PUBLICATIONS & TOOLS
- NCCOR Toolbox: Practical Case Study on Evaluating Produce Prescription Programs
- Toolkit: How to Screen for Sugary Drink Consumption in Early Childhood
- Social and Behavioural Change Communications for Prevention of Childhood Overweight and Obesity
CHILDHOOD OBESITY RESEARCH & NEWS
- Engineers Develop a Vibrating, Ingestible Capsule that Might Help Treat Obesity
- Light Exercise Could Be the Key to Reversing Childhood Obesity Linked to Sedentariness
- Children Who Are Sedentary May Have a Higher Risk of Heart Attack or Stroke Later in Life
- Congress Must Act to Fully Fund WIC in 2024, or Risk Nutrition Security for Millions of Women, Infants and Children
NCCOR’s 2023 Year in Review
January 2024, NCCOR
As we conclude another impactful year at NCCOR, it’s time to celebrate 15 years of innovation and collaboration. During 2023, NCCOR bolstered its commitment to addressing childhood obesity with groundbreaking new tools, influential research, and engaging events. Here are a few examples:
Advancing Knowledge and Research
NCCOR’s history of pioneering work was highlighted in a commentary published in the American Journal of Preventive Medicine, titled National Collaborative on Childhood Obesity Research Efforts to Advance Childhood Obesity Research: Progress and Next Steps. This paper celebrated a decade of our landmark tools—the Catalogue of Surveillance Systems and the Measures Registry—and outlined the advancements in childhood obesity research, including expansions to accommodate diverse populations and the development of the Measures Registry Resource Suite.
NCCOR also published a paper in the Journal of the Academy of Nutrition and Dietetics focusing on early childhood nutrition. The paper, Count Every Bite to Make ‘Every Bite Count’: Measurement Gaps and Future Directions for Assessing Diet from Birth to 24 Months, addressed critical gaps in dietary assessment during the early stages of life. Finally, we concluded the year by publishing a commentary with the Gretchen Swanson Center for Nutrition in Childhood Obesity titled The Influence of Social Determinants of Health and Structural Racism on Childhood Obesity.
Fostering Education and Awareness
2023 was a year of engaging and informative webinars. Our Connect & Explore series featured topics like the new clinical practice guidelines for childhood obesity, the introduction of the Healthy Eating Index-Toddlers-2020, health equity, and breastfeeding initiation. These webinars highlighted NCCOR’s unique role as a hub for knowledge dissemination and a chance to engage with leading experts from the American Academy of Pediatrics, CDC, NIH, and USDA.
We also produced a new Healthy Eating Index factsheet and launched a communications campaign focusing on the intersection of sleep and childhood obesity. This campaign features a new social media graphic and factsheet detailing the addition of sleep variables to our Catalogue of Surveillance Systems (CSS).
Enhancing Tools and Resources
NCCOR’s sleep initiative exemplifies our commitment to exploring emerging research areas. Poor sleep quality is a known risk factor for childhood obesity, but less is known about how sleep intersects with a child’s diet quality and level of physical activity. In 2023, NCCOR launched a major expansion of the CSS with 34 new sleep variables. Now, researchers have easier access to datasets exploring multiple risk factors for excess weight gain. The updated CSS was just one of our new offerings in 2023. A new NCCOR website launched in spring 2023 offering streamlined access to a wealth of resources. The redesigned site features a new Resource Library with search and filter functions to find what you need from over 200 NCCOR resources. Additionally, users will find a new Social Media Library, a complete Webinar Library, and a dedicated Student Hub, all aimed at enhancing user experience and accessibility.
As we start 2024, we celebrate the progress made last year and look ahead to new opportunities. Stay tuned for more updates. Join us as we continue to make strides in creating a healthier future for all children.
Publications & Tools
NCCOR Toolbox: Practical Case Study on Evaluating Produce Prescription Programs
January 2024, NCCOR
NCCOR’s Student Hub features tools and resources for students studying diet and physical activity. Not only does the Student Hub streamline finding the resources students need, but it also explains how to use them for thesis or capstone projects, systematic reviews, meta-analyses, surveys, presentations, or research studies. For example, our Q&A for Students factsheet offers an insightful case study on using the Measures Registry to evaluate the impact of a produce prescription program. This case study showcases how to select the best measures to determine children’s dietary behaviors that may be relevant for a specific population and intervention. This case study makes an excellent classroom learning tool, self-study guide, or a template for an in-class activity about evaluation.
Toolkit: How to Screen for Sugary Drink Consumption in Early Childhood
December 18, 2023, Salud America!
