August 2019

NCCOR Celebrates 10 Years During National Childhood Obesity Awareness Month

NCCOR, August 29, 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, during National Childhood Obesity Awareness Month, 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. Over the years, NCCOR has created a variety of unique tools and resources that have helped researchers, practitioners, students and faculty in the field. Keep reading to learn more about what NCCOR has to offer!

By far, the Measures Registry is one of NCCOR’s most used tools. The Measures Registry is a searchable database of diet and physical activity measures relevant to childhood obesity research. Its purpose is to standardize use of common measures and research methods across childhood obesity research at the individual, community, and population levels. The four User Guides were designed to complement the Measures Registry and provide an overview of measurement, describe general principles of measure selection, and share additional resources.

Building on this extensive resource, NCCOR will introduce new Measures Registry Learning Modules in September, to kick off National Childhood Obesity Awareness Month. This exciting new tool consists of 17 video modules that provide an overview of the key concepts in each of the Measures Registry’s four domains. Follow @NCCOR on social media to learn more about the unveiling of this new tool!

In the past decade, NCCOR has also created the Catalogue of Surveillance Systems (CSS), which provides one-stop access to more than 100 publicly available datasets relevant to childhood obesity research. This tool is accessed by researchers across the globe, with more than 86,500 visits from around the world.

In addition to the Measures Registry and CSS, the Youth Compendium of Physical Activities provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity. It can be used by a wide variety of people—including researchers, health care professionals, teachers and coaches, and fitness professionals, and in a variety of ways—including research, public health policy making, education, and interventions, to encourage physical activity in youth. If you’re a physical education teacher or public health practitioner, NCCOR has created fact sheets specifically designed to walk you through how to make the most of the Compendium for your purposes.

Though childhood obesity continues to be an epidemic in the U.S. and around the world, this month NCCOR is proud to celebrate all of the tools, research and resources that have been developed and continue to be develop in the field of childhood obesity research. To learn more about NCCOR’s work in the past 10 years, visit nccor.org/accomplishments.

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NCCOR's Toolbox

It’s back-to-school season! If you’re a physical education teacher, check out this fact sheet that can show you how to incorporate the Youth Compendium of Physical Activities into your lesson plans.

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National Obesity Monitor

This new interactive feature on stateofobesity.org lets visitors explore the latest national obesity data and trends over time, including by age group, sex, race and ethnicity. The data cover children as young as age 2, all the way up to adults, and come from the National Health and Nutrition Examination Survey (NHANES), which is conducted every two years by the National Center for Health Statistics and funded by the Centers for Disease Control and Prevention.

See the tool here

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Modeling Community Efforts to Reduce Childhood Obesity

This report discusses a whole-of-community obesity prevention intervention approach that may effectively reduce childhood obesity. These interventions are community-based initiatives that bring together community stakeholders and leverage existing resources and networks to implement obesity prevention efforts. The report was authored by researchers from the Brookings Institution, Tufts University, the University of Auckland, and Deakin University.

See the report here

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Abundant Screen Time Linked with Overweight Among Children

EurekAlert!, August 9, 2019

A recently completed study indicates that Finnish children who spend a lot of time in front of screens have a heightened risk for overweight and abdominal obesity, regardless of the extent of their physical activity.

The increase in childhood obesity is one of the largest health problems globally. The study investigated links between screen time and overweight by utilising the Finnish Health in Teens data (Fin-HIT), encompassing more than 10,000 children from across Finland. The children studied were between 9 and 12 years of age.

The subjects reported the time spent viewing television programmes and films on screens and the amount of sedentary computer use outside school hours. The children were measured for height, weight and waist circumference.

The results, published in the Scientific Reports journal, demonstrated that heavy screen time is associated with both overweight and abdominal obesity. There was no variance in the findings by age, gender, native language, sleep duration and exercise during free time. Watching a lot of television was also associated with overweight and abdominal obesity in children who exercised the most.

“It must be noted that this cross-sectional study does not reveal anything about causality. It may be that overweight children spend more time in front of screens, or that abundant screen time may result in overweight,” says researcher Elina Engberg from the University of Helsinki and Folkhälsan.

“Neither did the study measure the intensity of exercise; the participants were only asked about the amount of time they spent exercising in their free time. Further research on the combined effect of screen time, physical activity and diet on children’s weight is needed.”

Previously, not much research has been carried out on the link between screen time and children’s abdominal obesity. Overweight in children and related adverse health effects are illustrated by the waist-to-height ratio as well the body mass index.

