October 2019


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NEW: Robert Wood Johnson Foundation Releases First-Ever “State of Childhood Obesity” Report

October 24, 2019, NCCOR

This month, the Robert Wood Johnson Foundation released the first-ever edition of State of Childhood Obesity: Helping All Children Grow Up Healthy, a new report that will be produced annually. The report includes the best available data on national and state childhood obesity rates, recommends policies that can help address the epidemic, and shares stories about how communities and individuals are taking action across the nation.

The national childhood obesity rate has been relatively stable in recent years, after decades of increasing. However, the rate remains historically high. Childhood obesity puts young people at greater risk for serious health conditions such as high blood pressure, type 2 diabetes, heart disease, and asthma. Rates of childhood obesity also tend be higher in black and Latinx communities.

The new data come from the 2017 and 2018 National Survey of Children’s Health (NSCH), along with analysis conducted by the Health Resources and Services Administration’s Maternal and Child Health Bureau.

Highlights include:

  • In 2017, 4.8 million children aged 10 to 17 had obesity, according to the National Survey of Children’s Health.
  • The 2015-16 National Health and Nutrition Examination Survey found 18.5% of children aged 2 to 19 had obesity.
  • In the U.S. alone, childhood obesity is estimated to cost $14 billion annually in direct health expenses.

Find the interactive data on the 50 states and Washington D.C., in addition to information on policies and programs at

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Publications & Tools


Have you seen NCCOR’s new Measures Registry Learning Modules? Released last month, this new resource help researchers, practitioners, students, and faculty understand key measurement concepts for research and evaluation projects related to nutrition and physical activity.

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Atlas of Childhood Obesity

This report provides the latest estimates of infant, child, and adolescent obesity prevalence in 191 countries. It also provides estimates of the prevalence and numbers of children who will be living with obesity in 2030.

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Children, Food and Nutrition: Growing Well in a Changing World

This new report from UNICEF provides data for child malnutrition around the world today. It covers the “triple burden” of malnutrition, also known as the three strands of malnutrition, that is rapidly emerging in communities around the world. These three strands include: undernutrition, hidden hunger, and overweight/obesity.

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Children’s Drink: Food Advertising to Children and Teens Score (F.A.C.T.S)

This new report from the University of Connecticut’s Rudd Center for Food Policy and Obesity assesses the sales, nutrition, and marketing of children’s drinks. Findings show that sweetened drinks with added sugars and often low-calories sweeteners continue to dominate sales and advertising of drinks marketed for children’s consumption.

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Childhood Obesity Research & News

Sweet Excess: How the Baby Food Industry Hooks Toddlers on Sugar, Salt, and Fat

Washington Post, October 17, 2019

Leading health organizations recently released their first consensus recommendations about what young children should be drinking: only breast milk or, if necessary, infant formula until a baby is 6 months old, with water introduced around then and plain cow’s milk at around their first birthday.

That’s it. No juice, no flavored or plant-based milks, no caffeinated beverages or sodas.

The good news is parents of infants seem to be on the right track — breast-feeding is on the rise. But once children get into the toddler zone, it’s pandemonium.

There’s been a boom in unhealthy foods and beverages for children 6 months to 3 years old, packaged for convenience and often promising to make children stronger and smarter.

Dietary supplements said to boost the immune system. Squeezy pouches boasting three grams of protein and three grams of fiber. Oven-baked stone-ground wheat “wafflez,” superfood puffs and a baffling array of toddler milks purported to aid brain and eye development.

Billy Roberts, senior analyst of food and drink at market research firm Mintel, says that there were four times more product launches in the baby and toddler food aisle in 2018 than in 2005, with a huge surge in new toddler foods and drinks, most of which are extremely high in sugar.

What’s driving this surge? Experts point to several factors. Parents are demanding convenient, on-the-go packaging. Industry’s lust for market share has driven advertising aimed at parents of toddlers. And there’s been little nutritional guidance for new parents, who glean what they can from parenting chat rooms, family lore and pediatricians, many of whom had only a single class on nutrition during medical school.

With more dual-income families, convenience has become central to beleaguered parents passing packaged snacks back to hungry and/or bored toddlers in car seats kitted out with cup holders and snack wells.

