February 2023

What Is Implementation Science and How Can It Help Childhood Obesity Programs?

Sometimes even the best research ideas fail to make a difference. Or worse, an intervention can exacerbate public health inequities by not reaching those who most need it. Implementation science helps bridge the gap between science and how we implement interventions to create sustained, equitable outcomes.

Recently, NCCOR invited six experts from this emerging field to discuss both their research and practical experiences leading nutrition and physical activity programs. Nearly 200 people attended the virtual workshop, Implementation Science and Childhood Obesity: Sparking Conversations and Actions to Advance Equity. Below are five helpful takeaways from the speakers:

• Implementation science considers more than the intervention. It examines the 1) intervention, 2) the strategy used to implement the intervention, and 3) the context where the intervention occurs. When considered together, these indicators help identify opportunities to increase efficacy, address social determinants of health, and promote equity.
• Embrace change when needed. Effective interventions adapt in response to local cultures and needs. Programs may modify existing measures to capture these changes.
• Use implementation science early and often. Plan for adaptations, scale, and sustainability at the beginning of a project and refine these projections over time as the intervention matures.
• Everyone can benefit from learning about implementation science. Concepts from implementation science can help practitioners and policy makers refine their programs even if they don’t conduct their own research.
• Partnerships drive success. Every speaker during the NCCOR workshop emphasized the importance of local partners to help plan, implement, and refine programs. Begin recruiting partners early on, make a long-term commitment to them, and acknowledge them for their contributions.

This list is just a sample of ideas presented during the informative 3-hour workshop. Visit the NCCOR website to access the slides, recording, and a helpful resource list with links to peer reviewed articles, websites, videos, and professional trainings about implementation science.

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NCCOR Toolbox: Popular NCCOR Webinar Now Available Online

On January 11, 2023, NCCOR hosted a Connect & Explore webinar that explored “Breastfeeding Initiation Trends by WIC Participation and Race/Ethnicity Among Medicaid Births,” a research study soon to appear in the Journal of Nutrition Education and Behavior. The webinar provided a first hand look at the long-term breastfeeding initiation trends by prenatal WIC participation. The paper used birth certificate data from a sample of 24 states over the period 2009-2017 to examine trends in breastfeeding initiation among WIC-participating women on Medicaid compared to those not on WIC. The large number of women included in the dataset allowed the assessment of trends among different population groups including American Indian/Alaska Natives and Asian/Pacific Islanders. This unique information supports current efforts to improve breastfeeding, a protective factor against childhood obesity, among women from diverse groups that participate in WIC programs. Visit the webinar webpage on the NCCOR website to view the recording and access the slides.

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American Academy of Pediatrics Issues Its First Comprehensive Guideline on Evaluating, Treating Children and Adolescents with Obesity

January 9, 2023, American Academy of Pediatrics

The AAP has published its first comprehensive guidance in 15 years that highlights more evidence than ever that obesity treatment is safe and effective. Evidence-based recommendations on medical care for those age 2 and older are included within a new “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” published in the February 2023 Pediatrics (published online Jan. 9). The guideline is accompanied by an executive summary and two technical reports, “Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions,” and “Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities.”

The AAP guideline contains key action statements, which represent evidence-based recommendations for evaluating and treating children with overweight and obesity and related health concerns. These recommendations include motivational interviewing, intensive health behavior and lifestyle treatment, pharmacotherapy and metabolic and bariatric surgery. The approach considers the child’s health status, family system, community context, and resources.

The guideline discusses increased risks for children with special health care needs, as well as inequities that promote obesity in childhood, such as the marketing of unhealthy food, low socioeconomic status and household food insecurity. The role of structural racism has played in obesity prevalence is also discussed.

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Increasing the WIC Vegetable and Fruit Benefits Leads to More Vegetable and Fruit Purchases

January 3, 2023, L.A. County WIC Data

As more families faced new economic and nutrition security hardships during the COVID-19 pandemic, the U.S. Department of Agriculture (USDA) approved an increase to the dollar amount provided for vegetables and fruits through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Referred to as the Cash Value Benefit (CVB) for vegetables and fruits, the CVB was increased in June 2021 from $9/month to $35/month per child and revised 4 months later to $24/month per child in October 2021. The current amount of $25/month per child was adjusted for inflation in October 2022 and has been approved through September 2023. These changes presented an opportunity to track and document the spending habits of WIC participants through changes to the benefits they receive as part of their WIC food package.

