December 2025

Two New NCCOR Publications Advance Research in Physical Activity and Obesity Prevention

December 2025, NCCOR

NCCOR is pleased to share two new manuscripts that highlight major advances in the work to strengthen the evidence base for physical activity and obesity prevention. These publications—focused on the Physical Activity Research Opportunities (PARO) framework and the Obesity-Related Policy, Systems, and Environmental Research in the U.S. (OPUS) workshop—reflect NCCOR’s continued efforts to equip the field with tools and insights to accelerate progress in research, policy, and practice.

The first manuscript, titled “Development of the Physical Activity Research Opportunities (PARO) Framework” brings together years of dispersed research recommendations into one accessible, strategic resource. Published in the International Journal of Behavioral Nutrition and Physical Activity, the PARO framework synthesizes 385 physical activity research opportunities from 11 major sources, categorizing them by translational research phase and social ecological level. The framework highlights that most opportunities call for real-world research—particularly effectiveness and dissemination and implementation studies—and emphasizes the importance of policy, systems, and environmental (PSE) interventions. It also identifies critical gaps, including the limited consideration of physical activity for all populations. By organizing opportunities for physical activity research into a single resource, the PARO framework offers researchers, funders, practitioners, and policymakers a roadmap to more efficiently prioritize and coordinate their efforts, ultimately accelerating progress towards increasing physical activity at the population level.

NCCOR’s second publication, titled “Advancing policy, systems, and environmental change research to reverse upward trends in obesity prevalence—a new call to action,” distills insights from the 2024 OPUS workshop series and issues a bold agenda for the future of obesity-related PSE research. Published in the American Journal of Preventive Medicine and authored by OPUS co-chairs Drs. Jamie Chriqui, Tamara Dubowitz, and Shiriki Kumanyika, the commentary synthesizes lessons from more than 45 expert presenters across diverse fields including nutrition, physical activity, housing, transportation, and economic policy. It highlights four cross-cutting themes for accelerating impact: adopting broader and more innovative research methods and partnerships; recognizing the time required for meaningful PSE change; measuring upstream and partner-relevant outcomes; and building capacity across researchers, practitioners, communities, and decision-makers.

Together, these new manuscripts emphasize NCCOR’s commitment to advancing science that is actionable and aligned with real-world needs. By providing a clearer pathway for future research and elevating the importance of PSE strategies, both PARO and OPUS offer instrumental guidance to researchers and practitioners working to create healthier communities nationwide.

Access both articles and relevant resources on the NCCOR website.

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NCCOR Toolbox: Advancing Your Research with NCCOR’s Data

December 2025, NCCOR

Did you know you can integrate NCCOR data into your research? NCCOR’s Childhood Obesity Evidence Base (COEB) and Childhood Obesity Declines (CODP) projects provide valuable data for examining trends and evaluating interventions. For example, a recent study in Frontiers in Public Health used CODP data to generate a systems dynamic map to expand on the Getting to Equity framework.  These projects highlight the value in using existing NCCOR datasets to advancing public health research.

Are you using NCCOR’s data or resources in your work? Let us know—we’d love to feature your projects!

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State of Childhood Obesity 2025 Annual Report: A Generation of Change: Reflections from Two Decades of Childhood Obesity Prevention

November 2025, Robert Wood Johnson Foundation

In the early 2000s, leading health experts sounded the alarm about skyrocketing rates of obesity among America’s children. Research showed the longterm health impacts of obesity, but there was no widespread agreement about what might work to prevent it or reduce rates overall.

Alongside our partners, RWJF saw an urgent need for change. In 2007, this urgency led to our initial $500 million pledge to reverse the childhood obesity epidemic—a deliberately large commitment. It was clear that all sectors of society—government, businesses, philanthropy, and nonprofits—would need to be engaged, even if the exact roadmap for each was still unfolding.

By investing in a way that demonstrated our longterm commitment, we aimed to show our partners we would work alongside them as they made their own commitments too. So many who began this work in the early 2000s are still working to make lasting change. Their perseverance has made a difference for families and communities nationwide.

