March 2019


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NCCOR Celebrates 10 Years

NCCOR, March, 2019

The National Collaborative on Childhood Obesity Research (NCCOR) launched a decade ago with a clear vision: to bring together the nation’s leading health research funders to address the problem of childhood obesity in America. This year, NCCOR is celebrating 10 years of working together to advance the field.

By building on the strengths and perspectives of the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Robert Wood Johnson Foundation (RWJF), and the U.S. Department of Agriculture (USDA), this unique public-private partnership has demonstrated that a greater impact can be had by working together.

Watch this video to learn more NCCOR’s accomplishments from the past 10 years.

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Publications & Tools

NCCOR Toolbox

It’s that time of year again—the end of the semester is just around the corner! If you’re a graduate student looking to pull together or bolster a final project, check out our Measures Registry and Measures Registry User Guides Q&A For Students, to learn how to incorporate NCCOR tools into your research.

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State Nutrition Action Council (SNAC) Toolkit

Designed as an in-depth guide for states establishing cross-program partnerships and implementing initiatives to prevent and reduce obesity, the SNAC Toolkit includes recommendations, tools, and activities for: recruiting and retaining partners, selecting an initiative, developing a plan, and implementing and evaluating the initiative.

See the toolkit here

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2019 County Health Rankings Key Findings Report

By ranking the health of nearly every county in the nation, County Health Rankings & Roadmaps (CHR&R) illustrates how where people live affects how well and how long they live. CHR&R also shows what people can do to create healthier places to live, learn, work, and play.

See the report here

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Childhood Obesity Research & News

Sleep Problems During Pregnancy Affect Glucose, May Increase Risk of Childhood Obesity

March 19, 2019, EurekAlert!

A study conducted by Sarah Farabi, PhD, RN, while she was a post-doctoral fellow working with Dr. Teri Hernandez at the University of Colorado College of Nursing and School of Medicine in 2018 found that mild sleep apnea changed sugar levels during pregnancy and was connected to infant growth patterns related to increased risk of obesity.

Published in the Journal of Clinical Endocrinology and Metabolism, the study included 18 women who did not have gestational diabetes and a body mass index of 30-40 kg/m2 during their third trimester – making them at higher risk for sleep apnea. Twelve of the 18 participants were diagnosed with sleep apnea. “They were very surprised by the diagnosis. Often unrecognized, obstructive sleep apnea worsens over the course of a pregnancy and is associated with poorer perinatal outcomes like gestational diabetes and bigger babies,” said Farabi.

According to Farabi, “In this study, the more severe the mother’s sleep apnea, the more likely she was to have higher blood sugar throughout the day and night. The data indicate that improving sleep habits, as well as screening for and potentially treating sleep apnea may help improve maternal infant outcomes in this high-risk population.” Unlike other studies, the sleep patterns and glucose were directly measured using personal monitoring devices instead of relying on self-report, making the data much stronger in the story they tell.

“We showed that mild undiagnosed sleep apnea is related to higher glucose patterns during pregnancy, even in women who do not have gestational diabetes. By addressing sleep apnea with overweight women during pregnancy, we might be able to improve mother’s sugar levels and insulin resistance, as well as the potential for fetal overgrowth and childhood obesity,” said Farabi. The combination of improved sleep and nutrition patterns may improve maternal and fetal outcomes.

Study participants were monitored at home with a WatchPAT wrist device and finger probe for three consecutive nights. The WatchPAT detects oxygen saturation levels and external movement. During the three days, they also had their diet provided by the Colorado Clinical and Translational Science Bionutrition Core, and wore a monitor that measured glucose every 5 minutes. Two weeks after delivery, a non-invasive test called a PEAPOD measured the baby’s body composition via air displacement.

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Meal Kits and Recipe Tastings Increase Healthy Food Selections Among Food Pantry Clients

March 19, 2019, EurekAlert!

Food pantry clients are more likely to select whole grains and leafy greens when they are arranged with all ingredients needed to make a meal, reports a new study from the Rudd Center for Food Policy and Obesity at the University of Connecticut.

Nearly 40 million Americans face hunger, and many rely on the food banking system to supplement the groceries needed to feed themselves and their families. Consequently, it is essential to maximize the nutritional quality of food available through food pantries. At the same time, it is also important to encourage food pantry clients to select the healthier options.

