October 2023


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Sleep Variables Now Available in NCCOR’s Catalogue of Surveillance Systems

October 2023, NCCOR

Launched over a decade ago, NCCOR’s Catalogue of Surveillance Systems (CSS) has become an indispensable resource for childhood obesity research, providing centralized access to over 100 relevant data sets. Now, NCCOR is again accelerating progress in childhood obesity research by incorporating new sleep variables into 36 datasets in the database.

Like diet and physical activity, research suggests that sleep is an important determinant of childhood obesity. Adequate sleep is crucial for regulating appetite hormones, controlling food cravings, and supporting overall metabolic health. While the relationship between sleep and obesity is known, few resources exist where researchers can access comprehensive data with intersecting variables on sleep, diet, and physical activity.

By integrating new sleep variables into the CSS, NCCOR is filling this critical gap and enabling researchers, health care providers, and public health practitioners to explore the intricate relationship between sleep and childhood obesity easily and efficiently. This expansion not only facilitates better understanding but also streamlines research efforts, ultimately promoting more effective interventions and public health strategies to combat childhood obesity.

Users will benefit from the addition of the following sleep-related filter options:

  • Physical sleep environment
  • Social sleep environment
  • Sleep duration and quantity
  • Sleep disturbances and quality
  • Sleep timing and regularity

The Catalogue of Surveillance Systems is available at

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Publications & Tools

NCCOR Toolbox: Popular Healthy Eating Index Webinar Now Available Online

On September 7, 2023, NCCOR hosted a Connect & Explore webinar titled “Measuring Diet Quality Across the Lifespan: Introducing the New Healthy Eating Index-Toddlers-2020 and Healthy Eating Index-2020.” This special 90-minute webinar featured an expert panel of researchers who contributed to the new Healthy Eating Index (HEI). HEI is a scoring system to assess how well foods align with dietary guidelines. The National Cancer Institute and the U.S. Department of Agriculture developed the HEI and update it every five years. For the first time, the latest release includes two new scoring systems: HEI-2020 for children and adults aged 2 years and older, and the HEI-Toddlers-2020 for children aged 12 to 23 months. The session reviewed highlights from the 2020 update, explained why a toddler-focused version was needed, and described how to assess dietary quality for this age group.

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NIH Study Suggests Measurement Bias in Common Child Behavior Assessment Tool

September 29, 2023, EurekAlert!

Scores from a commonly used measure of behavior problems in young children may be skewed depending on the primary language, education, and sex of the caregiver who fills out the survey, as well as the child’s age and race, according to new research from the NIH’s Environmental influences on Child Health Outcomes (ECHO) Program.

ECHO Cohort researchers analyzed data from caregivers who filled out the widely used Child Behavior Checklist (CBCL) 1.5–5 on behalf of 9,087 young children ages 18 to 71 months from 26 ECHO research sites across the United States. The caregiver-reported survey evaluates a range of behavior problems in young children.


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USDA Launches Nutrition Hub to Combat Diet-Related Diseases in Underserved Communities

September 28, 2023, U.S. Department of Agriculture

The U.S. Department of Agriculture (USDA) today announced the opening of a pilot Nutrition Hub under the Agricultural Science Center of Excellence for Nutrition and Diet for Better Health (ASCEND for Better Health) initiative. The Nutrition Hub is being launched in partnership with Southern University, a historically black 1890 land-grant University in Louisiana, and host of the USDA-funded 1890 Center of Excellence for Nutrition, Health, Wellness, and Quality of Life.

USDA’s new Nutrition Hub, informed by community conversations, will be an engine for providing science-based, nutrition-related information at the community level, particularly in underserved communities disproportionately impacted by diet-related chronic diseases such as obesity, type 2 diabetes, and certain cancers. Future hubs will concentrate their efforts on additional high-need communities. USDA is following the successful Climate Hubs model that reaches more than 20,000 people yearly.