“Americans are snackers,” said Mary Story, a professor of global health, family medicine and community health at Duke’s Global Health Institute. “And the food industry is always looking for novel ways to market their products and increase demand.”

For a scientific report for the 2015 Dietary Guidelines Advisory Committee, her team found that 29 percent of toddlers’ calories were coming from snacks, most of which were salty or sweetened processed foods, not fruits and vegetables.

Jennifer Harris leads a multidisciplinary team of researchers at the University of Connecticut that studies food marketing to children, adolescents and parents, and how it affects diets and health.

She says that toddler snacks are often positioned as healthier than those for adults.

“But we didn’t find that to be the case in terms of added sugar, sodium, saturated fat and calories,” Harris said. “You wouldn’t give your toddler Cheetos, but you would give them Gerber puffs, which are basically the same thing.”

A yogurt-based Happy Baby snack for children contains a teaspoon of total sugar per serving, with four servings per pouch. Happy Tot’s organic bananas and carrots fiber and protein bar contains 2 teaspoons of sugar per serving. Happy Family Organics did not respond to requests for comment.

Lorrene Ritchie, director of the Nutrition Policy Institute at the University of California Division of Agriculture and Natural Resources, worries that low-income parents will be more inclined to spend their money on these heavily advertised baby foods, toddler milks and packaged snacks at the expense of healthier options.

“The amount of funding spent to promote healthy foods, which is mostly via federal nutrition education dollars such as WIC and SNAP-Ed, is dwarfed by food marketing which is mostly for unhealthy and ‘treat’ foods and beverages,” she said. “I fear we will never make a big dent in diet-related chronic disease until we level this playing field.”

Researchers found that children who watch 80 minutes of television per day view more than 800 ads for junk food annually. Toddlers and preschoolers are particularly vulnerable because they can’t distinguish between programming and promotion and don’t yet understand the intent of advertising to persuade.

Infants need to eat about 35 to 50 calories for each pound of their weight, largely to fuel the first year’s rapid growth spurt. That growth slows for toddlers, requiring 35 to 40 calories per pound, according to guidelines from the Institute of Medicine. If a toddler eats a total of 1,200 calories that includes Gerber sweet potato puffs (25 calories and 6 percent of the day’s carbs per serving) or Welch’s fruit snacks (80 calories and 11 grams of sugar per serving), that may squeeze out the healthy stuff.

Those decisions have consequences. The Centers for Disease Control and Prevention says that nearly 14 percent of 2- to 5-year-olds are obese (above the 95th percentile for body mass index), a percentage that is higher for African Americans, Hispanics and low-income Americans. A new study says that in the United States, childhood obesity alone is estimated to cost $14 billion annually in direct health expenses.

What babies and toddlers drink is equally key. Nearly four decades ago, Nestlé was villainized for convincing Third World mothers that infant formula was better than breast milk. In 1981 an international code limiting the marketing of breast-milk substitutes was ratified by the World Health Organization and was adopted by most countries, but not the United States, Harris said.

“The code was designed to protect consumers from unscrupulous marketing,” she said. “When infant formula is marketed to parents, it is positioned as convenient and more scientific because it’s a ‘formula,’ and that it’s an acceptable — if not a better — alternative to breast milk. All of that is prohibited under the code.”

As a result of the marketing prohibition, sales of formula for infants lagged. The multinational companies behind the $55 billion global baby food and formula industry had to expand their customer base, inventing new products. They developed follow-up formulas for children 6 months and up, often called “growing-up milks” or “toddler milks.”

Frequently marketed for picky eaters, these milks prey on parents nervous about the frequency and quantity of toddler feedings. They often make nutrient claims — “DHA and iron to support brain development” — but Harris said there are no legal requirements that these front-of-package claims be supported by sound scientific research. These products are typically composed of powdered milk, corn syrup solids and vegetable oil, with more sodium and less protein than whole cow’s milk. A Go & Grow toddler drink from Similac contains 150 calories, with 15 grams or 3 1/2 teaspoons of sugar per serving.

A statement from Abbott Nutrition, Similac’s parent company, said that Go & Grow by Similac does not contain added table sugar.