“We knew that pantries in our area were providing healthier foods, but we also understood that these items might need additional promotion for clients to select them. So, as we watched meal kits take off as a popular food preparation trend, we became interested to see whether a low-cost version could serve as an attractive and convenient method for increasing healthy food selection,” said study co-author Emma Stein.

The study, published in Public Health Nutrition, was conducted in a “client choice” food pantry, meaning clients could visit once a month and select the foods they wanted from the shelves based on personal preference and family size. To create the meal kit, a local chef developed two different low-cost recipes featuring whole grains and kale. The pantry was open three days a week – one day each week both recipes were prepared for clients to taste, and all of the ingredients were available together in a bundle. Another day each week, the recipes were prepared and available to taste, but the ingredients were available only on the shelves as usual. On the third day, the pantry operated as usual – the ingredients were available on the shelves, but there was not a prepared recipe to taste.

Findings indicate that clients were three times as likely to take kale and whole grains when they visited the pantry on days when recipe tastings and meal kits were available, compared to the days when neither was provided. In addition, including the meal kit with the recipe tasting doubled kale and whole grain selection when compared to providing the tasting alone. There also appeared to be a spillover effect from the meal kits – many clients selected additional brown rice and kale from the shelves, perhaps to prepare a larger portion.

Senior author of the study and Rudd Center Director, Marlene Schwartz, notes that “although providing recipes and tastings helps clients see how an unfamiliar food can be prepared, taking the extra step of putting together all of the ingredients into a bundle makes it that much more convenient for them to choose the healthier options that are offered. If we can provide these products in a way that we know will increase their selection, we are giving each client and their family the best opportunity to eat more healthfully.”

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How Fast Food Advertisements Get Under Your Skin, Whether You Realize It or Not

March 18, 2019, Huffington Post

For years, academics across the world have studied the effects fast food advertising has had on children and adolescents. With nearly 1-in-5 school-aged children in the United States qualifying as obese, these studies aim to figure out how TV commercials, product placement and the new frontier of digital marketing are leading to unhealthy lifestyles.

But let’s say you watch a commercial for a Big Mac. Do you immediately drive to McDonald’s and order the 563-calorie bomb? Not necessarily. However, fast food marketing seeps into your brain in a way you may not realize.

At the University of Michigan, associate professor Ashley Gearhardt runs The Food and Addiction Science and Treatment (FAST) lab, a simulated fast food restaurant that uses neuroimaging to study this sort of stimuli. She’s currently conducting a study on 180 teenagers and what happens in the striatum—the reward section of the brain—while viewing the ads, and how the ads can get “under the skin.” She showed teens three kinds of commercials: unhealthy fast food, healthier fast food and a control commercial for cell phones.

“When teenagers are seeing fast food commercials, it really seems to be activating reward centers of the brain more effectively than other types of advertisements,” Gearhardt told HuffPost about her preliminary findings (a published paper is forthcoming). “The teenagers that are showing this greatest reward activation of the brain seem to be at greater risk in gaining weight over time. It’s hard for people to defend against because it’s not a conscious process.”

She further explained that seeing something like a Big Mac on the screen doesn’t make you crave one—it makes you want everything in that category, and it’s happening on a biological level.

“That whole system is primed for you to be motivated to seek out ultra processed foods,” she said. “So you’ll start scrounging around in your kitchen, and you might not even make the link between what you’ve seen on the TV and why you suddenly have a hankering for food. It’s not actually about needing calories; it’s about desiring the reward of the food.”

It’s complicated to pinpoint a direct link to ads and obesity—other factors such as genes and your eating habits affect the outcome—but Emma Boyland, a psychology lecturer at the University of Liverpool, co-authored a paper in 2018 entitled “Sustained impact of energy-dense TV and online food advertising on children’s dietary intake: a within-subject, randomised, crossover, counter-balanced trial.” Kids aged 7 to 12 years old in that study watched advergames (Internet-based video games featuring branding) and TV advertisements.

Echoing some of Gearhardt’s findings, Boyland told HuffPost, “We do have evidence that exposure to unhealthy food and beverage marketing increases food consumption in children, and that they do not compensate for this increased consumption by eating less at the next meal.”

Jennifer Harris, director of marketing initiatives at the University of Connecticut’s Rudd Center for Food Policy & Obesity, and her team constantly publish papers on the correlation between fast food marketing and childhood obesity. Like Gearhardt, she thinks teenagers are especially vulnerable to junk food ads, more so than children 12 and under.

