September 2018


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Connect & Explore: Innovations in Behavioral Design to Enhance Active Living and Healthy Eating

September 27, 2018, NCCOR

On October 23, the National Collaborative on Childhood Obesity Research (NCCOR) will host a Connect & Explore webinar titled, “Innovations in Behavioral Design to Enhance Active Living and Healthy Eating.”

In 2017, NCCOR sponsored a symposium at The Environmental Design Research Association (EDRA) featuring authors of NCCOR’s Health, Behavioral Design, and the Built Environment White Paper. The symposium, Healthy Places: Using Behavioral Design to Enhance Active Living and Healthy Eating, focused on behavioral design—the science and practice of how physical and informational environments influence decisions and actions—and its application to enhance active living and healthy eating. On August 30, NCCOR published a chapter excerpted from the white paper in Food and Public Health—a book published by Oxford University Press—explaining how theories of behavior and design, and relevant fields of application (e.g., nutrition, physical activity) intersect to form a more comprehensive understanding of how theory and practice connect.

The NCCOR webinar on October 23 will feature the following three speakers from the EDRA symposium and highlight design guidelines that enhance active living and healthy eating in schools as well as advancements in the field since the 2017 symposium.

  • Jeri Brittin, PhDHDR, will illustrate applications of physical activity design guidelines for school architecture that were developed from a comprehensive review of literature and a collaborative effort between public health researchers and designers.
  • Joel Kimmons, PhDCenters for Disease Control and Prevention, will provide an overview of NCCOR’s behavioral design work and updates in the field.
  • Kim Rollings, PhDUniversity of Notre Dame, will discuss the development of a valid, reliable, and objective assessment tool to evaluate school cafeteria design effects on healthy eating: CAFES (Cafeteria Assessment for Elementary Schools).

Join us on Tuesday, October 23 at 4:00 p.m. ET, for the one-hour webinar.

Register today to receive webinar access. The event is free, but attendance is limited.

Invite a colleague, and please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will live tweet the event at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on

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Publications & Tools

RWJF Releases Annual State of Obesity Report

The annual State of Obesity: Better Policies for a Healthier America report provides the latest data on obesity and related health conditions, as well as 40 policy and practice recommendations from Trust for America’s Health and the Robert Wood Johnson Foundation.

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NCI GeoFLASHE Data Set is Available for Download

The National Cancer Institute (NCI) is pleased to announce the availability of a data set of neighborhood and contextual variables pulled from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. FLASHE is a survey of psychosocial, generational (parent-adolescent), and environmental correlates of cancer-preventive behaviors from adolescents and their parents.

The GeoFLASHE data set includes variables on neighborhood socioeconomic status, UV exposure, and neighborhood characteristics associated with walkability.

The purpose of the FLASHE study is to help researchers understand lifestyle behaviors that relate to cancer risk. These new data can be linked with existing FLASHE variables to provide an additional analytic dimension based on home and school locations. A methods report details how these variables were created and how they can be used to augment FLASHE data analysis.

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CDC Releases New Data on Self-Reported Adult Obesity Prevalence

The 2017 Adult Obesity Prevalence Maps show that adult obesity prevalence across the country remains high and differs by race, ethnicity, and education. The data come from the Behavioral Risk Factor Surveillance System, which is an ongoing, state-based, telephone interview survey conducted by CDC and state health departments. Height and weight data are self-reported.

In 2017, obesity prevalence ranged from a low of 22.6 percent in Colorado to a high of 38.1 percent in West Virginia. Seven states reported an adult obesity prevalence at or above 35 percent: Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma, and West Virginia. This is up from 5 states in 2016. Five years ago, all states had obesity prevalence lower than 35 percent.

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CDC Announces New Active People, Healthy NationSM Webpage

Active People, Healthy NationSM is a national initiative led by CDC to help 27 million Americans become more physically active by 2027. Increased physical activity can improve health and quality of life and reduce health care costs. The new web pages provide shareable graphics you can use to promote the importance of physical activity, outline the costs and benefits related to physical activity, and review five action steps to promote physical activity centered on core public health functions.

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Childhood Obesity Research & News

Strength-Based Exercises Could Help Child Obesity Fight, Study Finds

September 19, 2018, University of Edinburgh

Encouraging young people to do strength-based exercises – such as squats, push ups and lunges – could play a key role in tackling child obesity, research suggests.

Taking part in exercises that cause muscles to contract, and strengthen muscles and bones, was found to reduce children’s body fat percentage.

