January 2020





NCCOR Releases New White Paper: “Advancing Measurement of Individual Behaviors Related to Childhood Obesity: Implications and Recommendations for the Field”

NCCOR, January 28, 2020

This month, NCCOR released a new white paper following a workshop convened on May 20-21, 2019, called “Advancing Measurement of Individual Behaviors Related to Childhood Obesity.” This workshop was the first in a series of three workshops funded by The JPB Foundation and focused on measurement needs to capture individual behaviors related to childhood obesity. The other two workshops in the series are planned to focus on measurement needs for high-risk populations and measurement needs to capture policy and environmental influences.

This workshop aimed to gather together leading experts to (1) explore next steps for measurement science relevant to emerging areas for diet and physical activity in children, particularly from birth to twelve years of age, and (2) examine measurement science issues in two other topics of new relevance to childhood obesity—sedentary behavior and sleep.

Using findings from this first workshop, NCCOR released “Advancing Measurement of Individual Behaviors Related to Childhood Obesity: Implications and Recommendations for the Field,” which includes recommendations for actionable steps to address short-term (1-3 years) and medium-term (3-5 years) measurement needs in these areas. Recommendations include developing measurement methods for children younger than age 6 years, defining terms and core indicators or domains that can be measured, and examining the important of family, social, and environmental contexts and how they evolve with age. The white paper can be accessed on the NCCOR website at www.nccor.org/measurement-workshop-series/.

White papers for the other two workshops also will be posted on the NCCOR website. In addition, NCCOR plans to publish a synthesis of findings and recommendations from the three workshops in the scientific literature. NCCOR hopes these efforts will ultimately help reduce childhood obesity.

Original source

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NCCOR’s New Youth Compendium Fact Sheet for Classroom Teachers

NCCOR, January 27, 2020

This month, the National Collaborative on Childhood Obesity Research (NCCOR) released a new fact sheet that shows classroom teachers how to incorporate the Youth Compendium of Physical Activities into their curricula.

The Youth Compendium provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity. This tool is intended for widespread use by researchers, state and local health departments, educators, and fitness professionals.

The new fact sheet helps elementary through high school teachers select moderate to vigorous physical activities to keep students active throughout the day. Examples of activities include jumping jacks, hopping, skipping, and ball games such as bouncing and dribbling. It can be used in conjunction with NCCOR’s Youth Compendium Fact Sheet for Physical Education Teachers, which assists educators in creating lesson plans for physical education classes. To see the new factsheet, go to nccor.org/youthcompendium/classroom.

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Publications & Tools

NCCOR’s Toolbox

While you’re checking out the new Youth Compendium Fact Sheet for Classroom Teachers, be sure to look at NCCOR’s Youth Compendium Fact Sheet for Physical Education Teachers, which assists educators in creating lesson plans for physical education classes.

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Leading Health Indicators 2030: Advancing Health, Equity, and Well-Being

Experts from the health measurement and population health fields gathered on May 28, 2019, in Washington, DC, at a workshop organized by the National Academies of Sciences, Engineering, and Medicine for the Committee on Informing the Selection of Leading Health Indicators for Healthy People 2030. The workshop presentations and discussion aimed to help inform the committee’s task, which is to (1) advise on the criteria for selecting Healthy People 2030’s Leading Health Indicators (LHIs), and (2) to propose a slate of LHIs for the Healthy People Federal Interagency Workgroup (FIW) to consider in finalizing the Healthy People 2030 (HP2030) plan. This proceedings in brief provides a concise overview of that day.

Read the report

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Adult Physical Inactivity Prevalence Maps by Race/Ethnicity

According to new state maps of adult physical inactivity, all states and territories had more than 15 percent of adults who were physically inactive and this estimate ranged from 17.3 to 47.7 percent. Inactivity levels vary among adults by race/ethnicity and location.