Did you know consumption of sugary drinks—soda, sports and energy drinks, sugary fruit juices, and flavored milk—is higher among Latino children than the average child?
Heavy consumption of sugary drinks puts children at greater risk of obesity and disease.
This is why Healthy Eating Research created a new toolkit to help healthcare systems add a beverage screener to their electronic health record (EHR) system to ask parents questions about their child’s sugary drink consumption.
The goal is to identify “unhealthy beverage consumption patterns in young children and [help] families develop healthy beverage habits,” according to the toolkit.
Social and Behavioural Change Communications for Prevention of Childhood Overweight and Obesity
December 6, 2023, UNICEF
The toolkit is designed for UNICEF staff and partners who are developing Social Behaviour Change Communications (SBCC) for the prevention of overweight and obesity in children. The objectives of the toolkit are:
- To provide a brief introduction to the prevention of overweight and obesity in children and adolescents;
- To introduce SBCC (the strategic use of communications to bring about positive social and behaviour change) and outline how it has been used as one tool to prevent overweight and obesity in children;
- To provide a practical, step-by-step methodology for UNICEF staff and partners for designing, implementing, monitoring, and evaluating SBCC initiatives to prevent overweight and obesity in children.
Childhood Obesity Research & News
Engineers Develop a Vibrating, Ingestible Capsule that Might Help Treat Obesity
December 22, 2022, EurekAlert!
When you eat a large meal, your stomach sends signals to your brain that create a feeling of fullness, which helps you realize it’s time to stop eating. A stomach full of liquid can also send these messages, which is why dieters are often advised to drink a glass of water before eating.
MIT engineers have now come up with a new way to take advantage of that phenomenon, using an ingestible capsule that vibrates within the stomach. These vibrations activate the same stretch receptors that sense when the stomach is distended, creating an illusory sense of fullness.
In animals who were given this pill 20 minutes before eating, the researchers found that this treatment not only stimulated the release of hormones that signal satiety, but also reduced the animals’ food intake by about 40 percent. Scientists have much more to learn about the mechanisms that influence human body weight, but if further research suggests this technology could be safely used in humans, such a pill might offer a minimally invasive way to treat obesity, the researchers say.
“For somebody who wants to lose weight or control their appetite, it could be taken before each meal,” says Shriya Srinivasan PhD ’20, a former MIT graduate student and postdoc who is now an assistant professor of bioengineering at Harvard University. “This could be really interesting in that it would provide an option that could minimize the side effects that we see with the other pharmacological treatments out there.”
Srinivasan is the lead author of the new study, which appears today in Science Advances. Giovanni Traverso, an associate professor of mechanical engineering at MIT and a gastroenterologist at Brigham and Women’s Hospital, is the senior author of the paper.
A sense of fullness
When the stomach becomes distended, specialized cells called mechanoreceptors sense that stretching and send signals to the brain via the vagus nerve. As a result, the brain stimulates production of insulin, as well as hormones such as C-peptide, Pyy, and GLP-1. All of these hormones work together to help people digest their food, feel full, and stop eating. At the same time, levels of ghrelin, a hunger-promoting hormone, go down.
While a graduate student at MIT, Srinivasan became interested in the idea of controlling this process by artificially stretching the mechanoreceptors that line the stomach, through vibration. Previous research had shown that vibration applied to a muscle can induce a sense that the muscle has stretched farther than it actually has.
“I wondered if we could activate stretch receptors in the stomach by vibrating them and having them perceive that the entire stomach has been expanded, to create an illusory sense of distension that could modulate hormones and eating patterns,” Srinivasan says.
As a postdoc in MIT’s Koch Institute for Integrative Cancer Research, Srinivasan worked closely with Traverso’s lab, which has developed many novel approaches to oral delivery of drugs and electronic devices. For this study, Srinivasan, Traverso, and a team of researchers designed a capsule about the size of a multivitamin, that includes a vibrating element. When the pill, which is powered by a small silver oxide battery, reaches the stomach, acidic gastric fluids dissolve a gelatinous membrane that covers the capsule, completing the electronic circuit that activates the vibrating motor.
In a study in animals, the researchers showed that once the pill begins vibrating, it activates mechanoreceptors, which send signals to the brain through stimulation of the vagus nerve. The researchers tracked hormone levels during the periods when the device was vibrating and found that they mirrored the hormone release patterns seen following a meal, even when the animals had fasted.
The researchers then tested the effects of this stimulation on the animals’ appetite. They found that when the pill was activated for about 20 minutes, before the animals were offered food, they consumed 40 percent less, on average, than they did when the pill was not activated. The animals also gained weight more slowly during periods when they were treated with the vibrating pill.