“The formula’s main ingredients are nonfat milk and lactose — lactose is the naturally occurring milk sugar found in both breastmilk and cow’s milk. It’s a carbohydrate that provides an important source of energy for growing children.”

Toddler milks are more expensive than cow’s milk and aren’t covered by food assistance programs like WIC. They are often purchased by higher-income parents eager to give their children every possible advantage.

But there’s been an unintended, and potentially dangerous, development. Toddler milks are cheaper than infant formulas, which are more nutrient dense, with stricter composition requirements and Food and Drug Administration oversight. Frequently the packaging for infant formulas and toddler milks can look the same, which may lead to instances of infants being fed these nutritionally insufficient products by families trying to economize.

“We’ve done a paper on what the FDA should establish for toddler milks, because there’s no statement of identity and they are called all different things,” Harris said. “There needs to be clear labeling about the ages the product is intended for, and they need to make sure the packet looks different from infant formula. There just aren’t that many people talking about these things. The research hasn’t caught up with the market.”

There are bright spots in the baby-toddler nutrition world. Long dominated by the tiny glass jars of Gerber and Beech-Nut, entrepreneurs are launching healthier brands in convenient pouches and in the refrigerated aisle of the grocery store.

Neurosurgeon Teresa Purzner recently launched baby food company Cerebelly, with $6.7 million in funding to support a line aimed at brain development. Angela Sutherland and Evelyn Rusli launched Yumi organic baby foods in the Los Angeles area in 2017, a subscription service that mails customers tiny jars of “baby borscht” and parfaits of mango buckwheat pudding. And Serenity and Joe Carr, paleo-diet proponents, started Serenity Kids in 2016, a line of meat-forward, higher-fat baby foods available in 3.5-ounce pouches at Whole Foods for $3.99.

Most of these newcomers are significantly more expensive than Gerber and Beech-Nut, putting them out of reach for low-income parents. And WIC, which feeds about half of the 4 million babies born in the United States each year, has not approved pouches, sticking with more established shelf-stable glass jars that are often anchored by sugary fruit purées.

The government does not have guidelines for daily sugar limits for children under 2. But for children between 2 and 18, a limit of 25 grams of added sugar is recommended. In a recent analysis of 469 conventional baby foods in the United States, 35 percent contained more than 10 grams of total sugar in a 4-ounce, single-serve jar or pouch. As a point of comparison, a regular-sized Snickers bar has 20 grams of sugar.

Rick Klauser, chief executive of vegetable-forward Sprout Foods, said that major brands take advantage of government loopholes that don’t require fanciful nutrition and ingredient labeling on the front of packages to match up with the order of ingredients on the back.

“Consumers are already frustrated, they think they know what they are feeding their babies, but there’s a gap in my mind between what we’re telling people and what we’re feeding them,” he said.

Klauser said that cleaning up communication on labels is crucial for toddler food products, and that the return on investment will be seen in the reduction of health-care costs.

“By 18 months” he said, “a child’s nutrition journey is more or less forged.”

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Six Components of Healthy Family Meals

Max Planck Institute for Human Development, October 15, 2019

Turning the TV off, taking time to eat, not arguing at the table: Researchers from the Max Planck Institute for Human Development and the University of Mannheim have evaluated studies examining the quality of family meals. Their findings can serve as guidelines for parents and guardians wanting to help their children establish healthy eating habits.

A greater frequency of family meals is known to be associated with better nutritional health in children. Researchers from the Max Planck Institute for Human Development and the University of Mannheim have already shown that children from families who eat together more often have a lower body mass index (BMI) and eat more healthily overall.

But what exactly it is about family meals that makes them so important for children’s nutritional health? “Family meals do not automatically lead to better eating habits. Social, psychological, and behavioral aspects also play an important role,” says lead author Mattea Dallacker of the Max Planck Institute for Human Development. To delve deeper into these relationships, the researchers conducted a meta-analysis of studies looking at the qualitative aspects of family meals.

Better turn off the TV

They identified six components of family meals that are related to better nutritional health in children, and found that a positive atmosphere at mealtimes is just as important as healthy food. Children who help to prepare meals or whose parents set a good example with their own eating habits also eat more healthily. The length of the meal and switching off the TV also play an important role.

