December 2022


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How Does WIC Impact Breastfeeding Initiation?

A new analysis of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers greater clarity about breastfeeding initiation trends in the United States, especially among populations who are often underrepresented in breastfeeding statistics. Learn more about this research during the next Connect & Explore webinar, Breastfeeding Initiation Trends Among WIC Participants and Non-WIC Participants, on January 11, 2023, from 3:00-4:00 pm ET, when the authors of “Breastfeeding Initiation Trends by WIC Participation and Race/Ethnicity Among Low-Income Women in 24 States” will present their findings. 

Recently published in the Journal of Nutrition Education and Behavior, this study used birth certificate data from 24 states (2009-2017) to identify hospital births covered by Medicaid. Researchers then calculated breastfeeding initiation rates among women who participated in WIC compared to women who were eligible for WIC but not enrolled. The study’s large dataset enabled researchers to identify trends among population groups such as American Indian/Alaska Native and Asian/Pacific Islander mothers, which they conclude will help programs reduce disparities and improve breastfeeding initiation. 

During the webinar, the study’s authors will share more about their methodology, answer audience questions, and further discuss how their findings can help shape program delivery. The speakers are:  

  • Joanne Guthrie, PhD, MPH, U.S. Department of Agriculture  
  • Leslie Hodges, PhD, MA, U.S. Department of Agriculture  
  • Marie Elizabeth Thoma, PhD, MHS, University of Maryland  

Register today! Like all Connect & Explore webinars, this event is free, but you must register for log-in access. Please tell a colleague and follow us on Twitter for updates and live tweets during the event using the hashtag #ConnectExplore. For those who cannot attend, the webinar will be recorded and archived on     

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Publications & Tools

NCCOR Toolbox: Popular NCCOR Webinar Now Available Online

“Food is more than nutrition; health is more than weight, and diet is more than individual choice.” This was the inspiring message from Ted Fischer, PhD of Vanderbilt University who presented during the September Connect & Explore webinar titled Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems. The webinar detailed a new report authored by the Vanderbilt University Cultural Context of Health & Wellbeing Initiative and supported by the Robert Wood Johnson Foundation. Speakers explored how public health policy can work with, not against, cultural traditions and presented a new paradigm for contextualizing childhood obesity research. The full recording, including the slides, are now available on the NCCOR website.  

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New Infographic Illustrates Proposed Updates to the WIC Food Package

USDA’s Food and Nutrition Service published a new infographic detailing changes to the foods prescribed through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Known as the WIC package, these foods help meet the special nutritional needs of pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age who are at nutritional risk. The new WIC package reflects the latest nutritional science, supports equitable access to nutritious foods, and provides local WIC programs greater flexibility to accommodate personal and cultural preferences.

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State of Childhood Obesity Report Spotlights Commitment to Evolve How Health Is Measured

The Robert Wood Johnson Foundation (RWJF) recently released their annual State of Childhood Obesity report. This year’s theme, Meeting the Moment: Learning from Leaders at the Forefront of Change, highlights how their childhood obesity work continues to evolve and their commitment to finding better measures to assess health. The report focuses on the following areas: Improving Our Health Data, Creating Communities of Opportunity, Building Equitable Food Systems, and Advancing Priorities Policies. It also showcases the work of Vanderbilt’s Ted Fischer and Tatiana Paz Lemus (featured in recent NCCOR Connect & Explore webinar) who argue why we must move beyond a weight-centered view of health. Access the report and learn more about RWJF’s childhood obesity work on their website

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Childhood Obesity Research & News

Obesity Linked to Poor Brain Health in Children

November 28, 2022, EurekAlert!

Using MRI data from the largest long-term study of brain development and child health in the United States, researchers have found that higher weight and body mass index (BMI) in pre-adolescence are associated with poor brain health. The findings are being presented today at the annual meeting of the Radiological Society of North America (RSNA). 

“We know being obese as an adult is associated with poor brain health,” said researcher Simone Kaltenhauser, a post-graduate research fellow in radiology and biomedical imaging at the Yale School of Medicine in New Haven, Connecticut. “However, previous studies on children have often focused on small, specific study populations or single aspects of brain health.” 

Childhood obesity is a growing concern in the U.S. According to the Centers for Disease Control and Prevention, approximately one in every five American children is obese. 

Kaltenhauser’s study used imaging data from the Adolescent Brain Cognitive Development (ABCD) study that included 11,878 children aged 9-10 years from 21 centers across the country to represent the sociodemographic diversity in the U.S. 

