PUBLICATIONS & TOOLS
- NCCOR Toolbox: Project Page Explores Potential Solutions and Considerations for COVID-19 Recovery Funds
- New Paper Reports an Increase in Youth Weight during the First Months of the Pandemic
- Online Guide Helps Adults Talk to Their Children about Weight and Health
CHILDHOOD OBESITY RESEARCH & NEWS
- Childhood Obesity Increases Risk of Type 1 Diabetes
- School Segregation: Contributor to Racial/Ethnic Childhood Obesity Disparities
- Risk of Obesity Is 45% Higher among Adolescents Whose Diet Is Based on Ultra-Processed Food Products
Going Green to Increase Outdoor Physical Activity
A new publication from the Community Preventive Services Task Force (CPSTF) highlights the benefits of combining interventions that improve physical activity with those that improve park, trail, and greenway infrastructure. Based on a systematic review of 21 studies from 20 publications, these combined efforts resulted in more people engaging in moderate-to-vigorous physical activity (a median increase of 17%) and using parks, trails, or greenways (a median increase of 18.3%). Interventions that focused only on improving outdoor infrastructure did not show the same impact. A detailed report and supporting materials can be found on the CPSTF website.
Park, trail, and greenway interventions are designed to improve the built and natural environment for public use. Examples include designating public green space for recreation, improving park facilities, or building walking and biking paths. The CPSTF identified a range of additional activities that bolster the impact of these outdoor improvements, including additional signage, expanded hours, public awareness activities, enhanced transportation, and structured programs for physical activity.
These findings complement the recommendations of the NCCOR Physical Activity workgroup, which has made expanding access to trail use among underserved youth a top priority. In a 2020 scientific review, NCCOR identified programs and policies that effectively promoted trail use, and later published a companion brief identifying nine U.S.-based programs promoting trail use among youth. These resources add to the new CPSTF publication by providing public health practitioners tested strategies that improve the reach and scalability of greenspace interventions.
Visit the CPSTF website for an additional list of resources for implementing equitable and effective outdoor interventions.
Publications & Tools
NCCOR Toolbox: Project Page Explores Potential Solutions and Considerations for COVID-19 Recovery Funds
The NCCOR project page, “Impact of COVID-19 on Child Care Programs, Potential Solutions & Emerging Opportunities,” contains a range of proposed solutions for the use of Coronavirus Aid, Relief, and Economic Security Act (CARES) and American Rescue Plan (ARP) recovery funds. Proposed activities are based on research NCCOR conducted with the Gretchen Swanson Center for Nutrition, which explored the impact of the pandemic on early childhood care centers and identified what investments are needed in child care programming, research, and evaluation. The page organizes proposed activities by audience: researchers, federal agencies, early care and education administrators, and state policy makers.
New Paper Reports an Increase in Youth Weight during the First Months of the Pandemic
A new paper published in Clinical Obesity examines how pandemic-related closures affected children’s body weight. The study analyzed height and weight measures from a cohort of 4,509 children between the ages of 2 to 17 years who were from households with lower incomes. Researchers compared measures taken before the pandemic (January-March 2020) to those taken after three to six months of closures (June-September 2020). Significant weight gain occurred during this time, especially among children with severe obesity. Increased weight was also recorded among younger children, females, and children from racial and ethnic minority backgrounds. Click here to read the full paper online.
Online Guide Helps Adults Talk to Their Children about Weight and Health
Weigh In, an online guide from the Stop Obesity Alliance and the Alliance for a Healthier Generation, offers tools for talking with children about weight and health. Geared toward parents and caregivers of children ages 7-11 years old, Weigh In provides practical guidance for dealing with potentially sensitive conversations. Users can chose from seven situations: BMI confusion, body image, bullying, cultural differences, inter-family weight differences, parental obesity, and weight bias. Users will also find a comprehensive resource list for further information.
Childhood Obesity Research & News
Childhood Obesity Increases Risk of Type 1 Diabetes
April 28, 2022, University of Bristol
[Having] overweight in childhood increases the risk of developing type 1 diabetes in later life, according to the findings of a new study that analyzed genetic data on over 400,000 individuals. The study, co-led by researchers from the Universities of Bristol and Oxford and published today in Nature Communications, also provides evidence that [having] overweight over many years from childhood influences the risk of other diseases including asthma, eczema and hypothyroidism.
The number of individuals being diagnosed with type 1 diabetes has increased drastically in the last 20 years. One possible explanation is the rising prevalence of childhood obesity in an increasingly obesogenic environment. Poor diets with high fat, salt and carbohydrate may compromise early life health-promoting effects of the bacteria in the gut and pancreatic beta-cell fragility in childhood and subsequently increase type 1 diabetes risk.
