June 2024

Recap of the OPUS Workshop: Obesity-Related Policy, Systems, and Environmental Research

June 2024, NCCOR

Thank you to the over two dozen distinguished speakers and all those who attended NCCOR’s recent workshop, Obesity-Related Policy, Systems, and Environmental (OPUS), on June 4-5. This week’s event was the first in a two-part workshop series to explore and enhance the design and evaluation of policy, systems, and environmental (PSE) interventions to reduce childhood obesity. The discussions highlighted the critical need to expand our understanding of the systemic nature of obesity and to prioritize scalable strategies and methodological advancements.

In the coming weeks, the NCCOR website will post presentation recordings and slides. In the meantime, here is a recap of the key themes that emerged from the event:

 Systems Approaches to Obesity Prevention

The field can move towards more impactful and sustainable solutions by prioritizing systems thinking, community engagement, and equity. The dynamic model of the Amsterdam Healthy Weight Program demonstrated successful multi-level, integrated, and adaptive approaches to obesity prevention. Expanding systems interventions will require new science, methods, team building, and training.

Community Engagement and Equity

Authentic community engagement emerged as a cornerstone of effective PSE interventions. Building trust through regular engagement and respecting communities’ unique cultural contexts were emphasized as essential practices.

Effective Policy Measures

The impact of Chile’s regulation of ultra-processed foods on children’s eating behaviors demonstrated the potential of robust policy measures. Examples such as the statewide sugar-sweetened beverage excise taxes and changes to the WIC food package were highlighted as cost-effective strategies in the U.S.

Addressing Social Determinants of Health

Discussions underscored the importance of addressing broader social determinants of health, such as housing stability and educational opportunities. A recurring theme was the interconnectedness of these factors with obesity risk.

Future Directions

The workshop concluded with a forward-looking session on scaling systems approaches for equitable obesity prevention. Emphasis was placed on developing sustainable, integrated, and multi-sectoral interventions and on the political will to support and sustain these programs. Addressing structural racism and ensuring long-term support for these interventions are critical challenges.

The OPUS workshop provided a rich platform for researchers, practitioners, and policymakers to exchange knowledge and set the stage for innovative and effective obesity prevention strategies. Stay tuned for the next OPUS workshop in October 2024.

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

June 2024, 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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Virginia Tech Scientists Develop Visual Tool to Help People Group Foods Based on Their Levels of Processing

May 30, 2024, EurekAlert!

Fralin Biomedical Research Institute at VTC scientists studying ultra-processed foods have created a new tool for assessing the rewarding and reinforcing properties of foods that make up 58 percent of calories consumed in the United States. The foods have been linked to a wide range of negative health outcomes.

The research, which was published in April in the journal Appetite, provides a collection of carefully curated images of minimally processed and ultra-processed foods matched on 26 characteristics, including macronutrients, sodium, dietary fiber, calories, price, and visual characteristics such as a color and portion size.

The work was based on the NOVA classification system — “nova” means new in Portuguese — which groups foods into four categories based on their level of processing. Nutrition researchers at the University of São Paulo in Brazil developed the scale while studying the country’s sharp increase in obesity rates.

[Source]

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Ultra-Processed Foods Increase Cardiometabolic Risk in Children

May 21, 2024, EurekAlert!

A high consumption of ultra-processed foods during childhood is associated with worse cardiometabolic health. This is the main conclusion of a study led by a research team from the URV’s Human Nutrition Unit in collaboration with the Pere Virgili Health Research Institute (IISPV) and the Biomedical Research Networking Centre. Physiopathology of Obesity and Nutrition (CIBEROBN). The research was conducted on boys and girls between 3 and 6 years old and the main results were published in the scientific journal JAMA Network Open.

Ultra-processed foods tend to be high in saturated fat, sugar, salt, additives and pollutants, while poor in nutrients. Even so, pastries, soft drinks, milkshakes and snacks are often part of children’s diets. To study their effect on health in the first years of life, the research evaluated how the consumption of these products affects a population of more than 1,500 boys and girls aged 3 to 6 from various places (Reus, Córdoba, Santiago de Compostela, Navarra Valencia, Barcelona and Zaragoza), which are taking part in the CORALS multicentre study.

