PUBLICATIONS & TOOLS
- NCCOR's Toolbox
- Innovations in the Food System: Exploring the Future of Food: Proceedings of a Workshop
CHILDHOOD OBESITY RESEARCH & NEWS
- Chemicals Often Found in Consumer Products Could Lead to Obesity and Fatty Liver Diseases
- Healthy Eating Behaviors in Childhood May Reduce the Risk of Adult Obesity and Heart Disease
- COVID-19 School Closings May Spur Childhood Obesity, Experts Warn
- Nearly 1 in 5 US Kids Are Obese, According to Latest Data
- Getting Kids to Move More
- How Children Search for Health Information Online: An Observational Study
NEW! Spanish Translation of NCCOR’s Youth Compendium of Physical Activities
NCCOR, May 19, 2020
Great news for Spanish-language childhood obesity and physical activity researchers and practitioners: NCCOR’s Youth Compendium of Physical Activities is now available in Spanish!
The Youth Compendium of Physical Activities provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity. The Spanish version includes activities common in Spain, Mexico, and Colombia. It can be used by a wide variety of people—from researchers and health care professionals to teachers, coaches, and fitness professionals—and in a variety of ways—including research, public health policy making, education, and interventions to encourage physical activity in youth.
This resource was translated in response to the rise of childhood obesity in Latin America and a need identified by NCCOR members and Latin American researchers for a tool to help address the growing epidemic.
Publications & Tools
Looking for COVID-19 resources related to childhood obesity? NCCOR has compiled them for you here.
Innovations in the Food System: Exploring the Future of Food: Proceedings of a Workshop
On August 7–8, 2019, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop in Washington, DC, to review the status of current and emerging knowledge about innovations for modern food systems and strategies for meeting future needs. The workshop addressed different perspectives on the topic of food systems and built on the topic of sustainable diets from a workshop hosted by the Food Forum in August 2018. This publication summarizes the presentations and discussions from the workshop.
Childhood Obesity Research & News
Chemicals Often Found in Consumer Products Could Lead to Obesity and Fatty Liver Diseases
EurekAlert!, May 19, 2020
Chemical compounds found in many consumer products could be major contributors to the onset of lipid-related diseases, such as obesity, in humans, according to a Baylor University study.
Until recently, scientists thought that diseases such as obesity and fatty liver resulted from anomalies in the metabolism of lipids triggered by excessive energy intake, fat consumption and lack of physical activity. But the Baylor study, published in the international journal Toxicology and Applied Pharmacology, highlights the existence of chemical compounds people are exposed to via a variety of consumer products. These can lead to lipid-related metabolic diseases and weight gain.
“Previous studies have provided strong evidence linking some hormone-like compounds to obesity in humans, but this is the first study that showed a cellular and metabolic effect on human cells exposed directly to those compounds,” said Ramon Lavado, Ph.D., assistant professor of environmental science at Baylor.
Lavado’s team has been conducting experiments to determine whether their suspicion that obesogens — specific chemical compounds found to disrupt normal metabolic processes — promoted a dysregulation of lipid profiles in the human liver.
While poor nutrition and lack of exercise are known contributors to obesity, significant attention has emerged regarding the potential effects of some chemical compounds to trigger lipid-related diseases, Lavado said. Exposures to obesogens — particularly in early development in life — were found to disrupt normal metabolic processes and increase susceptibility to weight gain across the lifespan, he said.
As of the year 2000, there were an estimated 100,000 commercially available chemicals around the world. Two decades later, that amount has more than tripled, with approximately 350,000 chemicals being available, according to recent research published in Environmental Science & Technology.
Contributing chemicals to the diseases may be found in cigarette smoke, air pollution, pesticides, fungicides, flame retardants and a certain class of chemicals used in many consumer products to make them softer. Other contributors widely used in the past may have been industrial chemicals in paints, cements, fluorescent light ballast, sealants and adhesives.
For the study, Lavado said that he and his team used well-established techniques in the field of metabolomics and molecular toxicology to investigate whether the proportion of lipids related to diseases, such as obesity, was modified upon exposure to environmental obesogens — and if so, to what extent the lipid profile changed. Additionally, they used a technique called fluorescence microscopy to investigate whether environmentally relevant concentrations of the tested compounds had the ability to induce fat accumulation in liver tissue.
Study results indicated that the production of diglycerides and triglycerides increased significantly, while other less harmful lipids were found in smaller proportions, said Marco Franco, a Baylor doctoral candidate in environmental science in Lavado’s research group. Another novel finding was that those effects were observed in cells exposed to chemical concentrations that are often seen in the environment and to which people are exposed constantly.