In contrast to type 1 diabetes, there is irrefutable evidence that children who [have] overweight are more likely to develop type 2 diabetes and that weight loss can lead to its sustained remission. However, detecting reliable evidence for the factors that contribute to type 1 has been challenging, particularly given that individuals are typically diagnosed early in life before reaching adulthood.
Researchers analyzed human genetic data from 454,023 individuals from the UK Biobank and 15,573 type 1 diabetes cases from other cohorts and applied a scientific technique called Mendelian Randomization (MR) to provide evidence that childhood adiposity increases type 1 diabetes risk. As an individual’s genetic alleles are fixed at birth, MR is typically more robust to confounding factors than conventional epidemiological studies.
Furthermore, when adiposity differs between individuals, then whether that difference is due to environmental influences (such as diet or exercise) or is due to genetic influences will not change the increased disease risk caused by adiposity. This means that inferences regarding the consequences of obesity on disease risk from MR studies can be more reliable than from conventional observational studies. The authors of this study have pioneered a recent advancement in the field using MR to separate the independent contributions of adiposity at distinct timepoints in life (i.e. during childhood and adulthood).
By applying this technique, the study’s findings support the inference that greater adiposity in early life increases the risk of type 1 diabetes among individuals and that the increasing prevalence of childhood obesity likely contributes to the rising numbers of type 1 diabetes cases. For comparative purposes, the team also investigated the consequences of childhood adiposity on other diseases with an immune component, such as asthma, eczema and hypothyroidism.
They show, that whilst childhood obesity increases risk of these other diseases, this is likely due to a long-term consequence of being overweight for many years over the life course.
Dr Tom Richardson, a Research Fellow at Bristol’s MRC Integrative Epidemiology Unit and Bristol Medical School’s Population Health Sciences, and the study’s lead author, said: “The effect of childhood obesity directly increases type 1 diabetes risk, emphasizing the importance of implementing preventative policies to lower the prevalence of childhood obesity and its subsequent influence on the rising numbers of cases for this lifelong disease.
“A critical window exists in childhood to mitigate the influence of adiposity on the escalating numbers of type 1 diabetes diagnoses. A 22 per cent reduction in the number of these cases is plausible if the proportion of children within the highest obesity category were to be reduced by ten per cent, from 15.9 to 5.9 per cent. This will help ease healthcare burdens and also potentially improve the quality of life for individuals living with this lifelong disease.”
The study was funded by the Medical Research Council (MRC), the JDRF and Wellcome.
Note: edited for person-first language.
School Segregation: Contributor to Racial/Ethnic Childhood Obesity Disparities
April 26, 2022, EurkAlert!
Obesity gaps are larger between segregated schools and smaller in racially-integrated schools among child populations, according to a new study in Obesity, The Obesity Society’s (TOS) flagship journal. This is the first study to examine childhood obesity disparities specifically within integrated schools to begin to elucidate the role of school segregation in the racial/ethnic patterning of obesity among youth.
“School-level racial segregation matters for child health disparities. Programs and policies to reduce gaps in obesity early in life must prioritize socioeconomically disadvantaged schools, and segregated schools attended primarily by children of color,” said Brisa N. Sánchez, PhD, MS, MSc, Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pa. Sánchez is the corresponding author of the study.
Recent studies have observed that racial or ethnic adult health disparities revealed in national data dissipate in racially integrated communities, supporting the theory that “place, not race” is a key driver of racial/ethnic health disparities. In other words, the characteristics of places and the systems or policies that influence place characteristics are more important than personal characteristics of individuals. This study tested this theory among children.
Publicly available overweight/obesity rates obtained from the California Department of Education (CDE) for fifth, seventh and ninth grade students attending state public schools in the 2018-2019 school year who participated in the California FitnessGram test were evaluated in this cross-sectional study for childhood obesity disparities. The FitnessGram is a physical fitness test required for all children in the aforementioned grades that is administered in the spring of the academic year.
The main outcome of interest is the body-composition assessment of the FitnessGram test. For this assessment, objectively measured height and weight are used to obtain children’s body mass index (BMI). BMI is then compared with the Centers for Disease Control and Prevention’s age- and sex-specific BMI reference distributions to categorize children into three groups: healthy fitness zone, needs improvement and high risk, which correspond to the BMI categories of normal weight, overweight and obese.
More than 1.3 million students were involved in the body composition assessment of the FitnessGram test of whom 54% were Latino, 23% were White, 9.5% were Asian, 5.4% were Black and 2.4% were Filipino. Data for the five major racial/ethnic groups included in the study was collected in more than 8,900 schools. Other races/ethnicities were excluded from the study due to small sample sizes within schools that led to masking of most of their data.
Results showed disparities within integrated schools and between segregated schools. The overweight/obesity gap between Latino, Black and Filipino children compared with White children was larger between segregated schools, relative to disparities within integrated schools:
- Whereas the disparity in overweight/obesity between Latino and White children was 22% when comparing Latino children in Latino-segregated schools to White children in White-segregated schools, the disparity narrowed to 11% when comparing rates between White and Latino children in integrated schools.