The results showed that children who consumed more ultra-processed foods had higher scores on parameters such as body mass index, waist circumference, fat mass index and blood sugar levels. They also had lower levels of HDL cholesterol – regarded as good cholesterol – in their blood.

“Our findings give cause for concern”, says Nancy Babio, principal researcher of the study. “Although the magnitude of the associations we found could be thought to be of limited clinical importance, the boys and girls taking part in our study were very young but, even so, there was a significant relationship between their consumption and these parameters”, he adds. For the research team, these results should be understood as an early warning of what may happen in the future. “It is essential to recognise the importance of early eating habits and their future implications on cardiometabolic health”, Babio points out.

The study also shows that the children of mothers with little education or a lower socio-economic level generally consumed more ultra-processed foods, which makes them susceptible to health problems in the future. “Taking all this into account, public health policies should be targeting vulnerable populations”, says Jordi Salas-Salvadó, director of the research team, who also recommends that these foods should be replaced with healthier options such as unprocessed or minimally processed products.

Low price and ready availability.

Ultra-processed foods are increasingly common in the diet. Their ready availability and low price mean that they are widely consumed, especially among children, adolescents and their families, and particularly among those most vulnerable from a socio-economic and educational point of view, who are more prone to obesity. In this regard, the study underlines the urgency of addressing the problem of the overconsumption of these foods by children and the importance of drafting public policies and adopting preventive measures to protect the long-term health of future generations.

The study was carried out by the following team: doctoral student Nadine Khoury; URV researcher Nancy Babio and URV professor Jordi Salas-Salvadó – both principal researchers of the University’s Human Nutrition Unit – as well as postdoctoral researcher María Ángeles Martínez (the three supervisors of Nadine’s doctoral thesis). They are all affiliated to the Pere i Virgili Health Research Institute and the Biomedical Research Networking Centre. Physiopathology of Obesity and Nutrition (CIBERobn) of the Carlos III Health Institute.

[Source]

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Biden-Harris Administration Makes History Launching New Suite of Summer Nutrition Programs to Help Tackle Hunger and Improve Healthy Eating for Millions of Children

May 21, 2024, U.S. Department of Agriculture

The U.S. Department of Agriculture announced today the launch of “SUN Programs: USDA’s Summer Nutrition Programs for Kids,” to help improve nutrition security during the summer months. Through the suite of SUN Programs, families now have more choices and convenient ways to get summer nutrition support for their children and teens with new SUN Bucks, SUN Meals, and previously launched SUN Meals To-Go. Collectively, these programs continue the work of the Biden-Harris Administration in promoting food and nutrition security.

“Nearly 30 million children participate in USDA’s school breakfast and lunch programs on an average school day, but when school is out, kids lose access to those vital meals,” said Agriculture Secretary Tom Vilsack. “USDA’s SUN Programs offer more options for families to conveniently access the essential nutrition children need to thrive, learn and grow during summer and beyond.”

SUN Bucks, the new evidence-based Summer Electronic Benefits Transfer (Summer EBT) program, provides a grocery benefit of $120 per eligible school-aged child this summer; the benefit value will be adjusted annually for inflation and is higher outside of the contiguous 48 states. SUN Bucks helps families and caregivers expand their summer grocery budget to buy foods that best fit their family’s needs, cultural traditions and preferences. Research shows that this type of summer grocery benefit can reduce child hunger in the summer by 33%, and also improve eating patterns with increased whole grain, dairy, and fruit and vegetable consumption by children in participating households.

This inaugural summer, many states, the District of Columbia, all U.S. territories, and some tribal nations are partnering with USDA to make SUN Bucks available in their communities. About 21 million children are expected to benefit from SUN Bucks this summer.

In participating areas, SUN Bucks can be used at a variety of grocery stores and other food retailers and are in addition to other food benefits families may already receive, like the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Food Distribution Program on Indian Reservations (FDPIR). Families with eligible children currently receiving SNAP and other benefits will automatically be enrolled in SUN Bucks; others will need to apply each year.

