February 2020

NCCOR Unveils the Student Hub Webpage

NCCOR, February 2020

This month, NCCOR launched the new Student Hub! Students and faculty focused on public health and nutrition will find key resources to support coursework and research all in one place. Discover free tools and materials created by experts, along with real-world student case studies. Work efficiently and effectively knowing you are using tools that top childhood obesity researchers designed and use in their own work.

“The NCCOR Student Hub is easy to navigate and provides really useful information,” said Mary-Esther Gourdin, a student at George Washington University. “This site is going to be an invaluable tool for my capstone project when I’m evaluating and comparing the physical activity environments in the different neighborhoods of DC.”

Through the Student Hub, students can access the Measures Registry Resource Suite, the Catalogue of Surveillance Systems, and the Youth Compendium of Physical Activities, which assist students with their evaluation projects, thesis papers, and more.

As part of NCCOR’s Connect & Explore webinar series, the site will also feature student-focused webinars that highlight leading experts in the field on a variety of public health topics.

Register now to hear a real-world case study of how one graduate student used the Measures Registry to enhance their project with the Boys & Girls Clubs of America.

Stay connected to NCCOR with our quarterly e-newsletter! It will keep you up to date on the latest tools, resources, case studies, and webinars that NCCOR creates to further your studies. (Be sure to select “Student”).

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NCCOR's Toolbox

Check out the new Measures Registry Resource Suite page on the NCCOR website. It’s now easier than ever to learn about and access the Measures Registry, Measures Registry User Guides, and Measures Registry Learning Modules—all in one place!

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Marketing to Children in Supermarkets: An Opportunity for Public Policy to Improve Children’s Diets

According to a new report from the Rudd Center for Food Policy and Obesity, child-targeted cereals receive more shelf space, middle- and lower-shelf placements, and promotions compared with other cereals. This in-store marketing encourages children’s consumption of nutrient-poor foods.

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Child Opportunity Index (COI)

The COI measures and maps the quality of resources and conditions that matter for children to develop in a healthy way in the neighborhoods where they live.

See the data

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Sleep and Adiposity in Children from 2 to 6 Years of Age

Pediatrics, February 18, 2020

OBJECTIVES: To compare sleep in young children at different obesity risks, which were based on parental weight, as well as to explore the longitudinal associations of sleep characteristics with adiposity.

METHODS: In total, 107 children from an obesity prevention project were included, of which 43 had normal-weight parents (low obesity risk) and 64 had overweight and/or obese parents (high obesity risk). Sleep was measured yearly from ages 2 to 6 years by using actigraphy. Five sleep characteristics, that of late sleep, long sleep latency, short sleep duration, low sleep efficiency, and irregular sleep onset, were defined and scored across ages, with a higher score indicating more frequent exposure. The outcome variables, also measured yearly, were BMI z score and waist circumference.

RESULTS: There was no difference in sleep patterns among children at different risks. Higher short sleep duration score was associated with a greater increase in BMI z score (0.12; 95% confidence interval [CI] 0.01 to 0.25) across ages. Independently of sleep duration, higher late sleep score was associated with greater increases in BMI z score (0.16; 95% CI 0.05 to 0.27) and waist circumference (0.60 cm; 95% CI 0.23 to 0.98). Moreover, compared with children at low risk and without habitual late sleep, children at high risk and with habitual late sleep had greater increases in BMI z score (0.93; 95% CI 0.40 to 1.45) and waist circumference (3.45 cm; 95% CI 1.78 to 5.12).

CONCLUSIONS: More frequent exposures to late sleep were associated with greater increases in adiposity measures from ages 2 to 6 years, particularly in children with obese parents.

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A Little Scoop: Unilever Will Stop Marketing to Kids in an Effort to Curb Childhood Obesity

The Washington Post, February 14, 2020

Unilever, one of the oldest multinational consumer goods companies, pledged this week to stop advertising ice cream to children. By the end of this year, the company will stop marketing and advertising foods and beverages to children under the age of 12 in television and print, and for children under 13 via social media channels.

Unilever may not leap to mind when it comes to frozen dairy confections, but it should. The company owns premium brands Ben & Jerry’s and Talenti, workhorse ice creams Breyers, Klondike and Good Humor, and specialty bars and ice cream treat brands Magnum, Cornetto, Viennetta, Choc Ice and others.

“The World Health Organization names childhood obesity as one of the most serious public health issues of the 21st century. And it’s a key reason why Unilever is committing to new principles on marketing and advertising foods and beverages to children,” the company said in a statement.

The company says it will not run ads on television and other media where children under 12 represent more than 25 percent of the audience. It will not promote ice cream products in schools or children’s films. In addition, Unilever said it won’t employ celebrities or social media influencers or use licensed cartoon characters in marketing that appeals primarily to kids under 12.

