March 2024


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Upcoming NCCOR Webinar Highlights the Interplay between Sleep and Child Health

March 2024, NCCOR

Join NCCOR on March 13, 2024, from 3:00–4:00 p.m. ET for the next Connect & Explore webinar titled “Sleep’s Role in Child Health: Expanding NCCOR’s Catalogue of Surveillance Systems.” This 1-hour webinar will feature experts from the National Institutes of Health who led the effort to add sleep variables to the Catalogue of Surveillance Systems (CSS).

Launched over a decade ago, the CSS is an indispensable resource for childhood obesity research, providing centralized access to over 100 datasets relevant to dietary and physical activity assessments. Now, NCCOR is again accelerating progress in childhood obesity research by incorporating new sleep variables into 36 datasets.

Research suggests that behaviors that occur over the 24-hour cycle, including sleep, diet, and physical activity, are important determinants of childhood obesity. By integrating new sleep variables into the CSS, NCCOR is filling a critical gap and enabling researchers, health care providers, and public health practitioners to efficiently explore the intricate relationship between sleep and childhood obesity. This expansion streamlines research efforts and public health strategies to address child development.

Register for the upcoming Connect & Explore webinar to learn more about the updated CSS. Our featured speakers will discuss the intersection between sleep and childhood obesity and explain how the addition of sleep variables to the CSS can advance childhood obesity research. This webinar will feature:

  • Marissa Shams-White, PhD, MSTOM, MS, MPH, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health
  • Alfonso Alfini, PhD, MS, National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute, National Institutes of Health

Registration for the webinar is free but attendance is limited, so sign up early to secure a spot. Please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will live-tweet the webinar, so follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on

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Publications & Tools

NCCOR Toolbox: NCCOR Report Highlights How Structural Racism Affects Childhood Obesity

March 2024, NCCOR

NCCOR partnered with the Gretchen Swanson Center for Nutrition to publish a phase one report of a study aimed at dissecting the interplay between social determinants of health (SDoH), structural racism, and their influence on the environments that impact childhood obesity rates. The report, Exploration of Social Determinants of Health, Structural Racism, Environments, and Childhood Obesity, aims to catalog existing measures that can assess the impact of SDoH and structural racism on childhood obesity and to identify the data necessary for a deeper understanding of these dynamics. Through interviews with experts and a preliminary review of pertinent literature, this phase 1 study provides valuable insights and direction for future research.

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New Video Shares Author Perspectives on Structural Racism Research

March 2024, NCCOR

In a new video, GSCN explores their recent commentary with NCCOR about available measures for assessing how social determinants of health (SDOH) and structural racism (SR) impact childhood obesity. First author Daniele Vest, MSPH, RDN, shares her perspectives on the findings, future implications for the field, and how different measures can be used for a more equitable and accurate representation of Black communities. These measures can be used to conduct research that both identifies and acknowledges historical context, as well as the intersection of many complex issues that affect both nutrition and environments.

“Things have been built in a way that it’s going to be harder for people of color to access the same things as white people,” Vest emphasized. “We have to look at all these other factors because if not, we miss so many important things.”

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New Commentary Explores Policy Approaches to Obesity Prevention

March 2024, NCCOR

“Although new weight-loss drugs are important, scholars and policymakers shouldn’t lose sight of population-level strategies that can prevent excess weight gain and obesity among children in the first place,” states a new commentary in the New England Journal of Medicine, titled “Childhood Obesity Prevention — Focusing on Population-Level Interventions and Equity.” Authors Steven Gortmaker, PhD, Sara Bleich, PhD, and David Williams, PhD present promising public policy approaches, including taxing sugar-sweetened beverages and improving nutrition standards for WIC and the school lunch program.

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Childhood Obesity Research & News

Benefits of Meeting the Healthy People 2030 Youth Sports Participation Target

February 27, 2024, American Journal of Preventive Medicine


Healthy People 2030, a U.S. government health initiative, has indicated that increasing youth sports participation to 63.3% is a priority in the U.S. This study quantified the health and economic value of achieving this target.


