August 2020

6 Ways Graduate Students Can Get an Edge in School

NCCOR, August 2020

It’s almost National Childhood Obesity Awareness Month (NCOAM), and school is starting up again. Start the school year off strong during NCOAM with free resources and tools from NCCOR!

NCCOR’s resources can assist graduate students in all types of health programs to select the most appropriate measures or datasets for projects. NCCOR’s tools have also been used to enhance thesis and capstone projects by allowing students to successfully conduct systematic reviews and meta analyses, develop childhood obesity interventions, analyze secondary data sets, and much more.

If you’re a graduate student studying nutrition or physical activity related to childhood obesity, here are six things you can do to get an edge in your coursework or research this semester!

1. Sign up for NCCOR’s Student Hub e-Newsletter: This quarterly student e-newsletter connects you to free tools and resources that can support your schoolwork and research.
2. Check out our Student Resource Guide: This guide introduces NCCOR’s tools and resources to students and demonstrates how they can be used to enhance studies.
3. Look at NCCOR’s Q&A for Public Health Students: This handy guide for public health students will show you how you can use the Measures Registry Resource Suite and includes a case study.
4. Learn from experts with NCCOR’s Connect & Explore webinar archive: Hear from top experts in the field right at home. For a specific example on how to use NCCOR’s resources, check out this webinar featuring a graduate who used the Measures Registry.
5. Read this case study to learn how you can use NCCOR resources: If you watched the webinar in #4 and want to have the case study nearby to reference, you can find it on our website. The case study outlines one graduate student’s experience using NCCOR’s Measures Registry to enhance his summer project with the Boys & Girls Club.
6. Share this resource guide with your professor: This fact sheet explains what NCCOR’s Measures Registry Resource Suite is and how to incorporate it into the classroom. Your professor will appreciate you sharing this helpful resource!

To learn more about NCCOR’s resources for students, check out the NCCOR Student Hub and don’t forget to share with your friends!

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NCCOR’s Toolbox

Are you a graduate student or faculty member getting ready for school this fall? Sign up for NCCOR’s Student Hub e-Newsletter to get the latest on free tools and resources that will enhance and support coursework and research.

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A Consumer Food Data System for 2030 and Beyond

Patterns of food consumption and nutritional intake strongly affect the population’s health and well-being. The Food Economics Division of USDA’s Economic Research Service (ERS) engages in research and data collection to inform policy making related to the leading federal nutrition assistance programs managed by USDA’s Food and Nutrition Service. The ERS uses the Consumer Food Data System to understand why people choose foods, how food assistance programs affect these choices, and the health impacts of those choices.

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Assessing the Implementation of Kids’ Meals Healthy Default Beverage Policies in the State of California and City of Wilmington, Del.

Healthy default beverage policies are one policy approach to limiting kids’ sugary drink consumption and encouraging healthier beverage consumption. These policies specifically require restaurants to offer only healthier drinks instead of sugary drinks as the default options with kids’ meals, a combination of food and drink items sold as a single unit. This brief highlights findings from joint research conducted by the Nutrition Policy Institute at the University of California Division of Agriculture and Natural Resources and the Center for Research in Education and Social Policy at the University of Delaware to evaluate implementation and restaurant manager perceptions of this policy approach.

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Neonatal Adiposity and Childhood Obesity

Pediatrics, August 2020 Issue

OBJECTIVES: To explore the longitudinal association of neonatal adiposity (fat mass percentage) with BMI trajectories and childhood overweight and obesity from ages 2 to 6 years.

METHODS: We studied 979 children from the Healthy Start cohort. Air displacement plethysmography was used to estimate fat mass percentage. Child weight and recumbent length or standing height were abstracted from medical records. Overweight and obesity were defined as BMI levels ≥85th percentile for age and sex. Mixed-effects models were used to examine the association between neonatal fat mass percentage and BMI trajectories from age 2 to 6 years. We tested for effect modification by sex, race and/or ethnicity, and breastfeeding duration. We estimated the proportion of children classified as overweight or obese at specific levels of neonatal fat mass percentage (mean ± SD).

RESULTS: The mean neonatal adiposity level was 9.1% ± 4.0%. Child BMI levels differed by neonatal adiposity. Each SD increase in neonatal adiposity resulted in a 0.12 higher overall BMI level between ages 2 to 6 years (95% confidence interval: 0.03 to 0.20; P < .01), and this association was not modified by offspring sex, race and/or ethnicity, or breastfeeding duration. Increasing neonatal adiposity was associated with an increasing proportion of childhood overweight and obesity by age 5 years (P = .02).

CONCLUSIONS: We provide novel evidence that higher neonatal adiposity is significantly associated with higher overall BMI levels and an increased likelihood of overweight or obesity from ages 2 to 6 years. Because various prenatal exposures may specifically influence offspring fat accretion, neonatal adiposity may be a useful surrogate end point for prenatal interventions aimed at reducing future childhood overweight and obesity.

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Kids in the U.S. Are Eating More Fast Food, the CDC Reports

NBC News, August 17, 2020

Despite warnings about obesity and unhealthy diets, American kids and adolescents are eating even more fast food. A new report from the Centers for Disease Control and Prevention found that children and adolescents got 13.8 percent of their daily calories from fast food in 2015 to 2018, up from 12.4 percent in 2011 to 2012.

The report, from the CDC’s National Center for Health Statistics, also found that Black and Hispanic kids eat more fast food than their white counterparts, and over one third ate fast food on any given day.

What’s more, the proportion of calories from fast food increased with age, with children ages 2 to 11 getting 11.5 percent of their daily calories from fast food, compared with ages 12 to 19, at 18 percent.

The report included data from the National Health and Nutrition Examination Survey, which is given to a sample of the U.S. population every two years to gather information on health and nutrition.

