December 2024

NCCOR 2024 Year in Review

December 2024, NCCOR

This year, NCCOR maintained its position as a leader in advancing science and solutions to improve the health of children, families, and communities. From expanding its flagship tools to convening thought leaders in groundbreaking workshops, NCCOR has focused on empowering researchers, fostering collaboration, and addressing emerging challenges in the field. With initiatives rooted in equity, systems thinking, and implementation science, NCCOR continues to drive progress toward scalable, impactful solutions for childhood obesity prevention. As we reflect on 2024, we celebrate our shared accomplishments and look ahead to building an even brighter future.

• Expanding the Catalogue of Surveillance Systems (CSS)
  NCCOR added four important new datasets to our signature tool, the CSS. The new resources are the Hispanic Community Health Study/Study of Latinos, Framingham Heart Study, Future of Families and Child Wellbeing Study, and the Jackson Heart Study. These additions help users explore health disparities and systemic factors shaping public health outcomes.
• Investigating the Link between Sleep and Childhood Obesity
  NCCOR continues to advance sleep research. In March, we hosted a Connect & Explore webinar featuring two researchers who spearheaded adding sleep variables to the CSS. The webinar, Sleep’s Role in Child Health: Expanding NCCOR’s Catalogue of Surveillance Systems, explored how a child’s 24-hour behavior cycle may influence weight outcomes and how to use the updated CSS features to conduct sleep-related research.
• Publishing a New Booklet about NCCOR Tools
  NCCOR released a new publication spotlighting our seven major tools that simplify and enhance obesity research. This user-friendly booklet, A Guide to NCCOR’s Research Tools, is an especially helpful tool for new researchers or those who may be unfamiliar with NCCOR’s resources.
• OPUS Workshops: Shaping the Future of Obesity Prevention
  The Obesity-Related Policy, Systems, and Environmental Research in the U.S. (OPUS) initiative brought together leading experts to tackle pressing challenges in childhood obesity research.
  • OPUS I (June 4-5): A Call for Systems Thinking
    This foundational workshop emphasized the need for equity-driven, systems-based approaches to obesity prevention. Participants explored policy measures, methodological advancements, and the importance of community engagement.
  • OPUS II (October 9-10): Elevating PSE Interventions
    Building on OPUS I, the second workshop explored the design and evaluation of policy, systems, and environmental (PSE) interventions. It focused on rigorous evaluation methods, sustainability, and practical strategies for scaling interventions. Key insights are available in workshop summaries and videos on the NCCOR website.

Looking Ahead to 2025

As NCCOR looks to the future, several exciting initiatives are on the horizon. We anticipate releasing new publications and resources following the success of the OPUS workshops. NCCOR will also continue our work to advance implementation science and physical activity research. Additionally, NCCOR will host a Connect & Explore webinar addressing weight stigma. These efforts continue to underscore NCCOR’s leadership in advancing research and building evidence for childhood obesity prevention efforts.

Back to Top

NCCOR Toolbox: NCCOR’s Comprehensive Toolkit for Evaluating Childhood Healthy Weight Programs

December 2024, NCCOR

The NCCOR Toolkit for Evaluating Childhood Healthy Weight Programs provides guidance for designing and assessing community-based interventions. It helps users measure program impact, identify barriers, and ensure sustainability while offering tools for both in-person and remote evaluations. The resource is ideal for those at any stage of program development and includes detailed sections on evaluation readiness, process and outcome measures, contextual factors, and sustainability. Access the toolkit and additional resources here.

Back to Top

Empowering Early Development Awareness Through WIC Partnerships

December 2024, NCCOR

The Learn the Signs. Act Early. initiative by ASPHN, in partnership with the CDC, promotes early identification of developmental delays in children up to age five through milestone monitoring tools, parent education, and staff training. The program integrates resources into WIC clinics across the U.S., offering virtual modules, milestone apps, and social media outreach in English and Spanish. Currently, four states receive funding for implementation while others access technical support. The project enhances child development awareness and facilitates referrals to necessary services. Learn more at ASPHN.