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Adult Obesity Prevalence Maps

September 21, 2023, Centers for Disease Control and Prevention

New population data from 2022 show 22 states have an adult obesity prevalence at or above 35%, compared to 19 states in 2021, according to data from the Centers for Disease Control and Prevention (CDC). Just ten years ago, no state had an adult obesity prevalence at or above 35%. The 2022 Adult Obesity Prevalence Maps highlight the need for population-based interventions to ensure that all people have access to healthy foods, safe places for physical activity, stigma-free obesity prevention and treatment programs, and evidence-based health care services such as medication and surgery.


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New Online Module on Creating Healthy Eating Habits in Early Childhood Education Settings

September 6, 2023, Healthy Eating Research

Healthy Eating Research has developed a free, online module, in collaboration with Better Kid Care, to provide early childhood educators with practical strategies and tips to promote healthy eating habits in early childhood education (ECE) settings. The module highlights effective practices based on Healthy Eating Research’s evidence-based recommendations and best practices for promoting healthy eating behaviors in children aged 2 to 8 years.


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Childhood Obesity Research & News

New Program Helps Improve Toddlers’ Self-Control Skills and Healthy Eating Habits

September 28, 2023, EurekAlert!

Two of the best predictors of life-long health and well-being are early childhood self-control skills and healthy eating habits. A new program that teaches parents how to cook with their 2-year-olds is helping toddlers excel on both fronts. Doing things like stirring ingredients together without spilling and singing a song while something is in the microwave helps toddlers learn multiple important self-control skills, like paying attention, controlling their bodies, waiting patiently, and cooperating with their parents. Toddlers also get excited about being involved in the “grown-up” activity and are more likely to try the new foods they help make. Previous research has shown that self-control in preschool predicts adult outcomes like higher incomes and fewer health problems. Similarly, healthy eating habits in preschool predict how often adults eat their fruits and vegetables.

The Recipe 4 Success program was co-developed and rigorously tested by a team of researchers from the University of Wisconsin-Madison and The Pennsylvania State University and staff members of home visiting programs in seven cities, towns, and rural areas across Wisconsin and Pennsylvania. The results of the second randomized controlled trial of Recipe 4 Success have just been published in the journal Child Development.

“It’s encouraging that parents and toddlers are so excited about cooking healthy foods together. Parents easily learn new strategies that turn daily routines, like making lunch, into a form of quality time with their toddlers that is both educational and fun,” said lead author, Robert Nix, professor of human development and family studies at the University of Wisconsin-Madison. “We were happy to see that parents could use what they learned in the special cooking lessons to support their toddlers’ development in other activities, like playing with blocks.”

Recipe 4 Success was delivered as part of the Early Head Start home visiting program, one of several evidence-based home visiting programs designed for young families living in poverty and funded by the federal government. Home visiting programs partner with parents to promote the cognitive, social, emotional, and physical development of infants and toddlers, so they are prepared to succeed in school.

“Home visits are such a great way to ensure all children have the opportunity to thrive. My colleagues and I were so proud to collaborate with the dedicated home visitors who work hard every day to best serve the families in their programs. Together, we made home visits even better than they already were,” continued Nix. “Parents often participate in home visits because they want their children to be well-behaved and do well in school, which both depend on self-control skills. When Recipe 4 Success lessons were incorporated into home visits, toddlers developed better self-control skills and were willing to eat more nutritious foods, which may reduce common meal-time struggles and help children stay healthy and strong. Our next goal is to give Recipe 4 Success to as many home visiting programs as possible so even more families can benefit.”