“The behavioral change is profound, and that’s using the endogenous system rather than any exogenous therapeutic. We have the potential to overcome some of the challenges and costs associated with delivery of biologic drugs by modulating the enteric nervous system,” Traverso says.
The current version of the pill is designed to vibrate for about 30 minutes after arriving in the stomach, but the researchers plan to explore the possibility of adapting it to remain in the stomach for longer periods of time, where it could be turned on and off wirelessly as needed. In the animal studies, the pills passed through the digestive tract within four or five days.
The study also found that the animals did not show any signs of obstruction, perforation, or other negative impacts while the pill was in their digestive tract.
An alternative approach
This type of pill could offer an alternative to the current approaches to treating obesity, the researchers say. Nonmedical interventions such as diet exercise don’t always work, and many of the existing medical interventions are fairly invasive. These include gastric bypass surgery, as well as gastric balloons, which are no longer used widely in the United States due to safety concerns.
Drugs such as GLP-1 agonists can also aid weight loss, but most of them have to be injected, and they are unaffordable for many people. According to Srinivasan, the MIT capsules could be manufactured at a cost that would make them available to people who don’t have access to more expensive treatment options.
“For a lot of populations, some of the more effective therapies for obesity are very costly. At scale, our device could be manufactured at a pretty cost-effective price point,” she says. “I’d love to see how this would transform care and therapy for people in global health settings who may not have access to some of the more sophisticated or expensive options that are available today.”
The researchers now plan to explore ways to scale up the manufacturing of the capsules, which could enable clinical trials in humans. Such studies would be important to learn more about the devices’ safety, as well as determine the best time to swallow the capsule before to a meal and how often it would need to be administered.
Other authors of the paper include Amro Alshareef, Alexandria Hwang, Ceara Byrne, Johannes Kuosmann, Keiko Ishida, Joshua Jenkins, Sabrina Liu, Wiam Abdalla Mohammed Madani, Alison Hayward, and Niora Fabian.
The research was funded by the National Institutes of Health, Novo Nordisk, the Department of Mechanical Engineering at MIT, a Schmidt Science Fellowship, and the National Science Foundation.
Light Exercise Could Be the Key to Reversing Childhood Obesity Linked to Sedentariness
December 21, 2023, EurekAlert!
Increased sedentary time as a child through adolescence is directly linked to childhood obesity, but new research has found light physical activity may completely reverse the adverse process.
The study – conducted in collaboration with between University of Exeter, University of Eastern Finland, University of Bristol, and University of Colorado and published in Nature Communications – is the largest and longest follow-up to objectively measure physical activity and fat mass, using the University of Bristol’s Children of the 90s data (also known as the Avon Longitudinal Study of Parents and Children). The study included 6,059 children (53 percent female) aged 11 years who were followed up until the age of 24.
Recent reports concluded that more than 80 percent of adolescents across the globe do not meet the World Health Organization’s (WHO) recommended average of 60 minutes a day of moderate-to-vigorous physical activity. It is estimated that physical inactivity will have caused 500 million new cases of heart disease, obesity, diabetes, or other noncommunicable diseases by 2030, costing £21-million annually. This alarming forecast regarding the morbid danger of physical inactivity necessitates urgent research on the most effective preventive approach.
Yet results from this new study shows that moderate-to-vigorous physical activity is up to ten times less effective than light physical activity in decreasing overall gain in fat mass.
Dr Andrew Agbaje of the University of Exeter led the study and said: “These new findings strongly emphasise that light physical activity may be an unsung hero in preventing fat mass obesity from early life. It is about time the world replaced the mantra of ‘an average of 60 minutes a day of moderate-to-vigorous physical activity’ with ‘at least 3 hours a day of light physical activity’. Light physical activity appears to be the antidote to the catastrophic effect of sedentary time in the young population.”
During the study, a waist-worn accelerometer measured sedentary time, light physical activity, and moderate-to-vigorous physical activity among participants at ages 11, 15, and 24 years. Dual-energy X-ray absorptiometry-measured fat mass and skeletal muscle mass were also collected at the same ages and fasting blood samples were repeatedly measured for glucose, insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-sensitivity C-reactive protein. In addition, blood pressure, heart rate, smoking status, socio-economic status, and family history of cardiovascular disease were measured and controlled for in the analyses.
During the 13-year follow-up, sedentary time increased from approximately six hours a day in childhood to nine hours a day in young adulthood. Light physical activity decreased from six hours a day to three hours a day, while moderate-to-vigorous physical activity was relatively stable at around 50 minutes a day from childhood through young adulthood.
