July 2021

Lessons Learned from Global Efforts: Latin American-U.S. Collaborations

Childhood obesity now affects most parts of the globe. The World Health Organization estimates that 340 million children between the ages of 5-19 have overweight or obese, a rapid change from past generations. The prevalence of childhood obesity more than quadrupled from 1975 to 2016, jumping from 4% to 18%. Many countries face a double burden of undernutrition and obesity, as energy dense, low nutrient foods are widely available and often the most affordable.

As a result, addressing childhood obesity requires international and interdisciplinary approaches to improve childhood nutrition and physical activity. The Fogarty International Center at the National Institutes of Health recently published a compelling model for this type of research in a June 2021 special supplement of Obesity Reviews titled “Childhood Obesity Prevention Across Borders: The Promise of U.S.-Latin American Research Collaboration.” In this series, a multi-national group of researchers identified common ground and lessons learned for the adaptation and implementation of evidence-informed childhood obesity prevention interventions.

NCCOR has partnered with the Fogarty International Center to publish a new factsheet about their initiative and host a successful two-part webinar series. These resources are now available on the NCCOR website.

During the webinars, authors of the supplement shared ideas for successful research strategies and the benefits of citizen-involved science. They also explored how migration and cultural assimilation influence childhood obesity in the U.S. and Latin America. Other key themes from the Fogarty project include the importance of:

• Addressing equity and social determinants of health to develop effective and equitable policies and programs that consider social justice, historical trauma, and structural racism.
• Including migration when designing study methods to understand how the process of exposure to new cultures affects dietary and physical activity behaviors.
• Using innovative methods and scientific tools, such as implementation science, systems science, and participatory action models to develop more potent interventions and encourage collaboration among countries.
• Supporting sustainable capacity building aimed at research, policy, and practice activities within and across countries that will help to ensure that childhood obesity prevention efforts across borders in the Americas are synergistic and evidence-based.
• Enacting local and national policies that address gaps in evidence related to the design and evaluation of childhood obesity prevention policies and interventions.

Visit the NCCOR website to download the factsheet or view our recent webinars with the Fogarty Center. There you will also find more information about NCCOR’s global partnerships.

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NCCOR Toolbox: New Resource in the Guide to Methods for Assessing Childhood Obesity

NCCOR’s Guide to Methods for Assessing Childhood Obesity recently added a new resource—The American Body Composition Calculator, developed by the University of North Carolina. The Calculator provides estimates of body fat percentage. It uses demographic and anthropometric measures, with or without bioelectrical impedance (BIA). The NCCOR Guide is designed to assist users in selecting the most appropriate method of measuring adiposity in children when conducting population-level research and/or evaluation on obesity.

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WIC Online Ordering: Opportunities and Issues to Consider During the COVID‑19 Pandemic

The Healthy Eating Research (HER) published a suite of resources based on a pilot study in Tennessee. The Click & Collect model provided a three-step process for completing a WIC grocery order online. Materials include an issue brief outlining the project and infographics in Spanish and English.

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Understanding Obesity

The Strategies to Overcome & Prevent (STOP) Obesity Alliance recently released an online educational resource titled Understanding Obesity, which explores obesity and weight bias. They provide guidance on how to communicate about obesity without using stigmatizing language.

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Position Statement on the Identification and Prevention of Overweight and Obesity in the Pediatric Population

The National Association of Pediatric Nurse Practitioners published a position paper about childhood obesity. The organization presents ten recommendations for the prevention, diagnosis, and treatment of childhood obesity for obstetric and pediatric populations.

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UNF Study Indicates Black Teen Girls Seek Inclusive Body Types in Anti-Obesity Advertising

July 14, 2021, EurekaAlert!

A recent qualitative research study conducted by the University of North Florida, in partnership with Indiana University-Purdue Indianapolis and UF Health Jacksonville, shows that Black teenage girls want inclusive body types to be featured in advertising to combat teen obesity rates. Insights provided in the study are ideal for pediatricians and healthcare educators developing advertising and patient care plans to combat obesity among African American teens.

The study investigated social and cultural consequences of food consumption among African American teenage girls between the ages of 14-18 in Jacksonville, Fla., and explored best practices for anti-obesity communication in advertising. The teenagers in the study led active lifestyles and disagreed with traditional advertising that centered on a one-size-fits-all recommendation for weight management among teens like them.

Results from the study indicate preference for an inclusive body type approach that showcases advertising featuring diverse girls of different body types, races, etc., and that messaging should promote healthy lifestyles instead of a specific body-mass index measure. Utilization of social media platforms was recommended as the best communication method for message dissemination.

