June 2020

National Institutes of Health Releases Strategic Plan to Accelerate Nutrition Research Over Next 10 Years

NCCOR, June 2020

Newly released, the first NIH-wide strategic plan for nutrition research emphasizes cross-cutting, innovative opportunities to advance nutrition research across a wide range of areas, from basic science to experimental design to research training. This ambitious plan is the first of its kind that sets out to develop targeted and effective diet interventions in a diverse population.

The strategic plan is organized around four strategic goals that answer key questions in nutrition research:

1. Spur discovery and innovation through foundational research: What do we eat and how does it affect us?
2. Investigate the role of dietary patterns and behaviors for optimal health: What and when should we eat?
3. Define the role of nutrition across the lifespan: How does what we eat promote health across our lifespan?
4. Reduce the burden of disease in clinical settings: How can we improve the use of food as medicine?

The plan has five cross-cutting areas relevant to all these strategic goals, including minority health and health disparities; health of women; rigor and reproducibility; data science, systems science, and artificial intelligence; and training the nutrition scientific workforce.

The plan was developed by the NIH Nutrition Research Task Force (NRTF) with extensive input from the broader external research community and the public.

See the plan here.

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NCCOR’s Toolbox

In case you missed it last month, NCCOR’s Youth Compendium of Physical Activities is now available in Spanish!

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The Missing Mandate: Promoting Physical Activity to Reduce Disparities During COVID-19 and Beyond

This blog from the American College of Sports Medicine explains the role of physical activity in mitigating the spread of COVID-19 and reducing health disparities.

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The Racist Roots of Fighting Obesity

Scientific American, June 4, 2020

Black people, and black women in particular, face considerable health challenges. Compared with their rates in other racial groups, chronic cardiovascular, inflammatory and metabolic risk factors have been found to be elevated in black women, even after controlling for behaviors such as smoking, physical exercise or dietary variables.

Black women have also been identified as the subgroup with the highest body mass index (BMI) in the U.S., with four out of five classified as either “overweight” or “obese.” Many doctors have claimed that black women’s “excess” weight is the main cause of their poor health outcomes, often without fully testing or diagnosing them. While there has been a massive public health campaign urging fat people to eat right, eat less and lose weight, black women have been specifically targeted.

This heightened concern about their weight is not new; it reflects the racist stigmatization of black women’s bodies. Nearly three centuries ago scientists studying race argued that African women were especially likely to reach dimensions that the typical European might scorn. The men of Africa were said to like their women robust, and the European press featured tales of cultural events loosely described as festivals intended to fatten African women to the desired, “unwieldy” size.

In the eyes of many medical practitioners in the late 19th century, black women were destined to die off along with the men of their race because of their presumed inability to control their “animal appetites”—eating, drinking and fornicating. These presumptions were not backed by scientific data but instead embodied the prevailing racial scientific logic at the time. Later, some doctors wanted to push black men to reform their aesthetic preferences. Valorizing voluptuousness in black women, these physicians claimed, validated their unhealthy diets, behaviors and figures.

Today the idea that weight is the main problem dogging black women builds on these historically racist ideas and ignores how interrelated social factors impact black women’s health. It also perpetuates a misinformed and damaging message about weight and health. Indeed, social determinants have been shown to be more consequential to health than BMI or health behaviors.

Doctors often tell fat people that dietary control leading to weight loss is the solution to their health problems. But many studies show that the stigma associated with body weight, rather than the body weight itself, is responsible for some adverse health consequences blamed on obesity, including increased mortality risk. Regardless of income, black women consistently experience weightism in addition to sexism and racism. From workplace discrimination and poor service at restaurants to rude or objectifying commentary online, the stress of these life experiences contributes to higher rates of chronic mental and physical illnesses such as heart disease, diabetes, depression and anxiety.