Obesity rates for children and adolescents have more than tripled since the 1970s, and experts say a drop of just a few percentage points could save thousands of children from diabetes, heart disease and other health problems. According to a National Survey of Children’s Health report released in October, obesity rates among youths ages 10 to 17 averaged 15.3 percent nationwide, with a childhood obesity rate hitting 25.4 percent in Mississippi.

Obesity declined among toddlers on food assistance after Obama-era reforms. But now enrollment is falling.

This is not the first time Unilever has pledged to restrict advertising aimed at children. In 2010, the company joined 18 of the world’s largest food corporations in signing the Children’s Food and Beverage Advertising Initiative (CFBAI), pledging not to advertise Skippy and Popsicle brands to children younger than six. For children between the ages of 6 and 11, it would advertise those food and beverage products that met certain nutrition criteria.

While brands like Magnum, Ben and Jerry’s and Breyers are marketed more to adults, Good Humor targets children directly via ice cream trucks. With this week’s announcement, Unilever also debuts a “Responsibly Made for Kids” label. By the end of 2020, every ice cream in the kids’ range will have no more than 110 calories and a maximum of 12 grams of sugar per portion.

“It’s a move designed to help parents, caregivers and kids make informed choices about the food and drinks they buy, and to address the rise of social media, and the vast increase in products on sale,” the Unilever statement said.

Fran Fleming-Milici, director of marketing initiatives for the nonprofit Rudd Center for Food Policy and Obesity, says that to meet that sugar limit, many products may have added artificial sugars, something not recommended for children. And while she sees Unilever’s announcement as a step in the right direction, she says government regulation is essential.

“Their bottom line is profit, not public health,” she said. “Without policies that put some rules around marketing to children across all companies, it’s hard to believe one company is going to sacrifice its profits to effectively reduce consumption of unhealthy foods. Policies would be good in that sense because they level the playing field.”

Shu Wen Ng, an associate professor in the nutrition department at the University of North Carolina at Chapel Hill, says that many food and beverage companies voluntarily restrict their marketing to kids as a means of delaying stronger regulations.

“They can say, ‘We’ve already done all these things and we’re being proactive,’ as a delay tactic,” she said. “They can pledge things that sound great but have a lot of loopholes.”

She says that companies may make pledges of this sort to get credit for portion-size changes or ingredient reformulations they were already considering in anticipation of the Food and Drug Administration’s Nutrition Facts labels, which went into effect last month. The new nutrition panels list total calories in a bigger font, and serving size requirements have changed to reflect what people actually eat (read: more). And for the first time, the label calls out added sugar as opposed to those naturally occurring and updates the list of nutrients required or permitted to be declared on the label.

Unilever did not respond to a request for further details about the announcement.

Latin American countries such as Chile have led the way in reducing children’s exposure to advertisements. Foods high in added sugar, saturated fats, calories and added sodium must display black stop signs on front-of-package labels. Nothing with black stop signs can be sold or promoted in schools or included in child-targeted television ads or marketing strategies aimed at children. Consumption of sugar-sweetened drinks dropped nearly 25 percent after Chile adopted the rules in 2016.

In the United States, food, beverage and restaurant companies spent $13.5 billion in advertising in all media in 2016, according to the Rudd Center, a 7 percent increase since 2007 despite those commitments from major food companies who signed the Children’s Food and Beverage Advertising Initiative.

Unilever’s total revenue dropped to $58.22 billion in 2019 from $60.32 billion in 2017, and lagging ice cream sales may have contributed: Per capita consumption has trended downward, with people eating 20 percent less ice cream per year in 2018 than in 2000. In December, Nestle, the other dominant ice cream company, sold its U.S. ice cream business altogether.

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Mindfulness Helps Obese Children Lose Weight and Decrease Anxiety: Study

ABC News, February 11, 2020

There may be a new secret ingredient to the tried and true methods of diet and exercise for weight loss. A new study has shown that mindfulness can aid in weight loss for obese children who also have anxiety.

“Childhood obesity not only leads to chronic medical conditions such as diabetes and high blood pressure, it also leads to poor self-esteem and depression,” said Dr. Mona Degan, a primary care physician practicing in Los Angeles.

Food choices and activity levels have long been associated with children that are obese, but stress, depression and anxiety are also found in as many as 87% of obese children. Stress and anxiety are even worse when children are put on a diet, according to the study, so it can be important to treat the body and the mind.

Researchers tested the effects of mindfulness on stress levels for eight weeks using self-reported surveys and charted changes in appetite and the amount of weight lost in children with obesity and anxiety.