“How family members eat together is just as important as, or even more important than, how often they eat together,” says co-author Ralph Hertwig, Director at the Max Planck Institute for Human Development. The age of the children—whether toddlers or adolescents—and the family’s social and economic background were found to have no effect.

The meta-analysis synthesized the findings of 50 studies with more than 29,000 respondents from around the world that examined how one or more components of family meals relate to children’s nutritional health. The indicators of nutritional health were BMI, which served as an indirect measure of body fat and obesity, and diet quality, which was measured in terms of the number of portions of healthy and unhealthy foods consumed per day.

Important for the prevention of obesity

Although the size of the relationship between family meals and nutritional health is small, the researchers argue that family meals play an important role in obesity prevention. “A whole range of measures are needed to combat obesity in children and adolescents. Family meals are just one measure among many. But they can have a direct and early impact on children’s eating habits,” says Jutta Mata, Professor of Health Psychology at the University of Mannheim. The diversity of family structures is greater than ever in today’s modern societies, but the results appear to be independent of these variations. For example, it makes no difference whether just one or two parents are present at family meals.

Further studies are needed to find out whether the findings can be generalized—for example, to the use of smartphones or tablets during meals or to other settings such as school meals.

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Severe Obesity Among 10 and 11-Year-Olds Hits All-Time High in UK

CNN, October 11, 2019

Severe obesity has hit an all-time high among children in England in their last year of primary school, a government report has found.

The report, released Thursday by the UK’s National Health Service (NHS), examined more than a million 10 and 11-year-olds in state-maintained schools across England.

It found that 20.2% of children measured were obese, including 4.4% who were severely obese — that’s more than 26,000 children.

The NHS defines children’s obesity by calculating their Body Mass Index (BMI), taking into account their sex and age. Children above the 95th percentile are considered “obese,” while children above the 99.6th percentile are considered “severely obese.”

The findings come just a week after a report by the World Obesity Federation, which warned that there are 158 million obese children around the world.

According to the WOF, more than 250 million school-aged children and adolescents will be classed as obese by 2030, putting huge pressure on health care systems.

In absolute terms, the US is expected to have 17 million obese children by 2030, the largest number after China and India, the report found.

Children ‘drowning in unhealthy food’ options

The rate of severe obesity among children ages 10 and 11 in England marks a new record high — and this is the fourth consecutive year the record has been broken. When the NHS first began the annual report in 2006, only 2.4% of children (numbering 10,300) in that age range were severely obese.

These findings were published on the same day that UK Chief Medical Officer Dame Sally Davies released a report urging action on solving childhood obesity. The report reiterated the government’s aim of halving childhood obesity by 2030 — a goal that “we are nowhere near achieving” in England, Davies wrote.

“Today’s children are drowning in a flood of unhealthy food and drink options, compounded by insufficient opportunities for being active,” she said. There are 53,000 fast food outlets in England, with 62% of them within 400 meters (1,300 feet) of a primary school, according to the report.

Obese or overweight children may experience a range of related health issues such as diabetes, asthma, depression, fatty liver disease and joint pain. Recent years have seen a rise in Type 2 diabetes among UK youth, believed to be caused by a rise in obesity.

However, Davies added that biological and social factors, like health care and ethnicity, also significantly affect which children are most vulnerable to obesity. If the wealth gap continues to widen, as many as 33% of children in the most deprived areas could be obese by 2030, she said.

This is in line with the NHS report, which found that there are twice as many obese children living in “deprived areas” than in more affluent areas. The difference in rate for severe obesity is even more extreme — it’s more than four times higher for children who live in the most deprived communities.

“Combined overweight and obesity prevalence ranged from 41.5% for children living in the most deprived areas to 24.1% for children living in the least deprived areas,” the report found.

Davies called for earlier intervention in the medical sector, healthier food and drink options in the public sectors, and greater political leadership in driving change.

