June 2018


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Connect & Explore—America’s Eating Habits: Food Away from Home

June 28, 2018, NCCOR

On July 24, the National Collaborative on Childhood Obesity Research (NCCOR) will host a Connect & Explore webinar titled, “America’s Eating Habits: Food Away From Home.”

Food away from home (FAFH) plays a major role in the American diet. In recent decades, numerous factors have contributed to an increasing trend of FAFH consumption such as increased access and affordability to FAFH and an increase in two earner households. To better understand this trend, USDA’s Economic Research Service (ERS) has drawn on data from many sources to examine a range of factors influencing FAFH consumption, and the findings will be published in the forthcoming report, America’s Eating Habits: Food Away From Home. The report takes a comprehensive look at the role of FAFH in American diets, exploring nutritional composition of FAFH and key Federal programs that influence FAFH. The report also discusses how FAFH choices and availability relate to diet quality, income, age, and other socioeconomic factors.

The webinar will provide background and rationale for the research endeavor, highlight several findings from the report, and discuss the experience of undertaking this collaborative research effort.

Join us on Tuesday, July 24, at 2:00 p.m. ET, for the one-hour webinar. Guest speakers include two economists from USDA’s Economic Research Service, Abigail Okrent, PhD and Michelle Saksena, PhD.

Register today to receive webinar access. The event is free, but attendance is limited.

Invite a colleague, and please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will live tweet the event at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on

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Publications & Tools

Youth Risk Behavior Surveillance System 2017 Data and Results

CDC’s Division of Adolescent and School Health (DASH) released the 2017 national, state, and large urban school district Youth Risk Behavior Survey (YRBS) results. The release includes an MMWR Surveillance Summary that includes results from the 2017 National YRBS and from 39 state and 21 large urban school district YRBS’s; new fact sheets and summary documents; an updated version of Youth Online – a web-based data system that allows users to view and analyze national, state, and large urban school district YRBS results; and public-use datasets and technical documentation. The YRBS monitors six categories of priority health behaviors among high school students—behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors related to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and physical inactivity—plus the prevalence of obesity and asthma.

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CDC Releases 2018 State Indicator Report on Fruits and Vegetables

CDC released the 2018 State Indicator Report on Fruits and Vegetables. This report highlights approaches to increase the purchase, supply, and demand of fruits and vegetables in states and communities across the United States. These efforts can increase access to and affordability of fruits and vegetables in states and communities, strengthening regional food systems and supporting the local economy. Public health practitioners and decision makers can use this report to quickly assess how their state is doing and identify strategies they can put in place to improve access to fruits and vegetables in their communities.

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Advancing Obesity Solutions Through Investments in the Built Environment: Proceedings of a Workshop

The built environment—the physical world made up of the homes, buildings, streets, and infrastructure within which we all live, work, and play—underwent changes during the 20th and 21st centuries. These changes contributed to a sharp decline in physical activity and affected access to healthy foods, which have added to the weight gain observed among Americans in recent decades. As such, policies and practices that affect the built environment could affect obesity rates in the United States and improve the health of Americans. This Proceedings of a Workshop highlights key points made by workshop participants and discussions from the September 12, 2017 workshop. The workshop brought together diverse partners to examine the ways in which the places we live, work, and play influence obesity, health, and equity. Real estate developers, leaders from state, regional and local government, and innovative non-profit organizations came together to discuss strategies to create more healthful and equitable built environments, concluding with a wide-ranging discussion on next steps.

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WHO Launches Global Action Plan on Physical Activity

WHO has developed a new global action plan to help countries scale up policy actions to promote physical activity. The action plan shows how countries can reduce physical inactivity in adults and adolescents by 15% by 2030. It recommends a set of 20 policy areas, which combined, aim to create more active societies through improving the environments and opportunities for people of all ages and abilities to do more walking, cycling, sport, active recreation, dance, and play.

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Childhood Obesity Research & News

Active Voice: A New Youth Compendium of Physical Activities

June 26, 2018, American College of Sports Medicine

An important resource for physical activity researchers and practitioners is information about the amount of energy required to engage in various physical activities. Energy expenditure values provide a vital tool for connecting physical activity behavior and health.

