February 2019

Just Released: NCCOR’s 2018 Annual Report

February 28, 2019, NCCOR

NCCOR’s 2018 Annual Report, “A Decade of Transforming Childhood Obesity Research,” showcases accomplishments from the last year and the last decade, as the Collaborative celebrates 10 years since it was first launched.

In 2018, NCCOR:

• Updated more than 70 systems in the Catalogue of Surveillance Systems and added five new systems including NCI’s Family Life, Activity, Sun, Health, and Eating (FLASHE) study, and USDA’s National Household Food Acquisition and Purchase Survey (FoodAPS).
• Published a chapter called, “Behavioral Design as an Emerging Theory for Dietary Change” in Food and Public Health, a book from Oxford University Press. The chapter comes from a white paper NCCOR released in 2017, that resulted from a series of meetings with experts that NCCOR convened in 2015 and 2016.
• Convened community-based healthy weight program representatives, through NCCOR’s Engaging Health Care Providers and Systems, for a kick-off meeting to launch its collaborative learning project.
• Facilitated six webinars, with more than 760 attendees, on a range of topics from preventing childhood obesity in Latin America to America’s eating habits away from home with experts from across the field.
• Attended seven conferences where NCCOR shared resources and presented new tools in workshops.
• Developed new materials to translate information and disseminate it to reach new audiences. These materials include the Measures Registry Q&A for students, guides to help PE teachers and public health practitioners use the Youth Compendium of Physical Activities, and a fact sheet to help others learn from NCCOR’s success in building a public health collaborative.

These are just some highlights from the last year. Check out the full annual report here to learn more about what NCCOR accomplished in 2018 and in the last 10 years!

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NCCOR's Toolbox

This month, NCCOR is introducing a brand-new section to the monthly newsletter to feature some of the most useful and innovative tools that the Collaborative has to offer. Check back here each month to see what you can incorporate into your research methods or see all of NCCOR’s tools at nccor.org/nccor-tools/

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Healthy Youth Index

This tool from CDC’s Division of Adolescent and School Health has a newly updated website with a cleaner look and more user-friendly design. Researchers and practitioners can search for data and statistics, fact sheets, funded programs, and more to incorporate into their childhood obesity research.

See the resources here

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Food Research & Action Center School Breakfast Scorecard, 2017-2018 School Year

This annual report analyzes participation in the School Breakfast Program among low-income children nationally and in each state and the District of Columbia for the 2017–2018 school year. The report features best practices for increasing participation in the program, including breakfast after the bell models and community eligibility.

Read the report here

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Decisions to Act: Investing in Physical Activity to Enhance Learning and Health

A new report from the Physical Activity Research Center investigates why and how physical activity-supportive elementary schools prioritize and implement physical activity strategies to help students reach the recommended amount of daily physical activity.

Read the report here

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Why These Pacific Island Nations Have World’s Highest Childhood Obesity Rates

February 13, 2019, CNN

Childhood obesity continues to rise around the world, and the World Health Organization has called it “one of the most serious public health challenges of the 21st century.”

Yet the prevalence of childhood obesity appears to vary across countries.

Island nations in the Pacific, such as Nauru and the Cook Islands, appear to have the highest obesity rates among children 5 to 19, but the countries Ethiopia and Burkina Faso appear to have the lowest rates.

“There are still more children that are underweight in the world than there are obese, but that’s likely to change pretty soon,” said Tiago Barreira, an assistant professor in the Department of Exercise Science at Syracuse University in New York who has studied childhood obesity on a global scale.

The prevalence of child and adolescent obesity is expected to surpass the prevalence of moderate and severe underweight by 2022, according to a study published in the journal The Lancet in 2017.

The study estimated that in 1975, there were 11 million children 5 to 19 with obesity, and that number increased to 124 million in 2016.

The number of obese or overweight children 5 and younger climbed from 32 million globally in 1990 to 41 million in 2016, according to WHO data. If current trends continue, the number of overweight or obese children in that age group could increase to 70 million by 2025.

Where childhood obesity is most and least prevalent

The highest prevalence of obesity in children 5 to 9 is in the Pacific Islands, at around 30% for both boys and girls, said Juana Willumsen, an expert in WHO’s Department of the Prevention of Noncommunicable Diseases.