The term “mindfulness” incorporates psychological techniques focused on attention, body awareness, breathing and meditation. Its premise is awareness and nonjudgmental acceptance of one’s moment-to-moment thoughts in order to cope with common forms of psychological distress, like anxiety, worry, fear, anger and more.

Examples of mindfulness include an awareness of breath, noticing thoughts as they pass through the mind, noticing physical sensations, awareness of body reaction in response to stresses and paying attention to sound and smell.

The results showed that children ages 10 to 14 years old with obesity and anxiety showed significant declines in anxiety scores, hormones involved in appetite regulation, body mass index, and cortical levels — a stress hormone measured from the saliva — when they received mindfulness exercises and nutrition courses versus a group that only received nutrition courses.

Scientific evidence suggests that individuals under chronic stress lose the ability to control eating. In fact, most of the eating disorders identified in children, such as emotional eating, purging, binge eating or restricting, are often related to chronic stress and anxiety.

The stress of engaging in a diet might result in an unsuccessful attempt at weight loss.

“Stress leads to increased cortisol levels, which causes fat to build up in the stomach and results in weight gain,” said Degan. “Psychologically, it can also fuel obesity by leading to comfort and stress eating, which are poor coping mechanisms that last through adulthood.”

Degan was not involved in this particular study.

The current research supports the possible addition of mindfulness as a way to counteract the anxiety and stress experienced by children on a diet.

The relationship between mindfulness and reduction of anxiety is well established.

“Mindfulness practice reduces activity in the part of your brain called the amygdala, which is involved in the stress response, so effectively, by practicing mindfulness your baseline level of stress is reduced,” said Degan.

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Half of Us Face Obesity, Dire Projections Show

New York Times, February 10, 2020

Climate change is not the only source of dire projections for the coming decade. Perhaps just as terrifying from both a health and an economic perspective is a predicted continued rise in obesity, including severe obesity, among American adults.

A prestigious team of medical scientists has projected that by 2030, nearly one in two adults will be obese, and nearly one in four will be severely obese. The estimates are thought to be particularly reliable, as the team corrected for current underestimates of weight given by individuals in national surveys. In as many as 29 states, the prevalence of obesity will exceed 50 percent, with no state having less than 35 percent of residents who are obese, they predicted.

Likewise, the team projected, in 25 states the prevalence of severe obesity will be higher than one adult in four, and severe obesity will become the most common weight category among women, non-Hispanic black adults and low-income adults nationally.

Given the role obesity plays in fostering many chronic, disabling and often fatal diseases, these are dire predictions indeed. Yet, as with climate change, the powers that be in this country are doing very little to head off the potentially disastrous results of expanding obesity, obesity specialists say.

Well-intentioned efforts like limiting access to huge portions of sugar-sweetened soda, the scientists note, are effectively thwarted by well-heeled industries able to dwarf the impact of educational efforts by health departments that have minuscule budgets by comparison. With rare exceptions, the sugar and beverage industries have blocked nearly every attempt to add an excise tax to sugar-sweetened beverages.

Claims that such a tax is regressive and unfairly targets low-income people is shortsighted, according to Zachary J. Ward, public health specialist at Harvard and the lead author of the new report, published in The New England Journal of Medicine in December.

“What people would save in health care costs would dwarf the extra money paid as taxes on sugar-sweetened beverages,” he said in an interview.

Yet, in a city like Philadelphia, where a soda tax of 1.5 cents an ounce took effect three years ago, total purchases declined by 38 percent even after accounting for beverages people bought outside the city, his co-author Sara Bleich told me.

However, she quickly added, piecemeal changes like this are not enough to make a significant difference in the obesity forecast for the country. Rather, nationwide changes are needed in the ubiquitous food environment that has fostered a steady climb toward a weight-and-health disaster. As the new report clearly demonstrated, Americans weren’t always this fat; since 1990, the prevalence of obesity in this country has doubled.

People who choose to blame genetics are fooling no one but themselves, Mr. Ward said. Our genetics haven’t changed in the last 30 years. Rather, what has changed is the environment in which our genes now function.

“Food is very cheap in the United States, and super easy to access,” said Dr. Bleich, a professor of public health at the Harvard T.H. Chan School of Public Health. We eat out more, consuming more foods that are high in fat, sugar and salt, and our portion sizes are bigger.

As Mr. Ward noted, “You don’t even have to leave home to eat restaurant-prepared food — just call and it will be delivered. If you have a smartphone, Uber Eats will bring fast food to your door in minutes.”

As a society, we also snack more, a habit that starts as soon as toddlers can feed themselves. My dog knows all too well that the bottoms of strollers are a rich source of snacks.

“People are snacking throughout the day,” Mr. Ward said. “Snacking is the normal thing to do in the United States. In France, you never see anyone eating on a bus.”