In addition to the new grocery benefit, SUN Programs also provide nutritious meal and snack services during the summer months to kids 18 and under in communities and among populations with high rates of poverty throughout the U.S.:

• SUN Meals are served at schools, parks, community centers, and other neighborhood locations. This long-standing in-person summer meals program has been available in communities since 1968. Meals are often provided along with enrichment activities to support children’s healthy growth and development.
• SUN Meals To-Go, launched in 2023, offers pick-up and delivery options in some rural areas when and where SUN Meals are not available.

“It’s heartening to see Congress’s bipartisan action to help make sure no child goes hungry during the summer months,” said Agriculture Deputy Secretary Xochitl Torres Small. “President Biden’s investment in high-quality, nutritious school meals creates healthier brighter futures for kids across America and USDA’s SUN Programs give families more ways than ever to support their kids’ nutritional needs.”

These nutrition programs advance the goals of the Biden-Harris Administration’s national strategy to end hunger and reduce diet-related disease by 2030 set forth at the historic White House Conference on Hunger, Nutrition, and Health in September 2022.

To help families connect to services in their community, USDA’s SUN Programs website, www.fns.usda.gov/summer, directs visitors to local resources, including how to find a nearby SUN Meals site and see if SUN Meals To-Go are available in their area. Information will be updated throughout the summer. USDA’s SUN Programs website also provides information on SUN Bucks and links visitors to the states and jurisdictions offering the new grocery benefit. The site is also available in Spanish at www.fns.usda.gov/verano.

[Source]

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Racial Disparities in Childhood Obesity on the Rise

May 15, 2024, EurekAlert!

Among public school students in New York City, some of the greatest increases in childhood obesity in recent years were among those socioeconomic and demographic groups already bearing the greatest burden of obesity, including Black and Hispanic students and youth living in poverty. That is the conclusion of a new study published this week in the open-access journal PLOS ONE by Emily D’Agostino of Duke University, US, and colleagues.

Childhood obesity is a major public health concern associated with chronic health conditions and adverse mental health outcomes into adulthood. In the new study, researchers analyzed height, weight and socioeconomic and demographic data on 1.37 million unique students in the New York City public school system aged 5 to 15 from school years 2011-2012 through 2019-2020.

Among a study sample representative of over 600,000 youth in the school year 2019-20, 20.9% had obesity and 6.4% had severe obesity. Overall, rates of obesity and severe obesity decreased slightly between 2011-12 and 2019-20 (2.8% relative decrease in obesity and 0.2% in severe obesity, p<0.001), but increases were seen among Black, Hispanic, and foreign-born students (p<0.05). Moreover, nearly all groups experienced increases in obesity and severe obesity between 2016-17 and 2019-20. Some of the largest increases in obesity and severe obesity during these years were among those who already had higher prevalence, such as Black and Hispanic students and youth living in very-poor neighborhoods. Although White students experienced a relative increase in obesity prevalence between 2016-17 and 2019-20, the change was less than half that observed among Black students (2.3% vs. 6.5%, both p<0.01).

The authors conclude that the disparities in childhood obesity are widening, and point toward a need for greater implementation of equity-centered obesity prevention efforts.

The authors add: “Our study found that overall obesity prevalence has continued to decline among NYC public school youth. However, these findings warrant research exploring the role of the COVID-19 pandemic in childhood obesity in NYC to better evaluate and address disparities.”

[Source]

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Severe Obesity in Childhood Can Halve Life Expectancy, Global Modelling Study Finds

May 14, 2024 EurekAlert!

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) has, for the first time, quantified the impact of different aspects of childhood obesity on long-term health and life expectancy.

The modelling by stradoo GmbH, a life sciences consultancy in Munich, Germany, initiated and supported by Rhythm Pharmaceuticals and presented by Dr Urs Wiedemann, of stradoo, and colleagues at universities and hospitals in the UK, Netherlands, France, Sweden, Spain, USA and Germany found that age of onset, severity and duration of obesity all take their toll on life expectancy.

The development of obesity at a very young age was found to have a particularly profound effect.

For example, a child living with severe obesity (BMI Z-score of 3.5) at the age of four, who doesn’t subsequently lose weight, has a life expectancy of 39 years – about half of the average life expectancy.