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Food Insecurity and Obesity: Research Gaps, Opportunities, and Challenges

Translational Behavioral Medicine, October 2019


Food insecurity, defined as a lack of consistent access to enough food for an active, healthy life, is a major public health concern with 11.8% of U.S. households (15.0 million) estimated to be affected at some point in 2017 according to the United States Department of Agriculture Economic Research Service. While the link between food insecurity, diet quality, and obesity is well documented in the literature, additional research and policy considerations are needed to better understand underlying mechanisms, associated risks, and effective strategies to mitigate the adverse impact of obesity related food insecurity on health. With its Strategic Plan for NIH Obesity Research, the NIH has invested in a broad spectrum of obesity research over the past 10 years to understand the multifaceted factors that contribute to the disease. The issue of food insecurity, obesity and nutrition is cross-cutting and relates to many activities and research priorities of the institutes and centers within the NIH. Several research gaps exist, including the mechanisms and pathways that underscore the complex relationship between food insecurity, diet, and weight outcomes, the impacts on pregnant and lactating women, children, and other vulnerable populations, its cumulative impact over the life course, and the development of effective multi-level intervention strategies to address this critical social determinant of health. Challenges and barriers such as the episodic nature of food insecurity and the inconsistencies of how food insecurity is measured in different studies also remain. Overall, food insecurity research aligns with the upcoming release of the Strategic Plan for NIH Nutrition Research and will continue to be prioritized in order to enhance health, lengthen life, reduce illness and disability and health disparities.

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A Framework for Increasing Equity Impact in Obesity Prevention

American Journal of Public Health, October 2019


One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity-promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.

I propose a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. My core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health.

I describe the framework rationale and elements and provide research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Forty percent of US adults and nearly 20% of US youths aged 2 to 19 years have obesity, with increasing trends in adults and stable prevalence in youths. Obesity is epidemic globally, which is untenable because obesity has high health, social, economic, and personal costs. The causal narrative has become familiar: (1) population-wide obesity is linked to eating and physical activity patterns that are abnormal physiologically, yet have become normative; and (2) communities are laden with obesity-promoting influences, which overwhelm individuals’ efforts to control weight in a healthy range—a plethora of heavily marketed high-calorie, nutrient-poor foods and beverages combined with daily routines lacking in opportunities to be physically active. Changing these conditions requires comprehensive policy, systems, and environmental (PSE) changes to shift the range and balance of behavioral options toward an obesity-protective direction—no small feat and a long-term proposition.

Patterns of obesity prevalence include marked disparities by race/ethnicity. For example, prevalence is significantly higher in non-Hispanic Black (55%) and Hispanic (51%) than non-Hispanic White women (38%), and in Hispanic (43%; but not non-Hispanic Black [37%]), than non-Hispanic White (38%) men.1 Prevalence in 2- to 19-year-old youths is significantly higher in non-Hispanic Black (22%) and Hispanic (26%) than non-Hispanic White (14%) youths.1 Socioeconomic status effects are complex and differ by race/ethnicity; lowest risk is not always observed in the highest socioeconomic status strata of income or education.

These disparities are neither surprising nor coincidental. Risks of having obesity and related health problems are conditioned by adverse social circumstances, part of a deeper problem of systemic structural dynamics that curtail opportunities for advancement. Social disadvantage means a greater likelihood of living in poor-quality housing and in neighborhoods with fewer services and limited options for healthy eating and physical activity. Thus, even when progress is observed (e.g., declines in child obesity prevalence in some states and localities), detailed data may reveal widening gaps attributable to greater progress in White and higher-income than in ethnic minority and low-income youths.

Assuming that any observed progress can be attributed to PSE initiatives implemented over the past 10 to 15 years, persistent or widening disparities suggest a lack of reach to or effectiveness with those who need them the most. Differences in uptake or benefit from PSE approaches were suggested by findings from a large observational study of childhood obesity prevention policies and programs in 130 US communities. Positive associations were reported for the comprehensiveness and intensity of these policies and programs with children’s weight status and diet or physical activity behaviors in White, high-income children and communities but not in children from low-income families or Black or Hispanic children.

Ensuring that populations affected disproportionately by obesity benefit from preventive strategies is among the most pressing unmet challenges in policy and practice. Marked racial/ethnic and income disparities were clearly evident in the 1980s, predating recognition of epidemic obesity in the US population at large. However, documenting disparities does not necessarily trigger deliberate or effective action to address them.

I propose an equity-oriented obesity prevention framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking PSE strategies. The framework is grounded in established public health and health equity principles. I explain the rationale and key conceptual elements and refer to practice and research examples.

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