Back to Top

Rethinking Obesity: Principles for Compassionate Care

December 2024, NCCOR

The International Obesity Collaborative outlines five principles emphasizing that obesity is a complex, chronic disease influenced by biological, environmental, and social factors, not personal failure. It highlights the importance of early treatment, a focus on overall health rather than weight alone, and the availability of evidence-based therapies. Additionally, it stresses the need to combat weight bias and discrimination to ensure equitable care. These principles aim to promote compassionate, science-based approaches to obesity management. Learn more here.

Back to Top

Modeling Health and Economic Outcomes of Eliminating Sex Disparities in Youth Physical Activity

November 25, 2024, JAMA Network

Importance Sex disparities in physical activity (PA) and sports participation among US children and adolescents have been persistent. Quantifying the impact of reducing or eliminating these disparities may help determine how much to prioritize this problem and invest in interventions and policies to reduce them.

Objective To quantify what might happen if existing PA and sports participation disparities were reduced or eliminated between male and female children and adolescents.

Design, Setting, and Participants This simulation study used an agent-based model representing all children (aged 6 to 17 years) in the US, their PA and sports participation levels, and relevant physical and physiologic characteristics (eg, body mass index) as of 2023. Experiments conducted from April 5, 2024, to September 10, 2024, simulated what would happen during the lifetime of each cohort member if PA and sports participation levels for female participants were increased (to varying degrees) to match male participants in the same age group.

Main Outcomes and Measures Health outcomes, such as body mass index, incidence of weight-related conditions (eg, stroke, coronary heart disease, type 2 diabetes, and cancer), and economic outcomes (eg, direct medical costs and productivity losses).

Results This simulation study modeled 8 299 353 US children and adolescents (4 240 119 [51.1%] male and 4 059 234 [48.9%] female) aged 6 to 17 years. Eliminating PA sex disparities averted 28 061 (95% CI, 25 358-30 763) overweight and obesity cases per cohort by age 18 years, which in turn averted 4869 (95% CI, 4007-5732) weight-related disease cases during their lifetimes and resulted in recurring savings of $333.45 million (95% CI, $290.22 million to $376.68 million) in direct medical costs and $446.42 million (95% CI, $327.39 million to $565.44 million) in productivity losses (in 2024 US dollars) for every new cohort of 6- to 17-year-olds. Reducing PA disparities by 50% averted 9027 (95% CI, 6942-11 112) overweight and obesity cases. Eliminating sex disparities in sports participation averted 41 499 (95% CI, 37 874-45 125) cases of overweight and obesity and 8939 (95% CI, 8088-9790) weight-related disease cases during their lifetimes, generating recurring savings of $713.48 million (95% CI, $668.80 million to $758.16 million) in direct medical costs and $839.68 million (95% CI, $721.18 million to $958.18 million) in productivity losses.

Conclusions and Relevance In this simulation study of youth PA and sports participation, eliminating sex disparities could save millions of dollars for each new cohort of 6- to 17-year-olds, which could exceed the cost of programs and investments that could enable greater equity.

[Source]

Back to Top

National-Level and State-Level Prevalence of Overweight and Obesity Among Children, Adolescents, and Adults in the USA, 1990–2021, and Forecasts up to 2050

November 14, The Lancet

Background Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.

Methods In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m2 to less than 30 kg/m2 and obesity was defined as a BMI of 30 kg/m2 or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.

Findings In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years), 21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents (aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4) among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·8–111·1) in females. Forecast results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents (aged 5–14 years), 3·41 million older adolescents (aged 15–24 years), and 41·4 million adults (aged ≥25 years) will have overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will reach 43·1 million (37·2–47·4) and the total number of adults with overweight and obesity will reach 213 million (202–221). In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes from 2021 are projected in states such as Utah for adolescents and Colorado for adults.

Interpretation Existing policies have failed to address overweight and obesity. Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains central to any intervention strategies, particularly for children and adolescents.

