October 2021


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NCCOR Continues to Advance Measurement to Address Childhood Obesity

A new paper published in The American Journal of Preventive Medicine describes priorities and next steps for enhancing measurement tools and using high-quality measures in research to address the childhood obesity epidemic. The paper,  Advancing Measurement to Address Childhood Obesity: Results of 3 Workshops, comes from a series of workshops held in 2019 and early 2020 by NCCOR and funded by The JPB Foundation

These workshops focused on the measurement of individual behaviors; environmental influences; and policy influences related to diet, physical activity, sedentary behavior, and sleep. Each workshop focused on high-risk populations and communities. A white paper series that describes each workshop individually is available on the NCCOR website.

The authors of this paper, all of whom are NCCOR members, describe common challenges and opportunities that emerged across the three workshops. The workshops identified six major categories for action including: 

  1. Developing new measures 
  2. Reviewing what is known and maximizing cross-sectoral collaboration 
  3. Building measurement tools, guidance, and data resources 
  4. Enhancing capacity, dissemination, and collaboration 
  5. Developing research methods, approaches, and enhanced linkages 
  6. Expanding data collection, research, and publication.  

Within these categories, workshop attendees identified 73 specific actions, all of which are listed in the paper. Some actions include considering how behaviors vary across a 24-hour day, identifying metrics from housing and transportation sectors that are well developed and could be useful for community health, and creating a roadmap for cross-domain measure selection and adaptation.

The workshops have already sparked discussions within NCCOR and member organizations for initiatives related to childhood obesity. For example, NCCOR has updated its Measures Registry and Catalogue of Surveillance Systems with measures for Birth-24 months and relevant surveillance data sets focused on the social determinants of health. NCCOR also developed a new decision tree to provide guidance to address measure adaptation for high-risk populations. The next steps should include additional efforts to advance the quality of measurement for surveillance, epidemiology, and intervention research. 

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New Connect & Explore Webinar! Assessing the Children’s Food and Beverage Advertising Initiative

Join us for the next Connect & Explore webinar on November 10, 3-4 p.m. ET titled Assessing the Public Health Impacts of the Children’s Food and Beverage Advertising  Initiative.

Speakers from the Rudd Center for Food Policy and Obesity and RTI International will examine a recently released RTI report and discuss the effectiveness of industry self-regulation in promoting healthier choices in child-directed advertising. 

The Children’s Food and Beverage Advertising Initiative  (CFBAI) is a voluntary industry initiative started in 2006. Participating companies commit to featuring only foods that meet specific nutrition criteria when advertising to children under the age of 12. Recent changes in the initiative strengthened the nutrition standards and definition of child-directed advertising.  

Learn more about this initiative during the Connect & Explore webinar on November 10, 3-4 p.m. ET. The presentation will feature the following speakers: 

  • Jennifer Harris, UConn Rudd Center for Food Policy and Obesity   
  • Frances Fleming, UConn Rudd Center for Food Policy and Obesity       
  • Mary Muth, RTI International  

The webinar is free, but attendance is limited, so register today! In addition, please tell a colleague and share this information on your social networks using the hashtag #ConnectExplore. We will live-tweet the event, so be sure to 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: New Research Article— Systematic Review of Active Travel to School Surveillance in the United States and Canada

A link to NCCOR’s newest manuscript is now available on NCCOR’s research article page. The article titled Systematic Review of Active Travel to School Surveillance in the United States and Canada was recently published in the Journal of Healthy Eating and Active Living and is a product of NCCOR’s Youth Active Travel to School Surveillance Initiative workgroup. The manuscript recommends strategies for using existing surveillance systems to improve monitoring of trends related to active travel to school.  

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State of Childhood Obesity

The Robert Wood Johnson Foundation (RWJF) recently published a substantial new report about childhood obesity titled From Crisis to Opportunity: Reforming Our Nation’s Policies to Help All Children Grow Up Healthy. New data show that roughly one in six young people in the United States has obesity. The RWJF report presents solutions for addressing the recent increase in childhood obesity and creating equitable opportunities for all children to thrive. 