Based on that 2016 data, Nauru is followed by the Cook Islands at 36.1%, Palau at 35.5%, Niue at 33.3%, the Marshall Islands at 31.2%, Tuvalu at 31.1%, Tonga at 30.2%, Kiribati at 27.5%, Micronesia at 25.2% and Samoa at 24.9%.

Among children 10 to 19, Nauru still appears to have the highest obesity rate at 31.7%, followed by the Cook Islands at 30.3%, Palau at 29.4%, Niue at 27.6%, Tuvalu at 25.3%, Tonga at 24.9% and the Marshall Islands at 24.4%, according to WHO data from 2016.

“However, these are small countries,” Willumsen wrote in an email. “The next highest is Kuwait.” That Middle East country appears to have an obesity rate of 23.1% among children 5 to 9 and 22.8% among children 10 to 19, based on that WHO data from 2016.

On the other hand, “a number of countries have childhood obesity prevalence below 1% for boys,” Willumsen said, including Uganda and Rwanda among ages 5 to 9 and Niger, Burkina Faso and Ethiopia among ages 10 to 19, based on WHO data from 2016.

Several countries also have childhood obesity rates below 2% for girls, Willumsen said, including Cambodia and Burkina Faso among ages 5 to 19, according to 2016 data.

In the United States, the prevalence of childhood obesity was 18.5%, and it affected about 13.7 million children and adolescents in 2015 and 2016, according to the US Centers for Disease Control and Prevention.

A report from the Robert Wood Johnson Foundation, released last year, showed significant state-by-state differences in obesity rates among children 10 to 17. The report, based on combined data from 2016 and 2017, revealed that Mississippi had the highest childhood obesity rate at 26.1% for that time, and Utah had the lowest at 8.7%.

Across Europe, there seems to be similar rates of and differences in childhood obesity prevalence. A WHO report last year showed that of 34 countries in the European region, Cyprus, Greece, Italy, Malta, San Marino and Spain had the highest rates of childhood obesity. In these countries, about 1 in 5 boys was obese, and rates of obesity among girls were only slightly lower.

Denmark, France, Ireland, Latvia and Norway were among the countries with the lowest rates, ranging from 5% to 9% in either boys or girls, according to WHO. Those findings were based on 2015-17 data among children ages 6 to 9 from the WHO Childhood Obesity Surveillance Initiative.

‘The definition of obesity for children is not universal’

Obesity is defined by body mass index or BMI, which is a measure of the relationship between weight and height. Most health groups — including WHO — measure the condition in adults as when their body mass index is 30 or higher.

Yet in children, identifying and measuring obesity can be difficult, as their BMI drastically changes as they grow and standards around those measurements change with growth.

“The definition of obesity for children is not universal like the adults’,” Barreira said.

Also, “global data is a little problematic because the methods to collect data — self-reported or measured — and to analyze data differ. So some of the information that we have is not identical depending on who is reporting,” he said. “For children — depending on who is reporting — the World Health Organization has a standard, the CDC has another standard, so obesity rates vary.”

The CDC, for instance, defines childhood obesity as having a body mass index at or above the 95th percentile of a child’s age group in the CDC’s sex-specific growth chart.

Meanwhile, the WHO defines childhood obesity according to the WHO growth reference for school-age children and teens, so a body mass index that is two standard deviations above the average for a child’s age group and sex would be considered obese.

Overall, most health groups agree that there are several risk factors for childhood obesity, including eating high-calorie and low-nutrient foods and beverages; not getting enough exercise; sitting too much, such as watching television or other screen devices; medication use; and getting inadequate sleep.

WHO has noted that “replacing traditional foods with imported, processed food has contributed to the high prevalence of obesity and related health problems in the Pacific islands.”

Where a child lives can influence some of those risk factors, but overall, the link between risk factors and obesity has been well-established, Barreira said.

When it comes to exercise, a study published in the journal Obesity in 2017 found that across 12 countries — Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom and the United States — physical activity was a stronger predictor for childhood obesity than how much a child weighed when born.

“The main thing that we found was that there was a relationship between physical activity level — especially moderate to vigorous physical activity — and obesity in all those different places,” said Barreira, who was involved in the study. “So that relationship exists everywhere.”

