June 2022


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New from NCCOR: Resources to Create Thriving, Activity-Friendly Communities

Promote the health of your community with NCCOR’s newest tool, Resources to Make the Case for Improving Community Built Environments. This new resource collection builds on NCCOR’s years of physical activity research, by helping public health practitioners, decision-makers, and community members make the business case for investing in activity-friendly environments. On the NCCOR website, you will find ready-made materials to facilitate conversations with local leaders. Resources include:

  • Tips for talking about the economic benefits of activity-friendly communities: Start the conversation around activity-friendly communities with talking points and questions to guide you.
  • Making the Business Case for Activity-Friendly Places fact sheet: Bring this factsheet with you to a community town hall or meeting to share an overview of 10 measurable benefits of activity-friendly places, popular approaches to creating activity-friendly places, and a case studies, and other examples.
  • Customizable presentation: Download our PowerPoint presentation, which you can customize. The template allows you to insert your own data and images and choose what benefits to emphasize based on the needs of your community.
  • Recent research articles and other relevant resources: Learn more with two recent research articles NCCOR published on the benefits of improving the built environment, as well as resources and tools from other organizations.

Stay Tuned for More Resources to Create Thriving, Activity-Friendly Communities
This fall NCCOR will release an Economic Indicators Library that can be used to help your community decide what to indicators to prioritize and measure based on relevance to the most pressing local issues and needs, and your community’s vision for the future. Sign up for our mailing list to be notified of updated content.

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Publications & Tools

NCCOR Toolbox: Celebrate Great Outdoors Month with NCCOR’s Trail Use Resources

June is the Great Outdoors Month, a nationwide celebration of spending time in nature. NCCOR is committed to ensuring that all children have opportunities for outside play and exploration. Our trail use resource page features a scientific review of programs and policies that effectively promote trail use, especially for youth from under-resourced communities. The page also contains a program brief to help public health practitioners build or improve trail use programs for youth.

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SNAP-Ed to Expand the SNAP-Ed Toolkit

The U.S. Department of Agriculture’s SNAP-Ed Program recently announced that they will add 13 new interventions and three resources to their online SNAP-Ed Toolkit. The program plans a July launch, but the upcoming additions are available on their website now. They urge users to learn more about the changes and prepare for how they could use them in local programs. Visit SNAP-Ed to learn more about the upcoming additions.

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Podcast Series Explores Current Issues Related to Childhood Obesity

The Institute for Healthy Childhood Weight, a program of the American Academy of Pediatrics, recently released two new episodes of their podcast series, Conversations about Care. Produced in partnership with Bright Futures, the podcast series features conversations with healthcare providers discussing current themes and issues related to childhood healthy weight research and patient-centered care. The new episodes highlight practical strategies for talking with families about healthy foods and the link between childhood obesity and diabetes. Past episodes address a range of issues including weight stigma, screen time and sedentary behaviors, and cooking with kids.

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Childhood Obesity Research & News

“New and Improved” Supermarkets Trim Childhood Obesity in NYC

May 9, 2022, EurekAlert!

Access to newer supermarkets that offer fresh foods in some of New York City’s poorest neighborhoods was linked to a 1% decline in obesity rates among public school students living nearby, a new study shows. The modernized markets were also tied to reductions of between 4% and 10% in the average student BMI-z score, a measure of body weight based on height for each age group by gender.

Although the differences were small, researchers say the results, if translated into policy changes, could have a meaningful difference if applied to the more than 14 million (19%) American children estimated to be obese, with rates highest among Black and Hispanic children.

To substantially lower death rates from related illnesses, researchers say childhood obesity rates would have to decline at least three times more than what was observed in the study. A broad health policy approach that also included subsidies for nutritious foods, restrictions on marketing of junk foods, and warning labels could potentially make up the difference.

Led by researchers at NYU Grossman School of Medicine, the new study showed that within a year after opening of newly renovated or new supermarkets, obesity rates dropped from 24.3% to 23.3% among 22,712 school-age children living within a half-mile of eight such stores. This reduction was compared with no change in obesity rates (steady at 23.3%) among 86,744 students who resided farther away from one of the publicly subsidized stores with more space for fresh produce and perishable foods. City grants have been available since 2009 to lower the cost of renovating or opening supermarkets in the city’s lowest-income neighborhoods.

