June 2023

New NCCOR Paper Identifies Measurement Gaps and Provides Research Opportunities for Advancing Dietary Assessment in Infants and Toddlers

June 2023, NCCOR

A new commentary paper from the National Collaborative on Childhood Obesity Research (NCCOR) underscores the importance of measuring dietary intake during the critical early stages of life. The paper, “Count Every Bite to Make ‘Every Bite Count’: Measurement Gaps and Future Directions for Assessing Diet from Birth to 24 Months,” is now available online in the Journal of the Academy of Nutrition and Dietetics (JAND). The diets of young children were the primary focus in the most recent Dietary Guidelines for Americans 2020-2025 (DGA), which for the first time included comprehensive recommendations for infants and toddlers, urging that “every bite counts.”

The new DGA guidance reflects a growing awareness that early dietary patterns influence children’s food and beverage choices later in life and have health benefits in both the short term and over time. It also presents a new challenge for infant and toddler nutrition: Since every bite counts, how do we count and measure every bite?

To address this question, NCCOR convened a dietary assessment workgroup to identify measurement gaps specific to the first two years of life and propose research opportunities for addressing these gaps. The new paper outlines the group’s process and presents its findings. For example, the workgroup identified nine research gaps for dietary assessment among very young children: measurement error, proxy reporting, biased reporting, estimations of usual intake, understanding human milk composition, lack of biomarkers, device limitations, data processing developments, and the complexity of multidimensional and dynamic dietary patterns. These research gaps often overlap, so innovative solutions to address one may be applicable in other contexts.

The following are strategies to address research gaps:

1. Prioritizing diverse populations in research relevant to the DGA guidelines for infants and toddlers.
2. Developing a national research agenda to prioritize and rank research questions and topics concerning this age group.
3. Creating a comprehensive library of dietary assessment resources specifically designed for infants and toddlers.
4. Forging diverse and interdisciplinary research collaborations to address the complexities associated with dietary assessment in this population.
5. Acknowledging that multiple stakeholders across academia, government, and industry have a role in advancing dietary assessment for the birth to 24-month age group.

The paper concludes that with widespread collaboration, it is possible to not only follow the DGA and “make every bite count” but also measure every bite. This knowledge can contribute to improved dietary patterns, better health outcomes, and a reduced risk of childhood obesity. The commentary will be released in print in September as part of a JAND special issue.

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NCCOR Toolbox: Increasing Opportunities for Trail Use to Promote Physical Activity and Health Among Underserved Youth

June 2023, NCCOR

June is National Great Outdoors Month. NCCOR’s project, Increasing Opportunities for Trail Use to Promote Physical Activity and Health Among Underserved Youth, aims to identify what is known about the benefits of trail use, effective interventions or programs to promote trail use among underserved youth, and the facilitators and barriers related to trail use as a health-enhancing behavior among youth. Throughout the past three years, NCCOR has produced both a publication and a companion brief identifying evaluated programs and policies that effectively promote and increase the use of trails among youth, especially those from under-resourced neighborhoods and communities. Visit the project’s webpage to view the publication and brief.

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Gus Schumacher Nutrition Incentive Program (GusNIP): Year 3 Impact Findings

2023, U.S. Department of Agriculture

The Gus Schumacher Nutrition Incentive Program (GusNIP) aims to increase food and nutrition security among communities with low income while improving local economies and food systems in the United States (U.S.). GusNIP provides funding for grantees to develop and conduct projects that distribute financial incentives to consumers with low income for fruit and vegetable (FV) purchases and FV prescriptions. GusNIP also funds a separate NTAE Center (defined below) that supports GusNIP grantees through evaluation and technical assistance (TA). Formerly known as the Food Insecurity Nutrition Incentive (FINI) program, GusNIP is a competitive grant program funded through the United States Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA) with support from USDA Food and Nutrition Service. The “Year 3 Impact Findings” highlights the key findings from the program’s third year.

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USDA Summer Food Service Program

June 2023, U.S. Department of Agriculture

Help prevent summer hunger with USDA’s Summer Meals for Kids Site Finder. The Summer Food Service Program (SFSP) is a federally-funded, state-administered program. USDA reimburses program operators who serve no-cost, healthy meals and snacks to children and teens in low-income areas. Meals can be eaten in-person at local sites or on-the-go. Families can use the Site Finder tool to find directions to nearby meal sites, as well as their hours of operation and contact information.

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Discover MyPlate: Emergent Reader Mini Books

June 2023, U.S. Department of Agriculture

USDA recently expanded their Discover MyPlate: Nutrition Education for Kindergarten. Discover MyPlate now includes seven emergent readers featuring kindergarten-level sight words that help children build literacy skills while learning about the five food groups and MyPlate. All are welcome to download these materials and make copies. Emergent readers are also available for download as interactive eBooks. If you have difficulty opening any of these files in your Internet browser, please right-click on the link and “save link as.” Ordering: Print copies (set of 6) are only available in Spanish. Child nutrition program operators may request printed copies of this resource, while supplies last. The emergent reader mini book, “Where Food Comes From,” is currently not available in print.