Funding Bill & Melinda Gates Foundation.

[Source]

Back to Top

Childhood Overweight is Associated with Socio-Economic Vulnerability

November 4, 2024, EurekAlert!

More children have overweight in regions with high rates of single parenthood, low education levels, low income and high child poverty. The pandemic may also have reinforced this trend. This is shown by a study conducted by researchers at Uppsala University and Region Sörmland in collaboration with Region Skåne.

“During and after the pandemic, we see a greater difference between regions in terms of children’s weight. It even looks like it has exacerbated health inequalities,” explains Charlotte Nylander, a researcher at Uppsala University and the Centre for Clinical Research in Region Sörmland, where she is also a Senior Consultant in Child Health Care.

Approximately 85 percent of all Swedish four-year-olds in 2018, 2020 and 2022 were included in the study, which in total comprises over 300,000 individuals. The researchers compiled the regions’ data on overweight in childhood and then linked it to variables available from Statistics Sweden. The regions of Halland and Örebro are not included in the study due to a lack of aggregated data for 2022.

The results show that the prevalence of overweight or obesity has now fallen to the same levels as before the COVID-19 pandemic, i.e. 11.4%. During the pandemic, the prevalence was 13.3 per cent. However, in several regions, including Västernorrland, Gävleborg and Värmland, the figures are significantly higher than the national average (see attached figure).

“We were worried when we saw the peak during the pandemic and wondered what will happen next. But it is good news that it is back to pre-pandemic levels – we are happy about that. However, overweight in childhood is clearly still a concern that we need to work on,” adds Nylander.

She and her research colleagues are concerned that there was such a significant link to socio-economic disadvantage at the regional level. There were more overweight children in regions with many single parents, low education levels, low income and high child poverty.

“Child healthcare is an important public health arena. It is a matter of highlighting socio-economically disadvantaged children in healthcare and providing early advice on lifestyle habits that can help. But we also need to shift responsibility from the individual to society, where major efforts are needed to improve the situation,” notes researcher Mariette Derwig, a Senior Consultant in Child Health Care in Region Skåne.

[Source]

Back to Top

Preventing Obesity in Very Young Children Could Be in the Palm of Parents’ Hands

November 4, 2024, Johns Hopkins Medicine

A study co-led by a Johns Hopkins Children’s Center clinician-researcher shows that adding text messaging and other electronic feedback to traditional in-clinic health counseling for parents about feeding habits, playtime and exercise prevents very young children from developing obesity and potentially lifelong obesity-related problems.

Findings from the study, which was co-led by Eliana Perrin, M.D., M.P.H., Bloomberg Distinguished Professor of Primary Care at the Johns Hopkins University Schools of Medicine, Nursing and Public Health, will be published in JAMA and presented at the Obesity Society’s “Obesity Week” in San Antonio, both on Nov. 3. The work stems from decades of research showing that having obesity in early childhood significantly increases the risk of lifetime obesity, cardiovascular disease, diabetes and other serious diseases, particularly in low-income and minority populations.

About 1 in 5 school-aged children were affected by obesity in 2017–18, according to the U.S. Centers for Disease Control and Prevention — rates that have only increased during and since the COVID-19 pandemic. Efforts to reduce the rate have relied heavily on in-person interventions by pediatric providers, with limited success.

In an earlier study, also co-led by Perrin, investigators demonstrated that a “health literacy-informed” primary care-based intervention called the Greenlight Program, which Perrin and colleagues at other medical centers developed for parents, improved healthy growth in newborns until 18 months of age, but found that improvements were not sustained at age 2 years.

In an effort to extend the improvements through 2 years of age, when pediatrics office visits become less frequent, the new study focused on using digital technology to reinforce elements of the Greenlight Program, which previously only consisted of written materials and health counseling during primary care visits.

“We found that parents are eager for more information to help their children grow up healthy, and the vast majority of parents own smartphones,” says Perrin, who is also a general pediatrician at the Harriet Lane Clinic at the Children’s Center.