We also eat more highly processed foods, which have been shown to foster weight gain, thanks to their usually high levels of calories, sugar and fat.

A recent study showed that even when controlling for weight, consuming lots of processed foods raises the risk of developing Type 2 diabetes.

“It doesn’t take that many extra calories to result in weight gain,” Dr. Bleich said. “Through marketing, we’re constantly being sold on foods we didn’t even know we wanted. We’re all about immediate rewards. We’re not thinking about the future, which is why we’re going to see more than half the population obese in 10 years.”

Unless something is done to reverse this trend, Mr. Ward said, “Obesity will be the new normal in this country. We’re living in an obesogenic environment.”

“While there’s no one thing to throw at the problem,” Dr. Bleich said, “if I could wave a magic wand, I’d make a tax on beverages a federal mandate because they’re the largest source of added sugar in the diet and are strongly linked to weight gain and health problems. When people drink their calories, they don’t feel as full as when they consume solid food, so they end up eating more.”

This may also be true for calorie-free sweet drinks. Although the jury is still out on cause and effect, the link between beverage consumption and greater intake of calories may also apply to drinks flavored with no-calorie or low-calorie sweeteners.

With a third of meals now being eaten out, Dr. Bleich suggested that prompting restaurants to gradually, surreptitiously reduce the amount of fat, sugar and calories in the meals they serve could help put the brakes on societal weight gain. “Menus could make healthier, lower-calorie meals the default option,” she said.

Controlling portion sizes is another critically important step. “Big portions are especially motivating for low-income people who reasonably want to get more calories for their dollar,” she said. Low-income groups already have the highest rates of obesity and, the new projections show, they are the groups most likely to experience a rising prevalence of obesity and severe obesity.

Another policy-based approach that could reverse rising obesity projections might be to partner with climate control advocates, Dr. Bleich suggested. “If we pull more meat out of the American diet, it would help both the environment and weight loss,” she said.

“From a policy perspective,” Mr. Ward said, “prevention is the way to go. Children aren’t born obese, but we can already see excessive weight gain as early as age 2. Changes in the food environment are needed at every level — local, state and federal. It’s hard for individuals to voluntarily change their behavior.”

He said health-promoting changes in the food packages provided to low-income women, infants and children since 2009 have helped to reverse or stabilize obesity in the preschool children who receive them. Evaluations are currently underway to assess the impact of healthier school meals.

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Obesity Treatment Programs May Boost Kids’ Self-Esteem, Body Image

Reuters, February 6, 2020

Children who participate in obesity treatment programs get a benefit over and above weight loss: they may also start seeing themselves more positively, a new study suggests.

Based on an analysis of data from 64 previous studies, researchers concluded that obesity treatment programs appeared to boost kids’ self-esteem and improve body image – and not just because the kids lost weight.

“Professionally-administered pediatric weight management programs can lead to improvements in psychological wellbeing outcomes, including self-esteem and body satisfaction,” said Megan Gow, NHMRC Early Career Fellow at The University of Sydney, in Australia, and the study’s lead author.

It might be tempting to assume that both of the psychological outcomes were tied to actual weight loss, but it’s more complicated than that, Gow said in an email.

“We did an analysis to try to determine what was driving these improvements,” Gow said. “For body image improvements, weight loss was one factor that played a role in leading to greater improvements. Other factors that could be playing a role include the support provided from service providers and improvements in diet quality.”

While weight loss was associated with improvements in body image, it didn’t appear to play a role in boosting self-esteem, even though the programs achieved significant weight loss, Gow said.

Data pooled from 49 studies that examined the impact of obesity treatment programs on self-esteem showed the improvements were lasting, Gow’s team reports in Pediatric Obesity.

Similarly, in the pooled analysis of the studies that looked at changes in body image, Gow and her colleagues found treatment programs appeared to improve body satisfaction and that persisted through the follow-up periods.

The new study may help alleviate concerns that obesity treatment programs might cause psychological harms, said Marsha Marcus, a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine.

“The question of whether obesity interventions for children are entirely helpful or may have unintended harms associated with them is an important one,” Marcus, who was not involved in the new study said. “Some folks, especially those who focus on disordered eating, worry that any type of limiting of food intake can precipitate problems.”

Most of the literature to date has not confirmed that weight management has a negative effect on a variety of psychosocial issues, such as anxiety, depression and eating disorders, Marcus said.

The strength of the current research is that it systematically reviews all the literature on the questions of interest, Marcus said, adding that it also has drawbacks because it pools data from studies with a variety of interventions, investigators and places.

“(Still) it contributes to the literature, suggesting that, at least in the short and medium term, weight management does not have a deleterious effect on body image and self-esteem,” Marcus said. “Is it the final word? No.”

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