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Exercise During Pregnancy May Have Lasting Benefits for Babies

New York Times, August 7, 2019

Newborns whose mothers exercise during pregnancy may become physically coordinated a little earlier than other babies, according to a captivating new study of gestation, jogging and the varying ability of tiny infants to make a fist. The study’s findings add to growing evidence that physical activity during pregnancy can strengthen not just the mother but also her unborn children and might influence how well and willingly those children later move on their own.

The current physical activity guidelines in the United States and Europe call for children to run and play for at least an hour every day. But, according to most estimates, barely a third of European and American youngsters are that active. Many factors contribute to this physical languor, including crowded family schedules, lack of physical education programs in schools, childhood obesity and overly ample screen time.

But recently, Linda E. May, an associate professor of foundational science and research at East Carolina University in Greenville, N.C., began to wonder whether the prenatal environment might also play an unexpected role.

Her own earlier research hinted that the idea was plausible. For a 2011 study, she and her colleagues had compared the cardiac function of babies born to mothers who had been sedentary or worked out during pregnancy and found that infants whose mothers exercised developed stronger, more athletic hearts even before birth. Their pulses were slower and the beat-to-beat variability greater, a general indication of better-conditioned cardiac muscles.

At the time, Dr. May and her colleagues speculated that the babies’ hearts most likely had sped up and synchronized with their mothers’ during exercise, allowing the infants to enjoy the same heart benefits.

But whether exercise during pregnancy would likewise influence a child’s motor development and coordination remained unknown, Dr. May realized, and could matter. Other past research has shown that relatively poor coordination in early childhood is linked to higher risks for inactivity and obesity in adolescence and adulthood.

In essence, children who move with little ease tend to be children, and later adults, who move little.

So, for the new study, which was published this month in Medicine & Science in Sports & Exercise, Dr. May and her colleagues decided to look into whether exercise during pregnancy would affect babies’ physical coordination after birth.

The scientists began by recruiting 71 healthy, pregnant women, most in their first trimester, and carrying a single baby. They randomly divided these volunteers into two groups, one of which continued with their normal routines, as a control.

The others began exercising, reporting to the university physiology lab three times a week, for supervised, 50-minute sessions of moderate exertion. There, they jogged, walked briskly, rode stationary bicycles or joined aerobics classes, depending on their preferences, balance and comfort as their pregnancies progressed.

The sessions continued until each woman gave birth.

All of the mothers, in both groups, delivered healthy, normal-weight infants.

A month after each birth, mother and child returned to the lab, where a pediatric physical therapist completed a standard exam of the babies’ reflexes and motor skills, testing how well they controlled their heads while lying down, made a fist, rolled over, thrust out their arms, and otherwise reacted and moved.

The results were consistent. Babies whose mothers had exercised tended to perform better on almost all of the tests, suggesting that their motor skills were more advanced. These gains were especially notable among girls, who usually lag slightly behind boys at this age. But baby girls from the exercise group displayed the same relatively advanced physical capabilities as the boys in that group and more coordination than boys in the control group.

None of these variations were glaring. Every infant was healthy, with normal motor development. But the babies who had bounced along as their mothers jogged or danced were slightly ahead of the others in their ability to grip, jostle and control how they rolled.

This accelerated motor development “might encourage those children,” over subsequent months and years, to be more active than youngsters whose coordination lags, Dr. May says.

The researchers did not control for home life, though, so it is possible that the mothers who exercised during pregnancy also engaged and played more with their newborns later. In that case, the improvements in motor skills would have occurred after birth and not in utero. (The researchers did consider and account for breastfeeding, which also affects physical development.)

The study also cannot tell us how maternal exercise might have goosed unborn babies’ physical skills, if it did. Perhaps the infants received more blood, oxygen and nutrients through the placenta when their mothers exercised, affecting their brain and nervous system development, Dr. May says. Or the babies’ bodies might have sensed maternal exertions and released growth hormones and other biochemicals of their own that sped up the development of their motor cortexes.

Dr. May and her colleagues plan to delve into those issues in future studies.

But for now, she says, the study’s results suggest that pregnant women who exercise — assuming they are healthy and have clearance from their doctor — might amplify their baby’s nascent aptitude for and interest in movement.

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Maternal and Child Health and Nutrition: Week 1 of the PLOS Medicine Special Issue

EurekAlert!, August 6, 2019

This week, we see the publication of the first papers in PLOS Medicine’s special issue on nutrition in maternal and child health, advised by Guest Editors Dr. Lars Åke Persson of the London School of Hygiene & Tropical Medicine and based at the Ethiopian Public Health Institute, Addis Ababa; Dr. Kathleen M. Rasmussen of the Division of Nutritional Sciences at Cornell University, Ithaca, New York; and Dr. Huixia Yang of Peking University First Hospital and the Chinese Association of Obstetricians and Gynecologists.