See the maps

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Childhood Obesity Research & News

The food nutrition label gets a makeover

U.S. News, January 20, 2020

By Joan Salge Blake

For three decades, the Nutrition Fact Panel on the food label has provided a nutritional snapshot of the food inside a package. By law, the U.S. Food and Drug Administration dictates that the label must list not only the calories, but also other important nutrient information, such as the amount of heart-unhealthy saturated fat, cholesterol and sodium per serving.

With more than half of all adults currently having one or more preventable diseases such as heart disease, diabetes and obesity – all related to unhealthy diets and physical inactivity – the FDA decided that the label needed a makeover. The agency correctly realized that consumers could use some additional information to help them make better food decisions to improve their health and better manage their waistline.

Here are some of the important changes you’re now going to see on the label:

  • Realistic serving sizes.
  • Calories now stand out.
  • Added sugars are highlighted.
  • Recommended daily values updated.
  • Adjusted information in case you consume the entire package.

The serving sizes on many foods and beverages will now reflect what folks are actually consuming, not the portion size they should be eating. Gone are the days when a pint of ice cream was listed as containing four one-half-cup servings. (Seriously, have you ever doled out four servings from a pint of Ben & Jerry’s Cherry Garcia?)

The new serving size for ice cream is now two-thirds of a cup, which more accurately represents the three servings Americans, on average, are really scooping from that pint. Of course, with this increase in portion size, the calories per serving are also going to increase.

The serving size of soda is changing from 8 ounces to 12 ounces, and if you buy a 20-ounce bottle, the label will now provide the nutrition information for guzzling the entire bottle.

Calories Are a Stand Out

The calories per serving on the label is in a font size so large that I will no longer have to put on my reading glasses when shopping. With more than 70% of Americans overweight, this change screams out that calories count when it comes to better managing our waistlines.

Added Sugars Shout Out

Americans have a sweet tooth. We consume, on average, about 16 teaspoons of added sugars daily. Because research supports that an excessive amount of added sugars in the diet increases the risk of developing heart disease, type 2 diabetes and obesity, the amount of added sugars will be disclosed to help rein in your intake.

You may be shocked to learn that a 20-ounce bottle of a sugar-sweetened soda has more than 60 grams of added sugars – the equivalent of 15 teaspoons of sugar. This label change will help consumers decide to either downsize their portions or switch to another beverage and/or food to decrease the added sugars in their diet.

Daily Values Update

The recommended daily values for nutrients such as sodium, fiber and vitamins have been updated based on the latest research, and vitamin D, potassium, calcium and iron will be listed to reflect the nutrients that many Americans are falling short of in their diet.

Two for the Price of One

Some products, such as beverages and ice cream that come in a container that is larger than one serving but could potentially be consumed all in one sitting, will now provide a dual panel. This panel will provide you with the calories and nutrients per serving, as well as the amount you would be consuming should you finish the entire container in one sitting. So for example, while a serving of ice cream may be 270 calories, the label will also visually inform you that you’ll be inhaling 810 calories if you’re enjoying the entire pint container alone.

With this new label, you may be hearing loud gasps of shock from label-reading shoppers in the aisles of the supermarket. But it’s just one more way of shopping smarter and healthier.

Original source: https://health.usnews.com/health-news/blogs/eat-run/articles/new-nutrition-facts-label

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Whole milk may be better when it comes to children’s weight

New York Times, January 7, 2020

By Nicholas Bakalar

Whole milk may be healthier for children’s weight than low-fat milk, a review of studies suggests.

The American Academy of Pediatrics currently recommends switching to skim or low-fat (1 percent) milk at age 2.

Canadian researchers analyzed 14 prospective studies including 20,897 children up to 18 years old. The studies compared children who drank whole milk (3.25 percent fat) with those given milk containing less than 2 percent fat.

Combining the data from these studies, the scientists calculated that compared with children who drank low-fat milk or skim milk, those who drank whole milk were at a 39 percent reduced risk for overweight or obesity, and the risk for obesity declined steadily as whole milk consumption increased. The analysis is in the American Journal of Clinical Nutrition.