Families were recruited through organizations providing Early Head Start home visiting services. To be eligible, families had to be able to complete assessments in English and have a toddler. The study included 242 parents and their toddlers. Thirty-seven percent of families were white, 25% were Black, 19% were Latino, 17% were Multiracial, 2% were Asian American, and less than 1% were Native American. Ninety-one percent of caregivers were mothers, 5% were fathers, and 4% were other relatives. Forty-seven percent of parents were single or did not live with a partner. Sixty-five percent had a high school degree or less; 60% did not work outside the home; 20% had a part-time job; and 20% had a full-time job. Sixty-nine percent of families lived below the federal poverty threshold, and an additional 25% of families lived below 200% of that threshold; median family income was $1,555 per month. Fifty-one percent of toddlers were girls and 49% were boys. At the beginning of the study, toddlers were on average 2.5 years old.

Participating families were randomly assigned to receive the Recipe 4 Success preventive intervention across 12 weeks, delivered by their regular Early Head Start home visitors during their regularly scheduled home visits, or continue to receive their usual practice Early Head Start home visits. Families who participated in Recipe 4 Success did not receive extra home visits or extra-long home visits. The program included sequenced and highly structured food preparation lessons, which provided countless opportunities for parents to practice sensitive scaffolding of children’s self-control skills and learn responsive food parenting practices. The lessons also provided many opportunities for toddlers to practice self-control and be exposed to new healthy foods. Each lesson required about 45 minutes of a typical 90-minute home visit. The goal was to help parents see how routine daily activities they had to do anyway, like cooking, could become a way to spend high-quality special time with their toddlers that also taught critically important new skills.

After families completed the cooking lessons, they were tested to see whether they could apply the skills they had learned to other situations, such as building a block tower or completing a puzzle. The research found that parents who participated in the Recipe 4 Success program, compared to parents who continued with regular home visits, were more engaged and responsive and provided better support for their toddlers’ learning of new skills, as demonstrated in video-recorded parent-child interaction tasks. They also were more effective in the way they introduced their toddlers to novel healthy foods. Moreover, their toddlers had better self-control skills, greater attention spans, and were more compliant, as demonstrated in waiting tasks, observer ratings, and parent reports. They also were more likely to continue helping to make and eat healthy foods at home, as demonstrated by food and activity diaries, collected over three days.

The authors acknowledge some limitations to the study. Although the trial included many Latino families it had to exclude some Latino families that only spoke Spanish due to important differences in their experiences with the study, such as housing instability among more marginalized communities. Although this study demonstrated important intervention effects of Recipe 4 Success, it could not document exactly what aspects of the program accounted for parent and toddler change. For example, it may be that both the new lessons themselves and having parents be so much more involved in the focal activities that both contributed to program effects. The independent contributions of those different components is the topic of another study, currently under review.

Recipe 4 Success lessons are a cost-effective way to boost the impact of home visits. This study demonstrates how carefully designed and tested curricula can help maximize the effectiveness of human services.


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Research Spotlight: Association of Food Insecurity on Body Mass Index Change in a Pediatric Weight Management Intervention

September 27, 2023, Mass General Hospital

The following is an interview with Lauren Fiechtner, MD, co-author of the paper, The Association of Food Insecurity on Body Mass Index Change in a Pediatric Weight Management Intervention.

What was the question you set out to answer with this study?

Childhood obesity is a critical public health concern. One potential determinant of obesity that is less understood is food insecurity, defined as a lack of consistent access to enough food for everyone in the household to live an active, healthy life. We wanted to understand the association of food security status on changes in body mass index (BMI) in a Healthy Weight Clinic (HWC), a clinically-based multicomponent Pediatric Weight Management Intervention consistent with national clinical practice recommendations.

What Methods or Approach Did You Use?

This analysis included 201 participants from two HWC programs. We compared BMI change per year between the food insecure group and food secure group, accounting for child baseline BMI, age and sex, and Supplemental Nutrition Assistance Program (SNAP) enrollment. What was unique about our approach was adjusting for SNAP enrollment. 

What Did You Find?

Children in households with food insecurity had a 0.50 (0.26–0.74) kg/m2 BMI increase per year compared to households that were food secure. This means that children in houses experiencing food insecurity had an increase in BMI, suggesting that food insecurity may reduce the effectiveness of the HWC.

What are the Implications?