[Source]

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Universal School Meals: A Powerful Strategy to Combat Food Insecurity

November 2025, National Policy Institute, University of California Agriculture and Natural Resources

Food Insecurity in California

Nearly 1 in 6 CA households with children—over 660,000 households—are food insecure, with limited or uncertain access to adequate food. Food insecurity in childhood is associated with:

• Poor overall health, both as children and into adulthood
• Lower academic achievement, developmental delays

 School Meals Help

• Since 2022, California has offered two nutritious meals every school day to all of its 6 million TK-12 students, regardless of their family income
• School meals are the overall healthiest source of food in U.S. children’s diets
• Cuts and restrictions to SNAP (CalFresh) in U.S. H.R.1 of 2025 make School Meals for All more important than ever in addressing food insecurity

NPI Studied Food Insecurity and School Meals

2023 survey of 3,377 parents/caregivers in 4 states with School Meals for All (CA, ME, MA, VT) and 4 states with the traditional means-tested approach (AZ, TX, IL, NH).

Key Findings from Across 8 States

12% less food insecurity among families with children in states with School Meals for All compared to states with means-tested school meals.

Greatest reduction in food insecurity among:

• Lowest income households (19% lower)
• Households just above reduced-price meal eligibility threshold (18% lower)

The most extreme form of food insecurity—where families need to skip meals—was 17% lower in states with School Meals for All.

Conclusion

School Meals for All programs are associated with lower food insecurity, especially among the most vulnerable families.

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DNPAO Data, Trends, and Maps

September 2025, Centers for Disease Control and Prevention

This interactive database provides national, state, and county-level data about the health status and behaviors of Americans as well as environmental or policy supports. Categories include breastfeeding, fruits and vegetables, physical activity, sugar drinks, media use, and obesity/weight. Visitors can examine data by demographics such as sex and race/ethnicity. The data comes from multiple sources.

[Source]

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Everyday Routines in Early Infancy May Shape Later Obesity Risk, Study Finds

November 20, 2025, EurekAlert!

In the United States, approximately 14.7 million children and adolescents between the ages of 2 and 19 are living obesity, according to the Centers For Disease Control and Prevention. Since children living with obesity are at greater risk for a number of long-term health consequences such as Type 2 diabetes and cardiovascular disease, early identification of risk behaviors is crucial. Pediatricians and other health professionals have opportunities to provide guidance on healthy eating, sleep and physical activity with families however, these preventative efforts are often limited by the brief time available during well child visits.

But could the routines that shape a child’s weight trajectory be set much earlier?

A new study from researchers at Penn State, published in JAMA Network Open, suggests that a handful of routines around feeding, sleep and play during the first two months of an infant’s life can be linked to higher weight just a few months later. The researchers analyzed data gathered from the Early Healthy Lifestyles (EHL) screening tool — a tool designed to identify child appetite, feeding, sleep and play routines linked to child weight outcomes — and demonstrated that it could help pediatricians and nutritionists working with families with young infants provide more personalized guidance during well child visits.

The findings could help pediatricians and other health care providers pinpoint risk behaviors for obesity. By identifying specific areas where families might benefit from personalized support, health professionals can promote responsive caregiving and improve a child’s health from the very start, the researchers said.

“By just two months of age, we can already see patterns in feeding, sleep and play that may shape a child’s growth trajectory,” said Yining Ma, doctoral student at The Child Health Research Center at Penn State and lead author on the study. “This shows how important it is to screen early in infancy so we can support families build healthy routines, prevent excessive weight gain and help every child get off to the best possible start.”

Children growing up in low-income contexts are more likely to experience challenges that affect healthy growth, including limited access to resources that support nutritious eating and active play, the researchers said. Parents may also receive mixed messages from sources such as pediatricians and community-based providers — like the federally funded Women, Infants, Children (WIC) program, which provides nutrition education and support to pregnant and postpartum women and children — and that can be confusing, especially for new parents, the researchers said.

“With the limited time available during pediatric and nutrition visits, it’s essential to help providers focus on what matters most for each family,” said Jennifer Savage Williams, professor and director of The Child Health Research Center at Penn State and senior author of the study. “Having something like the EHL tool that helps providers identify specific routines and behaviors linked to later child weight would be valuable for screening and counseling efforts.”

The researchers analyzed EHL tool submission data from 143 mothers and their infants receiving care from the Geisinger Health System and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in northeastern Pennsylvania. The EHL tool is a 15-item questionnaire that asks about daily routines such as infant diet, sleep, play and appetite as well as caregivers’ approach to feeding, and can potentially help health professional provide more tailored support and guidance.

The researchers identified nine everyday behavioral routines, reported on the EHL when infants were two months old that were linked to higher BMI and weight-for-length z scores — a measure that compares a child’s weight to the median weight for their height and sex — at six months of age. The team then created a score by adding up the number of less healthy behaviors parents reported. For each additional behavior used at two months, infants had significantly higher BMI and weight-for-length z score. The findings suggest that even small differences in early habits can influence growth within the first months of life, according to the researchers.