- The statewide disparity in overweight/obesity prevalence between Black and White children was 18% when comparing Black children in Black-segregated schools to White children in White-segregated schools, but narrowed to 6% within integrated schools.
- The disparity between Filipino and White children was 8% between segregated schools, but reversed to -1% within integrated schools.
- Overweight/obesity differences between Asian and White children were similar statewide and between segregated schools.
“Findings from this study suggest school segregation can foster the development of obesogenic conditions that disproportionately affect Latino, Black and Filipino childrens’ obesity risks. While this study sheds light into the importance of school segregation, further research is needed to identify the mechanisms through which racial/ethnic integration and segregation in schools influence the current disparities in childhood obesity rates,” said Liliana Aguayo, PhD, MPH, an expert in childhood obesity disparities, TOS member and research assistant professor at Emory University’s Hubert Department of Global Health in Atlanta, Ga. Aguayo was not associated with the research.
The study’s authors add that future research should examine the joint role of individual-level economic factors and racial/ethnic segregation to shed additional light on disparities and ways to reduce them. The researchers add that they were unable to conduct analyses that jointly examine economic and racial/ethnic disparities because the publicly available data from the CDE does not allow cross-classification of these factors within schools. Future research should also employ analytical approaches to disentangle the confounding effects of segregation and person-level race/ethnicity and produce valid estimates of individual-level disparities attributable to person-level factors, and, thus amenable to individual-level interventions, instead of disparities driven by segregation and concomitant place-based or structural interventions. Given findings from this and previous studies, estimating disparities within more granular levels of geography is critical to more accurately assess environmental determinants of disparities.
Other authors of the study include Nuha Mahmood of the University of Michigan Medical School, University of Michigan, Ann Arbor; Emma Sanchez-Vaznaugh, San Francisco University, San Francisco, Calif; and Mika Matsuzaki of Johns Hopkins University School of Public Health, John Hopkins University, Baltimore, Md.
The study, titled “Racial/Ethnic Disparities in Childhood Obesity: The Role of School Segregation,” will be published in the May 2022 print issue.
The authors declared no conflict of interest.
Risk of Obesity Is 45% Higher among Adolescents Whose Diet Is Based on Ultra-Processed Food Products
April 12, 2022, EurekAlert!
Based on data for 3,587 adolescents aged 12-19 who took part in the 2011-16 National Health and Nutrition Examination Survey (NHANES) in the United States, researchers at the University of São Paulo (USP) in Brazil have calculated the impact of consuming ultra-processed foods on the risk of obesity.
They divided participants in the study into three groups according to the amount of ultra-processed foods consumed. When they compared those with the highest level (64% of total diet by weight on average) with those with the lowest level (18.5%), they found that the former were 45% more likely to [have obesity], 52% more likely to have abdominal obesity (excess fat around the waist) and, most alarmingly, 63% more likely to have visceral obesity (excess fat on and around the abdominal organs, including the liver and intestines), which correlates closely with the development of high blood pressure, coronary artery disease, type 2 diabetes, dyslipidemia (high cholesterol), and a heightened risk of death.
The complete results of the study, which was supported by FAPESP, are reported in an article published in the Journal of the Academy of Nutrition and Dietetics.
FAPESP funded the study via four projects (15/14900-9, 16/25853-4, 18/17972-9 and 19/22278-7).
“There is substantial scientific evidence of the negative role of ultra-processed foods in the obesity pandemic. This is very well-established for adults. With regard to young people, we’d already found that consumption of these products is high, accounting for about two-thirds of the diet of adolescents in the US, but research on the association between consumption of ultra-processed foods and health outcomes, including obesity, was scarce and inconsistent,” Daniela Neri, first author of the article, told Agência FAPESP. Neri is affiliated with the Center for Epidemiological Studies in Nutrition and Health (NUPENS) at the School of Public Health (FSP-USP).
Led by Professor Carlos Augusto Monteiro, the NUPENS team was one of the first to associate changes in the industrial processing of food with the obesity pandemic, which began in the US in the 1980s and has since spread to most other countries. Based on this hypothesis, the group developed a food classification system called NOVA, based on the extent to which products are industrially processed. The system informed the recommendations in the 2014 edition of the Dietary Guidelines for the Brazilian Population, which emphasized the benefits of a diet based on fresh or minimally processed foods, and emphatically ruled out ultra-processed foods ranging from soft drinks, filled cookies and instant noodles to packaged snacks and even an apparently innocent type of wholemeal bread (more at: agencia.fapesp.br/20905/).