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New WHO Framework Available for Prevention and Management of Obesity

May 17, 2023, World Health Organization

WHO launches a new Health Service Delivery Framework for Prevention and Management of Obesity, as a health system-focused component of the WHO Acceleration Plan to Stop Obesity.

The new framework promotes expanded access to obesity prevention and management services for all age groups across the life course. It guides the integration and organization of obesity prevention and management services through the health system and community as critical components of universal health coverage. The framework is based on the principles of primary health care, follows a chronic care approach, and is supported by the integration of obesity prevention and management into existing service delivery frameworks across the health care system, including communities and homes. It also supports the planning of required resources for the scaling up and sustainability of services.

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Short-Term Efficacy of a Childhood Obesity Prevention Program Designed to Pair Feeding Content with Nutrition Education

May 29, 2023, Childhood Obesity

Background: Family-based programs show considerable promise in preventing overweight and obesity in young children. However, dissemination is difficult because significant participant and staff involvement is required. This study examined the short-term efficacy of adding parental feeding content to a widely-used nutrition education curriculum for families in low-resourced communities comparing the influence of two delivery methods (in-class and online) on parents’ feeding knowledge, practices, and styles.

Methods: In this cluster randomized controlled trial, parents of 2- to 8-year-old children enrolled in the EFNEP (Expanded Food and Nutrition Education Program) in Colorado and Washington were randomly assigned to: in-class nutrition education only, in-class nutrition education with in-class feeding content, or in-class nutrition education with online feeding content. Data from the 382 participants who completed both pretest and posttest assessments are reported in this study.

Results: Multilevel analyses showed empirical support for the influence of the program on parents’ feeding knowledge, practices, and styles. Online and in-class methods were equally effective in delivering feeding content in low-resourced communities. Consistent effects were seen across the two delivery methods for encouraging children to try new foods (p < 0.05), use of child-centered feeding practices (i.e., greater responsiveness, p < 0.05), child involvement in food preparation (p < 0.05), and understanding the number of presentations often necessary for child acceptance of a new food (p < 0.001). Location and language differences were seen across some constructs.

Conclusions: This study demonstrates the efficacy of in-class and online approaches to feeding highlighting the program’s positive effects on promoting healthy feeding behaviors for parents of children in low-resourced families. ClinicalTrials.gov Identifier: NCT03170700.

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Topiramate for Weight Management in Children with Severe Obesity

May 29, 2023, Childhood Obesity

Background: Topiramate has been shown to result in significant weight loss compared to placebo in adults with obesity. However, there are no consensus guidelines on the acceptability, safety, and efficacy of topiramate for weight loss in children. We present a literature review and case series on topiramate use in young children with severe obesity.

Methods: We performed a PubMed search from January 2000 to February 2022 utilizing keywords, “topiramate” and “obesity” and “children” and “adolescent.” For our case series, children were identified through retrospective chart review from a multidisciplinary weight management program. Eligibility criteria: age ≤12 years, class II or III obesity, completed 16 weeks of topiramate therapy as adjunct to lifestyle modifications. Semistructured interviews were conducted with one parent to review side effects.

Results: Literature search yielded nine articles. All studies reported trends toward BMI reduction and weight loss with topiramate monotherapy. Five children met case series eligibility (mean age 10 years 3 months ±1.5 years, 60% female). After 16 weeks of topiramate, all children had a decrease in BMI as a percentage of the 95th percentile (mean −12% [−5% to −18%]). Parents reported improvement in impulsive eating and decreased desire to overeat compared to baseline. Four out of five reported no side effects, one reported drowsiness which resolved by dosing at nighttime.

Conclusions: Results suggest that topiramate is well tolerated and may be utilized for weight management in younger children. A randomized controlled trial investigating the impact of topiramate for weight management in this age group is warranted.

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Trends and Persistent Disparities in Child Obesity During the COVID-19 Pandemic

May 24, 2023, Childhood Obesity

The COVID-19 pandemic has been associated with increases in pediatric obesity and widening pre-existing disparities. To better understand the pandemic’s long-term impacts, we evaluated trends in obesity across different demographic groups during the pandemic through December 2022. Using a retrospective cohort design, we analyzed electronic health record data from a large pediatric primary care network. Logistic regression models fit using generalized estimating equations estimated odds ratios (ORs) for changes in the level and trajectory of obesity across 2-year month-matched periods: prepandemic (June 2017 to December 2019) and pandemic (June 2020 to December 2022). Among a cohort of 153,667 patients with visits in each period, there was a significant increase in the level of obesity at the pandemic onset [OR: 1.229, 95% confidence interval (CI): 1.211–1.247] followed by a significant decrease in the trend for obesity (OR: 0.993, 95% CI: 0.992–0.993). By December 2022, obesity had returned to prepandemic levels. However, persistent sociodemographic disparities remain.