This study is among the few that report molecular and physical changes at the cellular level, and the quantification of specific types of lipids that emerge as a result of chemical exposure, Lavado said.
“In the case of lipid profile alterations, the idea that chemical compounds may trigger and/or contribute to the development of lipid-related diseases deserves extensive research in the future,” he said.
Additionally, study results strongly support the use of animal alternatives with more human relevance as a valuable tool in the characterization of health effects caused by chemicals for which humans are often exposed but lack thorough toxicological data, Lavado said.
Healthy Eating Behaviors in Childhood May Reduce the Risk of Adult Obesity and Heart Disease
EurekAlert!, May 11, 2020
How children are fed may be just as important as what they are fed, according to a new scientific statement from the American Heart Association, “Caregiver Influences on Eating Behaviors in Young Children,” published today in the Journal of the American Heart Association.
The statement is the first from the Association focused on providing evidence-based strategies for parents and caregivers to create a healthy food environment for young children that supports the development of positive eating behaviors and the maintenance of a healthy weight in childhood, thereby reducing the risks of overweight, obesity and cardiovascular disease later in life.
Although many children are born with an innate ability to stop eating when they are full, they are also influenced by the overall emotional atmosphere, including caregiver wishes and demands during mealtimes. If children feel under pressure to eat in response to caregiver wants, it may be harder for them to listen to their individual internal cues that tell them when they are full.
Allowing children to choose what and especially how much to eat within an environment composed of healthy options encourages children to develop and eventually take ownership of their decisions about food and may help them develop eating patterns linked to a healthy weight for a lifetime, according to the statement authors.
“Parents and caregivers should consider building a positive food environment centered on healthy eating habits, rather than focusing on rigid rules about what and how a child should eat,” said Alexis C. Wood, Ph.D., the writing group chair for the scientific statement and assistant professor at the U.S. Department of Agriculture/Agriculture Research Services Children’s Nutrition Research Center and the department of pediatrics (nutrition section) at Baylor College of Medicine in Houston.
The statement suggests that parents and caregivers should be positive role models by creating an environment that demonstrates and supports healthy food choices, rather than an environment focused on controlling children’s choices or highlighting body weight. Parents and caregivers should encourage children to eat healthy foods by:
- providing consistent timing for meals;
- allowing children to select what foods they want to eat from a selection of healthy choices;
- serving healthy or new foods alongside foods children already enjoy;
- regularly eating new, healthy foods while eating with the child and demonstrating enjoyment of the food;
- paying attention to a child’s verbal or non-verbal hunger and fullness cues; and
- avoiding pressuring children to eat more than they wish to eat.
Wood noted that some parents and caregivers may find it challenging to allow children to make their own food decisions, especially if the children become reluctant to try new foods and/or become picky eaters. These behaviors are common and considered normal in early childhood, ages 1 to 5 years, as children are learning about the tastes and textures of solid foods. Imposing rigid, authoritarian rules around eating and using tactics such as rewards or punishments may feel like successful tactics in the short term. However, research does not support this approach; rather, it may have long-term, negative consequences. An authoritarian eating environment does not allow a child to develop positive decision-making skills and can reduce their sense of control, which are important developmental processes for children.
In addition, the authoritarian approach has been linked to children being more likely to eat when they are not hungry and eating less healthy foods that are likely higher in calories, which increase the risk of overweight and obesity and/or conditions of disordered eating.
On the other hand, an indulgent approach, where a child is allowed to eat whatever they want whenever they want, does not provide enough boundaries for children to develop healthy eating habits. Research has also linked this “laissez-faire” approach to a greater risk of children becoming overweight or having obesity.
Research does suggest that some strategies can increase children’s dietary variety during the early years if they are “picky” or “fussy” about foods. Repeatedly offering children a wide variety of healthy foods increases the likelihood they will accept them, particularly when served with foods they prefer. In addition, caregivers or parents who enthusiastically eat a food may also help a child accept this food. Modeling eating healthy foods – by caregivers, siblings and peers – is a good strategy for helping children to be open to a wider variety of food options.
“Children’s eating behaviors are influenced by a lot of people in their lives, so ideally, we want the whole family to demonstrate healthy eating habits,” said Wood.