Behaviors linked to higher weight at six months include:

• Feeding practices such as using bottle sizes that aren’t appropriate for an infant’s developmental stage, nighttime feeding and a mother’s perception that her infant is always hungry
• Sleep habits such as putting an infant to bed after 8 p.m., waking two or more times during the night, having a TV on in the room where an infant sleeps and putting a baby to bed when they are already asleep instead of drowsy
• Limited active play or tummy time and a parent using a cellphone or television while playing with the infant

The behaviors identified on the screener — like using food to calm an upset baby who isn’t showing signs of hunger — are common strategies that parents often use to comfort their infants in the moment. But these well-intended actions can sometimes limit a child’s chances to learn self-regulation, said Savage Williams. On the other hand, responsive parenting practices, when caregivers pay close attention to their child’s signals and respond in a warm, timely and appropriate way, helps children develop healthy regulation across a variety of needs, the researchers explained.

“Responsive parenting can sometimes feel harder in the moment,” Savage Williams said. “But, when families build consistent and predictable routines in the household, they can help the child develop the ability to regulate themselves. As kids grow up and they have more autonomy, those early routines give them the skills to make healthy decisions on their own.”

The research team plans to expand this work to include families from a wider range of backgrounds to see if the findings hold true across different populations. Since many of the identified behaviors don’t occur in isolation but rather together, the team said they also hope to investigate how these behaviors cluster and interact to shape children’s growth over time.

“When parents get mixed messages, it puts the burden on families to figure out what is right for them, and that can be overwhelming,” Savage Williams said. “Our goal is to help streamline that process by giving providers a consistent way to talk about unhealthy routines and the behaviors that matter most for children’s growth.”

Other Penn State authors include Amy Moore, assistant professor of nutritional sciences; and Zachary Fisher, assistant professor of human development and family studies. Lisa Bailey-Davis, professor of population health sciences and director of the Center for Women’s & Children’s Research at Geisinger College of Health Sciences, also contributed to this paper.

Funding from the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the National Center for Advancing Translation Sciences of the National Institutes of Health supported this work.

[Source]

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Ultra-Processed Foods and Human Health

November 18, 2025, The Lancet

This 3-paper Series reviews the evidence about the increase in ultra-processed foods in diets globally and highlights the association with many non-communicable diseases. This rise in ultra-processed foods is driven by powerful global corporations who employ sophisticated political tactics to protect and maximise profits. Education and relying on behaviour change by individuals is insufficient. Deteriorating diets are an urgent public health threat that requires coordinated policies and advocacy to regulate and reduce ultra-processed foods and improve access to fresh and minimally processed foods. The Series provides a different vision for the food system with emphasis on local food producers, preserving cultural foods transitions and economic benefits for communities.

[Source]

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The Lancet Child & Adolescent Health: High Blood Pressure in Children and Adolescents Nearly Doubled Between 2000 and 2020, Suggests Largest Global Study to Date

November 12, 2025, EurekAlert!

The rate of children and adolescents experiencing high blood pressure worldwide nearly doubled between 2000 and 2020, according to a new meta-analysis published in The Lancet Child & Adolescent Health journal.

In 2000, approximately 3.2% of children had hypertension, but by 2020, the prevalence had increased to more than 6.2% of children and adolescents under age 19, affecting 114 million young people around the world. The study suggests that obesity is a substantial driver of the increase in childhood hypertension, with nearly 19% of children and adolescents living with obesity affected by hypertension, compared to less than 3% in children and adolescents considered a healthy weight.

“The nearly twofold increase in childhood high blood pressure over 20 years should raise alarm bells for healthcare providers and caregivers,” said study author Prof Igor Rudan, Director of the Centre for Global Health Research at The Usher Institute, University of Edinburgh (UK). “But the good news is that we can take steps now, such as improving screening and prevention efforts, to help control high blood pressure in children and reduce the risks of additional health complications in the future.”

Based on a meta-analysis of data from 96 large studies involving more than 443,000 children across 21 countries, the researchers found that how blood pressure is measured in children and adolescents can affect prevalence estimates. When hypertension is confirmed by a healthcare provider over at least three in-office visits, the prevalence was estimated to be approximately 4.3%. However, when the researchers also included out-of-office assessments such as ambulatory or home blood pressure monitoring, the prevalence of sustained hypertension climbed to about 6.7%. The research highlighted that conditions like masked hypertension—where hypertension is not detected during routine checkups—affect nearly 9.2% of children and adolescents globally, indicating potential underdiagnosis. Simultaneously, the prevalence of white-coat hypertension (a condition where a person’s blood pressure is elevated only when they are in a medical setting, such as a doctor’s office, but is normal at home or when measured with a home blood pressure monitor) was estimated at 5.2%, which suggests that a notable proportion of children might be misclassified.