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USDA Funds 36 Projects Aimed at Connecting Families to WIC through Partnership with FRAC as part of Investing in America Agenda

May 18, 2023, U.S. Department of Agriculture

The U.S. Department of Agriculture (USDA), through a cooperative agreement with USDA’s Food and Nutrition Service (FNS) and the Food Research & Action Center (FRAC), has awarded $16 million in subgrants funding from the American Rescue Plan Act of 2021 to 36 projects aimed at testing innovative outreach strategies to increase participation and equity in the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC. The WIC Community Innovation and Outreach Project, or WIC CIAO, subgrantees include WIC state and local agencies and community-based organizations, including four subgrants led by tribal nations or entities.

“The Biden-Harris Administration is making a difference in the lives of pregnant women, moms, babies and young children by providing proven health interventions through the WIC program,” said Agriculture Secretary Tom Vilsack. “We’re pleased to work with such a strong and diverse group of subgrant partners across the nation to ensure everyone eligible for WIC can tap into its incredible benefits.”

WIC is one of the most powerful, evidence-based public health programs available, with a long history of improving health and developmental outcomes for children. Yet, only 50 percent of all eligible individuals participate in WIC, a shortfall of almost 6 million moms, babies, and young children missing out on key benefits.

“While our efforts to increase participation among eligible groups appear to be taking hold, we have more work to do,” said Stacy Dean, deputy under secretary for Food, Nutrition and Consumer Services.

The WIC CIAO project aims to expand partnerships with community organizations and use community-level data to develop and implement innovative WIC outreach efforts. For example, projects include co-locating WIC staff at medical offices and partnering with Head Start in the Cherokee Nation in Oklahoma; developing culturally and linguistically appropriate materials for outreach to communities with large numbers of Middle Eastern and North African residents in Michigan; and increasing retention of Black and Latino families after infants turn one by addressing language, culture, and environmental barriers in Mobile County, Ala.

The full list of grantees and their project details can be found on the hellowic.org project summaries webpage.

“FRAC deeply appreciates the opportunity and support from USDA to ensure this vital program is available and accessible to all who need it,” said Luis Guardia, president of FRAC. “WIC has played an essential role in helping children grow up healthy and ensuring mothers get the support they need before, during, and after pregnancy. But for the program to truly maximize its potential, we need to get 100 percent of eligible individuals enrolled and actively participating. We look forward to working closely with our partners to achieve this important goal.”

Today’s announcement is part of President Biden’s Investing in America agenda, which is investing in the prosperity and well-being of families and communities and growing the American economy from the bottom up and middle-out.

These projects are part of a broader strategy to modernize and innovate in WIC to connect more eligible people to the program and serve them well throughout the entire time they’re eligible. FNS has recently invited WIC state agencies to apply for several grant opportunities funded by the American Rescue Plan Act of 2021 to:

• Improve the WIC shopping experience. This includes improving the in-store experience by making it easier to identify WIC products, streamlining the checkout experience through innovations such as self-checkout and working toward online shopping.
• Make WIC easier to access through technology, such as text messaging, mobile-friendly websites, appointment scheduling and language tools.
• Implement mobile pay in the WIC Farmers’ Market Nutrition Program so that participants can more conveniently buy fresh and locally grown fruits and vegetables.

USDA competitively awarded the WIC Community Innovation and Outreach Cooperative Agreement to FRAC, which is supported by partners UnidosUS, Native American Agriculture Fund, and Gretchen Swanson Center for Nutrition. Visit hellowic.org to learn more about the WIC CIAO Project and subgrant awardees. Visit WIC Modernization to learn more about USDA’s WIC modernization and innovation efforts in action.

These efforts are part of the National Strategy on Hunger, Nutrition, and Health which was released in conjunction with the first White House Conference on Hunger, Nutrition, and Health in over 50 years, hosted by President Biden on September 28, 2022.

USDA touches the lives of all Americans each day in so many positive ways. In the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, ensuring access to healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov and follow on Twitter.

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Child and Adolescent Obesity

May 18, 2023, Nature

Abstract: The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive–emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.

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Behavior Change Techniques that Prevent or Decrease Obesity in Youth with a Low Socioeconomic Status: A Systematic Review and Meta-Analysis

May 18, 2023, Childhood Obesity

Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries.

Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs.

Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies’ effect sizes.

Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.

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