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Evidence-Based Recommendations and Best Practices for Promoting Healthy Eating Behaviors in Children 2 to 8 Years

A new publication from Healthy Eating Research (HER) provides clarity to parents and caregivers seeking to encourage healthy eating behaviors among young children. The new report presents more than 30 evidence-based recommendations, which demonstrate that autonomy, structure, and repetition are key to helping young children develop healthy eating habits. The new HER publication contains a technical report for researchers and policymakers as well as a suite of engaging educational materials for parents and caregivers. 

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Childhood Obesity Research & News

Study Finds Link Between Sleep Habits and Weight Gain in Newborns

October 22, NIH

Infants who sleep longer through the night and with fewer interruptions may be less likely to become overweight during their first six months of life, according to a study published in the journal SLEEP. While the research only showed a link – not a cause-effect relationship – between infants’ sleep and weight, the findings suggest that newborns can reap some of the same health benefits that others get from consistent, quality shut-eye.   

The research emerged from the Rise and SHINE (Sleep Health in Infancy & Early Childhood) study, which analyzes ways sleep may influence a newborn’s growth and development. The five-year study is being supported in part by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.   

“What is particularly interesting about this research is that the sleep-obesity association we see across the lifespan appears in infancy and may be predictive of future health outcomes,” said  Marishka K. Brown, Ph.D., director of the  National Center on Sleep Disorders Research, located within the NHLBI. Brown noted that multiple studies have shown links between good sleep and improved health. For children, this includes a reduced risk of developing obesity and diabetes, while supporting development, learning, and behavior.    

In the current study, researchers observed 298 newborns and found that for every hourly increase in nighttime sleep, measured between 7 p.m. and 8 a.m., the infants were 26% less likely to become overweight. Likewise, for each reduction in nighttime awakening, they were 16% less likely to become overweight.   
To conduct the study, researchers partnered with mothers who delivered a baby at Massachusetts General Hospital between 2016-2018. Unlike other infant sleep studies, which have relied on parent reports, the researchers used ankle actigraphy watches to objectively track nighttime movement, capturing three nights of data at the first- and six-month marks.    

Parents also kept infant sleep diaries and shared insights about activities that could have impacted each infant’s sleep pattern or weight, like how often they breastfed or whether the infant had eaten solid food before age four months.    

To assess weight, the researchers used the World Health Organization’s age and sex-specific growth charts. An infant was considered overweight if they were at or above the 95th percentile for weight and length. The researchers also took maternal health and sociodemographic considerations into account while reviewing the data.   

Susan Redline, M.D., M.P.H., a study author who is also a senior physician at Brigham and Women’s Hospital and a professor of sleep medicine at Harvard Medical School, said her colleagues were intrigued with the idea of studying associations between infant sleep patterns and weight. Mainly, they wanted to understand what happened as infants progressed from the sporadic sleep schedules common in early infancy to a longer overnight sleep pattern. They found infants who progressed to steady nighttime sleep – 8.8 hours a night on average by the end of the study – and who had fewer nighttime awakenings were less likely to be overweight in those first six months. 
After the first month, researchers found 30 of the infants (10.3% of the study sample) were overweight, although most – 21 – reached a normal weight at six months.  At the end of the six-month mark, 26 infants (8.8%) were overweight, including 15 who were not previously overweight.   

The researchers suspect a few factors could explain these results. Some parents may soothe infants who have trouble sleeping by providing milk or introducing them to solid foods. Also, if an infant was not getting enough high-quality sleep at night, they could have felt hungry and tired the next day – leading to more eating and less movement, which in turn could contribute to the infant’s weight. While additional data is needed to observe these potential links and any other impacting factors, the evidence so far suggests that sufficient and consolidated sleep could be powerful tools in reducing obesity risks early in life. 