The Adult Compendium of Physical Activities is a widely accepted tool to estimate and classify energy expenditure for a multitude of activities in which adults participate. The Adult Compendium uses METs (metabolic equivalent of tasks) as a standardized measure of energy expenditure, with the assumption that one MET is the energy expenditure of a person at rest. MET is calculated as activity metabolic rate divided by the resting metabolic rate. Recognizing the usefulness of physical activity energy expenditure values for children and youths, Ridley and colleagues developed the first compendium of energy expenditure for young people. Although this was an important first step, there were several limitations: 1) nearly two-thirds of the data was obtained from adults; 2) MET values were derived from studies with small sample sizes; and 3) MET values did not vary across ages (5 to17 years), although energy expenditure for the same activity is known to vary by age in children.

An Updated Youth Compendium of Physical Activities

We presented an updated “Youth Compendium of Physical Activities” in the February 2018 issue of MSSE. This work resulted from a partnership between the CDC, the NCI, the NCCOR and an international group of leading researchers.

At a meeting in April 2012, an international group of experts agreed that an updated, expanded and web-accessible youth compendium would be a valuable contribution to the field. The Working Group on Youth Energy Expenditure then began work on three main tasks.

First, the working group concluded the best metric that would function across four age groups, sex and physical characteristics was the youth METs (METy). This is conceptually like adult METs. However, adult MET uses 3.5 for the energy cost for resting adults, whereas METy uses Schofield sex- and age-specific basal metabolic rate equations. Details of this work have been described in other papers, e.g., PLOSOne, 2015.

Second, the expert group updated the previous literature review to include new estimates of youth energy expenditure for additional physical activities. During this process, gaps were identified in some activities and for some ages. To fill these gaps, the group identified new data through a solicitation for papers published in the Journal of Physical Activity and Health.

Third, and finally, the group used data from two systematic reviews, plus pooled data among individuals from four studies and papers in the Journal of Physical Activity and Health supplement to develop the Youth Compendium of Physical Activities. This work involved steps to:

  • Perform multiple imputation of missing METy values;
  • Smooth observed and imputed METy values;
  • Develop a coding scheme for this Youth Compendium;
  • Classify physical activities into 16 major categories.

The new Youth Compendium presents the energy costs of 196 physical activities derived exclusively from pediatric data, expressed in terms of METy, for four age categories. Although this compendium advances the work of Ridley and other independent investigators, some important gaps remain. These include a lack of measured energy expenditure for occupational activities in young people, as well as limited data for children younger than six years and for young people with disabilities.

We anticipate this new Youth Compendium will be a valuable resource for researchers and practitioners interested in improving the health of children and adolescents through physical activity. For additional information, go to:

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Emotional Eating in Childhood is Learned at Home

June 19, 2018, University College London

The tendency for children to eat more or less when stressed and upset is mainly influenced by the home environment and not by genes, according to a new UCL-led study.

The study, published today in Pediatric Obesity, found that genetics only play a small role in young children’s emotional overeating and undereating, unlike other eating behaviours in childhood such as food fussiness.

The current research, which analysed data from over 398 British twins, builds on a previous UCL study published in 2017 which highlighted the strong effect of the home environment on emotional eating. In this study, half the families were selected specifically because the parents had obesity, to see if the effect of the home environment on emotional eating was still strong. Notwithstanding this, researchers still found that emotional eating is driven by environmental factors, regardless of the child’s risk of obesity.

“Experiencing stress and negative emotions can have a different effect on appetite for different people. Some crave their favourite snack, whereas others lose their desire to eat altogether when feeling stressed or sad. This study supports our previous findings suggesting that children’s emotional over- and under-eating are mostly influenced by environmental factors completely shared by twin pairs and that genes are largely unimportant for emotional overeating in childhood.

“We will continue to research the home environmental factors that might play a role in emotional eating, such as certain parental feeding practices or stress around the dinner table,” said Dr Moritz Herle, (UCL Great Ormond Street Institute of Child Health), who co-led the research.

Parents involved in the Twins Early Development Study (TEDS) described their twins’ tendencies to eat more or less than usual when experiencing emotions, such as feeling upset or anxious. They answered questions when their twins were 4-years-old. The researchers then compared how similar identical and non-identical twin pairs were for emotional over-eating and under-eating.

“The results were surprising because previous studies have shown that other eating behaviours are strongly influenced by genes in early childhood; such as being fussy about food. We actually don’t know a great deal about the physical and mental health consequences of emotional eating in childhood, because studies that track those children over many years haven’t been done.

