, both large and small, the study followed two groups of 3 to 15 year-old children in four New Jersey cities — Camden, New Brunswick, Newark, and Trenton. These cities were known to be initiating policy and environmental changes aimed at childhood obesity prevention. The first group was studied from 2009-10 to 2014-15, the second from 2014 to 2016-17.

“Our research design allowed us to examine the patterns of relationship between changes in children’s weight status and changes in the food environment over several meaningful distances and lengths of exposure. We found that community food environment in urban neighborhoods matters for children’s weight outcomes, especially as it relates to small stores located near children’s homes,” commented Michael Yedidia, senior author and co-director of the study, Professor, Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.

Children’s exposure to changes in the food environment in each city was calculated for every month during the study. The researchers looked at changes in the number of food outlets across various proximities (quarter mile, half mile, and one mile around a child’s home) over different lengths of time (12 months, 18 months, and 24 months before the final interview). Changes included store openings and closings, family moves from one neighborhood to another, and upgrades to existing food stores, fostered by community initiatives to improve offerings at convenience stores.

Food outlets were categorized as supermarkets, small grocery stores, convenience stores, pharmacies, full-service restaurants, or limited service restaurants. Stores were classified as small grocery stores if they sold a specific selection of healthy items such as five different types of fruits, five different types of vegetables, lower fat milk, and fresh or frozen meat. Convenience stores participating in “healthy corner store” initiatives were classified as upgraded convenience stores.

Less healthy changes were found in children when their exposure to convenience stores increased over time. For example, exposure to an additional convenience store within a mile of a child’s home over 24 months resulted in 11.7 percent greater likelihood of a child being in a higher body mass index range compared to other children of the same sex and age at the end of the study. In contrast, exposure to an additional small grocery store within a mile over 24 months resulted in 37.3 percent lower odds of being in a higher body mass index category. No consistent patterns were found for changes in exposure to supermarkets, restaurants, or pharmacies.

“While we found no consistent results for supermarkets, our findings do not suggest that large stores are not an important feature of the food environment. Rather, most of our sample living in dense urban cities had access to supermarkets at baseline and did not experience significant change in access to supermarkets over time,” observed Dr. Ohri-Vachaspati.

Investigators suggest that elevating the healthfulness of food offered at upgraded convenience stores to levels similar to that of small grocery stores through community initiatives has the potential to improve children’s weight status.

The researchers noted that the study design allowed for consideration of a child’s experience growing up in a community where the food environment is dynamic and multiple changes occur simultaneously. Dr. Yedidia observed, “The need for a more refined understanding of the impact of local food environments on children’s weight status and health has become more evident during the COVID-19 pandemic, which has been accompanied by increased food insecurity among low-income populations.”

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Yes, many of us are stress-eating and gaining weight in the pandemic

December 4, 2020, New York Times

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables; instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”

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A safety net unraveling: Feeding young children during COVID-19

November 19, 2020, American Journal of Public Health

The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP).

Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss.

Critical steps are needed to repair our nation’s fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond.

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Parental contributors to the prevalence and long-term health risks of family weight teasing in adolescence

November 9, 2020, Journal of Adolescent Health


Weight teasing from family members is common during adolescence. However, little is known about parental factors that increase adolescents’ risk for family weight teasing and its adverse health sequelae. Using multi-informant data from adolescents, mothers and fathers, the current longitudinal study examined how parental concerns about their child’s weight and their own weight contribute to family weight teasing in adolescence and its long-term health consequences.


Data were collected in the population-based Project EAT 2010–2018 (Eating and Activity over Time) study, following a longitudinal cohort of young people (N = 2,793). Parental weight concerns for their adolescent and themselves were reported by mothers (N = 2,298) and fathers (N = 1,409) at baseline and examined as a predictor of family weight teasing in adolescence as well as a moderator of family weight teasing effects on health eight years later.


Mothers’ and fathers’ concerns about their child’s weight, as well as mothers’ dieting frequency, increased the likelihood of adolescents experiencing family weight teasing. Longitudinal analyses revealed that adolescents teased about their weight by family had higher levels of stress ( β = .21, 95% confidence interval [CI] = .09–.33) and substance use ( β = .16, 95% CI = .04–.28), and lower self-esteem ( β = −.16, 95% CI = −.28 to −.05) in young adulthood.


Findings highlight parent weight concern, particularly concern for their child’s weight, as a risk factor for family weight teasing. These findings underscore the importance of encouraging parental attention to health, rather than weight, in family-based treatment and public health initiatives.

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