An agent-based model developed in 2023 represents each person aged 6–17 years in the U.S. On each simulated day, agents can participate in sports that affect their metabolic and mental health in the model. Each agent can develop different physical and mental health outcomes, associated with direct and indirect costs.


Increasing the proportion of youth participating in sports from the most recent participation levels (50.7%) to the Healthy People 2030 target (63.3%) could reduce overweight/obesity prevalence by 3.37% (95% CI=3.35%, 3.39%), resulting in 1.71 million fewer cases of overweight/obesity (95% CI=1.64, 1.77 million). This could avert 352,000 (95% CI=336,200, 367,500) cases of weight-related diseases and gain 1.86 million (95% CI=1.86, 1.87 million) quality-adjusted life years, saving $22.55 billion (95% CI=$22.46, $22.63 billion) in direct medical costs and $25.43 billion (95% CI= $25.25, $25.61 billion) in productivity losses. This would also reduce depression/anxiety symptoms, saving $3.61 billion (95% CI=$3.58, $3.63 billion) in direct medical costs and $28.38 billion (95% CI=$28.20, $28.56 billion) in productivity losses.


This study shows that achieving the Healthy People 2030 objective could save third-party payers, businesses, and society billions of dollars for each cohort of persons aged 6–17 years, savings that would continue to repeat with each new cohort. This suggests that even if a substantial amount is invested toward this objective, such investments could pay for themselves.


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Patients with Low Income Face Hurdles in Overcoming Eating Disorders

February 22, 2024, Cornell University

Individuals with eating disorders who have low income are frequently misdiagnosed and lack adequate access to appropriate therapy, according to researchers from Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons.

Their paper, published in the Cognitive Behaviour Therapist on [February] 19, identified the barriers to care that come with having low income and offered guidelines on how therapists can make accommodations for these patients to improve diagnoses and access to treatment.

Approximately 30 million people in the United States experience an eating disorder, which can cause many medical complications and increase the risk of early death. Though people of all income levels and backgrounds can be affected, the cost of treatment – approximately $11,800 annually per patient – is out of reach for many.

“Patients with an eating disorder and low income represent a vulnerable and overlooked group. Studies suggest that they may have more severe symptoms but are less likely to be correctly diagnosed,” said Suzanne Straebler, research associate in psychiatry at Weill Cornell Medicine and clinical director of the Center for Eating Disorders Outpatient Specialty Clinic at NewYork-Presbyterian/Weill Cornell Medical Center. “Even with an appropriate diagnosis, it is highly unlikely they will receive a recommended evidence-based treatment.”

The authors believe that educating health care providers is key to better identifying individuals with eating disorders and helping them overcome barriers to treatment and healing. For those with low income, these factors that often overlap may include having lower education levels; identifying as a sexual or gender minority; being part of a historically marginalized ethnic or racial group; and having limited English proficiency.

“We are trying to get more basic information out so that providers feel more comfortable and confident in identifying these cases and in making referrals for treatment,” said co-author Deborah R. Glasofer, associate professor of clinical medical psychology (in psychiatry) at Columbia University Vagelos College of Physicians and Surgeons and clinical psychologist at the New York State Psychiatric Institute’s Eating Disorder Research Unit.

Patients with low income face enormous obstacles in overcoming an eating disorder. For a person who is food insecure, food banks or pantries may not have the types of food that a patient with an eating disorder needs. “Frequently, patients receive foods that they are unable to eat due to the food being a ‘feared’ or ‘avoided’ food. Or the amount is insufficient in terms of the nutrition and calories required to gain necessary weight,” said Straebler.

The authors suggest several ways to address shortcomings in the system. Therapists could help patients access government or local food resources and could engage with local food banks to educate them about eating disorders and maximize the chances of successful patient recovery.

Patients would also benefit from effective communication with treatment materials in different languages and access to interpreters during therapy. In addition, therapists need to have cultural humility – the willingness to learn about and understand different cultures. This would allow therapists to support not only patients but also include their families through the process.