It is important to note that not all strategies work for all children, and parents and caregivers should not feel undue stress or blame for children’s eating behaviors. “It is very clear that each child is an individual and differs in their tendency to make healthy decisions about food as they grow. This is why it is important to focus on creating an environment that encourages decision-making skills and provides exposure to a variety of healthy, nutritious foods throughout childhood, and not place undue attention on the child’s individual decisions,” concluded Wood.
Caregivers can be a powerful force in helping children develop healthy eating habits, and yet their role is limited by other factors. The statement authors encourage policies that address barriers to implementing the statement’s recommendations within the wider socioeconomic context, including social determinants of health such as socio-economic status, food insecurity and others. While efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the lifespan, they note that they will be most effective as part of a multi-level, multi-component prevention strategy.
COVID-19 School Closings May Spur Childhood Obesity, Experts Warn
Washington Post, May 8, 2020
School is still in session, albeit online, but many American children are no longer sitting in a traditional classroom with scheduled gym periods or the chance to run around at recess. They are distance learning at home, where it’s tempting to snack all day in front of a screen.
Prompted by fears of coronavirus transmission, numerous schools shut down in March, stretching the usual two-to-three-month interval at home into five months or longer. Childhood obesity experts are worrying that children — who often gain weight during the summer when they’re home — will add even more pounds, escalating an already serious public health problem.
“Weight gained each summer accumulates year after year since children don’t usually lose it when they return to school,” says Andrew Rundle, who heads the childhood obesity research project within the Columbia (University) Center for Children’s Environmental Health.
“We’ve basically doubled their time out of school, and all the risk factors for weight gain we see in the summer will be magnified by the lockdown.”
Research has found that children, especially racial and ethnic minorities, are at greater risk of weight gain when they are out of school. Not only are they out of school now, social distancing is also keeping many indoors.
“This pandemic will have multiple impacts on childhood health and development, one of them that it places kids at higher risk of experiencing obesity,” Rundle says. “This is likely to have lasting impacts throughout their lives.”
A 2016 study, for example, found that obesity rose from 8.9 percent to 11.5 percent during the two summers between kindergarten and the end of second grade, while overweight increased from 23.3 percent to 28.7 percent, with no rise during the actual school years.
Joseph Workman, assistant professor of sociology at the University of Missouri at Kansas City and one of the study authors, projects that nearly six months of school closure could result in a 4.86 percentage point increase in childhood obesity.
“This would be a case of one public health crisis exacerbating another public health crisis,” Workman says.
Obesity afflicts 13.7 million American children and adolescents ages 2 through 19, or 18.5 percent, according to the Centers for Disease Control and Prevention. It is 13.9 percent among 2- to 5-year-olds, 18.4 percent among 6- to 11-year-olds and 20.6 percent among those ages 12 to 19, the CDC says.
Moreover, minority children suffer from higher rates of obesity than white children, with Hispanics and African Americans at 25.8 percent and 22 percent respectively, compared with whites, at 14.1 percent, according to the CDC. Research suggests these disparities result from factors such as genetics, physiology, culture, socioeconomic status or a combination.
“Childhood obesity is what I like to call the insidious pandemic,” says Joan C. Han, associate professor of pediatric endocrinology at the University of Tennessee, who also directs the pediatric obesity program at Le Bonheur Children’s Hospital in Memphis. “Unlike coronavirus, which rapidly became a worldwide threat, childhood obesity has spread more quietly, gradually tripling in prevalence over the course of decades, but which one might argue is even more deadly, and should be taken very seriously.”
The rate of childhood obesity has more than doubled in recent decades among preschool children, as well as those ages 12 to 19, and more than tripled among those ages 6 to 11, according to research.
“Once upon a time, city kids might have spent the summer playing stickball, or rural kids might have spent a summer keeping the chicken coop clean,” says Paul von Hippel, associate professor of public policy, sociology, statistics and data science at the University of Texas in Austin, and another co-author of the 2016 study on summer weight gain among children.
Today, however, “the biggest change in behavior that we see when summer vacation starts is that kids watch a lot more television, and that’s especially true for kids from lower income families. Television is a major predictor of obesity,” von Hippel says, adding it’s still unclear whether TV’s influence encourages children to exercise less, snack more, exposes them to junk food advertising — or something else.
Shelter-in-place orders, with parents working from home, likely contribute to obesity by decreasing physical activity, “especially for children living in urban areas with limited access to outdoor space safe for social distancing,” says Eliza Whiteman Kinsey, a postdoctoral research scientist at Columbia University’s Mailman School of Public Health. “Parents working from home . . . is also likely to increase screen time [for children.]”