“This dataset is unique in that it closely approximates the U.S. population,” Kaltenhauser said. 

After excluding children with eating disorders, neurodevelopmental and psychiatric diseases, and traumatic brain injury, the study group included 5,169 children (51.9% female). According to the children’s BMI z-scores—measures of relative weight adjusted for a child’s age, sex and height—the overweight and obesity rates within the study group were 21% and 17.6%, respectively. 

To gain a comprehensive view of brain health within the study group, the team evaluated information from structural MRI and resting-state functional MRI (fMRI), which enables researchers to measure brain activity by detecting changes in blood flow. With resting state fMRI, the connectivity between neural regions—known as resting state networks—can be observed while the brain is at rest. The researchers also evaluated data from diffusion tensor imaging—a technique that helps assess white matter—and restriction spectrum imaging, an advanced diffusion MRI technique.   

After correcting for age, sex, race-ethnicity, handedness and socioeconomic status, the research team used linear models to determine associations between weight and BMI z-scores and the imaging metrics.  

The researchers observed structural brain changes in children with higher weight and BMI z-scores, including significant impairment to the integrity of the white matter. Areas of degradation included the white matter of the corpus callosum, the principal connector between the brain’s two hemispheres, and tracts within the hemispheres that connect the lobes of the brain. 

“It is striking that these changes were visible early on during childhood,” Kaltenhauser said. 

The researchers also observed a thinning of the outermost layer of the brain, or the cortex, which has been associated with impaired executive function. 

“We expected the decrease in cortical thickness among the higher weight and BMI z-score children, as this was found previously in smaller subsamples of the ABCD study,” Kaltenhauser said. “However, we were surprised by the extent of white matter impairment.” 

Resting-state fMRI images revealed that increased weight and BMI z-scores were associated with decreased connectivity in the functional networks of the brain that involve cognitive control, motivation and reward-based decision making. 

“Increased BMI and weight are not only associated with physical health consequences but also with brain health,” Kaltenhauser said. “Our study showed that higher weight and BMI z-scores in 9- and 10-year-olds were associated with changes in macrostructures, microstructures and functional connectivity that worsened brain health.” 

Senior author Sam Payabvash, M.D., a neuroradiologist and assistant professor of radiology and biomedical imaging at the Yale School of Medicine, said the study’s findings provide an important mechanistic explanation of other studies that show higher BMI in children is associated with poor cognitive functioning and school performance. 

“The longitudinal ABCD study gives us the opportunity to observe any changes that occur in children with higher weight and BMI z-scores,” Dr. Payabvash said. “We’ll need to watch over the next 6 to 10 years.” 

Co-authors are Clara Weber, Huang Lin, Ajay Malhotra, M.B.B.S., M.D., R. Todd Constable, Ph.D., Julián N. Acosta, M.D., Guido J. Falcone, M.D., Sarah N. Taylor, M.D., Laura R. Ment, M.D., and Kevin N. Sheth M.D. 


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Patient and Family Perspectives on Terms for Obesity

November 21, 2022, EurekAlert!

When it comes to talking about body weight with teens, what words should parents use? A new study from the UConn Rudd Center for Food Policy & Health offers insights about the terminology for weight that adolescents most prefer, dislike, and have negative emotional reactions to when their parents raise the topic. 

Using a national online panel, researchers surveyed 1,936 parents and 2,032 adolescents. Parents were surveyed about what words they use to refer to their child’s weight. Adolescents were asked about their emotional reactions to these words and their preferences for the terminology they want their parents to use to refer to their weight. 

“Body weight is a sensitive topic for many youth, and the way that parents talk about it can have an emotional impact on their children,” says Rebecca Puhl from the Rudd Center, and lead author of the study. “Words matter, and we need to understand how youth feel about the words parents use to describe their weight and what words they feel most comfortable with.” 

The researchers examined weight communication in racially and ethnically diverse mothers and fathers and adolescent girls and boys, across a range of body sizes. Study findings, published in the journal Pediatrics, show that certain weight-related words lead to emotional distress in adolescents. 