Families with young children appear to benefit economically and nutritionally from the increased CVB by being able to purchase more types and amounts of vegetables and fruits. These data support making the increased CVB a permanent part of the WIC food packages.

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Special Supplement: Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field

November 2022, Sage Journals

This supplemental issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field,” is entirely devoted to practice-based wisdom from the field of nutrition, physical activity, and obesity programs. The specific aims of this supplement are to advance public health research and practice by showcasing innovative community-centered interventions, implementation, adaptations, and evaluations employed by the Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity, and Obesity (DNPAO) cooperative agreement recipients: State Physical Activity and Nutrition Program (SPAN, DP18-1807), Racial and Ethnic Approaches to Community Health (REACH, DP18-1813), and the High Obesity Programs (HOP, DP18-1809).

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Mental Health in Children and Adolescents with Overweight or Obesity

January 19, 2023, BMC Public Health

Background

Overweight and obesity represent huge concerns for children’s physical and mental well-being. This study examined the relationship between body mass index (BMI) and health-related quality of life (HRQoL), somatoform complaints, and behavioral problems in children and adolescents. Additionally, the influence of sex, age, and socioeconomic status (SES) on these associations was considered.

Methods

In total, we studied 2350 participants between the ages of 4 and 18 years (1213 4- to 10-years-old (child sample) and 1137 11-to 18-year-olds (adolescent sample)). To assess HRQoL, somatoform complaints, and behavioral difficulties, we applied the KIDSCREEN-27, a short form of the Giessen Complaints Questionnaire, and the Strengths and Difficulties Questionnaire (SDQ). The BMI was transformed to BMI standard deviation scores (BMI-SDS), according to German gender- and age-specific reference data. Associations were investigated using linear regression analyses. Each association was checked for interaction with sex, age, and SES.

Results

Regarding HRQoL, we found worsening scores in physical well-being and psychological well-being with increasing BMI-SDS. Somatoform complaints were not significantly associated with BMI-SDS. Conduct problems, peer relationship problems, and emotional problems (the latter only in the adolescent sample) were positively associated with BMI-SDS. While we did not observe any significant interactions with sex, we found some significant interactions with age and/or SES.

Conclusion

Our findings highlight the importance of mental difficulties in children and adolescents with higher BMI and, consequently, underline the relevance of including psychological interventions in the treatment of overweight or obesity.

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Racial and Ethnic Comparisons in Satisfaction with Services Provided by the Special Supplemental Nutrition Program for Women, Infants, and Children in California

January 14, 2023, MDPI

Abstract

Understanding satisfaction of nutrition education and other services provided in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is needed to ensure the program is responsive to the needs of diverse populations. This study examined the variation of WIC participants’ perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference. Phone surveys were conducted in 2019 with California WIC families with children aged 1–4 years. While most participants (86%) preferred one-on-one nutrition education, online/mobile apps were also favored (69%). The majority (89%) found nutrition education equally important to receiving the WIC food package. Racial/ethnic groups differed in which WIC service they primarily valued as 20% of non-Hispanic White people rated the food package as more important than nutrition education compared to 5% of Spanish- and 6% of English-speaking Hispanic people, respectively. More Spanish (91%) and English-speaking Hispanic people (87%) than non-Hispanic white (79%) or Black people (74%) changed a behavior because of something they learned at WIC (p < 0.001). Spanish-speaking Hispanic people (90%) had the highest satisfaction with WIC nutrition education. Preferential differences among participants suggest that providing flexible options may improve program satisfaction and emphasizes the need for future studies to examine WIC services by race and ethnicity.

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Discovery of Metabolic Switch Could Lead to Targeted Treatment of Obesity, Cancer

January 11, 2023, EurekAlert!

An Iowa State University research team has discovered a method for modifying the function of an enzyme crucial to fat production, which could lead to more effective treatments for childhood obesity and cancer.

While the research was in fruit fly larvae, being able to speed up or slow down lipid metabolism could have significant implications for human health, said Hua Bai, an associate professor of genetics, development and cell biology.

“We’ve identified what’s basically a metabolic switch. It’s like the accelerator on a car,” he said.