Less obvious difficulties include not having adequate electricity to cook a meal or not having the technology or the private space to participate in telehealth appointments. Some solutions could include guiding patients to relevant governmental, community or charitable support resources.

“Our paper highlights the need for therapists to understand their role in helping normalize and regulate patterns of eating, regardless of an individual’s specific eating disorder or financial situation,” Glasofer said.


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Decreasing Sedentary Time in Class Reduces Obesity in Children

February 22, 2024, EurekAlert!

The study, published in Obesity Facts, is the first scientific assessment of the impact that reducing sedentary behaviour in the classroom has on obesity in primary school children. The authors say that the positive impact on children’s weight, regardless of factors like socio-economic status, suggests that the approach could be a cheap and effective way to improve children’s health.

According to the most recent estimates (2022-23), 22.7% of Year 6 children in England [have obesity]*. This is up from 18.9% in 2012-13.

Previous exercise interventions in schools aimed at reducing obesity have met with some success in the short term, but have been resource-intensive and haven’t always led to lasting behavioural changes.

In this study, researchers from UCL and ISEH investigated the effect of reducing sedentary time, rather than increasing exercise, on physical activity and obesity in children at 30 UK state primary schools.

Teachers at 26 of those schools were trained to include Active Movement in lessons, with four control schools continuing to teach as normal. Active Movement is a new approach to reducing child inactivity by integrating non-sedentary behaviour and low-level activity into daily routine2.

All schools completed a self-reported survey to gauge how active a child is in terms one and three, while three intervention and three control schools also measured children’s waist-to-height ratio.

In the schools where more movement was introduced, children’s waist-to-height ratio was reduced by 8% and sport participation increased by 10% between term one and term three of the academic year. Children with a higher baseline waist-to-height ratio showed the greatest improvement, regardless of socio-economic status, age, or gender.

Dr Flaminia Ronca, first author of the study from UCL Division of Surgery & Interventional Science and the Institute of Sport, Exercise and Health, said: “Studies have shown that for most children in the UK, classroom time is the most sedentary part of their life. By introducing movement into teaching in creative ways, such as standing up to answer questions or walking around the classroom as part of a learning exercise, we can significantly reduce their sedentary time and our study shows that this can lead to a recognisable improvement in their waist-to-height ratio.”

The intervention schools followed the Active Movement programme, a school-based programme developed by Professor Mike Loosemore and Peter Savage that integrates behaviours such as standing and walking in the classroom. It was designed to integrate non-sedentary behaviour and low-level physical activity into a child’s normal school routine without disrupting the curriculum.

Peter Savage, an author of the study from Active Movement, said: “When we first propose the idea of active movement to teachers, their first reaction is often to say that they don’t know how they’ll manage to do this on top of everything else. But they usually discover that active movement can make a classroom easier to manage, rather than harder. Not only are children getting physical benefits from being less sedentary, the learning environment is improved.”

While obesity affects children from all backgrounds in the UK, those from the most deprived areas are more than twice as likely as those from the least deprived areas to be obese. Children from the poorest areas are also likely to attend schools with fewer resources than those in more affluent areas. The approach trialled in this study is valuable because it doesn’t require schools to spend money on equipment or staff to implement it.

Professor Mike Loosemore, senior author of the study from UCL Division of Surgery & Interventional Science and the Institute of Sport, Exercise and Health (ISEH), said: “Our results show that reducing sedentary behaviours during school time can be an effective obesity reduction strategy for primary school children who are overweight.

“What’s even more encouraging is that this method was effective regardless of the child’s socio-economic status, age or gender. It is something that schools could introduce without needing to invest heavily in equipment or staff, and everyone will benefit.”

*Edited for person-first language.


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Obesity Care Can Make a Big Difference, but Few Get It, Study Suggests

February 21, 2024, EurekAlert!

When someone has obesity, losing even 5% of their body weight can make a major difference in their health — especially if they can keep from regaining it.