The authors speculate that are several possible mechanisms. It may be that children who drink whole milk consume fewer calories from other food. Some studies suggest that milk fat has properties that make people feel full. Reverse causality could also be at play: It’s possible that skinny children have parents who offer them whole milk to fatten them up.

Still, the senior author, Dr. Jonathon L. Maguire, a pediatrician at the University of Toronto, noted that none of these observational studies could prove cause and effect. “We really need more clinical trials to figure out whether we’re doing the right thing,” he said.

Original source: https://www.nytimes.com/2020/01/07/well/whole-milk-may-be-better-when-it-comes-to-childrens-weight.html

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Processed foods highly correlated with obesity epidemic in the US

EurekAlert!, January 6, 2020

George Washington University

As food consumed in the U.S. becomes more and more processed, obesity may become more prevalent. Through reviewing overall trends in food, George Washington University (GW) researcher Leigh A. Frame, PhD, MHS, concluded that detailed recommendations to improve diet quality and overall nutrition are needed for consumers, who are prioritizing food that is cheaper and more convenient, but also highly processed. Her conclusions are published in a review article in Current Treatment Options in Gastroenterology.

“When comparing the U.S. diet to the diet of those who live in “blue zones” – areas with populations living to age 100 without chronic disease – the differences are stark,” said Frame, co-author of the article, program director for the Integrative Medicine Programs, executive director of the Office of Integrative Medicine and Health, and assistant professor of clinical research and leadership at the GW School of Medicine and Health Sciences. “Many of the food trends we reviewed are tied directly to a fast-paced U.S. lifestyle that contributes to the obesity epidemic we are now facing.”

The rising obesity epidemic in the U.S., as well as related chronic diseases, are correlated with a rise in ultra-processed food consumption. The foods most associated with weight gain include potato chips, sugar sweetened beverages, sweets and desserts, refined grains, red meats, and processed meats, while lower weight gain or even weight loss is associated with whole grains, fruits, and vegetables. Other food trends outlined in the report include insufficient dietary fiber intake, a dramatic increase in food additives like emulsifiers and gums, and a higher prevalence of obesity, particularly in women.

In mice and in vitro trials, emulsifiers, found in processed foods, have been found to alter microbiome compositions, elevate fasting blood glucose, cause hyperphagia, increase weight gain and adiposity, and induce hepatic steatosis. Recent human trials have linked ultra-processed foods to decreased satiety (fullness), increased meal eating rates (speed), worsening biochemical markers, including inflammation and cholesterol, and more weight gain. In contrast, populations with low meat, high fiber, and minimally processed foods — the “blue zones” — have far less chronic diseases, obesity rates, and live longer disease-free.

“Rather than solely treating the symptoms of obesity and related diseases with medication, we need to include efforts to use food as medicine,” said Frame. “Chronic disease in later years is not predestined, but heavily influenced by lifestyle and diet. Decreasing obesity and chronic disease in the U.S. will require limiting processed foods and increasing intake of whole vegetables, legumes, nuts, fruits, and water. Health care providers must also emphasize lifestyle medicine, moving beyond ‘a pill for an ill.'”

Original source: https://www.eurekalert.org/pub_releases/2020-01/gwu-pfh010620.php


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Native Americans fight historical discrimination to lower diabetes, obesity rates

Eastern Arizona Courier, January 4, 2020

By Daniel Gatalica

Alex Alejandre lost 75 pounds in a year. His wife, Mary, lost 40.

They want to set a good example for their 17-year-old son, Nathan, and take a personal stand against obesity, which can lead to diabetes and other serious health problems, especially in Native Americans.

“The health of my child is everything to me. I want him to grow up to be healthy,” said Alex, a member of the Salt River Pima-Maricopa Indian Community. With the help of a community program, his family is getting healthy.