The focus of Bai’s research lab is the cellular and molecular mechanisms that cause animals to age. That was the initial intent of studying fatty acid synthase, an enzyme that plays a role in de novo lipogenesis, which is the process of turning excess dietary carbohydrates into fat. Typically, levels of fatty acid synthase rise and fall based on an animal’s cellular needs and diet.

Surprisingly, the researchers noticed that early in a fruit fly’s development, de novo lipogenesis increases without an accompanying boost in the expression of fatty acid synthase. That suggested there must be some other factor at play, Bai said.

After proteins such as fatty acid synthase are created based on genetic code, their function can be altered by one of several different types of post-translational modification. Bai’s team found one of those processes, acetylation, affected one of the 2,540 amino acids that combine to make fatty acid synthase, changing how effective it was at producing fat.

The research was published last month in the Proceedings of the National Academy of Sciences, a peer-reviewed journal.

In addition to its role in obesity, elevated levels of de novo lipogenesis are linked to cancer, so controlling it through a single amino acid could lead to highly targeted treatments, Bai said.

“Fine tuning the acetylation levels of fatty acid synthase would be a much more precise treatment than blocking the entire protein,” he said.

It’s not certain that the processes Bai’s team studied will work the same in humans, but the two species’ genomes are similar, which is part of the reason fruit flies are a common research subject. Still, capitalizing on the discovery to treat human disease is many years away, he said.

“The potential is high, but further testing is needed in other animals,” he said.

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USDA and National Urban League Partner to Promote Equity, Increase Nutrition Security and Expand Services in Underserved Communities Across America

January 11, 2023, U.S. Department of Agriculture

Today, U.S. Department of Agriculture (USDA) Secretary Tom Vilsack and Marc H. Morial, President of the National Urban League, announce a Memorandum of Understanding (MOU) to reaffirm and strengthen the relationship between USDA and the historic civil rights organization. USDA and National Urban League share a common mission to enhance equity across the country, ensure access to adequate nutrition and improve quality of life for underserved populations.

Through this strategic partnership, USDA and National Urban League will work collaboratively to promote nutrition and food security, increase access to healthy foods, and ensure equitable service delivery of USDA programs in underserved communities across the country. Moreover, this union will encourage urban agriculture as a means of increasing food production and access, making a living, and improving the environment, thereby building stronger communities.

“This signing reinforces USDA’s commitment to improving health outcomes and quality of life in the communities that we serve,” said Secretary Vilsack. “To help those who have been historically underserved, it is paramount that we work together with a shared commitment to improve access to our programs, equip people with the resources they need, and advance equity goals.”

“This is a broad and far-reaching initiative that will address inequity and create opportunity at every level of the Department’s programming and regulatory responsibility,” Morial said. “We’re proud to collaborate with a forward-thinking agency that is committed to carrying out the Biden-Harris Administration’s whole-of-government equity agenda.”

In addition to ensuring adequate nutrition and promoting health equity, this MOU establishes the inclusion of urban agriculture and rural development opportunities into USDA’s workforce development and entrepreneurship programs so current and future workers can acquire the skills needed to meet the demands of highly skilled agricultural jobs.

Together, USDA and National Urban League will explore and develop ways to engage the civil rights organization in an effort to enhance USDA’s ability to fulfill its missions efficiently and fairly. The first phase of the partnership will focus on identifying and developing areas in which the USDA offices and agencies can improve their ability to carry out missions through cooperation with and assistance from the National Urban League. Areas include but are not limited to home ownership, access to broadband, help for veterans, and youth development.

Another common goal of this partnership will be to increase awareness and understanding of USDA programs and resources.

This partnership is in alignment with the Biden-Harris Administration’s Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government and is another example of USDA’s commitment to advance the goals of equity to better serve the needs of traditionally underserved communities.

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Effects of School-Based Nutrition, Gardening, Cooking Intervention on Metabolic Outcomes in High-Risk Youth

January 10, 2023, EurekAlert!

In this secondary analysis of a randomized clinical trial of 695 children, a school-based gardening, nutrition, and cooking intervention resulted in improved glucose control and reduced low-density lipoprotein cholesterol in high-risk youth. These findings suggest that elementary schools should incorporate garden-based interventions as a way to improve metabolic parameters in children.

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