A 2018 opinion piece co-authored by psychologists, sociologists, and behavioral scientists in the journal BMC Medicine argued that bias against fat people is actually a larger driver of the so-called obesity epidemic than adiposity itself. A 2015 study in Psychological Science, among the many studies supporting this argument, found that people who reported experiencing weight discrimination had a 60 percent increased risk of dying, independent of BMI (and therefore regardless of body size). The underlying mechanisms explaining this relationship may reflect the direct and indirect effects of chronic social stress.

Additionally, living in racially segregated, high-poverty areas contributes to disease risk for black women. Low-income black neighborhoods are often disproportionately impacted by a lack of potable water and higher levels of environmental toxins and air pollution. These factors add to the risk for respiratory illnesses such as asthma and lung disease. They also increase the chance of serious complications from the novel coronavirus.

Further, these neighborhoods typically have a surfeit of fast-food chains and a dearth of grocery stores offering more nutritious food choices. Food insecurity, which is defined as the lack of access to safe, affordable and nutritious foods, has a strong association with chronic illness independent of BMI.

Simply blaming black women’s health conditions on “obesity” ignores these critically important sociohistorical factors. It also leads to a prescription long since proved to be ineffective: weight loss. Despite relentless pressure from the public health establishment, a private weight-loss industry estimated at more than $72.7 billion annually in the U.S., and alarmingly high levels of body dissatisfaction, most individuals who attempt to lose weight are unable to maintain the loss over the long term and do not achieve improved health. This weight-focused paradigm fails to produce thinner or healthier bodies but succeeds in fostering weight stigma.

Chronic diseases such as diabetes or heart conditions are mislabeled “lifestyle” diseases, when behaviors are not the central problem. Difficult life circumstances cause disease. In other words, the predominant reason black women get sick is not because they eat the wrong things but because their lives are often stressful and their neighborhoods are often polluted.

The most effective and ethical approaches for improving health should aim to change the conditions of black women’s lives: tackling racism, sexism and weightism and providing opportunity for individuals to thrive.

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Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

Journal of Nutrition Education and Behavior, June 1, 2020

Objective

To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children.

Design

Cross-sectional survey.

Setting

Two US weight management centers.

Participants

259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2–18 years)

Main Outcome Measure(s)

Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation.

Analysis

Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates.

Results

Patients had increased odds of engaging in family dinners if they reported lower family discouragement ( P = .003) and had younger children ( P < .001), and increased odds of engaging in family breakfast if they had higher family communication ( P = .002) and younger children ( P = .020). Patients had increased odds of talking about their child’s weight if their child was perceived to have an overweight/obese weight status ( P < .001). Patients with older children had increased odds of talking about their weight with their child ( P = .021).

Conclusions and Implications

Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.

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Study Pinpoints Top Sources of Empty Calories for Children and Teens

EurekAlert!, June 1, 2020

A new study of children and teens found that more than 25% of the calories they consume were considered empty – those from added sugars and solid fats. The top sources of these empty calories were soft drinks, fruit drinks, cookies and brownies, pizza, and ice cream.

“Our findings suggest a need for continued research into what children and adolescents are eating,” said Edwina Wambogo, PhD, who was a recent postdoctoral Cancer Research Training Award Fellow with the National Cancer Institute. “Examining the whole landscape of available foods and beverages for children and adolescents can help inform new ways to promote healthier eating.”

Wambogo, the primary investigator for the study, will present the research as part of NUTRITION 2020 LIVE ONLINE, a virtual conference hosted by the American Society for Nutrition (ASN).

The researchers used data from the 2007-2008 through 2015-2016 National Health and Nutrition Examination Survey to analyze diet trends for children and adolescents ages 2 to 18 years old.

“Over the time period studied, we observed a downward trend in the percent of calories coming from empty calories without any associated decrease in total calorie intake,” said Wambogo. “This trend was mostly driven by declines in added sugars intake, including those from soft drinks and fruit drinks.”