Native American adults are 50 percent more likely to be affected by obesity than non-Hispanic whites, according to a report by the federal Centers for Disease Control and Prevention. Native Americans also are twice as likely as non-Hispanic whites to have diabetes, the CDC says.

Diabetes and obesity are linked; more than 90 percent of people with Type 2 diabetes are affected by some degree of obesity, according to the Obesity Action Coalition. Excess weight can make the cells of muscle and other tissue more resistant to self-produced insulin.

Historical discrimination and modern disparities have left Native Americans with less access to good farmland and grocery stories. But several communities, from the Navajo Nation to the Pima-Maricopa tribe, are instituting programs to educate and help members battle for better health.

Junk food and historical disparities

The Navajo Nation Reservation, the largest in the United States, sprawls across 27,413 square miles but has only 13 grocery stores, according to the American Nutrition Association.

“We have fast food restaurants and more that are just all across the Navajo Nation,” said Lucinda Charleston, program director of the Navajo Special Diabetes Project by the Navajo Department of Health. “A lot of individuals are tired from work and are looking for a quick meal, leading them to eat junk food.”

Obesity can start at a young age, when access to physical activity is limited.

“P.E. (physical education) teachers are often cut out from schools in the nation where funding is no longer available,” said Dr. Jill Jim, executive director for the Navajo Department of Health.

For students in the most remote areas of the reservation, she said, school bus rides often are an hour or more, which is more time spent sedentary.

Obesity and diabetes also is rooted in the historical discrimination against indigenous people, according to Shervin Aazami, deputy director of congressional relations at the National Indian Health Board.

“Acts of physical and cultural genocide, forced relocation from ancestral lands, involuntary assimilation into Western culture and persecution and outlawing of traditional ways of life, religion and language, have resulted in disproportionately higher rates of health problems among the Native community,” he said.

Mary Alejandre, the Pima-Maricopa woman who shed 40 pounds, agrees.

“I think the cause of the issue is that they isolated us in these little areas with unfarmable land,” she said. “There was a damper on our water resources, and in order to keep us alive they gave us these boxes of unhealthy canned foods – flour, lard, canned vegetables, powdered milk, et cetera.”

Aazami said the federal government doesn’t put enough funds into the Native American health system, contributing to diabetes and obesity. Funding for the Indian Health Service, a division of the U.S. Department of Health and Human Services, was roughly $5.8 billion in fiscal 2019, he said.

“However, the IHS Tribal Budget Formulation Workgroup, which is a nationally representative body of tribal leaders, budget experts, and tribal policy experts, estimate that IHS needs to be funded at over $37 billion to meet current health needs,” Aazami said. “Chronic underfunding of the Indian health system forces a greater allocation of resources to the most dire health conditions and contributes to less investment in public health prevention.”

Getting healthy

Federal officials and tribal leaders are implementing programs and services to fight the toll of obesity and diabetes.

The Indian Health Service has a Special Diabetes Program for Indians, which focuses on prevention and treatment. Aazami said the program has reduced end-stage kidney failure by 54 percent and diabetic eye disease by 50 percent in the Native population.

The CDC has funded the Good Health and Wellness in Indian Country program to revitalize Native foods, improve reconnections to culture and inform communities about traditional tools and ways for staying healthy.

In 2014, the Navajo Nation Council approved a 2 percent junk food tax on sweetened beverages and foods high in fat, salt and sugar, including candy, chips, pastries and fried foods bought on the reservation.

Research into the effectiveness of the law, conducted by Navajo officials in collaboration with Northern Arizona University’s department of health services, said obesity, diabetes and related diseases are multifaceted health problems that can’t be curbed based solely on diet, but that the junk food tax “may ultimately address the critical public health concern by promoting communities to improve their health through physical activity, health education, and traditional knowledge, as well as improving access to these healthy resources.”

Charleston said education is a key part of the Navajo diabetes program.