Moreover, shoppers are buying more packaged foods, which often are unhealthy, but last longer than fresh ones, experts say.
“I was in a supermarket recently where the fresh fruit and vegetables were well stocked, but the shelves were empty when I got to the cookies and snacks,” Rundle says. “People were loading up on ice cream and cookies and microwave dinners, and bringing these high calorie foods into their homes. All the food companies that make processed foods are reporting major sales bumps. Sitting in math class may not burn many calories, but the kids aren’t snacking.”
Also, many economically disadvantaged children rely on public schools for meals during the week. With schools closed, and families suffering financial hardship from job layoffs, “the loss of schools as a safety net for providing nutrition is very concerning,” Han says. “The cheapest foods are among the unhealthiest. This contributes to the disproportionately higher risk of obesity among children in poverty.”
Studies have found that childhood obesity portends dangerous health consequences in adulthood.
“Unhealthy weight gain, even as early as age 5, creates a trajectory of weight gain throughout one’s whole life,” Rundle says, having studied obese children through adulthood to age 50. As adults, they have high body mass indexes, body fat, as well as hypertension, diabetes, heart disease, cancer and stroke, he says. “That’s what we’ve seen in the long term. It’s stunning.”
Experts urge parents to provide kids with food that includes whole grains, vegetables, fruits, lean proteins and dairy products. Substituting low sugar/low salt frozen and canned items is a good alternative if fresh produce is difficult to find, or if parents worry about food waste or spoilage. Avoid buying sugary drinks and packaged snacks, such as chips or candy, tough to resist once they are in the house. Reduce screen time and encourage more physical activity — even indoors — if possible.
“This situation is worse in part because families are under more stress,” von Hippel says. “We went into it without much warning, without a plan. And we didn’t know how long it would last. It might be kind of fun to eat toaster pastries . . . for a week or two, but as the weeks stretch into months, you need a more sustainable plan.”
Nearly 1 in 5 US Kids Are Obese, According to Latest Data
Associated Press, May 8, 2020
The news is disappointing, given that programs across the country have for years been trying to reduce childhood obesity, one expert said.
“We really were expecting and hoping to see the trends decrease,” said Dr. Tannaz Moin, a UCLA obesity researcher.
Obesity — which means not merely overweight, but seriously overweight — is one of the nation’s leading public health problems. Adult obesity also has been trending upward, but childhood obesity is especially worrisome because it can put kids on track for problems like diabetes and heart disease, she said.
The Centers for Disease Control and Prevention findings come from a gold-standard health survey that measures participants’ height and weight. The latest data come from surveys done in 2017 and 2018, when more than 2,800 U.S. children participated.
It found 19.3% of kids ages 2 to 19 were obese. That’s up slightly from the 18.5% in the 2015-2016 national survey. The increase isn’t considered statistically significant, meaning there’s a mathematical chance the rates didn’t truly rise.
But it follows an upward trend since 2005-2006, when 15.4% of U.S. kids were obese.
The percentage of kids who are severely obese remains at about 6%, where it’s been for several years, the CDC found.
A range of factors contribute to childhood obesity, including eating a lot of processed foods and sugary beverages, and a lack of physical exercise.
The current coronavirus crisis — with school closings and stay-at-home orders — can’t be helping, Moin said.
“Kids for the most part are at home, and not at school with recess, and getting even less (physical) activity,” she said. “We may see worse trends in the coming years, especially if this pandemic continues the way it is.”
The CDC quietly released the findings last month in an infographic in the back of one of its publications.
Getting Kids to Move More
New York Times, May 6, 2020
When we asked readers recently what they wanted to know about the coronavirus and exercise, many parents responded with variations of the question — or in some instances, the cri de coeur — of how do I get my kids to move more and stop sitting all day in front of laptops, phones and televisions?
It’s a legitimate concern. “A growing body of evidence shows excessive sitting to be linked with various health risks, low self-esteem and decreased academic achievement in school-aged children and youth,” says Taija Juutinen Finni, a professor of health sciences at the University of Jyvaskyla in Finland who studies inactivity in young people.
But how do we encourage young people to be more active, without making activity one more draining chore? Exercise scientists and coaches, some of them also parents, had some suggestions.
Chase Bubbles and Dance
Parents’ primary goal should be to find a way — any way — to encourage homebound offspring to get up and move, at least a little, says Stuart Phillips, the director of the Centre for Nutrition, Exercise and Health Research at McMaster University in Hamilton, Ontario. “Getting some kind of physical activity every day greatly improves their mood, sleep and, of course, their health.”