“This study underscores the importance of sleep health not just for adults, but for people of all ages,” said study author Redline. “Parents should consult with their pediatricians on the best practices to promote healthy sleep, which can include keeping consistent sleep schedules, providing a dark and quiet space for sleeping, and finding the most appropriate ways to respond to infant awakenings.”   
This study was supported by the NHLBI (R35 HL135818), the National Institute of Diabetes and Digestive and Kidney Diseases (K24DK105989), and the Health Resources Services Administration (R40MC32753).    

Original source

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Filling Half of Kids' Plates with Fruits and Veggies Helps Increase Consumption

October 18, EurekAlert!

Filling half of a child’s plate with fruits and veggies isn’t just recommended by the United States Dietary Guidelines, it also helps increase the amount of produce that kids end up eating, according to Penn State research. 

In a controlled feeding study, the researchers tested two strategies for encouraging kids to eat more fruits and vegetables. 

The first was simply adding 50 percent more to fruit and vegetable side dishes at kids’ meals throughout the day. The second was substituting 50 percent more fruits and vegetables for an equivalent weight of the other foods. For example, if they added 50 grams of veggies to the lunch meal, they also subtracted 50 grams of mac  and cheese. 

The researchers found that adding more fruit and vegetable side dishes resulted in the kids eating 24 percent more veggies and 33 percent more fruit compared to the control menus. Substituting fruits and veggies for some of the other foods resulted in kids consuming 41 percent more veggies and 38 percent more fruit. 

Barbara Rolls, Helen A. Guthrie Chair and director of the Laboratory for the Study of Human Ingestive Behavior at Penn State, said the findings suggest ways parents, caregivers and schools can help encourage healthy eating. 

“When deciding what to feed kids, it’s easy to remember that half of the food should be fruits and vegetables,” Rolls said. “If you start seeing that you’re serving too much and have more waste, you could cut back the higher calorie-dense food while adding more produce. Experiment and have some fun trying different fruits and vegetables to see what they like and so you can serve meals with a sensitivity to their personal taste.” 

The study was recently published in the American Journal of Clinical Nutrition. 

According to a  previous study  by the Centers for Disease Control and Prevention, about 60 percent of children don’t eat enough fruit and 93 percent don’t eat enough vegetables, suggesting a need for strategies to encourage kids to eat more produce. 

Since 2011, the MyPlate dietary guidelines have encouraged people to fill half their plates with fruits and vegetables, with the hope that this would also increase people’s intake. But the researchers said that despite being a policy for a decade, the strategy had never been systematically tested in preschool children. 

“For most foods, kids will eat more when served larger portions, so we wanted to test whether increasing the amount of fruits and vegetables that are served over five days would increase intake,” said Liane Roe, research nutritionist at Penn State. “We also wondered whether substituting produce for other foods would increase intake more than simply adding extra fruits and veggies.” 

For the study, the researchers recruited 53 children between the ages of three and five who were enrolled in Pennsylvania childcare centers. Each participant was served all their meals and snacks for five days during three different periods in a random order. 

For the control period, they were served meals they typically got in their childcare center, and for the period testing the addition strategy, the portions of fruits and vegetables were increased by 50 percent. For the period testing the substitution strategy, fruits and vegetables were increased by 50 percent and the other foods were reduced by an equivalent weight. 

“We served the children all of their meals, snacks, and beverages for five consecutive days, and we weighed all the items we served, as well as the leftovers, to measure intake,” Roe said. “We sent home evening and morning snacks for the kids, but the majority of the meals were served in the childcare center.” 

As a caution, Rolls said that even though the study was successful in getting kids to eat more fruits and vegetables, the majority of the kids still didn’t eat the recommended daily amount of vegetables for their age group — about a cup and a half – although they did reach this target for fruits. 