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Public Health Nutrition: Translating Research into Practice

February 6, 2019, Journal of Nutrition Education and Behavior

Public health nutrition is a unique, multifaceted discipline that includes a wide range of experts in the research, policy, and programming sectors.  A goal of the SNEB Public Health Nutrition Division is to help translate public health nutrition research into practice and policies. This translation process is essential to ensure practitioners have the tools to implement effective, evidence-based interventions that have demonstrated improvements in nutrition-related behaviors and health outcomes of the target audiences. Furthermore, collaboration between researchers and practitioners is necessary to ensure that researchers are testing interventions that can feasibly be implemented in public health settings. The need for translating research into practice is certainly not new to the field of public health nutrition. However, as nutrition education programs continue to evolve to meet the changing needs of the population, the dissemination of information between practitioners, policy-makers, and researchers will remain important. Many nutrition programs, including the Supplemental Nutrition Assistance Program-Education (SNAP-Ed), have expanded their programming to include strategies that influence food and physical activity environments. Such program expansion can be made more effective and cost-efficient through the sharing of evidence-based interventions that target individual behaviors, environmental factors, and related policies. Additionally, utilizing evidence-based programming and evaluation instruments can be helpful for practitioners when obtaining initial funding and providing evidence of programmatic impact to secure continued funding. Furthermore, close collaboration between researchers and practitioners is necessary to generate evidence to help establish or advance local, state, and national level nutrition-related policies. Several resources are available to assist researchers and practitioners throughout the translation process. The Centers for Disease Control and Prevention’s Knowledge to Action (K2A) Framework is a tool to support collaborative efforts between researchers and practitioners. Through the K2A Framework, specific guidance is provided on researching, implementing, and evaluating interventions that are feasible and replicable for practitioners. Additionally, the National Cancer Institute and National Collaborative on Childhood Obesity Research have extensive collections of individual and environmental level diet and physical activity measures that researchers and practitioners can adopt. Lastly, the SNAP-Ed Toolkit is an example of how interventions can be made available for professionals to use in practice. This toolkit includes interventions, curricula, and evaluation instruments that are either research- or practice-tested and determined to be appropriate for SNAP-Ed implementing agencies. Continued contribution to these and similar resources by both researchers and practitioners will help facilitate the essential task of translating research into useful public health interventions.

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Keeping the Peace When Mom and Grandma Disagree on Feeding the Kids

February 1, 2019, EurekAlert!

Many mothers have to navigate a sea of advice from family and experts when it comes to feeding their babies. Nonetheless, nutrition educators typically focus only on the mother, even in Latino communities where grandmothers and other older female relatives often play major roles in caring for children.

A new study shows programs to reduce childhood obesity and other nutrition programs should incorporate all family members who regularly take care of children, not just their mothers.

Ann Cheney, an assistant professor in the Center for Healthy Communities at the UC Riverside School of Medicine, co-led the study with Tanya Nieri, an associate professor in the UCR Department of Sociology. The study focused on food and feeding in low-income Latino families and sought to generate ideas for the development of early childhood obesity prevention programs based on mothers’ experiences.

“Mothers are busy. We can’t assume that only the mother feeds her baby,” Cheney said. “In many cultures, senior women in family and community help with childcare and instruct new mothers on how, when, and what to feed their baby.”

The researchers talked about feeding babies with 19 women who had a child under 2 years old enrolled in Early Head Start programs in Riverside and San Bernardino counties. The participants were Latina, mostly of Mexican descent. Many lived in extended family households, which included in-laws or other members of their families of origin. A little over half spoke English as their dominant language, with the rest speaking predominantly Spanish.

Through Early Head Start nutritional education, the mothers knew a lot about healthy diets for babies but faced conflicting ideas from older female relatives. They knew, for example, that doctors do not recommend giving solid food to babies under six months old because it increases the risk of obesity. But many of them were told by their own mothers, mothers-in-law, or grandmothers to give their babies oatmeal, mashed rice and beans, or other soft foods to help their babies feel fuller and gain weight, even though the mothers did not think their babies were too thin.