However, a tendency to want to eat more in response to negative emotions could be a risk factor for the development of obesity, and emotional over- and under-eating could be potentially important in the development of eating disorders such as anorexia nervosa or binge eating disorder. Understanding how these tendencies develop is crucial, because it helps researchers to give advice about how to prevent or change them, and where to focus future research,” said Dr Clare Llewellyn (UCL Institute of Epidemiology & Health), senior lead researcher.

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Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents

June 15, 2018, Pediatrics Journal


BACKGROUND AND OBJECTIVES: Shorter sleep duration is associated with childhood obesity. Few studies measure sleep quantity and quality objectively or examine cardiometabolic biomarkers other than obesity.

METHODS: This cross-sectional study of 829 adolescents derived sleep duration, efficiency and moderate-to-vigorous physical activity from >5 days of wrist actigraphy recording for >10 hours/day. The main outcome was a metabolic risk score (mean of 5 sex-specific z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance), for which higher scores indicate greater metabolic risk. Secondary outcomes included score components and dual-energy radiograph absorptiometry fat mass. We measured socioeconomic status, race and/or ethnicity, pubertal status, and obesity-related behaviors (television-viewing and fast food and sugar-sweetened beverage consumption) using questionnaires.

RESULTS: The sample was 51.5% girls; mean (SD) age 13.2 (0.9) years, median (interquartile range) sleep duration was 441.1 (54.8) minutes per day and sleep efficiency was 84.0% (6.3). Longer sleep duration was associated with lower metabolic risk scores (−0.11 points; 95% CI: −0.19 to −0.02, per interquartile range). Associations with sleep efficiency were similar and persisted after adjustment for BMI z score and physical activity, television-viewing, and diet quality. Longer sleep duration and greater sleep efficiency were also favorably associated with waist circumference, systolic blood pressure, high-density lipoprotein cholesterol, and fat mass.

CONCLUSIONS: Longer sleep duration and higher sleep efficiency were associated with a more favorable cardiometabolic profile in early adolescence, independent of other obesity-related behaviors. These results support the need to assess the role of sleep quantity and quality interventions as strategies for improving cardiovascular risk profiles of adolescents.

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$14 Million to Fund Research Aimed at Reducing Childhood Obesity

June 11, 2018, Washington University School of Medicine in. St Louis

Researchers at Washington University School of Medicine in St. Louis are receiving $14 million to test and evaluate a family-based program aimed at reducing childhood obesity. The treatment program will be administered by health-care providers in primary-care settings in the St. Louis area, Louisiana and upstate New York. The project is funded by the Patient-Centered Outcomes Research Institute (PCORI), an independent, nonprofit organization authorized by Congress under the Affordable Care Act.

Led by researchers at the School of Medicine, the study also will involve the University of Rochester Medical Center in New York, the LSU Pennington Biomedical Research Center in Baton Rouge, La., and the American Academy of Pediatrics Institute for Healthy Childhood Weight in Itasca, Ill. In the United States, one in five children and one in three adults are considered obese. Health-care providers in the study will deliver 12 months of family-based treatment — which targets both the child with obesity as well as a parent with an unhealthy body weight. In previous smaller studies, this approach has reduced obesity in children and improved their markers of heart health while helping parents lose an average of 20 pounds.

For comparison purposes, others in the study will receive a standard intervention recommended by the American Academy of Pediatrics and the American Medical Association. The standard intervention will entail children and families receiving counseling focused on improving nutrition and increasing physical activity. They also will receive medical care focused on obesity and related conditions. If after three to six months a child and family need more support, they will be offered a more intensive strategy tailored to the needs and motivation of the child and family.

The family-based treatment component of the program encourages parents to become active participants in the treatment. For example, parents who are obese will be assisted in achieving their own weight-loss goals. This family-centered, comprehensive approach to weight loss is designed to help parents and children make lasting changes in eating and activity habits, while teaching positive parenting techniques that can be applied in a number of scenarios.

For example, the Washington University researchers previously have worked with parents and children to identify how to eat healthy meals while at school. The research team also has taught parents how to create a home environment that supports healthy eating and activity and to model healthy behaviors so that children learn from example to make healthier choices.