Key findings include: 

  • Adolescents’ most preferred terms included “healthy weight” and “normal weight.” 
  • At least half of adolescents reported that they never want parents to use the terms “obese,” “fat,” “extremely obese,” “plus-size,” “big,” “weight problem,” “large” and “high BMI” to describe their weight. 
  • The terms “overweight,” “fat” and “extremely obese” elicited the most negative emotions in adolescents – at least a third felt embarrassment, shame, and sadness when parents used these words to refer to their weight. 
  • Girls and sexual minority youth reported more negative emotions in response to weight terminology than boys and heterosexual youth. 
  • Emotional reactions to weight terminology were fairly consistent across weight status and race/ethnicity of adolescents, with a few exceptions: 
  • The term “thick” was more preferred by Black and Hispanic/Latinx youth, and youth with higher weight. 
  • “Curvy” was more preferred by girls, Hispanic/Latinx youth, sexual minority youth, and those with higher weight. 

In some cases, parents reported using words that adolescents don’t feel comfortable with. Fathers reported using weight terms more frequently than mothers, as did Hispanic/Latinx parents compared to White and Black parents. 

While study findings show several consistencies in adolescents’ preferred weight terminology, there were also differences in preferences across sex, sexual orientation, race/ethnicity, and weight status. 

“Our findings highlight the need to recognize diversity in adolescent preferences for weight terminology,” says Puhl. “By asking adolescents their preferred terms when discussing weight-related health, parents can promote more supportive and less stigmatizing communication with their children.” 

This study was supported by a grant from WW International, Inc. Study co-authors include Leah Lessard of the Rudd Center for Food Policy and Health at the University of Connecticut, and Michelle Cardel and Gary Foster of WW International, Inc. 


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Solving Childhood Obesity Requires Strong Connections Within Coalitions, New Study Suggests

November 16, 2022, Tufts University

How do you solve a problem as vast and intractable as childhood obesity? A new study from researchers at Friedman School of Nutrition Science and Policy and ChildObesity180 offers important new clues. It suggests coalitions working to end childhood obesity can more quickly create lasting change if members form close relationships with people in different types of organizations from their own, are able to learn new information rapidly, and can share that new knowledge both within their existing networks and with people in other sectors. 

“We saw that it was relevant whether or not the members of a coalition were talking more often with people outside their own sector,” says Travis Moore, the study’s lead author and a postdoctoral researcher in the Friedman School’s Division of Nutrition Interventions, Communication, and Behavior Change. “If a coalition is comprised of people from public health, hospitals, schools, and community agencies, for example, but the public health people are only talking with other public health people and the community agency people are only talking among themselves, change happens more slowly.” 

The study, published in September in BMC Public Health, examined three of the 9 communities enrolled in Catalyzing Communities, an initiative to create successful community-wide interventions to prevent and decrease rates of childhood obesity nationwide. The initiative is part of ChildObesity180, a Tufts University effort founded by Christina Economos, dean ad interim of the Friedman School and senior author of the study, to address the complex drivers of childhood obesity and its impact at all stages of life. 

Catalyzing Communities works closely with multisector community coalitions to use evidence-based systems solutions in order to identify high-impact opportunities to improve health and increase health equity for children. 

In this most recent study, researchers examined how community coalition formation changed over time in general, and how an intervention could be tailored to improve the adoption of childhood obesity prevention strategies within coalitions. Coalitions whose members quickly learn new insights about how child health promotion is driven and make more partnerships across sectors will be the most successful, the research suggests. 

“Coalitions become more effective more quickly when members maintain their current partnerships while simultaneously making lots of connections across sectors and maintaining those relationships as well,” says Economos, who is also the New Balance Chair in Childhood Nutrition and professor of nutrition at Tufts. “Coalition members who learn more about childhood obesity prevention tend to increase the number of people with whom they share that information. And the people who are connected to those coalition members also increase their understanding and engagement with the issue.” 

Moore notes that, while we know a lot about the causes of childhood obesity, we know far less about how to effect change and create health equity. “Most research focuses on the structure of coalitions,” Moore says. “Our research attempts to understand how groups evolve over time and ultimately create change. Through our research, we believe we can help groups create better mechanisms for redistributing both knowledge and resources to create health equity.” 

Communities participating include Greenville, South Carolina; Somerville, Worcester, and East Boston, Massachusetts; Cuyahoga Country, Ohio; Tucson, Arizona; Milwaukee, Wisconsin; Harlem, New York; Garfield Park, Illinois; and Harris County, Texas. 

Citation: Work in this article is supported by funding from the JPB Foundation. Complete information on authors, funders, and conflicts of interest is available in the published paper. 


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