The researchers said that in addition to the strategies in the current study, there are additional things parents and caregivers can do to increase intake. 

“Serving fruits and vegetables as a first course or snacks when kids are hungry can boost their intake, as can incorporating them into mixed dishes,” Rolls said. “For example, you can blend some cauliflower or squash into a sauce for mac and cheese or add fruit puree into a brownie or cake mix. You don’t decrease the palatability of the dish, but the kids are eating more produce. You should also encourage them to eat the whole veggies on their own, as well as incorporating them into other foods.” 

Christine Sanchez, Penn State; Alissa Smethers, Monell Chemical Senses Center; and Kathleen Keller, associate professor of nutritional sciences at Penn State, also participated in this work. 

The National Institutes of Health helped support this research. 

Original source

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Childhood Obesity May Lead to Greater Risk of Thyroid Cancer

September 29, Endocrinology Advisor

Obesity during childhood and adolescence, as determined by elevated body mass index (BMI) z (standard deviation)-scores, was associated with an increased risk of malignant thyroid nodules, authors of a retrospective, cross-sectional study in JAMA Network Open reported. The investigators concluded that BMI z-scores — which are adjusted for a child’s age and sex — may be a significant clinical factor to consider when making decisions about thyroid nodule surgery. 

Included in the study were children and young adults (N=116) aged 21 years and younger who underwent surgery for a thyroid nodule between 2003 and 2019 at the Monroe Carell Junior Children’s Hospital at Vanderbilt University Medical Center, Nashville, Tennessee. Thyroid nodule characteristics were correlated with patient demographics. Obesity in childhood and adolescence was defined as a BMI z-score greater than 1.65, which is in the 95th percentile or greater for age- and sex-specific BMI. 

Median age of the patients was 16.1 years (range, 0.4-21.0 years). Eighty percent were female and 87% were White. The median BMI z- score was 0.9 (interquartile range [IQR], 0.0-2.0). 

Stratified by malignancy status, benign nodules were more frequently associated with Black patients (10% benign vs 4% malignant) and Asian patients (3% vs 0%, respectively). Among Hispanic patients, all had malignant nodules (0 benign vs 7% malignant; P =.03). Benign nodules were associated with lower BMI z-scores, compared with malignant nodules (median, 0.7 vs 1.4; P =.02). 

Importantly, the investigators said, patients with higher BMI z-scores did not always have larger thyroid nodules (r, 0.135; P =.24) or more extensive disease in their neck (r, 0.197; P =.33) at presentation than their lower BMI z-score counterparts. However, higher BMI z-scores were significantly and independently associated with the probability of malignant thyroid nodules at presentation (odds ratio [OR], 1.551; 95% CI, 1.212-2.145; P =.008). 

This study was limited by its retrospective cross-sectional nature and moderate size but “was rigorously controlled for multiple variable that are often associated with obesity or socioeconomic status,” the researchers wrote. 

The investigators said their findings indicate that higher BMI-z scores during childhood and adolescence likely increase the risk for thyroid neoplasm malignancy. This confirms evidence from adults which associates obesity with increased risk for most cancers, including thyroid cancer. 

Unlike thyroid cancer in adults, the investigators did not observe a correlation between malignancy and ethnicity. These discrepancies may indicate that the disease process in pediatric thyroid cancer is different from that seen in adulthood. 

Guidelines suggest that surgical decision-making in younger patients may be informed by clinical factors that alter the risk of malignant neoplasms,” the authors concluded. “Our study suggests that BMI z-score should be considered such a clinical factor and considered when making the decision to proceed with surgery for a thyroid nodule in a younger patient.” 

Ortega CA, Gallant J-N, Chen S-C, et al. Evaluation of thyroid nodule malignant neoplasms and obesity among children and young adults. JAMA Netw Open. Published online July 9, 2021. doi:10.1001/jamanetworkopen.2021.16369 

Original source

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