“Teenagers don’t have well-developed cognitive control mechanisms,” Harris told HuffPost. “Their frontal cortex doesn’t develop until the early 20s, so they’re very impulsive.”

Tack on peer pressure, that they’re hyper reward-oriented, that no protections exist for them and the fact they have access to money, teenagers are fast food companies’ ideal demographic. However, Rudd published a studied in January 2019 on how fast food companies have increased their targeting to black and Hispanic communities, an already susceptible-to-obesity demographic. “From a public health perspective, they’re the last consumers you want to be pushing fast food, soda and candy to,” Harris said.

Advertising is everywhere, even if you don’t realize it

Children and teens are watching less TV than they used to, but Gearhardt and Harris both said kids are still exposed to 9 to 10 fast food ads every day, and that doesn’t include unquantifiable ads on social media, “educational” YouTube clips that teach young kids colors using M&Ms and Coke bottles, and product placement, which is more subliminal than TV commercials.

The most famous example of product placement is Reese’s Pieces in “E.T.” (supposedly, sales jumped 65 percent). Placements can be found in “Mac and Me” (the bulk of the film takes place in McDonald’s), “Teenage Mutant Ninja Turtles” (Domino’s), “Superman II” (Coke and Marlboro), “Little Nicky” (Popeyes) and “Wayne’s World,” which hilariously spoofed product placement. A 2018 study researched brand retention in showing people traditional commercials and spots with product placement. “These comparisons indicate the superiority of product placement—brands presented in this manner were more frequently recalled by viewers,” the study discovered.

Currently, social media is understudied, but Boyland and four other academics just published a paper on “The impact of social media influencer marketing of foods (healthy and unhealthy) on children’s food intake.” The study had 176 children from the ages of 9 to 11 years old watch Instagram and YouTube influencers eat snacks. “Children who viewed influencers with unhealthy snacks had significantly increased overall intake compared with children who viewed influencers with non-food products,” the paper reads. “Viewing influencers with healthy snacks did not significantly affect intake.”

“The ability to target individuals most likely to respond to the marketing and to expose them to the content at vulnerable moments when they are most likely to respond is what sets digital apart as, if anything, being a more powerful influence than TV,” Boyland said.

Here’s how to check ourselves (and our kids)

So, what can be done to combat nefarious Big Fast Food? Gearhardt suggests having your kids view programming on non-commercial platforms, such as Netflix.

Boyland thinks it’s the state’s responsibility to patrol advertisements and protect children. “It must be an issue for policymakers to reduce the power of the food industry to manipulate its citizens rather than relying on those citizens defending themselves,” she said.

In the U.K., Ofcom regulates television, radio, telecommunications and wireless communications services and sets standards for television advertising. Policies in reducing fast food ads during children’s programming have been effective, and Boyland said the government is considering banning unhealthy ads before 9 p.m.

Long before Harris received her Ph.D, she worked on the other side of the fence, in marketing. Because of that, she takes a more pessimistic stance.

“Companies can’t do anything unless they’re forced to,” she said. “Because if one company decides to do the right thing, then it’s going to hurt their business if their competitors don’t. That’s why consumers have to demand that they stop marketing the worst products to children and communities of color. The public opinion has to start turning and people will have to start making these companies responsible for what they’re doing.”

Even though people know fast food is bad for them—similar to the cigarette epidemic—they’ll continue to eat Big Macs and its ilk.

“With food companies, people love these products,” Harris said. “There are strong emotional associations that have been created through advertisements and other means. Children recognize brands and logos by the time they’re 2 years old. It’s very powerful, and once those emotional attachments are established, they’re very difficult to get rid of.”

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Chronic Short Sleep Associated with Adolescent Obesity

March 14, 2019, University of Michigan Health Lab

Older children and teenagers may have a higher risk of obesity if they consistently don’t get enough sleep, according to recent Michigan Medicine research.

The study, published in the Journal of Pediatrics, found the highest levels of obesity in adolescents who weren’t sleeping enough night after night, even more so than those so-called “yo-yo” sleepers who sometimes logged enough shut-eye, but sometimes fell short.

That means although catching up on sleep isn’t the best strategy for adolescents to ensure they are reaping all the other sleep benefits like cognition and alertness, it could positively impact weight if that’s the only way to manage more hours in a week, researchers say.