Our findings highlight the implications food insecurity could have on the success of HWCs, and other pediatric obesity treatments in helping children to achieve a healthy weight.

What are the Next Steps?

Based on these findings, we suggest that providers identify and address food insecurity in their patient populations. Additionally, collaboration among community-based hunger-relief organizations to reduce food insecurity could support improved effectiveness of pediatric obesity treatment.


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USDA Expands Access to School Breakfast and Lunch for More Students

September 26, 2023, U.S. Department of Agriculture

The U.S. Department of Agriculture today announced that it is giving an estimated 3,000 more school districts in high-need areas the option to serve breakfast and lunch to all students at no cost, by expanding the availability of the Community Eligibility Provision, commonly known as CEP.

“Today’s announcement comes as we approach the one-year anniversary of the historic White House Conference on Hunger, Nutrition, and Health, where the Biden-Harris Administration promised to advance a pathway to healthy school meals for all students,” said Agriculture Secretary Tom Vilsack. “USDA has taken an important step toward fulfilling that promise by expanding access to CEP. Increasing access to free, healthy school breakfast and lunch will decrease childhood hunger, improve child health and student readiness, and put our nation on the path to better nutrition and wellness.”

CEP is a simplified meal service option that allows schools to provide meals at no cost to all students without requiring families to apply for free and reduced-price meals. Instead, school districts receive federal funding based on a formula using existing data from SNAP and other programs, and local or state funds must fill any gap between program costs and federal support. Before this final rule, at least 40% of students had to live in households participating in certain income-based federal assistance programs, in order for a school, group of schools, or school district to be eligible for CEP. This final rule lowers that threshold from 40% to 25%.

While this change in CEP applies across the country, it will be particularly impactful in states and school districts which commit to supporting healthy school meals for all students with their own funds.

Eight states have taken additional permanent actions to make sure hunger is not a barrier to children’s success, in addition to allowing eligible schools to participate in CEP. California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico and Vermont passed state laws allowing their schools to serve healthy school meals to all their students at no cost. In these states, schools that previously were not eligible for CEP can now take advantage of this final rule to experience more efficient, streamlined school meal operations as well as predictable federal funding levels.

CEP – and all models for providing healthy school meals for all at no cost – is a win-win for schools, kids, families and communities and provides many benefits, including:

  • Lowering food costs for families;
  • Increasing food and nutrition security, especially for students from households that barely miss the cutoff to be eligible for free and reduced-price school meals;
  • Eliminating school meal debt;
  • Reducing social stigma for students who eat free or reduced-price meals, while other students pay full price;
  • Increasing student participation in school breakfast and lunch programs, which increases revenues and helps schools offer healthier meals; and
  • Saving time by simplifying program operations for hardworking school nutrition staff.

“Healthy school meals are an essential part of the school environment — just like teachers, classrooms and books – and set kids up for success and better health,” said Stacy Dean, USDA deputy under secretary for Food, Nutrition, and Consumer Services. “More children are fueled for learning and development when they can count on tasty, nutritious meals at school. While there is still more work ahead to ensure every K-12 student in the nation can access healthy school meals at no cost, this is a significant step on the pathway towards that goal.”

USDA is also supporting expanded access to healthy school meals by offering extensive financial support for schools, including providing:

  • 50 cents more per lunch and 18 cents more per breakfast for school year 2023-24, compared to last school year’s base reimbursement rates, through annual inflation adjustments and Supply Chain Assistance;
  • $30 million in Healthy Meals Incentives grants to 264 small and rural school districts nationwide;
  • $30 million in Equipment Grants for states and school districts operating school lunch programs; and
  • Nearly $11 million in Farm to School Grants, serving 1.2 million children.

USDA also continues to expand its Direct Certification for Medicaid Demonstration Projects, which ensure that eligible children in households receiving Medicaid benefits automatically receive free or reduced price school meals without their families filling out an application. The demonstration projects have been implemented in 38 states, and USDA continues to invite more states to participate. In school year 2019-2020, 1.4 million students received free and reduced-price school meals thanks to direct certification through Medicaid.