“Promoting one-size-fits-all messaging is counterproductive and excludes important cultural factors that influence food choice, options and normative beliefs regarding food culture and body genetics,” said Dr. Natalie A. Mitchell, UNF marketing professor and principal investigator of the study. “These teenage girls respond best to messages that portray them as curvy and healthy.”

Research participants reported struggling to balance their cultural food preference of soul food, often high in fat and sugar, with healthier food options. Results also revealed that the teenage girls preferred “slim thick,” curvier body types, which include slim waistlines with shapely bottoms regardless of their petite, thin frames and is considered cultural capital, according to the research team.

“A driving force behind the desire for the Coca-Cola bottle frame commonly seen within the African American community is due to celebrity culture that celebrates such body types,” said Mitchell.

Through in-depth interviews and photo elicitation, the girls identified celebrity body types whom they greatly admired and desired. Tiffany Haddish and Tyra Banks were the celebrities most frequently selected. Decisions were based on celebrity curvy frames and their likability.

Original source

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Association of Early Antibiotic Exposure with Childhood Body Mass Index Trajectory Milestones

July 12, 2021, JAMA Network

Importance
Past studies have showed associations between antibiotic exposure and child weight outcomes. Few, however, have documented alterations to body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) trajectory milestone patterns during childhood after early-life antibiotic exposure.

Objective
To examine the association of antibiotic use during the first 48 months of life with BMI trajectory milestones during childhood in a large cohort of children.

Design, Setting, and Participants
This retrospective cohort study used electronic health record data from 26 institutions participating in the National Patient-Centered Clinical Research Network from January 1, 2009, to December 31, 2016. Participant inclusion required at least 1 valid set of same-day height and weight measurements at each of the following age periods: 0 to 5, 6 to 11, 12 to 23, 24 to 59, and 60 to 131 months (183 444 children). Data were analyzed from June 1, 2019, to June 30, 2020.

Exposures
Antibiotic use at 0 to 5, 6 to 11, 12 to 23, 24 to 35, and 36 to 47 months of age.

Main Outcomes and Measures
Age and magnitude of BMI peak and BMI rebound.

Results
Of 183 444 children in the study (mean age, 3.3 years [range, 0-10.9 years]; 95 228 [51.9%] were boys; 80 043 [43.6%] were White individuals), 78.1% received any antibiotic, 51.0% had at least 1 episode of broad-spectrum antibiotic exposure, and 65.0% had at least 1 episode of narrow-spectrum antibiotic exposure at any time before 48 months of age. Exposure to any antibiotics at 0 to 5 months of age (vs no exposure) was associated with later age (β coefficient, 0.05 months [95% CI, 0.02-0.08 months]) and higher BMI (β coefficient, 0.09 [95% CI, 0.07-0.11]) at peak. Exposure to any antibiotics at 0 to 47 months of age (vs no exposure) was associated with an earlier age (−0.60 months [95% CI, −0.81 to −0.39 months]) and higher BMI at rebound (β coefficient, 0.02 [95% CI, 0.01-0.03]). These associations were strongest for children with at least 4 episodes of antibiotic exposure. Effect estimates for associations with age at BMI rebound were larger for those exposed to antibiotics at 24 to 35 months of age (β coefficient, −0.63 [95% CI, −0.83 to −0.43] months) or 36 to 47 (β coefficient, −0.52 [95% CI, −0.72 to −0.31] months) than for those exposed at 0 to 5 months of age (β coefficient, 0.26 [95% CI, 0.01-0.51] months) or 6 to 11 (β coefficient, 0.00 [95% CI, −0.20 to 0.20] months).

Conclusions and Relevance
In this cohort study, antibiotic exposure was associated with statistically significant, but small, differences in BMI trajectory milestones in infancy and early childhood. The small risk of an altered BMI trajectory milestone pattern associated with early-life antibiotic exposure is unlikely to be a key factor during prescription decisions for children.

Original source

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Urban Areas with High Levels of Air Pollution May Increase Risk of Childhood Obesity

July 12, 2021, EurekaAlert!

Children living in urban areas with high levels of air pollution, noise, and traffic may be at higher risk of childhood obesity, according to a study by the Barcelona Institute for Global Health (ISGlobal), a center supported by the “la Caixa” Foundation, and the University Institute for Primary Care Research Jordi Gol (IDIAP Jordi Gol). The study was funded by the La Marató de TV3 Foundation.