Despite this positive trend, the analysis revealed that for all age groups studied more than 25% of their caloric intake came from empty calories, with the percentage of empty calories increasing with age. The top food sources for these calories remained almost the same from 2007-2008 to 2015-2016. However, with increasing age, the sources shifted from beverages such as fruit drinks and flavored milks to foods such as pizza and sweet bakery products. In terms of drinks, older children and teens also tended to consume more calories from soft drinks rather than fruits drinks, flavored milks and whole milk.

Based on their findings, the researchers suggest several strategies that might be used to help children and teens consume healthier foods:

• Designing interventions that target top sources of energy and empty calories.
• Nutrition education that addresses hidden sources of empty calories from frequently consumed foods.
• Increased marketing that promotes healthier foods to children and teens and limited marketing of less healthy foods.
• Product reformulation such as reducing added sugars in beverages.
• Changing the food environment to ensure availability of healthy foods and limit access to less healthy foods.

Researchers are planning a follow-up study to examine how the top sources of energy and calories consumed by this age group vary by family income. They also want to study further how added solid fats and sugars in beverages may impact intake of calories among children and adolescents.

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It’s Not Obesity. It’s Slavery.

New York Times, May 25, 2020

About five years ago, I was invited to sit in on a meeting about health in the African-American community. Several important figures in the fields of public health and economics were present. A freshly minted Ph.D., I felt strangely like an interloper. I was also the only black person in the room.

One of the facilitators introduced me to the other participants and said something to the effect of “Sabrina, what do you think? Why are black people sick?”

It was a question asked in earnest. Some of the experts had devoted their entire careers to addressing questions surrounding racial health inequities. Years of research, and in some instances failed interventions, had left them baffled. Why are black people so sick?

My answer was swift and unequivocal.

“Slavery.”

My colleagues looked befuddled as they tried to come to terms with my reply.

I meant what I said: The era of slavery was when white Americans determined that black Americans needed only the bare necessities, not enough to keep them optimally safe and healthy. It set in motion black people’s diminished access to healthy foods, safe working conditions, medical treatment and a host of other social inequities that negatively impact health.

This message is particularly important in a moment when African-Americans have experienced the highest rates of severe complications and death from the coronavirus and “obesity” has surfaced as an explanation. The cultural narrative that black people’s weight is a harbinger of disease and death has long served as a dangerous distraction from the real sources of inequality, and it’s happening again.

Reliable data are hard to come by, but available analyses show that on average, the rate of black fatalities is 2.4 times that of whites with Covid-19. In states including Michigan, Kansas and Wisconsin and in Washington, D.C., that ratio jumps to five to seven black people dying of Covid-19 complications for every one white death.

Despite the lack of clarity surrounding these findings, one interpretation of these disparities that has gained traction is the idea that black people are unduly obese (currently defined as a body mass index greater than 30) which is seen as a driver of other chronic illnesses and is believed to put black people at high risk for serious complications from Covid-19.

These claims have received intense media attention, despite the fact that scientists haven’t been able to sufficiently explain the link between obesity and Covid-19. According to the Centers for Disease Control and Prevention, 42.2 percent of white Americans and 49.6 percent of African-Americans are obese. Researchers have yet to clarify how a 7 percentage-point disparity in obesity prevalence translates to a 240 percent-700 percent disparity in fatalities.

Experts have raised questions about the rush to implicate obesity, and especially “severe obesity” (B.M.I. greater than 40), as a factor in coronavirus complications. An article in the medical journal The Lancet evaluated Britain’s inclusion of obesity as a risk factor for coronavirus complications and retorted, “To date, no available data show adverse Covid-19 outcomes specifically in people with a BMI of 40 kg/m2.” The authors concluded, “The scarcity of information regarding the increased risk of illness for people with a BMI higher than 40 kg/m2 has led to ambiguity and might increase anxiety, given that these individuals have now been categorised as vulnerable to severe illness if they contract Covid-19.”

Promoting strained associations between race, body size, and complications from this little-understood disease has served to reinforce an image of black people as wholly swept up in sensuous pleasures like eating and drinking, which supposedly makes our unruly bodies repositories of preventable weight-related illnesses. The attitudes I see today have echoes of what I described in “Fearing the Black Body: The Racial Origins of Fat Phobia.” My research showed that anti-fat attitudes originated not with medical findings, but with Enlightenment-era belief that overfeeding and fatness were evidence of “savagery” and racial inferiority.