“Our primary focus is implementing three areas for diabetes prevention: increasing diabetes education, increasing nutrition education and increasing more physical activity events across the Navajo Nation,” she said.

“We have put all the numbers aside and our goal to educate our Navajos about what prediabetes and obesity looks like, because we know that prediabetes and the early stages of weight gain are reversible.”

The program also has implemented wellness activities and wellness centers where school-aged children can be more physically active.

The Salt River Pima-Maricopa Indian Community also has a fitness center, the two-story Way of Life Facility.

The Alejandre family credits the center and its programs with guiding their journey to good health.

Mary has a private session with a personal trainer every week at the facility, which offers a large workout area with weights, cardio equipment and a pool and slide.

The Alejandres, who also run marathons and 5Ks, attribute the much of their weight loss to Brazilian jiu-jitsu, which they say makes working out fun.

“There’s something about someone beating you up,” Mary said.

She, her husband and their teenage son are members of Kiko France Brazilian Jiu-Jitsu, where they train multiple times a week.

After two years of training, Alex has earned a blue belt. Nathan and Mary are close to achieving their blue belts.

Besides working on their physical fitness, they watch their diet. Mary avoids junk food, feeding her family traditional foods instead.

“Our Pima tribe is very fortunate to have an agricultural and environmental awareness department where they cultivate traditional foods and they grow it,” she said. “They have a garden on the Salt River where you can plant these foods and you can harvest it when available.”

Alex said he ate the wrong foods when he was growing up.

“As a kid, I would indulge in unhealthy junk food,” he said. “Nowadays, I avoid that. I make sure no soda, and the staple of my diet is rice and chicken.”

And Alex and Mary Alejandre have achieved one more goal. Their son believes his parents are a good example.

“I keep on the right path, to stay healthy both mentally and physically,” Nathan said.

Original source: https://www.eacourier.com/free-access/native-americans-fight-historical-discrimination-to-lower-diabetes-obesity-rates/article_faf2ff3c-301e-11ea-ba3d-639d8db9de3d.html


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Dietary quality among children from 6 months to 4 years, NHANES 2011-2016

The American Journal of Clinical Nutrition, January 2020


The US Dietary Guidelines for Americans provide dietary recommendations for individuals aged ≥2 y and metrics exist to assess alignment. Nonfederal feeding recommendations exist for children <2 y, but limited metrics and assessment of dietary quality are available.


We aimed to assess dietary quality of children aged 6 mo–4 y using a modified Diet Quality Index Score (DQIS).


NHANES 2011–2016 dietary data were used to estimate the dietary quality of children 6 mo–4 y old using a modified DQIS. Differences in mean modified DQIS by demographics were assessed using linear regression.


Mean modified DQIS ± SE was 22.4 ± 0.23 out of 45 possible points (50%) for children 6 mo–4 y of age on a given day. Modified DQIS scores on a given day decreased with age (27.7 ± 0.27 for 6- to 11-mo-olds, 23.9 ± 0.31 for 1-y-olds, 21.4 ± 0.26 for 2- to 3-y-olds, and 20.6 ± 0.49 for 4-y-olds; P < 0.0001 for trend). Children 6–11 mo old had 16% higher overall modified DQIS scores than 1-y-olds (P < 0.0001) and higher modified DQIS subcomponent scores for refined grains and protein, indicating higher age-appropriate intakes (P < 0.05). Similarly, children 6–11 mo old also had higher modified DQIS subcomponent scores, indicating no or limited intake, for 100% fruit juice, sugar-sweetened beverages, other added sugars, and salty snacks (P < 0.02).


Dietary quality declines with age and may begin as early as 1 y. The modified DQIS tool could help assess the dietary quality of young children. This may be important when identifying programmatic and policy efforts aimed at establishing and maintaining healthy dietary patterns beginning at an early age.

Original source: https://academic.oup.com/ajcn/article/111/1/61/5607411

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