The current federal physical activity guidelines recommend that children and teenagers exercise for at least an hour a day, while preschoolers between the ages of 3 and 5 should be up and whizzing about for three hours or more. But, for now, young people “should just try to get out of breath once in a while,” Dr. Juutinen Finni says.
To that end, the researchers recommend that, in technical parlance, you let the wild rumpus start. “Hopping, skipping, ball toss, bear crawls and crab walks can be fun ways to engage younger kids,” says Samantha Stephens, a pediatric exercise physiologist and research fellow at the Hospital for Sick Children in Toronto. Avoid over-exuberant bouncing, of course, in deference to safety and any downstairs neighbors.
Or “set up a disco” in the living room, Dr. Juutinen Finni suggests, stringing holiday lights and creating a cross-generation family playlist. “Dancing together is fun,” she says and lifts pulses and spirits.
You also could meld academics and aerobics, helping both seem less rote. “In math, students could do calculations, and then get to perform as many jumps as the last answer,” Dr. Juutinen Finni says. Or, if they are studying shapes and geometry, suggest they step off the dimensions of your rooms and calculate just how rhomboid some of those spaces are.
Whenever possible, too, get outside, wearing masks and gloves as required, and go analog. “Use chalk to create a hopscotch course” on a sidewalk, Dr. Stephens says. “Blow bubbles and have your kids catch them. Play tag.” Not surprisingly, young people move more when outdoors. In a 2019 study of almost 6,500 children in 12 nations, any hour spent outside resulted in more physical activity than comparable time indoors.
Join the Resistance
Young people should also aim to be strong, and some of them, especially teenagers, may be more receptive to weight training than family dancing. “If your kids don’t want to run, bike or walk but would lift a weight or a sack of flour, do a push-up, squat, jump, skip, then great!” Dr. Phillips says.
“Resistive work is safe for kids,” he adds, “and likely helps to prevent injuries in sports, has beneficial metabolic effects, and a huge mental health benefit.”
It also can be done with little or no equipment. “Body weight training is a great form of resistance exercise,” Dr. Phillips says.
For a brief, child-friendly body weight workout, try several push-ups, followed by some “mountain climbers” — with the young people on all fours, kicking first one leg and then the other behind them, as if scaling a steep slope — and 30 seconds or so of “Superman,” meaning children lie on their stomachs on the floor and lift and hold their arms and legs, as if whooshing through the air.
Young people could Zoom these sessions with friends or allow their parents to join in, for competition and comic relief.
Recess for All
But perhaps the most important message for parents is “don’t try to be the P.E. teacher,” says Ali McManus, a professor of health and exercise at the University of British Columbia Okanagan campus, whose research focuses on children. “If we make exercise too prescriptive, it will be yet another thing to make many parents feel they are failing” and children and teenagers resentful.
Instead, reframe physical activity as a respite from the demands and anxieties of the pandemic, she says. “Parents need recess, too.” So, for your sake and theirs, get up when you can and hop or shimmy with your youngsters. Or suggest your teens, spouse and you download the adventure app “Zombies, Run!,” and add bloodcurdling frisson to an all-family after-school jog.
And know that having the time, space and opportunity to exercise during the shelter-at-home edicts are privileges not available to everyone, every day. If, this afternoon, you cannot break away from Zoom conferences for a dance-off, relax, Dr. Juutinen Finni says, and aim for the more-modest goal of getting your offspring up off the couch every hour. Standing up, by itself, “provides a healthy stimulus to the leg muscles in children,” she says, and lifts some of the weight from busy parents’ shoulders.
How Children Search for Health Information Online: An Observational Study
Journal of Nutrition Education and Behavior, May 1, 2020
To evaluate whether children could find the correct answers to obesity-related health questions on the Internet and observe the search strategies children use when searching for such information.
Twenty-five parent-child dyads, from a southwestern US summer day camp, participated in this cross-sectional study. Parents’ health literacy skills were evaluated. Children searched the Internet for 6 questions related to nutrition and physical activity. Search activities were recorded via Camtasia. Quantitative (ie, time spent per question) and qualitative data (ie, themes related to difficulties searching) were extracted by rewatching the recordings.
All parents had either proficient or basic levels of health literacy. The question that had the highest rating for being correctly answered pertained to physical activity recommendations, whereas none of the children were able to find recommended servings of food groups.
Conclusions and Implications
Children were not successful in finding correct answers to most of the questions and used ineffective search strategies. Interventions that teach children effective search strategies for health information are needed.