Dr Wiedemann says: “While it’s widely accepted that childhood obesity increases the risk of cardiovascular disease and related conditions such as type 2 diabetes (T2D), and that it can reduce life expectancy, evidence on the size of the impact is patchy.

“A better understanding of the precise magnitude of the long-term consequences and the factors that drive them could help inform prevention policies and approaches to treatment, as well as improve health and lengthen life.”

To learn more, the researchers created an early onset obesity model that allowed them to estimate the effect of childhood obesity on cardiovascular disease and related conditions such as type 2 diabetes (TD2), as well as life expectancy.

Four key variables were included: age of obesity onset, obesity duration, irreversible risk accumulation (a measure of irreversible risks of obesity – health effects that remain even after weight loss) and severity of obesity.

Severity of obesity was based on BMI Z-scores. A widely used measure of weight in childhood and adolescence, BMI Z-scores indicate how strongly an individual’s BMI deviates from the normal BMI for their age and sex, with higher values representing higher weight.

For example, a 4-year-old boy with an average height of 103 cm and a “normal” weight of about 16.5 kg (2st 8lb) will have a BMI Z-score of 0. A boy of the same age and height who weighs 19.5 kg (3st 1lb) will have a BMI Z-score of 2, which is just in the obese range, and one who weighs 22.7 kg (3st 8lb) will have a BMI Z-score of 3.5, which indicates severe obesity.

Data came from 50 existing clinical studies on obesity and obesity-related comorbidities, such as type 2 diabetes, cardiovascular events and fatty liver. The studies included more than 10 million participants from countries around the world, approx. 2.7 million of whom were aged between 2 and 29 years.

The model shows that earlier onset and more severe obesity increase the likelihood of developing related comorbidities.

For example, an individual with a BMI Z-score of 3.5 (which indicates severe obesity) at age 4 and who doesn’t go on to lose weight has a 27% likelihood of developing T2D by the age of 25 and a 45% chance of developing T2D by the age of 35.

In contrast, an individual with a BMI Z-score of 2 at age 4 will have a 6.5% chance of T2D by the age of 25 and 22% chance by the age of 35.

The early onset obesity model also shows that a higher BMI Z-score at an early age leads to a lower life expectancy.

For example, a BMI Z-score of 2 at age 4 without subsequent weight reduction decreases average life expectancy from approx. 80 to 65 years. Life expectancy is further reduced to 50 years for a BMI Z-score of 2.5 and 39 years for a BMI Z-score of 3.5.

In contrast, a BMI Z-score of 3.5 at age 12 without subsequent weight reduction yields an average life expectancy of 42 years.

Comparisons with data from studies not included as input for the model and the opinions of leading experts confirmed the model’s accuracy.

It was also possible to model the effect of weight loss on life expectancy and long-term health. For example, an individual living with severe early onset obesity (BMI Z-score of 4 at age 4) who doesn’t subsequently lose weight has a life expectancy of 37 years and a 55% risk of developing type 2 diabetes at age of 35. Weight loss that results in a BMI Z-score of 2 (just in the obese range) at age of 6, will increase the life expectancy to 64 and reduce the risk of type 2 diabetes to 29%.

The modelling also shows that earlier weight loss returns more years of life than later weight loss.

Dr Wiedemann says: “The early onset obesity model shows that weight reduction has a striking effect on life expectancy and comorbidity risk, especially when weight is lost early in life.”

The model’s limitations include not taking into account the cause of obesity, genetic risk factors, ethnic or sex differences, as well as not factoring in how different co-morbidities interact with each other.

Dr Wiedemann concludes: “The impact of childhood obesity on life expectancy is profound.

“It is clear that childhood obesity should be considered a life-threatening disease. It is vital that treatment isn’t put off until the development of type 2 diabetes, high blood pressure or other ‘warning signs’ but starts early.

“Early diagnosis should and can improve quality and length of life.”

[Source]

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Source of Sugar May Be More Important Than Amount When It Comes to the Development of Obesity in Children

May 12, 2024, EurekAlert!

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) suggests that the source of sugar is more important than the amount of sugar when it comes to the development of obesity in children.

The study found that the total amount of sugar consumed when very young was not associated with weight at age 10 or 11.