“Our study highlights that one in four New York City public school kids sampled, predominantly Hispanic and Black, is obese, a worrisome sign of the depth of the problem facing children’s health in the city,” says study lead investigator and epidemiologist Pasquale Rummo, PhD, MPH. Childhood obesity is strongly linked to long-term risk of heart disease, stroke, and diabetes, says Rummo.

Among the study’s other key results was that obesity risk scores declined more among students in kindergarten through grade 8 than in students in grades 9 through 12.

Rummo, an assistant professor in the Department of Population Health at NYU Langone Health, attributes this to the fact that teenagers have greater freedom to travel outside their local neighborhood than younger kids. Teenagers also traditionally have more money to spend on snack food at bodegas or fast-food restaurants.

“These results, however small, demonstrate that supermarket subsidies might play an effective role in addressing the complex problem of childhood obesity in America, especially among our most at-risk Hispanic and Black children,” says study senior investigator Brian Elbel, PhD, MPH. Elbel is a professor in the Departments of Population Health and Medicine at NYU Langone.

Publishing in the journal JAMA Pediatrics, the new study is the largest investigation to date on the effects of the New York City supermarket development subsidies on childhood obesity. Previous research involved single-store studies, producing mixed results that researchers hoped the current study would help resolve. Other studies also focused on the impact of subsidies on adult obesity, while the new study is the first to focus on children and their weight.

For the investigation, researchers identified at least one supermarket in each of the city’s boroughs that from 2009 to 2016 participated in New York City’s Food Retail Expansion to Support Health (FRESH) program.  As part of FRESH, the city offered grants and tax breaks to renovate or build new nearly two dozen supermarkets in low-income neighborhoods with high unemployment to improve local access to healthy foods.

Researchers then analyzed seven years of public school health records for those students in kindergarten through high school who lived within a mile or more of the FRESH supermarkets. Body weight measurements were then compared for one year before and for up to a year after the supermarket was redone or newly built.

The research team already has plans to look at the health effects of other supermarket-based incentives, such as discounted prices for fruits and vegetables, and whether these subsidies increase their consumption and impact obesity rates. Further investigation is also needed, says Elbel, into what effects, if any, modern supermarkets have on what food students really purchase and consume, data that was not available for the latest analysis.

Elbel stresses that all policy efforts, including FRESH grants, designed to improve public health need to be evaluated for their long-term impact.

Funding for the study was provided by National Institute of Health grants R01DK108682 and R01DK097347.

Besides Rummo and Elbel, Jeremy Sze, MA, also at NYU Langone, served as a study co-investigator.


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Obesity Increased among Children, Teens from Low-Income Families during Early Pandemic Months

May 8, 2022, News Medical

Note: Dr. Ihuoma Eneli, the researcher featured in this article, was a contributor to NCCOR’s A Toolkit for Evaluating Childhood Healthy Weight Programs.

During the first six months of the COVID-19 pandemic, the proportion of children and adolescents from low-income families with overweight or obesity increased markedly, according to new research being presented at this year’s European Congress on Obesity (ECO) in Maastricht, Netherlands (4-7 May). The study is by Ihuoma Eneli, MD, MS, FAAP, Director of the Center for Healthy Weight and Nutrition at the Nationwide Children’s Hospital and Professor of Pediatrics at The Ohio State University in Columbus, Ohio, and colleagues.

The cohort study of over 4,500 young people (aged 2-17 years) from a large primary care network in the State of Ohio is one of the first to present findings on how the COVID-19 pandemic impacted weight change in young people from lower socioeconomic groups.

Childhood obesity has long been a major health concern in the USA, and the researchers say that the early pandemic months of full lockdowns may have compounded the problem, further widening racial/ethnic disparities in obesity.

“The early months of school closures, bans on social gatherings, disruptions to sleep and lack of exercise, increased screen time and snacking, as well as heightened stress and anxiety created the perfect storm for having issues with weight gain,” says Professor Eneli.

For this study, researchers analysed electronic medical record data from young people aged 2–17 years, attending a large network of 12 primary care clinics in the Nationwide Children’s Hospital in the State of Ohio. The network provides care for more than 100,000 young people, most of whom receive public insurance like Medicaid.