“We already know short sleep duration is associated with childhood obesity, but we thought it could be more nuanced than that,” says first author Erica Jansen, Ph.D., M.P.H., a former research fellow at the University of Michigan Sleep Disorders Centers and current assistant professor in U-M’s School of Public Health. “What this really highlights is: it’s not just the kids who have some nights of short sleep who are at risk for obesity; rather, it’s the kids who are consistently not getting enough sleep.”

Better measures of sleep and obesity

Jansen and second author Galit Levi Dunietz, Ph.D., M.P.H., assistant professor in the U-M Division of Sleep Medicine, led the study into sleep habits and adiposity (fatness) among 528 students ages 9 to 17 living in Mexico City. Each child or teenager wore a wrist monitor for seven days to track sleep duration.

“It was important to objectively measure how long the adolescents were sleeping by having them wear monitors on their wrists,” Dunietz says. She adds it’s relatively rare to see a sample this large of child and teenage sleep duration that hasn’t been self-reported, and this reduces the risk of measurement error and bias.

Because body mass index may not be the best marker of obesity for children, researchers added three additional measures: triceps skinfolds, waist circumference and percent body fat. Thirteen percent of the participants met the study criteria for obesity, while 25 percent were overweight.

For obesity, yo-yo sleep beats chronic short sleep

“Teens are a vulnerable population to sleep debt, and 41 percent of the study participants had insufficient sleep,” Jansen says. “Adolescents with insufficient sleep had a higher prevalence of obesity, in particular those who had consistent insufficient sleep. Conversely, adolescents reporting consistent sufficient sleep had the lowest adiposity measures in this observational cross-sectional study.”

Obesity rates continue to rise globally in all age groups, driving more and more researchers to investigate better ways to attack it. Diet and physical activity programs haven’t been fully successful in preventing teenagers from becoming obese or encouraging them to reach a lower BMI, researchers say, and they believe sleep may prove to be a manageable add-on to affect weight control as well.

Dunietz notes that although 40 percent of the Mexican adolescents didn’t sleep enough on average, this represents a lower percentage than their US counterparts, of which an estimated 60 to 70 percent do not meet sleep duration recommendations.

This could be because the study participants have a different school day than most teens in the U.S.: some attend classes in the morning, while others attend classes in the afternoon. That two-shift school scheduling is due to high population density in Mexico City, the investigators say.

Previous research by Dunietz noted that, while many sleep experts endorse allowing teenagers to sleep in a little longer each day before hitting the books, half of parents in a U.S. survey were against the idea of pushing school start times back.

Avoid the need to catch up

Researchers urge parents to take this data as a reminder to encourage positive sleep hygiene. Children ages 6 to 12 should get nine to 12 hours of sleep every night, while teens ages 13 to 18 should sleep for eight to 10 hours, according to the consensus recommendations by the American Academy of Sleep Medicine, which are endorsed by the American Academy of Pediatrics.

“Obviously, the best thing is to get enough sleep on a consistent basis,” Jansen says. “The feeling among sleep researchers is you can’t ever fully catch up on lost sleep. But, although we cannot assume causality, our findings suggest that if you’re not getting enough sleep on a consistent basis, catching up a bit on the weekends could have some protective benefit when it comes to excess weight.”

After insufficient sleep, researchers note, a longer time in bed the following night could allow for more time in slow-wave, or deep sleep; it is during this stage of sleep that a hormone called growth hormone is released, which could protect against obesity.

However, future studies must be conducted to address causality, given that sleep and adiposity were measured at the same time in this study.

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Is Infant Temperament Associated with Future Risk of Childhood Obesity?

March 11, 2019, JAMA Pediatrics

This observational study looked at whether the temperament of infants born to mothers with gestational diabetes was associated with future risk of childhood obesity at ages 2 to 5 years. Children whose mothers develop diabetes during pregnancy are more likely to become obese but how infant temperament might influence the development of obesity in this population isn’t clear. In healthy populations, the evidence for the influence of infant temperament on child weight status has been mixed. Participants in this study included 382 mother-infant pairs who filled out a survey to assess infant temperament at ages 2 to 6 months. Findings suggest elevated soothability (children who are easily soothed have elevated soothability) was associated with increased likelihood of early childhood obesity. Infant temperaments of elevated soothability and activity also were associated with the early introduction of fruit juice and sugar-sweetened beverages before the age of 6 months and shorter breastfeeding duration. Explanations for why elevated soothability might contribute to obesity risk still need to be identified.

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