“Childhood high blood pressure is more common than previously thought, and relying solely on traditional in-office blood pressure readings likely underestimates the true prevalence or leads to misdiagnosis of hypertension in children and adolescents. Early detection and improved access to prevention and treatment options are more critical than ever to identify children experiencing or at-risk for hypertension. Addressing childhood hypertension now is vital to prevent future health complications as children transition to adulthood,” said study author Dr Peige Song, of the Zhejiang University School of Medicine (China).

The analysis suggests that children and adolescents with obesity are at a nearly eight times higher risk of developing high blood pressure, with approximately 19% of children with obesity having hypertension, compared to 2.4% of children and adolescents considered to be within a healthy weight range. This happens because obesity can cause other health problems, such as insulin resistance and changes in blood vessels, which make it harder to keep blood pressure within a healthy range.

The study also suggests that an additional 8.2% of children and adolescents have prehypertension, meaning blood pressure levels are higher than normal but do not yet meet the criteria for hypertension. Prehypertension is especially prevalent during adolescence, with rates reaching around 11.8% among teenagers, compared to about 7% in younger children. Blood pressure levels also tend to increase sharply during early adolescence, peaking around age 14, especially among boys. This pattern emphasises the importance of regular blood pressure screening during these critical years. Children and adolescents with prehypertension are more likely to progress to full hypertension.

The authors acknowledge some limitations of the study, including data variability due to differences in measurement methods, study designs, and regional healthcare practices. Many of the articles included originated from low- and middle-income countries, which may influence the overall estimates’ applicability globally. Additionally, some specific hypertension phenotypes and out-of-office assessments had limited data. Lastly, practical barriers such as lack of access to advanced blood pressure monitoring tools in some areas could hamper widespread adoption of recommended diagnostic procedures.

Writing in a linked Comment, lead author Rahul Chanchlani of McMaster University (Canada), who was not involved in the study, said, “Harmonised diagnostic criteria, expanded out-of-office monitoring, and context-sensitive surveillance are essential next steps. Education of healthcare providers, families, and policymakers is also crucial. The integration and implementation of childhood hypertension into broader non-communicable disease prevention strategies is a priority, recognising that cardiovascular risk begins not in middle age, but in childhood. The task ahead is straightforward: to ensure that no child’s elevated blood pressure goes undetected, unrecognised, or untreated.”

[Source]

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Testing Implementation Strategies for a Family Healthy Weight Program: Results from the Nebraska Childhood Obesity Research Demonstration 3.0 Pilot Trial

November 3, 2025, Childhood Obesity

Background

Building Healthy Families (BHF) is an adapted family healthy weight program (FHWP) designed for and implemented in rural areas. To increase the likelihood of the broad dissemination and implementation of BHF to other rural communities, the Nebraska Childhood Obesity Research Demonstration 3.0 project developed the BHF Online Training Resources and Program Package (BHF Program Resources). The BHF Program Resources is a “turn-key” online platform that includes a train-the-trainer system, program materials, and a data portal for use by community-based implementation teams.

Methods

A community-randomized type 3 hybrid effectiveness-implementation pilot study tested the BHF Program Package only (BHF-PO) with and without an action learning collaborative (BHF-LC) to determine relative implementation fidelity and effectiveness among community-based implementation teams. RE-AIM was used for planning and reporting outcomes.

Results

The BHF-LC communities demonstrated higher implementation fidelity during the core sessions (90.6% vs. 75.8%, p = 0.076), with greater contact hours (17.8 vs. 14.8, p = 0.096). Adoption and Maintenance were successfully achieved but did not differ by the study condition. Children in the BHF-LC communities attended significantly more sessions (79% vs. 69%, p < 0.05, Reach) and showed a greater change in the BMI z-score (−0.15 ± 0.14 vs. −0.08 ± 0.16, p < 0.05, Effectiveness) by 3 months.

Conclusions

Rural communities can implement the BHF program with fidelity using online resources; however, adding a learning collaborative may improve early implementation quality and child engagement. These findings warrant further testing in a larger trial.

[Source]

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