The rise in consumption among kids and young teens is not unexpected, experts say.

“These are not surprising findings when you think about how strapped families are these days for both time and money, and how fast food can be an easy option for stressed families,” said Dr. Eliana Perrin, professor of pediatrics at Duke University School of Medicine.

The report only included data through 2018, and therefore didn’t touch on how kids and families are eating during the pandemic, but Perrin speculated that it had most likely exacerbated the problem.

While some families are privileged to work and cook from home, “too many families are poorer than they were before, have more food insecurity and have more work to do with less support,” she said. “So fast food once again becomes, I think, a too-easy default for their stressed lives.” And it’s likely that these changes affected people of color more.

Eating too much fast food is bad for childrens’ health because of the high calorie count coupled with too few nutrients, Perrin said. A poor diet can also lead to heart problems and obesity.

Obesity affects an estimated 18.4 percent of U.S. children ages 6 to 11 and 20.9 percent of adolescents ages 12 to 19, according to the CDC. Obesity rates are higher among Black and Hispanic children.

Another factor that may have played a role in the increase in fast-food consumption is advertising, said Frances Fleming-Milici, director of marketing initiatives at the UConn Rudd Center for Food Policy and Obesity. A report from her institution compared the average number of TV advertisements viewed from 2007 to 2016. “We saw a big increase in ad exposure for preschoolers and children for particular fast-food restaurants,” she said.

And many of the ads were targeted at Black and Hispanic children.

“Compared to white youth, Black youth view twice as many ads for fast food and other restaurants,” Fleming-Milici said. On Spanish-language television, “about half of all the food ads that they view are fast-food restaurants,” she added.

Perrin said that targeted marketing contributes to health disparities.

“I think this is a major health equity issue,” she said.

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Scientists Sound the Alarm: Lockdowns May Escalate the Obesity Epidemic

EurekAlert!, August 13, 2020

Scientists sound the alarm: Lockdowns may escalate the obesity epidemic. Emotional stress, economic anxiety, physical inactivity and social distance – locking down society to combat COVID-19 creates psychosocial insecurity that leads to obesity, warn three Danish researchers. Counter measures are needed if we are to keep the public both metabolically healthy and safe from the coronavirus

Rates of obesity may explode because of strategies to limit the spread of COVID-19, warn a trio of researchers at the University of Copenhagen and Aarhus University. Investment in obesity research will help inform counter strategies that people eating healthily, feeling happy and staying active, while also combatting COVID-19.

“We are concerned that policy makers do not fully understand how strategies such as lockdowns and business closures could fuel the rise of obesity – a chronic disease with severe health implications, but with few reliable treatment options,” says Associate Professor Christoffer Clemmensen, from the Novo Nordisk Foundation Center for Basic Metabolic Research (CBMR), at the University of Copenhagen.

Alone, inactive and hungry

In a letter published in the scientific journal Nature Reviews Endocrinology, Clemmensen and two co-authors outlined how COVID-19 containment strategies could increase rates of obesity.

Firstly, it is well documented that people with limited economic resources are more likely to eat highly-processed and energy-rich food. These foods have been shown to stimulate people’s appetites, so that they end up eating more calories than they need.

“It is likely that more people will turn to these forms of food, as more people lose their jobs and experience economic hardship,” says co-author Professor Michael Bang Petersen, from the Department of Political Science at Aarhus University.

Secondly, physical distancing increases anxiety by limiting our ability to socially interact. Feelings of loneliness and isolation, combined with confinement within a home setting, can impact our food behavior and lead us to overeat. This effect is compounded by lower levels of physical activity, as people are urged to work from home and venture out as little as possible.

Stopping the virus and protecting metabolic health

Co-author Professor Thorkild I.A. Sørensen from CBMR at the University of Copenhagen, stresses that we still do not exactly understand how a person’s mental health and economic status end up increasing a person’s risk of developing obesity.

“We know that there are links between obesity and a person’s class and mental health, but we don’t exactly understand how they make an impact,” says Sørensen.

More research is needed to uncover the cause and effect, but the three co-authors say the scientific expectations are clear: physical distancing and rising rates of unemployment should lead us to expect increased rates of obesity.

Together they urge governments and decision makers to consider what impact COVID-19 containment strategies, such as lockdowns, will have on the public’s metabolic health. With this in mind, counter strategies should be considered to ensure that the public remains healthy, happy and active – and also safe from the coronavirus.

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US Obesity Epidemic Could Undermine Effectiveness of a Covid-19 Vaccine

CNN News, August 5, 2020

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded Covid-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that Covid-19 vaccines will be any different.

“Will we have a Covid vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

“Will it still work in the obese? Our prediction is no.”

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with Covid-19 were more likely to die than leaner ones, suggesting a perilous future awaited the US, whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more — known as morbid obesity or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with Covid-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

 Obesity interferes with immune response

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the body’s immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus.

In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for Covid-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue — or fat — in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

“Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored,” pleaded researchers from the Mayo Clinic’s Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population — both adults and children — has been largely ignored.

“I’m not entirely sure why vaccine efficacy in this population hasn’t been more well reported,” said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. “It’s a missed opportunity for greater public health intervention.”

In 2017, scientists at the University of North Carolina – Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, researchers showed for the first time that vaccinated obese adults were twice as likely to develop influenza or flu-like illness compared with adults of a healthy weight.

Curiously, the study found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but these adults still responded poorly.

“That was the mystery,” said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. “It’s not insurmountable,” said Petit, who is researching Covid-19 in obese patients. “We can design better vaccines that might overcome this discrepancy.”

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase III trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it’s still safer for obese people to get vaccinated than not.

“The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.”

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