“Generally speaking, ultra-processed food and drink contain chemical additives designed to make the products more appealing to the senses, such as colorants, aromatizers, emulsifiers and thickeners. Many ultra-processed foods have high energy density and contain a great deal of sugar and fat, all of which contributes directly to weight gain,” Neri said. “But even low-calorie products such as diet drinks can favor the development of obesity in ways that go beyond nutritional composition, such as by interfering with satiety signaling or modifying the gut microbiota.”
The recently published study used data collected by a methodology known as 24-hour food recall, in which subjects are asked to report all foods and beverages consumed in the previous 24 hours, detailing amounts, times and places. Most of the participants included in the analysis (86%) were interviewed twice on this topic, with an interval of two weeks between interviews.
The adolescents were divided into three groups on the basis of this information: those in whose diet ultra-processed foods accounted for up to 29% by weight, between 29% and 47%, and 48% or more.
The researchers also used anthropometric data, such as weight, height, and waist circumference. These measures were evaluated against age- and sex-specific growth charts approved by the US Centers for Disease Control (CDC).
“Total obesity risk was estimated on the basis of body mass index, or BMI, which is weight [in kilos] divided by height squared [in meters],” Neri said. “We used waist circumference to assess abdominal obesity, and sagittal abdominal diameter, a less well-known parameter, as a proxy for visceral obesity.”
Measuring sagittal abdominal diameter, she explained, is an indirect and non-invasive method to estimate the amount of visceral fat: “The subject lies down and we use a caliper or sagittometer to measure the distance between the top of the gurney and the region of the belly button. The softer subcutaneous fat falls to the sides, and the visceral fat, which is harder, stays in place. This approach avoids possible measuring errors that could be caused by skin folds in the region of the waist.”
All the data analyzed in the study came from NHANES surveys conducted between 2011 and 2016. According to Neri, the findings can be extrapolated for Brazilian adolescents, who are also exposed to ultra-processed foods from an early age, albeit to a lesser extent than their American peers.
“Brazil doesn’t conduct surveys of adolescent nutrition that also collect anthropometric data in person. Nationwide surveys of this kind are very costly and require continuous funding. We do have a few similar surveys, but they’re simpler,” Neri said.
An example is Vigitel, an annual national survey conducted by the Health Ministry to monitor chronic disease risk and protection, involving telephone interviews with over-eighteens. The latest data from this survey, published in January 2022 by the Institute for Health Policy Studies (IEPS), show that the adult obesity rate in Brazil almost doubled from 11.8% in 2006 to 21.5% in 2020.
The Consumer Expenditure Survey (POF) conducted by IBGE, the national statistics bureau, collects data on the dietary habits of adolescents and adults, but not on their health.
According to the latest POF, which was conducted in 2017-18, more than half (53.4%) of the average Brazilian’s daily calorie intake comes from fresh foods such as vegetables, fruit, meat and milk or minimally processed foods such as grains and flours, 15.6% from processed ingredients such as sugar, salt and olive oil, 11.3% from processed foods such as cheese, artisan bread and fruit and vegetable conserves, and 19.7% from ultra-processed foods. In the case of adolescents, the survey data shows that ultra-processed foods account for 27% of calorie intake, and for over-sixties the proportion is 15.1%.
In another study conducted by NUPENS, the researchers compared data on the diet of Brazilian adolescents from the 2017-18 POF with similar data from Argentina, Australia, Chile, Colombia, Mexico, the United Kingdom and the US.
Ultra-processed foods ranged from 19% of energy intake in Colombia and 27% in Brazil to 68% in the UK and 66% in the US. Despite the variability in proportional terms, the impact of ultra-processed foods on diet quality was similar in all the groups analyzed, according to Neri.
“In this study, too, the subjects were divided into groups according to their consumption of ultra-processed foods. We observed a deterioration in the quality of their diet as the proportion of ultra-processed foods increases, boosting energy density and sugar content, and reducing fiber content. The negative effect is very similar across all countries regardless of the proportion of ultra-processed foods, region or culture,” she said.
Although rice and beans still constitute the staple diet for most Brazilians, she added, a survey commissioned by the Health Ministry in 2019 showed that consumption of ultra-processed foods is frequent even among under-fives. More than 80% of all children in this group regularly consume these products.
“Children who consume these products have proportionally less room to consume fresh produce or minimally processed foods at a time when dietary habits are being formed,” Neri said. “By being exposed to these obesogenic foods, children and adolescents are being programmed for future health problems. It’s extremely worrying.”
Families alone cannot be made responsible for controlling this exposure, which requires a reform of the prevailing dietary system as a whole. “We must go beyond consumer education by taking public policy action on several fronts,” Neri said. “Different strategies are possible, such as placing restrictions on advertising, especially when it targets children, and raising taxation on ultra-processed food products while at the same time improving access to fresh produce. Another vitally important measure would be to require manufacturers of these products to include clearer information on labels to help consumers make better choices.”
Note: edited for person-first language.