Now, a new study in tens of thousands of people with obesity shows the impact of different weight management treatments in achieving this goal.

For those who received one of these treatments — nutrition counseling, medically supervised meal replacements, any anti-obesity medications or bariatric surgery — the odds of losing 5% of their body weight or more in just a year ranged from nearly 1 in 4 to nearly surefire, depending on the treatment.

But the study also suggests that most people with obesity aren’t getting weight-related care from their usual source of health care. The study team, from Michigan Medicine, the University of Michigan’s academic medical center, report their findings in JAMA Network Open.

The team behind the study hopes their findings will inspire more primary care clinics, health systems and insurers to increase the number of people with obesity who get help in choosing, starting and staying on a treatment that works for them. Members of the research team have spent the past few years building and testing a program to do just that for patients receiving primary care through U-M Health.

Underuse of widely available treatments

Effective weight management treatment doesn’t necessarily require using one of the GLP-1 medicines such as semaglutide or tirzepatide that are often in short supply and not covered by insurance. In fact, the study involved data from the years just before any such drugs received FDA approval for treating obesity.

Rather, the study points to the power of offering patients a range of options that are all supported by medical evidence, from nutrition counseling and medication to meal replacement and bariatric surgery.

Both at the individual and population level, receiving one of these under a provider’s guidance was much more likely to lead to a weight loss of 5% or more, compared with anything patients with obesity might have done on their own, the study shows.

“These findings suggest that all weight management treatment options can be highly effective. The challenge is helping individual patients find a treatment that works for them and that they can stick with over time,” said Dina Hafez Griauzde, M.D., M.Sc., senior author of the new study and a certified obesity medicine specialist. She is an assistant professor of internal medicine at the U-M Medical School, and a primary care physician and co-director of the weight management program at VA Ann Arbor Healthcare System.

The anonymous data for the study came from all patients with obesity who went to a primary care provider at any of U-M’s clinics in the five years before the COVID-19 pandemic. In all, only 5% of the patients in this population who had a body-mass index of 30 or more received one of the evaluated weight management treatment options in 2017; that rose to about 7% in 2019.

Lead author James Henderson, Ph.D., a research scientist in the Department of Internal Medicine who led the detailed statistical modeling and analysis of the patient data, notes that the study focuses not just on individuals but also on populations.

The percentage of people in the study population who qualified for a diagnosis of obesity rose during the study period. Without weight management treatments people with obesity in this population were equally likely to gain at least 5% of their baseline weight as to achieve at least a 5% weight loss, effectively  “cancelling out” on the population level.

“Our model shows that even doubling the currently small percentage of patients receiving weight management treatment from their care team could tip the balance at the population level, counteracting the overall trend toward weight gain,” said Henderson.

More about the study

Of the nearly 54,000 patients with obesity in the study, nearly 49,000 did not have any record of working with a U-M provider to try any of the weight management therapies that the study looked at.

The team matched data from each of the 5,090 patients who did receive weight management treatment from their U-M team with data from a patient who was similar in many ways, including BMI, but did not receive such care at U-M. Then they tracked weight changes over time.

Nutrition counseling was the most common treatment used, with 3,364 patients having at least one appointment with a registered dietitian. Only 189 patients had at least one visit for a meal replacement program, 520 went through bariatric surgery, and 1,428 took any form of anti-obesity medication.

Medications considered as a group for the study were orlistat (available as a generic drug or under the names Xenical and Alli), liraglutide (sold as Victoza or Saxenda), drug combinations involving naltrexone and buproprion (Contrave), or phentermine and topiramate (Qsymia), and also GLP-1 medications approved for diabetes management at the time of the study.

After a year, the team calculated that those who didn’t use a WMT under the supervision of a U-M provider would have about a 1 in 6 chance of losing 5% of their body weight or more.

By contrast, those who received nutrition counseling would have greater than a 1 in 5 chance of losing 5% or more. The probability of losing at least this much weight by taking an anti-obesity medication was a little higher, greater than a 1 in 4 chance.