The findings also suggests an increase in muscle mass – gained from strength-based exercises – could help boost children’s metabolism and energy levels.

The effects were small but meaningful, prompting calls for further research to investigate how resistance training could treat and prevent the growing issue of child obesity.

Researchers at the Universities of Edinburgh and Dundee examined the findings from a number of studies that explored effects of resistance training on body weight for children aged eight to 16 years.

They found that resistance training decreased body fat, but had no overall effect on other measures, including lean muscle mass, body mass index and waist circumference.

This is the most extensive review so far of resistance training’s impact on young people.

Research from 18 studies across eight countries was examined, including the US, Australia, and Japan.

Helen Collins, a PhD student at the University of Edinburgh and Sport and Exercise Scientist at the University of Dundee, said the results show the positive effect resistance training can have on maintaining a healthy weight and reducing body fat for young people.

“Treatment, and more importantly, prevention, of child obesity is a growing concern. Our findings highlight the need for more robust research into the role strength-based exercises can play in helping everyone make healthy life choices and be more physically active.”

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Young Children's Oral Bacteria May Predict Obesity

September 19, 2018, Penn State University

Weight gain trajectories in early childhood are related to the composition of oral bacteria of two-year-old children, suggesting that this understudied aspect of a child’s microbiota — the collection of microorganisms, including beneficial bacteria, residing in the mouth — could serve as an early indicator for childhood obesity. A study describing the results appears September 19 in the journal Scientific Reports.

“One in three children in the United States is overweight or obese,” said Kateryna Makova, Pentz Professor of Biology and senior author of the paper. “If we can find early indicators of obesity in young children, we can help parents and physicians take preventive measures.”

The study is part of a larger project with researchers and clinicians at the Penn State Milton S. Hershey Medical Center called INSIGHT, led by Ian Paul, professor of pediatrics at the Medical Center, and Leann Birch, professor of foods and nutrition at the University of Georgia. The INSIGHT trial includes nearly 300 children and tests whether a responsive parenting intervention during a child’s early life can prevent the development of obesity. It is also designed to identify biological and social risk factors for obesity.

“In this study, we show that a child’s oral microbiota at two years of age is related to their weight gain over their first two years after birth,” said Makova.

The human digestive tract is filled with a diverse array of microorganisms, including beneficial bacteria, that help ensure proper digestion and support the immune system. This “microbiota” shifts as a person’s diet changes and can vary greatly among individuals. Variation in gut microbiota has been linked to obesity in some adults and adolescents, but the potential relationship between oral microbiota and weight gain in children had not been explored prior to this study.

“The oral microbiota is usually studied in relation to periodontal disease, and periodontal disease has in some cases been linked to obesity,” said Sarah Craig, a postdoctoral scholar in biology at Penn State and first author of the paper. “Here, we explored any potential direct associations between the oral microbiota and child weight gain. Rather than simply noting whether a child was overweight at the age of two, we used growth curves from their first two years after birth, which provides a more complete picture of how the child is growing. This approach is highly innovative for a study of this kind, and gives greater statistical power to detect relationships; the novel statistical techniques we utilized belong to the field of Functional Data Analysis, and were pioneered by the statisticians in our group.”

Among 226 children from central Pennsylvania, the oral microbiota of those with rapid infant weight gain — a strong risk factor for childhood obesity — was less diverse, meaning it contained fewer groups of bacteria. These children also had a higher ratio of Firmicutes to Bacteroidetes, two of the most common bacteria groups found in the human microbiota.

“A healthy person usually has a lot of different bacteria within their gut microbiota,” said Craig. “This high diversity helps protect against inflammation or harmful bacteria and is important for the stability of digestion in the face of changes to diet or environment. There’s also a certain balance of these two common bacteria groups, Firmicutes and Bacteroidetes, that tends to work best under normal healthy conditions, and disruptions to that balance could lead to dysregulation in digestion.”

Lower diversity and higher Firmicutes to Bacteroidetes (F:B) ratio in gut microbiota are sometimes observed as a characteristic of adults and adolescents with obesity. However, the researchers did not see a relationship of weight gain with either of these measures in gut microbiota of two-year-olds, suggesting that the gut microbiota may not be completely established at two years of age and may still be undergoing many changes.