However, children who got a higher proportion of their sugar from unsweetened liquid dairy products (milk and buttermilk) were less likely to go on to live with overweight or obesity.

Similarly, getting more sugar from fruit was associated with less weight gain.  However, getting a lot of sugar from sweet snacks such as cakes, confectionery and sweetened milk and yoghurt drinks, such as chocolate milk, was linked to being of higher weight.

“The high consumption of sugary foods is considered a risk factor for childhood overweight and obesity and so children are advised to consume less sugar-rich foods, such as confectionery, cakes and sugar-sweetened drinks, and eat more fruit and unsweetened dairy products, such as milk and yoghurt,” says lead researcher Junyang Zou, of the Department of Epidemiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.

“But while fruit and unsweetened dairy products are considered healthy, they contain high amounts of intrinsic sugars – sugar that occurs naturally in the food, rather than being added. We wanted to know if the source of sugar, added versus intrinsic, as well as the amount, affects the likelihood of developing overweight or obesity.

“While this has been studied before, the results are inconsistent and there is a lack of high quality research on the topic.”

To address this, Ms Zou and colleagues used data from the GEKCO Drenthe study1, an ongoing longitudinal study of a cohort of children born in Drenthe, in the northern Netherlands, between April 2006 and April 2007, to explore the association between total sugar intake in early childhood and the intake of sugar from different sources on weight, weight gain and the development of overweight and obesity.

The answers to a food intake questionnaire filled in by the parents of 891 children (448 males) when the children were 3 years were used to calculate daily total sugar intake and the daily sugar intake from 13 food groups [vegetables; fruits (whole fruit only); cereals; starchy vegetables; nuts; legumes; meat, eggs, vegetarian meat substitutes, and oil, butter, and margarines; milk and milk products; coffee and tea, and coffee and tea-based drinks; sugar-sweetened beverages (including fruit juice, lemonade and sweetened milk and yoghurt drinks); savoury products including homemade and ready meals and soup; sugary snacks such as cakes, confectionery and chocolate; toppings/sauces/sugars].

Height and weight, as measured by trained nurses, were used to calculate BMI Z-scores, the change in this score between 3 and 10/11 years and weight status at 10/11 years (normal weight/overweight/obese, as defined by International Obesity Task Force 2012 criteria).2

BMI Z-scores are a widely used measure of weight in childhood and adolescence.  They show how a young person’s BMI compares to the average BMI for their age and sex, with higher values representing a higher weight.

All 891 children were included in the BMI-Z score at 10/11y and change in BMI-Z score analyses. 817 of the children (414 males) were included in the weight status analysis (74/891 were living with overweight or obesity at age 3 and were excluded from this analysis).

Average total daily sugar intake was 112g.  This made up around a third (32%) of the total daily energy intake of 1,388 calories.

The main sources of sugar were fruit (average daily intake = 13g), dairy products (18.6g), sugar-sweetened beverages (41.7g) and sugary snacks (13.1g).

At 10/11 years of age, 102 children with normal weight at the age of 3 had developed overweight or obesity.

Total sugar intake at 3 years was not related to BMI Z-score, weight gain or weight status 10/11 years.

However, a higher intake of sugar from sugary snacks was related to a higher BMI Z-score at 10/11.

In contrast, a higher daily sugar intake from fruit (whole fruit only) was related to a lower BMI Z-score at 10/11 years and less weight gain. (No significant association was found between fruit juice and weight.)

And a higher sugar intake from unsweetened liquid dairy products (milk and buttermilk) was related to a lower odds of developing overweight/obesity at age 10/11. Children with the highest intake of these products aged 3 had a 67% lower risk of going on to have overweight/obesity, compared to those with the lowest intake.

The study didn’t look at why these foods affected weight differently.  However, possible explanations include slower release of sugar from pieces of fruit than from sugary snacks and differences in how the sugars in the different foods (sucrose in cakes and confectionery, fructose in fruit and lactose in dairy) act on the body.

The researchers conclude that when it comes to developing obesity in childhood, the source of sugar seems to be more important than the amount.

Ms Zou adds: “Children should be encouraged to have fruit and milk instead of sweetened milk and yoghurt drinks, sweets, cakes and other foods rich in added sugar.”

[Source]

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