Today, the stakes of these discussions could not be higher. When I learned about guidelines suggesting that doctors may use existing health conditions, including obesity, to deny or limit eligibility to lifesaving coronavirus treatments, I couldn’t help thinking of the slavery-era debates I’ve studied about whether or not so-called “constitutionally weak” African-Americans should receive medical care.

Fortunately, since that event I attended five years ago, experts focused on the health of African-Americans have continued to work to direct the nation’s attention away from individual-level factors.

The New York Times’ 1619 Project featured essays detailing how the legacy of slavery impacted health and health care for African-Americans and explaining how, since the era of slavery, black people’s bodies have been labeled congenitally diseased and undeserving of access to lifesaving treatments.

In a recent essay addressing Covid-19 specifically, Rashawn Ray underscored the legacy of redlining that pushed black people into poor, densely populated communities often with limited access to health care. And he pointed out that black people are overrepresented in service positions and as essential workers who have greater exposure than those with the luxury of sheltering in place. Ibram X. Kendi has written that the “irresponsible behavior of disproportionately poor people of color” — often cited as an important factor in health disparities — is a scapegoat directing American’s attention from the centrality of systemic racism in current racial health inequities.

Evaluating the inadequate and questionable data about race, weight and Covid-19 complications with these insights in mind makes it clear that obesity — and its affiliated, if incorrect implication of poor lifestyle choices — should not be front and center when it comes to understanding how this pandemic has affected African-Americans. Even before Covid-19, black Americans had higher rates of multiple chronic illnesses and a lower life expectancy than white Americans, regardless of weight. This is an indication that our social structures are failing us. These failings — and the accompanying embrace of the belief that black bodies are uniquely flawed — are rooted in a shameful era of American history that took place hundreds of years before this pandemic.

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US Department of Agriculture Summer Meals Program

Nutrition Today, May/June 2020 Issue

This article provides an overview of the US Department of Agriculture Summer Meals Program (SMP) and highlights opportunities to strengthen SMP’s public health impacts. We also discuss initial SMP implications of 2 relevant policy provisions of the Families First Coronavirus Response Act (P.L. 116-127), signed into law on March 18, 2020. Ensuring access to summer meals among high-risk students can provide (1) supplemental nutrition assistance to families that helps address food insecurity during the summer months when there are no school meals, (2) healthy meals in structured settings that might help reduce obesity risk, and (3) support to other programs that offer other benefits such as education, physical activity, or job training.

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Tracking of Obesity Among 2- to 9-Year-Olds in an Electronic Heath Record Database From 2006 to 2018

Obesity Science and Practice, June 2020

Background and objective: As obesity among children and adolescents is associated with major health risks, including the persistence of obesity into adulthood, there has been interest in targeting prevention efforts at children and adolescent. The longitudinal tracking of BMI and obesity, as well as the effects of initial age and duration of follow-up on this tracking, were examined in a large electronic health record (EHR) database.

Methods: The data consisted of 2.04 million children who were examined from 2006 through 2018. These children were initially examined between ages 2 and 9 years and had a final examination, on average, 4 years later.

Results: Overall, children with obesity at one examination were 7.7 times more likely to have obesity at a subsequent examination than children with a BMI ≤ 95^th percentile. Further, 71% of children with obesity at one examination continued to have obesity at re-examination. Although 2-year-olds had a relative risk of 5.5 and a positive predictive value of 54%, then sensitivity of obesity at younger ages was low. Of the children who were re-examined after age 10 y and found to have obesity, only 22% had a BMI ≥ 95^th percentile at age 2 years.

Conclusions: Despite the tracking of obesity at all ages, these results agree with previous reports that have found that an elevated BMI at a very young age will identify only a small proportion of older children with obesity.

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