In many parts of the world maternal and child health outcomes are increasingly impacted by indirect causes, many of which are related to nutrition. Women with diabetes, anemia or who are overweight are at a higher risk of childbirth-related complications. Their newborns, in turn, are also at a higher risk of experiencing adverse health outcomes later in life. With nearly one in three persons in the world suffering from at least one form of malnutrition – from undernutrition to obesity via diet-related non-communicable diseases – and infant nutrition being crucial particularly in the first 1,000 days of life, this Special Issue will focus on these topics with impactful research content.

In a Research article, Jane L Tarry-Adkins and colleagues reveal that babies born to mothers with gestational diabetes who are treated with metformin are likely to be of a lower birthweight than babies whose mothers are treated with insulin. Significantly, the children exposed to metformin are heavier than the insulin-exposed children at 18-24 months. Knowing that there is an increased risk of CVD and diabetes for children who undergo ‘catch up’ growth, it will be important to understand if these risks apply to children exposed to metformin.

Sophie E Moore and colleagues present the results of their trial to test whether nutritional supplements for pregnant women in a rural region of The Gambia improve a child’s immune response. 875 women were randomised to receive one of 4 supplements: standard care of iron and folic acid (FeFol); FeFol plus multiple micronutrients; FeFol plus protein-energy; or FeFol plus protein-energy and micronutrients. Infants were vaccinated at 8, 12 and 16 weeks of age with the diphtheria-tetanus-pertussis vaccine and those whose mothers had received the combined FeFol, micronutrient and protein-energy supplement showed improved vaccine responses. This is a striking example of how a mother’s nutritional status can impact a child beyond pregnancy and any immediate birth outcomes.

With much focus recently on complications occurring from obesity during pregnancy such as gestational diabetes – and the subsequent increased risk of developing type 2 diabetes – as well as increased risk of adiposity in children, there is increased awareness of the need for a healthy BMI at the start of pregnancy. Zainab Akhter and colleagues, in their systematic review and meta-analysis, reveal the increased risk of having a smaller size for gestational age baby and increased risk of preterm birth for mothers who have bariatric surgery prior to pregnancy. These findings indicate the need for additional nutritional support before conception and during pregnancy, and increased monitoring throughout pregnancy.

The issue will continue over the coming weeks with further research papers – to view the papers, visit our Special Issue Collection.

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Youth Empowerment Program Can Prevent Childhood Obesity

Boston University School of Medicine, August 1, 2019

First-of-its-kind study had Worchester youths create their own narratives about reducing sugary drink consumption, successfully leading to behavior changes and preventing excess weight gain.

A new pilot study led by Boston University School of Public Health (BUSPH) researchers is the first to use youth-produced narratives to empower youth to reduce sugary drink consumption and obesity risk. In the study, published in the International Journal of Behavioral Nutrition and Physical Activity, participants in the pilot program at the Boys and Girls Club (BGC) of Worcester and their parents consumed fewer sugary drinks and more water over a six-month period than children and parents at a demographically-similar BGC in a nearby city.

“Youth created their own narratives around why it was important for them — not their parents, teachers, or researchers like myself — to change the types of beverages they were drinking,” says study lead author Dr. Monica Wang, assistant professor of community health sciences at BUSPH. “This type of empowerment strategy recognizes youth as experts in their own lives, and may be particularly engaging for youth of color.”

After a training from Wang and her colleagues, BGC staff in the pilot study led an ethnically diverse group of nine- to twelve-year-old youths in activities that promoted replacing sugar-sweetened beverages with water, including blind taste tests of flavored water, a corner store scavenger hunt, and role play skits about ways to drink water and what to do when tempted by sugary drinks. The staff also guided the participants in creating written, audio, and video narratives to promote replacing sugar-sweetened beverages with water and provide strategies for doing so. The youths then taught their parents or guardians what they had learned each week, shared their narratives, and led a culminating BGC community event at the end of the six-week program.

“Most obesity prevention programs target multiple behaviors, but we found that a youth empowerment program targeting one dietary behavior could prevent obesity risk among youth,” Wang says. “Reducing sugary drinks through youth empowerment may be a promising starting point for families to engage in additional healthy eating efforts down the road.”

Wang notes that 12 BGCs have expressed interest in the program for a future, larger-scale study.

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Do Diet and Physical Activity Strategies Help Prevent Obesity in Children (Aged 0 to 18 Years)?

Cochrane, July 23, 2019

Background

More children are becoming overweight and obese worldwide. Being overweight as a child can cause health problems, and children may be affected psychologically and in their social life. Overweight children are likely also to be overweight as adults and continue to experience poor physical and mental health.