In total, 4,509 young people whose weight and height had been recorded at least once during clinic visits before the pandemic (1 January to 30 March 2020) and at least once during the early pandemic (1 June to 30 September 2020) were included in the analyses comparing how BMI and weight category changed after the onset of the COVID-19 pandemic, and whether these changes differed by sex, age group, race/ethnicity, after adjusting for visit type and time lapse. Youth with complex chronic conditions were excluded from the study.

The researchers found that the proportion of youth with overweight, obesity, or severe obesity increased from 38% to 45% before the pandemic; and declined by almost 6% in the healthy weight category (see figure 1 in paper linked below).

Overall, around 1 in 5 young people gained at least 5 kg (more than 4% gained at least 10 kg) and increased their BMI by at least 2 units. Average (median) weight gain was highest among young people with severe obesity, who gained on average almost 6kg.

Interestingly, among underweight youth, over 45% switched to the healthy weight category, with a median (average) weight gain of over 2 kg.

Further analyses found that younger children (2–9 years), girls, and ethnic-minority youth were more likely to change to a worse weight category. For example, children aged between 2 and 9 years old were almost twice as likely to move up to a higher weight category (eg, healthy weight to overweight, or obesity to severe obesity) than 14-17 year old teenagers. Similarly, Hispanic children and teenagers were twice as likely to move up a weight category than their White peers (see table 1 in paper linked below).

According to Professor Eneli: “This study reflects findings from the early 3-6 months during the pandemic. As families and communities began to adapt, the trajectory of weight change later during the pandemic may differ and deserves further study. Along with several negative pandemic-related consequences on child health (e.g., increased mental health concerns, food insecurity, deficits in immunization coverage and school performance), addressing the excessive weight gain should be a top priority for families, administrators, or policymakers.”

The authors note that this is an observational study that is limited to a single primary care network in the USA, which limits the generalisability of the findings. In addition, the researchers cannot rule out the possibility that other unmeasured factors such as lifestyle behaviours and sleep patterns may have affected the results.


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Strengthening School Lunch Nutritional Standards May Help Improve Obesity Outlook for Low-Income Children

May 5, 2022, EurekAlert!

Regulations that strengthened the nutritional requirements for school lunches were associated with a decline in signs of obesity among free or reduced-price lunch participating school children in kindergarten through 5th grade, according to a new RAND Corporation study.

Examining low-income children over two periods of time, researchers found that students who participated in the free or reduced-price federal National School Lunch Program after nutrition standards were strengthened showed less weight gain than children who participated in the earlier version of the program.

The findings are published in the journal JAMA Network Open.

“Our findings suggest that improving nutritional standards for school lunches can help reduce the trajectory toward obesity among the low-income children who participate in federal school lunch programs,” said Andrea S. Richardson, the study’s lead author and a policy researcher at RAND, a nonprofit research organization.

Obesity remains high among American children, with severe obesity growing particularly fast among low-income groups.

While school meals are a critical source of nutrients for low-income children, a growing body of evidence suggests that prior to 2010 they may have contributed to childhood obesity.

In response, Congress adopted the Healthy, Hunger Free Kids Act of 2010, which elevated nutritional standards for federal school lunch programs. The healthier menus, which included increased fruit, vegetable, and whole grain amounts, were adopted in 2012.

Researchers examined the influence of the healthier school lunch regulations by examining two groups of low-income children both before and after the adoption of the healthier school lunch standards. The two groups totaled about 5,960 children.

The study found that children who participated in the school lunch program before the nutritional reforms showed more signs of weight gain by the time they reached 5th grade, as compared to children who did not participate in the school lunch program.

Once the healthier nutrition standards were put into place, children who participated in the school lunch program did not show any differences in weight gain when compared to children who did not participate in the school lunch program.

The findings suggest the nutritional improvements prompted by the Healthy and Hunger-Free Kids Act may have eased the link seen previously between participation in subsidized school lunches and obesity among school children.

While the findings support the benefits of higher standards for school lunches, researchers said that many of the low-income students in the study still appeared to be headed toward obesity.

“Increasing access to school meals with more-rigorous nutritional requirements that are culturally pleasing to children may be needed to achieve greater success in reducing child obesity,” Richardson said.

Support for the study was provided by the National Cancer Institute. Other authors of the study are Margaret M. Weden and Irineo Cabreros, both of RAND; and Ashlesha Datar of the University of Southern California.


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