“There are usually dramatic changes to an individual’s microbiota as they develop during early childhood,” said Makova. “Our results suggest that signatures of obesity may be established earlier in oral microbiota than in gut microbiota. If we can confirm this in other groups of children outside of Pennsylvania, we may be able to develop a test of oral microbiota that could be used in clinical care to identify children who are at risk for developing obesity. This is particularly exciting because oral samples are easier to obtain than those from the gut, which require fecal samples.”

Interestingly, weight gain in children was also related to diversity of their mother’s oral microbiota. This could reflect a genetic predisposition of the mother and child to having a similar microbiota, or the mother and child having a similar diet and environment.

“It could be a simple explanation like a shared diet or genetics, but it might also be related to obesity,” said Makova. “We don’t know for sure yet, but if there is an oral microbiome signature linked to the dynamics of weight gain in early childhood, there is a particular urgency to understand it. Now we are using additional techniques to look at specific species of bacteria–rather than larger taxonomic groups of bacteria–in both the mothers and children to see whether specific bacteria species influence weight gain and the risk of obesity.”

INSIGHT (Intervention Nurses Start Infants Growing on Healthy Trajectories) is coordinated through the Penn State Milton S. Hershey Medical Center. This work is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); the Penn State Eberly College of Science; the Penn State Institute for Cyberscience; the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH); and the Pennsylvania Department of Health using Tobacco CURE funds.

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Modification of Lifestyle Behaviour During Pregnancy for Prevention of Childhood Obesity

September 7, 2018, The Lancet

In The Lancet Child & Adolescent Health, Bernadeta Patro Golab and colleagues report a meta-analysis combining data sets from 34 prospective pregnancy and birth cohorts from Europe and North America to examine an important public health question: how do maternal obesity and pregnancy complications affect the risk of childhood obesity? This analysis of individual patient data from 160 757 mother–offspring pairs allowed the authors to examine with greater precision the influence of several low-prevalence pregnancy complications and maternal obesity on childhood obesity. The results confirm findings from previous observational analyses; offspring of mothers with gestational diabetes or gestational hypertension, or both, have higher odds of being overweight throughout childhood and adolescence. However, the authors additionally found that these associations are largely explained by pre-pregnancy or early-pregnancy weight status, such that if these pregnancy complications in obese women were eliminated, the higher odds of childhood overweight would remain. They also showed that pre-eclampsia was associated with decreased body-mass index (BMI) in early childhood (age 2–5 years), another observation that was largely explained by maternal weight status.

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Transforming Active Transportation: Impacts of Safe Routes to School

September 6, 2018, National Physical Activity Plan

A Conversation with Cass Isidro, Executive Director, Safe Routes to School National Partnership

The Safe Routes to School National Partnership works to ensure communities where children can walk and bike to school without harm, feeling confident and safe in doing so. Only 13% of children currently walk and bike to school. Safe Routes to School aims to make walking and biking to school a cultural norm. The NPAPA sat down with Cass Isidro, the executive director of Safe Routes to School National Partnership, to discuss the role of policies and partnership on the success and evolution of the Safe Routes movement.

Safe Routes to School – Impacting Communities Nationwide

“The great thing about the work of Safe Routes to School is that all of the impacts are linked. At the individual level we impact physical activity for our youngest citizens. We are focused on promoting kids independence and confidence about their ability to walk and bike to work. This translates into families’ perceptions and interactions with their communities. Communities are in turn made safer for all. The work of Safe Routes to School also promotes interconnectedness. Safe Routes to School makes its biggest impact in that all of these benefits are happening concurrently; they can’t be pulled apart. Safe Routes to School creates multiple benefits from a single intervention.

So much of the work that creates these impacts happens at the community level.  Safe Routes to School Initiatives are really different for each community. In some situations there is some sort of impetus for walking and biking, a groundswell that creates demand, and Safe Routes to School is a part of the solution. Each community receives customized planning and solutions in relation to their Safe Routes to School initiative. Our model is community vision driven.  We start with the community perspective and engage directly with community members throughout the process. This allows each situation to be approached with that community in mind, understanding the unique experiences, barriers, policy environment, and funding situation at play. Each Safe Routes to School solution may look a bit different; this flexibility is a large part of the model’s success.” These on the ground efforts in communities across the country are further supported by the work being done at the national policy level.