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Adolescent Bariatric Surgery: The Need for Tailored Educational Materials

September 7, 2023, Childhood Obesity

Rates of class III, or greater, obesity have risen among adolescents in the United States. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for severe obesity among teenagers that results in improvements in cardiometabolic and psychosocial health. Despite its effectiveness, MBS remains largely underutilized and misconceptions exist among providers, parents/guardians, and adolescents. In addition, adolescents who have undergone MBS procedures report there are some topics they wish they had known more about before surgery and express concern that their unique needs are not understood. One potential solution to address these concerns includes preoperative educational materials tailored for adolescents. Currently, there are no standardized recommendations for preoperative educational materials. This editorial suggests the use of community-engaged research, and qualitative methodology, to consult with the primary stakeholder groups of preoperative adolescents, postoperative adolescents, parents/guardians, and clinicians to develop tailored materials that address the unique needs of adolescents undergoing surgical treatment for obesity.


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Early Treatment of Child Obesity is Effective

September 17, 2023, EurekAlert!

The early treatment of obesity in children is effective in both the short and long term, researchers from Karolinska Institutet report in a study published in The International Journal of Obesity.

The researchers followed over 170 young children in Sweden who had received treatment for diagnosed obesity. The children were recruited to the randomised controlled study when they were between four and six years old via children’s clinics in Region Stockholm.

The children and their parents were randomly assigned to one of three treatment conditions: standard treatment, parental support group, or parental support group with follow-up telephone support.

The children and parents in the standard treatment group had meetings focusing on diet and exercise with a doctor, paediatrician and/or dietician. The two parental support groups did not involve the children and focused on how the parents could promote healthy lifestyles in the family in a positive way and without conflict.

“Such conversations can centre on how to set boundaries, how to teach children new behaviours and how to communicate with preschools, grandmothers, neighbours and other adults in the children’s world,” says principal investigator Paulina Nowicka, Associate Professor in Pediatric Science at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and professor of  Food studies, nutrition and dietetics at Uppsala University.

After attending the parental support groups, half of the participants were then randomly assigned a follow-up phone call.

Studies have been done on children who have been treated for obesity before,” says Professor Nowicka. “But most of them have only been followed up after six months or a year, so we have no data on how the children fared over a longer period than that.”

The study that she and her colleagues have now published suggest that early obesity treatment has a lasting effect.

“The children in all three groups improved their weight status and saw a reduction in their degree of obesity,” she says. “The children whose parents received parental support had the best results, especially so those who also received follow-up phone calls. We also found that more children in this third group showed a clinically relevant improvement of their weight status associated with better metabolic health, by which I mean better levels of blood lipids and glucose.”

According to Professor Nowicka, most parents know what kind of food they are to serve their children:

“They usually know this – but what do you do with a child who loves food and always wants to eat, or one that’s always hungry? How do you go about it without making a taboo of food?” she says. “You have to try to build a clear structure at home, one that makes the child know that lunch is on its way and know that they’ll be getting supper.”

She continues: “But you also need to do things together to strengthen family bonds, like getting the child involved in the cooking, giving the child vegetables if they’re hungry and not rewarding them with food. It’s also important to make sure that food isn’t associated with emotions and achievement.”

While obesity is difficult to treat, she explains, the study shows that intensive treatment is safe and efficacious for pre-school children:

“Treating children at that age is much more effective than if you start treating them in their teens,” she says. “Some adolescents are looking at possible bariatric surgery and we hope that this can be avoided with earlier treatment.”

The study was a collaboration among researchers at Karolinska Institutet, Uppsala University, Warwick Medical School and Oxford University. It was financed by the Centrum for Innovative Medicine (CIMED) and the Masonic Home for Children in Stockholm Foundation. There are no reported conflicts of interest.


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