The mothers also knew not to give their babies sugar but were often told by older female relatives to add sugar to milk or other foods so the baby would consume more of it. These relatives also often fed the children, making it harder for the mother to stick to the healthy feeding recommendations she learned through Early Head Start.

Some of the older relatives had experienced food insecurity growing up and did not want their grandchildren to experience it too. To the older generation, chubby babies with full stomachs were healthy babies. Although their advice came from love and concern for the baby’s health, the mothers knew some of the grandparents’ recommendations could to lead to obesity and other health problems.

The mothers used two strategies to balance their child’s healthy diet against preserving family harmony. They could agree to the relative’s instructions in face-to-face interactions, but later, feed the child as they wished. They could also use the opportunity to educate the family member by saying “no” and explain why. Most mothers used both strategies in different situations and with different family members.

“It is difficult at times to tell the family, ‘no.’ But we are thinking of the well-being of our children. Because our (family) roots are very strong,” one study participant said. “But families have to learn new ways too.”

The authors concluded that government sponsored nutrition education programs, like Early Head Start nutrition education, prioritize nuclear family dynamics and identify parents as primary caregivers. The researchers recommend that nutrition education programs should recognize the diversity of families and acknowledge other family arrangements including extended families, and programs should incorporate extended families in addition to the child’s parents.

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Rutgers Study Finds Need For Early Childhood Obesity Prevention Interventions Beyond Preschool Education Settings

January 30, 2019, Newswise

A Rutgers study has found a need for early childhood obesity prevention interventions beyond preschool education settings.

The paper, which appears in the journal PLOS ONE, reviewed 34 studies of obesity prevention programs and policies spanning pregnancy, infancy and preschool and found that there is a need for culturally adapted, bilingual nutrition and physical activity programs for children and their families.

“The studies show that most healthcare system initiatives did not to improve childhood growth trajectories and that culturally adapted, bilingual nutrition and physical activity programs were more beneficial to children and their families,” said lead author Sheri Volger, a graduate student at Rutgers School of Health Professions. “We also discovered there is little research on the cost-effectiveness of these programs and how much it actually costs to implement these prevention strategies.”

In the United States, about 14 percent of preschool children are obese, with the highest rates among low-income racial and ethnic minority communities. In the Rutgers study, researchers found that less than half of the obesity prevention initiatives recommended during pregnancy, infancy or preschool worked at improving appropriate weight gain in children. Some studies did work to improve health behaviors, such as limiting screen time, providing alternative playtime activities and serving nutritious snacks at childcare centers, but the researchers only included studies with a body mass index (BMI) outcome in the scoping review.

“Our study took a life course approach, which takes into account the important role that early life events play in shaping an individual’s future health,” said Volger.

While almost 80 percent of the interventions examined occurred during the preschool years, with 63 percent of these conducted in early childcare education settings serving low-income families, such as Head Start or the YMCA, only 42 percent registered a significant improvement in the BMI in children at high risk of obesity. “This finding underscores the needs to expand obesity prevention programs beyond the early childhood education setting,” she said.

The majority of the studies conducted during pregnancy studied lower income, pregnant minority women who were receiving health care services through clinics, home visits and primary care practices in order to help prevent excess gestational weight gain and accelerated infant growth during pregnancy.

Workshops and groups sessions were among the most beneficial programs components aimed at decreasing BMI scores. These programs taught by trained educators reinforced healthy lifestyles habits to families and childcare employees. “We found that programs that incorporated parental or family participation tended to be the most successful. The study reinforces the need to develop multi-level, multi-component obesity prevention, public health initiatives, focusing on the child, family and community to obtain the largest population research,” Volger said.

The study also highlights the need to intensify early childhood obesity preventive efforts during critical periods of health development. The researchers say future studies should estimate the feasibility, effectiveness and cost of implementing multilevel obesity prevention interventions and policies. “This early life stage is a critical time period because there is a growing body of evidence showing that it represents a phase when young children are developing food preferences but also susceptible to biological changes that will impact the child’s short-term health, and long-term risk for chronic metabolic conditions,” she said.

The paper was co-authored by Diane Rigassio Radler and Pamela Rothpletz-Puglia, associate professors at Rutgers School of Health Professions.

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