It was observed that each minute spent sedentary was associated with a 1.3-gram increase in total body fat mass. Both male and female children gained an average of 10kg of fat mass during growth from childhood until young adulthood. However, sedentary time potentially contributed 700 grams to 1kg of fat mass (approximately seven to ten percent) of the total fat mass gained during growth from childhood until young adulthood. A 1kg increase in fat has been linked to a 60-percent higher risk of premature death in a person’s early 50s.
Each minute spent in light physical activity during growth from childhood through young adulthood was associated with a 3.6-gram reduction in total body fat mass. This implies that cumulative light physical activity decreased total body fat mass by 950 grams to 1.5kg during growth from childhood to young adulthood, (approximately 9.5 to 15 percent decrease in overall gain in fat mass during the 13-year observation period). Examples of light physical activity are long walks, house chores, slow dancing, slow swimming, and slow bicycling.
In contrast, time spent in moderate-to-vigorous physical activity – including meeting the 60 minutes a day recommended by the WHO – during growth from childhood through young adulthood was associated with 70 to 170 grams (approximately 0.7 to 1.7 percent) reduction in total body fat mass. Prior to this study, it has not been possible to quantify the long-term contribution of sedentary time to fat mass obesity and the magnitude by which physical activity may reduce it. But this study confirmed the report from a recent meta-analysis of 140 school-based randomised controlled trials across the globe that engaging in moderate-to-vigorous physical activity had minimal or no effect in reducing childhood BMI-obesity.
Dr Andrew Agbaje of the University of Exeter said: “Our study provides novel information that would be useful in updating future health guidelines and policy statements. Public health experts, health policymakers, health journalists and bloggers, paediatricians, and parents should encourage continued and sustained participation in light physical activity to prevent childhood obesity.”
The paper entitled ‘Effects of Accelerometer-based Sedentary Time and Physical Activity on DEXA-measured Fat Mass in 6059 Children’ is published in Nature Communications.
Dr Andrew Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund, and the Foundation for Pediatric Research.
Children Who Are Sedentary May Have a Higher Risk of Heart Attack or Stroke Later in Life
December 14, 2023, EurekAlert!
Children who are physically inactive may have high cholesterol in early adulthood and subsequent heart health issues in their mid-forties, according to new research published in The Journal of Clinical Endocrinology & Metabolism.
High cholesterol during childhood has been associated with early signs of heart disease when individuals reach their mid-twenties and an increased risk of premature cardiovascular death in their mid-forties. Several clinical trials aimed at lowering cholesterol levels in the youth population have had minimal or no effect.
“Our study shows increased sedentary time in childhood may contribute to two-thirds of the total increase in a person’s cholesterol levels before their mid-twenties. This suggests childhood sedentariness may be a major risk factor for elevated cholesterol and subsequent premature heart attack or stroke when individuals reach their mid-forties,” said study author Andrew O. Agbaje, M.D., M.P.H., of the University of Eastern Finland in Kuopio, Finland. “We also discovered light-intensity physical activity from childhood may be 5-8 times more effective than moderate-to-vigorous physical activity at reversing the adverse effect of sedentary time on high cholesterol.”
The researchers studied activity tracker data and repeated measures of cholesterol in 11-year-old children followed for up to 13 years from the Avon Longitudinal Study of Parents and Children.
They assessed the association between sedentary time and high cholesterol levels and found sedentary time increased from approximately 6 hours/day in childhood to 9 hours/day in young adulthood, and contributed nearly 70% to the increase in their overall cholesterol levels.
They also determined light physical activity decreased from 6 hours/day in childhood to 3 hours/day in young adulthood but was cumulatively associated with reduced total cholesterol. Increased total body fat slightly reduced the effect of light physical activity on total cholesterol.
Moderate-to-vigorous physical activity was relatively stable around 50 mins/day from childhood until young adulthood and was only associated with reduced total cholesterol, but increased total body fat seriously diminished the effect of moderate-to-vigorous physical activity on total cholesterol.
“Engaging in light physical activity for 3-4 hours/day may be an effective way to reduce high cholesterol and avoid heart health issues later in life,” Agbaje said.
The study was funded by the Finnish Cultural Foundation, the Finnish Foundation for Cardiovascular Research, the Yrjö Jahnsson Foundation, the Jenny and Antti Wihuri Foundation, the Orion Research Foundation, the Aarne Koskelon Foundation, the Paulo Foundation, the Paavo Nurmi Foundation, and the Ida Montinin Foundation.