“With family-based treatment, one thing we’ve found repeatedly is that the better a parent does, the better the child does, and vice versa,” said principal investigator Denise E. Wilfley, PhD, the Scott Rudolph University Professor of Psychiatry and director of the Washington University Center for Healthy Weight and Wellness. “We not only see that they’re eating in healthier ways — for example, by increasing intake of fruits and vegetables and cutting back on unhealthy foods and sugar-sweetened beverages — we see big improvements in physical activity.”

Being overweight or obese increases risk for diabetes, heart disease, cancer, orthopedic problems, fatty liver disease — a potential precursor to cirrhosis and even liver cancer — and psychological problems such as depression and anxiety. And children considered obese have a high likelihood of remaining so throughout adulthood. The U.S. Preventive Services Task Force recommends that clinicians screen kids ages 6 and older for obesity and to offer or refer them to treatment.

Wilfley, also a professor of medicine, of pediatrics, and of psychological and brain sciences, said 15 to 25 pediatric and family medicine practices will be involved in this project. The American Academy of Pediatrics Institute for Healthy Childhood Weight will train pediatricians in each of the practices. “It’s quite likely we may have upward of 100 child-care providers involved — including pediatricians, nurses and family-practice doctors — providers who are interested in child welfare and child health,” Wilfley said.

The project is one of several projects funded by PCORI, which supports research to provide patients, caregivers and clinicians with information that can be used to make better decisions about health care. “This project was selected not only for its scientific merit and commitment to engaging patients and other health-care stakeholders in a major study conducted in a real-world setting, but also for its potential to answer important questions about childhood obesity and to fill a crucial evidence gap,” said PCORI Executive Director Joe Selby, MD. “We look forward to following the study’s progress and working with the researchers to share the results.”

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Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices with Gut Microbiota and Risk of Overweight in the First Year of Life

June 4, 2018, JAMA Pediatrics



The effect of neonatal and infant feeding practices on childhood obesity is unclear. The gut microbiome is strongly influenced by feeding practices and has been linked to obesity.


To characterize the association between breastfeeding, microbiota, and risk of overweight during infancy, accounting for the type and timing of supplementary feeding.

Design, Setting, and Participants

In this study of a subset of 1087 infants from the prospective CHILD pregnancy cohort, mothers were recruited between January 1, 2009, and December 31, 2012. Statistical analysis was performed from February 1 to December 20, 2017.

Main Outcomes and Measures

Feeding was reported by mothers and documented from hospital records. Fecal microbiota at 3 to 4 months (from 996 infants) and/or 12 months (from 821 infants) were characterized by 16S ribosomal RNA sequencing. Infants with a weight for length exceeding the 85th percentile were considered to be at risk for overweight.


There were 1087 infants in the study (507 girls and 580 boys); at 3 months, 579 of 1077 (53.8%) were exclusively breastfed according to maternal report. Infants who were exclusively formula fed at 3 months had an increased risk of overweight in covariate-adjusted models (53 of 159 [33.3%] vs 74 of 386 [19.2%]; adjusted odds ratio, 2.04; 95% CI, 1.25-3.32). This association was attenuated (adjusted odds ratio, 1.33; 95% CI, 0.79-2.24) after further adjustment for microbiota features characteristic of formula feeding at 3 to 4 months, including higher overall richness and enrichment of Lachnospiraceae. A total of 179 of 579 infants who were exclusively breastfed (30.9%) received formula as neonates; this brief supplementation was associated with lower relative abundance of Bifidobacteriaceae and higher relative abundance of Enterobacteriaceae at 3 to 4 months but did not influence the risk of overweight. At 12 months, microbiota profiles differed significantly according to feeding practices at 6 months; among partially breastfed infants, formula supplementation was associated with a profile similar to that of nonbreastfed infants (higher diversity and enrichment of Bacteroidaceae), whereas the introduction of complementary foods without formula was associated with a profile more similar to that of exclusively breastfed infants (lower diversity and enrichment of Bifidobacteriaceae and Veillonellaceae). Microbiota profiles at 3 months were more strongly associated with risk of overweight than were microbiota profiles at 12 months.

Conclusions and Relevance

Breastfeeding may be protective against overweight, and gut microbiota may contribute to this effect. Formula feeding appears to stimulate changes in microbiota that are associated with overweight, whereas other complementary foods do not. Subtle microbiota differences emerge after brief exposure to formula in the hospital. These results identify important areas for future research and distinguish early infancy as a critical period when transient gut dysbiosis may lead to increased risk of overweight.

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