Searching for studies

We searched many scientific databases to find studies that looked at ways of preventing obesity in children. We included studies aimed at all ages of children. We only included studies if the methods they were using were aimed at changing children’s diet, or their level of physical activity, or both. We looked only for the studies that contained the best information to answer this question, ‘randomised controlled trials’ or RCTs.

What we found

We found 153 RCTs. The studies were based mainly in high-income countries such as the USA and European countries although 12% were in middle-income countries (Brazil, Ecuador, Egypt, Lebanon, Mexico, Thailand and Turkey). Just over half the RCTs (56%) tried out strategies to change diet or activity levels in children aged 6 to 12 years, a quarter were for children aged 0 to 5 years and a fifth (20%) were for teenagers aged 13 to 18. The strategies were used in different settings such as home, preschool or school and most were targeted towards trying to change individual behaviour.

Did they work?

One widely accepted way of assessing if a child is overweight is to calculate a score based on their height and how much they weigh, and relating this to the weight and height of many children their age in their country. This is called the zBMI score. We found 61 RCTs involving over 60,000 children, that had reported zBMI scores. Children aged 0 to 5, and children aged 6 to 12 who were helped with a strategy to change their diet or activity levels reduced their zBMI score by 0.07 and 0.04 units respectively compared to children who were not given a strategy. This means these children were able to reduce their weight. This change in zBMI, when provided to many children across a whole population, is useful for governments in trying to tackle the problems of obesity in children. Strategies to change diet or physical activity, or both, given to adolescents and young adults aged 13 to 18 years, did not successfully reduce zBMI.

We looked to see if the strategies were likely to work fairly for all children, for example girls and boys, children from wealthy or less wealthy backgrounds, children from different racial backgrounds. Not many RCTs reported this, but in those that did, there was no indication that the strategies increased inequalities. However we could not find enough RCTs with this information to help us answer this question. We also looked to see if children were harmed by any of the strategies, for example by having injuries, losing too much weight or developing damaging views about themselves and their weight. Not many RCTs reported this, but in those that did, none reported any harms from children who had been given strategies to change their diet or physical activity.

We looked at how well the RCTs were done to see if they might be biased. We decided to downgrade some information based on these assessments. The quality of the evidence was ‘moderate’ for children aged 0 to 5 for zBMI, ‘low’ for children aged 6 to 12 and moderate for adolescents (13 to 18).

Our conclusions

Strategies for changing diet or activity levels, or both, of children in order to help prevent them becoming overweight or obese are effective in making modest reductions in zBMI score in children aged 0 to 5 years and in children aged 6 to 12 years. This can be useful to parents and children concerned about children becoming overweight. It can also be useful for governments, trying to tackle a growing trend of children who are becoming obese or overweight. We found less evidence for adolescents and young people aged 13 to 18, and the strategies given to them did not reduce their zBMI score.

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Trends in Calories and Nutrients of Beverages in U.S. Chain Restaurants, 2012-2017

American Journal of Preventative Medicine, July 17, 2019

Introduction

Although beverages comprise one third of all menu items at large chain restaurants, no prior research has examined trends in their calorie and nutrient content.

Methods

Beverages (n=13,879) on the menus of 63 U.S. chain restaurants were the final analytic sample obtained from a restaurant nutrition database (MenuStat, 2012–2017). For each beverage type, cluster-bootstrapped mixed-effects regressions estimated changes in mean calories, sugar, and saturated fat for beverages available on menus in all years and for newly introduced beverages. Data were analyzed in 2018.

Results

Traditional sugar-sweetened beverages, sweetened teas, and blended milk-based beverages (e.g., milkshakes) were significantly higher in calories from 2012 to 2017 for newly introduced beverages (p-value for trend <0.004). For all newly introduced sweetened beverages, sugar increased significantly (2015, +7.9 g; 2016, +8.2 g; p<0.004) whereas saturated fat declined (2016, −2.3 g; 2017, −1.6 g; p<0.004). For beverages on menus in all years, saturated fat declined significantly (p<0.001), whereas mean calories and sugar remained relatively constant. Significant declines were observed for sweetened coffees (−10 kcal, −0.5 g saturated fat, p<0.001), teas (−2.6 g sugar, p=0.001), and blended milk-based beverages (−28 kcal, −4.2 g sugar, −0.8 g saturated fat, p<0.001). From 2012 to 2017, the total number of beverage offerings increased by 155%, with 82% of this change driven by sweetened beverages.

Conclusions

Sweetened beverages available in large chain restaurants were consistently high in calories, sugar, and saturated fat and substantially increased in quantity and variety from 2012 to 2017.

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