If someone were able to stick with medically prescribed meal replacement for a year – not an easy task for many people — they would have a 1 in 2 chance of losing 5% of their weight. And those who choose bariatric surgery would have a 9 in 10 chance of losing at least 5% of their weight and an 8 in 10 chance of losing at least 10%.

Navigating weight management in a new way

In the past two years, U-M Health has enhanced its broad effort to increase weight management care. It recognizes the complex nature of obesity, which research at U-M and other major centers has shown to be shaped by genetics, life experiences, the food environment, physical and mental health conditions, and more.

U-M’s primary care-based program is called the Weight Navigation Program. Griauzde serves as research director, working with its medical director, endocrinologist Andrew Kraftson, M.D. The WNP works in collaboration with primary care physicians and other providers, who may not have time during regular appointments, or specialized training, to handle all aspects of weight management treatment.

Patients in the program see a primary care physician who is board-certified in obesity medicine, to learn about and choose a treatment path tailored to their needs. Then, through ongoing support — including regular check-ins via text messaging — their progress is tracked, and their treatment plan adapted as needed if they don’t respond to the initial chosen treatment.

The program is supported by the Departments of Family Medicine and Internal Medicine, including the Divisions of General Medicine and Metabolism, Endocrinology and Diabetes, and the Elizabeth Weiser Caswell Diabetes Institute. In addition to working with individual patients, the program harnesses data science to track its performance, and is preparing to publish the first findings about its impact.

The program also partners with researchers across U-M who are running weight-related studies, such as diet and lifestyle studies based in the School of Nursing and a two-year structured Weight Management Program.

In addition to Henderson, Griauzde and Kraftson, the new study’s authors are Anne P. Ehlers, MD, MPH; Joyce M. Lee, MD, MPH; Kenneth Piehl, BS; and Caroline R. Richardson, MD. Griauzde, Henderson, Ehlers and Lee are members of the U-M Institute for Healthcare Policy and Innovation, whose Data and Methods Hub team worked with the researchers. Richardson, a former faculty member in Family Medicine and member of IHPI, is now at Brown University.

The study was funded by multiple grants from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (DK123416, DK092926, DK089503, DK020572, DK092926), including funding for the Michigan Center for Diabetes Translational Research and the Michigan Nutrition Obesity Research Center.

Weight Loss Treatment and Longitudinal Weight Change Among Primary Care Patients With Obesity, JAMA Network Opendoi:10.1001/jamanetworkopen.2023.56183


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Diet and Physical Activity by Prediabetes Status Among U.S. Adolescents: National Health and Nutrition Examination Survey, 2007–2018

February 12, 2024, Childhood Obesity


Background: Prediabetes among adolescents is on the rise, yet it is unclear if modifiable risk factors vary by prediabetes status.

Methods: This study examined associations between diet (primary objective) and physical activity (secondary objective) by prediabetes status among U.S. adolescents (12–19 years) who participated in the National Health and Nutrition Examination Survey from 2007–2018. Differences in Healthy Eating Index (HEI)-2015–2020 scores (total and 13 component scores), nutrients of public health concern, and physical activity were examined by prediabetes status (no prediabetes vs. prediabetes).

Results: Adolescents (n = 2,487) with prediabetes had significantly lower whole grains component scores and intakes of vitamin D, phosphorus, and potassium (all p < .05), than adolescents without prediabetes. Physical activity levels were not optimal for either group, there were no differences by prediabetes status (n = 2,188).

Conclusion: Diabetes prevention interventions for adolescents are needed and should promote a healthy diet target and encourage physical activity.


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Es Niño o Niña?: Gender Differences in Feeding Practices and Obesity Risk among Latino Infants

February 8, 2024, Current Developments in Nutrition


Background: Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy.

Objectives: The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life.

Methods: Latino mother–infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants’ lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk.

Results: The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (≥85th weight-for-length percentile). Infants’ obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90).

Conclusions: The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls.


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