Published in Environment International, the study analysed data on 2,213 children aged 9 to 12 years in the city of Sabadell (Barcelona) who were participating in the ECHOCAT and INMA projects. Forty percent of the children were overweight or obese. The researchers investigated the association between urban factors that the children were exposed to between October 2017 and January 2019 (ambient air pollution, green spaces, built environment, density of unhealthy food establishments, road traffic and road traffic noise) and various measures of childhood obesity (body mass index, waist circumference and body fat) and weight-related behaviours (fast food and sugar-sweetened beverage consumption, physical activity, sedentary behaviour, sleep duration and well-being).

To date, few studies have assessed whether the urban environment influences children’s behaviours in order to better understand the relationship between this environment and the risk of childhood obesity. An understanding of the mechanisms of this relationship will facilitate the development of community-level health promotion programmes to encourage healthier behaviours in the city. Another novel aspect of this study is that it assessed multiple urban exposures together, in accordance with the concept of exposome or the study of multiple simultaneous environmental factors.

Possible Mechanisms

“Higher levels of air pollution, traffic and noise were associated with higher body mass index and a higher likelihood of the child being overweight or obese,” explained lead author Jeroen de Bont, a researcher at ISGlobal and IDIAP Jordi Gol. Although the mechanisms that could explain this association remain unknown, the scientific team proposed various hypotheses. Air pollution could disrupt the molecular mechanisms that cause obesity by inducing inflammation or oxidative stress, hormone disruption and visceral adiposity (although the studies published to date have been performed in mice). Noise could influence sleep deprivation and increase stress hormones, which are associated with physical development in childhood and could increase the risk of becoming overweight.

The findings were consistent with those obtained in the same study when some environmental exposures were analysed separately. In particular, the number of unhealthy food establishments in an area was also found to be associated with childhood obesity, probably because such an environment may favour higher fast food consumption and higher caloric intake.

The study did not, however, find an association between the urban environment and the level of physical activity, sedentary behaviour and other weight-related behaviours in children, although it is thought that such factors could play a role. (For example, in areas with a good public transport network and nearby facilities and shops, journeys tend to be made on foot or by bicycle, which increases children’s physical activity.) The fact that the study did not find an association between these factors could be attributed to “the difficulty of determining to what extent obesity itself influences weight-related behaviours,” explained de Bont. Moreover, information on children’s physical activity was collected using a questionnaire that did not take into account where the activities took place. “We were able to find out if the children played basketball or football, but not if they cycled in nearby green spaces, for example,” he added.

Finally, “socioeconomic status plays an important role in the association between the urban environment and childhood obesity that is not yet clear,” commented last author Martine Vrijheid, a researcher at ISGlobal. In this study, children living in more deprived areas on the outskirts of the city had higher rates of overweight and obesity even though they were exposed to lower levels of air pollution, road traffic and noise and had access to more green spaces. Further research is needed to shed light on this issue.

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Excessive Screen Time Linked to Obesity in U.S. Preteens

June 28, 2021, EurekaAlert!

A new national study finds that children in the United States with greater screen time usage at ages 9-10 are more likely to gain weight one year later.

The study, publishing in Pediatric Obesity on June 28, found that each additional hour spent on virtually all forms of screen time was associated with a higher body mass index (BMI) one year later. In particular, researchers found that each extra hour spent watching or streaming television, YouTube videos, video games, video chat, and texting led to a higher risk of weight gain one year later. At the start of the study, 33.7% of children were considered overweight or obese, and this increased to 35.5% one year later, a proportion that is expected to rise in the late teens and early adulthood.

BMI is calculated based on height and weight. Researchers analyzed the BMI z-scores, which is relative weight adjusted for a child’s age and sex, of 11,066 preteens who are part of the Adolescent Brain Cognitive Development Study, the largest long-term study of brain development in the United States. The children answered questions about their time spent on six different screen time modalities, including television, social media, and texting.

“Screen time is often sedentary and may replace time for physical activity. Children are exposed to more food advertisements and are prone to snacking and overeating while distracted in front of screens,” said lead author, Jason Nagata, MD, assistant professor of pediatrics at the University of California, San Francisco.

“A negative body image and subsequent overeating may be a result of exposure to social media and unattainable body ideals,” said senior author, Kyle T. Ganson, PhD, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “This study emphasizes the need for more research on how screen time impacts the well-being of young people now and in the future.”

“The study was conducted prior to the COVID-19 pandemic, but its findings are especially relevant for the pandemic,” noted Nagata. “With remote learning, the cancellation of youth sports and social isolation, children have been exposed to unprecedented levels of screen time.”

“Screen time can have important benefits such as education and socialization during the pandemic, but parents should try to mitigate risks from excessive screen time including increased sedentary time and decreased physical activity. Parents should regularly talk to their children about screen-time usage and develop a family media use plan,” said Nagata.

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