Building on that knowledge, to conduct the new study, which was co-led by Vanderbilt University and five other academic medical institutions, the researchers recruited nearly 900 parent-infant pairs between October 2019 and January 2022 from newborn nurseries or pediatric primary care clinics at Duke University, University of Miami, New York University/Bellevue Hospital Center, University of North Carolina, Stanford University and Vanderbilt University Medical Center.

At the start of the trial, all babies were 21 days old or younger, born after 34 weeks gestation, at a healthy weight, and with no chronic medical conditions that might affect weight gain.

The participants were about 45% Hispanic, 20% white and nearly 16% Black. More than 55% were considered to have limited health literacy based on the Newest Vital Sign, a widely used health literacy screening tool developed by researchers at the University of Arizona, and nearly 16% reported household food insecurity, meaning limited access to healthy food choices.

The infant-parent pairs were randomly sorted into two groups. Both groups received Greenlight Program education, with counseling on healthy nutrition and behaviors from their primary care providers, along with eight educational booklets matching the child’s age at regular well visits, with guidance and goal-setting tips in English or Spanish on feeding, physical activity, sleep and screen time.

Next, half (449) of the infant-parent pairs received personalized, interactive text messages from a fully automated system to support health behavior goals and also access to a web-based “dashboard” designed to help parents keep track of healthy goals.

Goals (such as fewer sugar-sweetened beverages or less screen time) were texted in English or Spanish every two weeks until 2 years of age. Those texts were followed by five automated check-in messages throughout the two weeks. Parents were asked to self-rate their goal progress.

Based on parents’ responses, the automated digital intervention system then provided immediate feedback, tips for addressing challenges and encouragement based on progress.

The researchers found that children of parents who received the digital intervention as well as personal counseling had healthier weight-for-length growth curves over the first two years of life than children of parents who had counseling only, which resulted in an estimated reduction of 0.33 kg/m at the 24-month time point. Researchers say while this doesn’t sound like a lot, it’s consistent with the U.S. Preventive Services Task Force target for effective obesity trials. Also, obesity prevention for the digital group was significant. Some 7% of the digital intervention group had obesity, compared with nearly 13% of the clinic-only group, which is a nearly 45% adjusted relative reduction.

The researchers conclude that their digital intervention led to healthier weight-for-length paths and reduced the incidence of obesity at 2 years of age when added to in-person health counseling.

The investigators say the digital services were effective in populations that traditionally experience the highest risk of obesity, and “could have significant impact” if implemented on a broader scale.

Moreover, they concluded “the intervention effect” occurred as early as 4 months and sustained throughout the two years. The researchers say this study may be one of the first ever to prevent early childhood obesity, particularly in a large group of diverse participants.

Perrin indicated that research shows most young children with obesity do not outgrow it. “What is kind of exciting from our study is we prevented those children who would have had an unhealthy weight in the first place and helped them have a healthier weight, which sets them up better for health throughout their lives,” she says.

Finally, the researchers say the digital intervention had a greater effect on children from households with food insecurity, on Hispanic and non-Hispanic Black children, and those with lower health literacy. “If we can prevent obesity in these children at greatest risk, we can also create better health equity in the future,” Perrin says.

The researchers hope to be able to follow the patients as they grow up.

Additional authors include William Heerman, Russell Rothman, Jonathan Schildcrout, Aihua Bian, Laura Adams and Evan Sommer from Vanderbilt University Medical Center; Lee Sanders from Stanford University; Kori Flower from University of North Carolina at Chapel Hill; Alan Delamater from University of Miami; Melissa Kay from Wake Forest University; Charles Wood from Duke University; Rachel Gross and H. Shonna Yin from New York University; and other Greenlight investigators.

This work was supported by the Patient-Centered Outcomes Research Institute (AD-2018C1-11238). Study data were collected and managed using REDCap electronic data capture tools hosted at Vanderbilt University Medical Center and supported by the National Center for Advancing Translational Sciences/National Institutes of Health (UL1 TR000445).