The manuscript, “Associations of Sedentary Time and Physical Activity from Childhood with Lipids: A 13-Year Mediation and Temporal Study,” was published online, ahead of print.
Congress Must Act to Fully Fund WIC in 2024, or Risk Nutrition Security for Millions of Women, Infants and Children
December 13, 2023, U.S. Department of Agriculture
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided vital nutrition assistance to nearly 6.7 million pregnant women, new mothers, babies, and young children across the country in September of this year (see table). For the past 25 years, Congress, on a bipartisan basis, has committed to fully funding WIC to serve every eligible pregnant woman, infant, mother, and child who applies. But this year, despite repeated Administration requests, Congress has yet to fully fund this vital program. Without the necessary additional funding, millions of eligible pregnant women, new mothers, infants, and young children are at risk of missing out on WIC’s critical nutrition assistance at some point next year.
WIC costs are higher this year than last year, in part because more eligible people are signing up for the program – meaning more pregnant women, new mothers, infants, and children are getting access to nutritious food and important health resources they need to thrive. However, in the two Continuing Resolutions enacted so far this year, Congress did not provide the additional $1 billion in estimated funding needed to ensure WIC can serve all those who seek its services in fiscal year 2024.
It is critical that Congress provide additional funding for WIC in the January appropriation. The longer Congress puts off fully funding WIC, the greater the risk to mothers, babies, and children seeking nutrition and health support from the program. Through the two recent Continuing Resolutions, Congress has indicated that the U.S. Department of Agriculture and states should spend current funding at a faster rate in order to serve everyone who is eligible for the first half of the fiscal year (or through March 2024), but they haven’t provided the funds to cover the program once those resources run out. That means that if Congress does not address the needed funding when they ultimately pass a full-year appropriation, the impact of cuts would be magnified because USDA will have to absorb all of them in the final months of the fiscal year.
To illustrate the scale of the funding shortfall at this point in the year: If Congress were to fund the program at the current, lower Continuing Resolution level for the remaining months of the fiscal year, the $1 billion shortfall that will occur is equivalent to 1.5 months of benefits for all program beneficiaries. The $1 billion shortfall also equals the estimated cost of providing six months of benefits to all pregnant women and infants participating in WIC.
A federal funding shortfall of this magnitude presents states with difficult, untenable decisions about how to manage the program. Many states would likely implement waiting lists for applicants to reduce costs. Under program rules, waiting lists would be implemented first for non-breastfeeding postpartum women, next for children ages 1 to 5 years old who do not have higher-risk medical issues, and then for pregnant and breastfeeding women and infants who do not have higher-risk medical issues. But given the size of the funding shortfall, it is likely that waiting lists would stretch across all participant categories, affecting both new applicants and mothers, babies, and young children enrolled in the program who are up for renewal of benefits.
To provide a sense of the number of people whose benefits could be at risk if states turned to waiting lists, even for short periods, USDA estimates that 810,000 eligible people apply for WIC services in a given month nationwide, which includes those new to the program and those whose WIC benefits are up for renewal. Many states would likely have to utilize waiting lists for an extended period to address the funding gap that would result if Congress funded WIC at the Continuing Resolution level for the rest of the year.
Indeed, it is possible that even waitlisting applicants and taking other cost-cutting measures like reducing clinic hours would not be enough to close the shortfall. In that case, some states might be forced to discontinue or suspend benefits for current participants – which is allowed by program rules as a last resort.
Cutting off access to WIC for pregnant women, new mothers, and infants and children would have severe and harmful consequences. An abundance of research shows the critical role that WIC plays in supporting maternal health and child development. WIC participation during pregnancy is associated with lower risk of preterm birth, lower risk of low birthweight, and lower risk of infant mortality. Children on WIC are also more likely to consume a healthier diet, and this impact grows the longer a child stays on WIC.
The U.S. Department of Agriculture’s Economic Research Service recently found that household food insecurity increased last year, at a time when significant safety net enhancements that helped people through the worst of the pandemic began to end, and the enhanced Child Tax Credit enacted in the American Rescue Plan expired. More than half of food insecure families reported gaining assistance through federal nutrition programs like WIC to make ends meet—an indication of how important the programs are in helping to support families, and what’s at risk if Congress cuts or underfunds them.
Nearly 40 percent of America’s infants participate in WIC, which is available only to pregnant women, new mothers, infants, and children who meet income guidelines and are determined to be at nutritional risk by a health professional. Families with young children, particularly infants, can struggle to make ends meet. The Biden-Harris Administration understands this and is committed to giving America’s children the healthiest start at a good life. Curbing access to nutrition security programs like WIC is counter to this effort and instead punishes parents and children.