The authors affiliated with The Johns Hopkins University did not declare any conflicts of interest under Johns Hopkins University policies.

[Source]

Back to Top

Biden-Harris Administration to End Online Junk Fees for Low-Income Families Paying for School Meals

November 1, 2024, U.S. Department of Agriculture

Agriculture Secretary Tom Vilsack today announced that students eligible for free and reduced price school meals must not be charged junk fees along with the cost of a meal served through the School Breakfast Program and National School Lunch Program. This policy, effective school year 2027-2028, will lower costs for families with income under 185% of federal poverty guidelines – equal to $57,720 for a family of four – by ensuring they are not burdened by processing fees when purchasing school meals for their children.  Today’s action is a first step. USDA will examine fees charged to families with a goal of eliminating online junk fees for all families regardless of income level to further remove barriers to access healthy meals.

The U.S. Department of Agriculture’s Food and Nutrition Service issued a memo today to schools across the country about this policy. The school year 2027-2028 implementation date gives schools ample time to modify current systems or establish new contracts; however, USDA is encouraging schools to implement this requirement as soon as possible. The memo also reiterated USDA’s longstanding policy that schools must offer all families a free and accessible method for making deposits to school meal accounts – and that schools must ensure families know about this option.

“USDA and schools across America share the common goal of nourishing schoolchildren and giving them the fuel they need to learn, grown and thrive,” said Agriculture Secretary Tom Vilsack. “While today’s action to eliminate extra fees for lower income households is a major step in the right direction, the most equitable path forward is to offer every child access to healthy school meals at no cost. We will continue to work with Congress to move toward that goal so all kids have the nutrition they need to reach their full potential.”

“Today’s announcement reflects the President and Vice President’s broader efforts to lower food costs and eliminate junk fees,” said National Economic Advisor Lael Brainard. “The Department of Agriculture’s action applies to the 1 million children who receive reduced priced meals and lays the foundation to eliminate these junk fees for all 30 million children that receive healthy meals at school every day.”

Last year, the Administration committed to bring down costs for Americans by cracking down on junk fees, which are hidden fees that increase costs for customers and bring financial stress on low-income families. And this year, USDA promised to bring relief to families of children who eat school meals, in response to a report from the Consumer Protection Financial Bureau which found that online school meal payments are raising costs for them.

K-12 schools serve nutritious meals to about 30 million children every school day. While this policy applies to all students eligible for free or reduced lunch, it will most directly benefit the more than 1 million students who received reduced price school meals. By law, students who are eligible for reduced price meals cannot be charged more than $0.30 for breakfast and $0.40 for lunch. But some families end up paying more than that, by way of processing fees they’re charged when depositing money into their student’s school meals account using an online method. The policy announced today will ensure fairness for all students receiving meals at a reduced price, even when paying online. Schools may choose to use their own funds to cover the processing fees associated with online payment systems.

The memo also includes best practices schools can use to inform families of the payment methods available that do not add fees.

Healthy School Meals for All  

Advancing a pathway to free healthy school meals for all is a priority set forth in the Biden-Harris Administration’s White House National Strategy on Hunger, Nutrition and Health.

Eight states have taken permanent actions to provide healthy school meals at no cost to all their students: California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico and Vermont.

Meanwhile, in other states, many schools in high-need areas provide free meals to all their students through the Community Eligibility Provision, commonly known as CEP. Last year, USDA gave an estimated 3,000 more school districts the option to serve breakfast and lunch to all students at no cost by expanding the availability of CEP.

Support for Healthy Kids  

USDA is committed to helping kids lead healthy lives. The Department has taken several actions to bolster programs that provide critical nutrition to infants and children. Specific to the school meal programs, USDA has provided a total of nearly $13.2 billion in extra financial support for schools across the country since 2021.

USDA touches the lives of all Americans each day in so many positive ways. Under the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate-smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov.

[Source]

Back to Top