The Importance of Policy in Safe Routes to School

“Policy is at the core of what we do, part of our founding mission. Years ago there were increases in federal funds related to alternative transportation methods; Safe Routes to School National Partnership saw the need to protect and sustain these funds. More recently our policy efforts have been centered on how policy can improve, or hinder, active transportation for specific groups within in a community. Policy issues must be examined with an equity focus.  Some policies tend to impact certain groups of people or certain geographic regions more than others. At Safe Routes to School National Partnership we are examining unintended consequences of policies and beginning to understand what can be done to improve policies – for all – moving forward.” This work is not done alone; partners are a big part of these efforts.

A Partnership Network as a Key to Success

“We work with over 800 partners nationwide, at all different levels. At the local level we work with leader advisory committees. These groups are comprised of people, many of whom are Safe Routes to School state coordinators, who manage Safe Routes projects and interact with local communities. At the state and metropolitan level we interact with many cross sector partners (such as Departments of Transportation, Departments of Health, and Education Departments) to pursue common goals.  Finally, at the federal level we are working with groups like America Walks, Girl Trek, National Recreation and Park Association, and American Heart Association. With these partners one of our key objectives is to create a unified voice. It is really important that we don’t occasionally check in on those in the lane next to us, but instead are right there with them all the time. Schools districts and education centers are subject to diverse demands; they are repeatedly approached by all types of organizations. It is critical to the success of the partners various missions that we not contradict each other, but rather present a unified voice that can help improve the lives children and communities on multiple levels.

As you can see, at Safe Routes to School we work with all types of partners, across geographic scope and sector of focus. Recently our work has evolved to begin working with some new and interesting partners, increasing the impact and reach of the Safe Routes to School model.

Street Harassment and Bullying: Recently we’ve begun working on with partners related to street harassment and bullying that prevent kids from walking to school, particularly for middle and high school children.

Food Access and Active Transportation: Our newly developed cross-sector relationships have looked at ways to impact food access through active transportation. How can walking and biking help people get to the food in their community?

Physical Activity Focus: Finally, we are focusing on Safe Routes to School as a specific physical activity solution. In the beginning we were solely looking at Safe Routes to School as a way to get kids outside and lessen dependence on cars. With our partners we’ve expanded to consider the way Safe Routes to School can help kids achieve the recommended 60 minutes of physical activity each day.

Our partners, old and new, continue to play a fundamental role in the work of Safe Routes to School. As we look back and celebrate the work that has been accomplished it is impossible to separate the work from the partnerships critical to the success.”

The Evolution and Future of Safe Routes to School

“Throughout the years Safe Routes to School has naturally evolved as the work is being done. As we worked and engaged with communities Safe Routes to School became safe routes for everyone else too – to work, to parks, to food. Safe Routes to School broadened the way we operate and are now engaging at a level beyond Safe Routes to School, we’re looking at community wide issues. We are thinking about how we, as an organization, function as a citizen in the larger world. How we can tackle some of the big issues society is facing such as racism and poverty and division? How can we bring our collaborative efforts and dynamic team to impact these larger issues beyond Safe Routes to School? Because these larger issues fundamentally impact our original Safe Routes to School mission as well.”

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Role of Policies and Practices Within Early Care and Education Programs to Support Healthy Food and Physical Activity Practices

September 1, 2018, Childhood Obesity

Obesity rates among young children continue to rise in spite of earlier indications of slowing trends. Healthy lifestyle behaviors, such as eating a healthy diet and engaging in regular physical activity, are important to obesity prevention, and are associated with better developmental outcomes and disease prevention in young children. During the early years, children need to be exposed to environments that support the development of health-promoting nutrition and physical activity behaviors. Other than one’s family, early care, and education (ECE) programs are the most influential setting in the support of children’s heathy weight development and represent an important “target of opportunity” for health promotion efforts. More than 60% of young children are enrolled in an out-of-home care setting, spend more than 30 hours there each week, and obtain between 50%–75% of daily calories in these settings.

More than five years ago, Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, created an ECE workgroup to bring together researchers, policy advocates, and other professionals to advance an ECE research agenda and create opportunities for information sharing and advancements in public health practice. This supplement of 13 articles published in Childhood Obesity unites a group of outstanding researchers focusing on the role of policies and practices within ECE programs to support healthy practices. Each article addresses one or more important influences, including public policies, such as the federally funded Child and Adult Care Food Program (CACFP) or state licensing standards, facility-level policies for physical activity or screen-time, and food procurement practices to mention a few. This supplement is a landmark publication because it is the first to address early care and education settings, both child care centers and family child care homes, to illustrate and guide best practices for healthy weight development.

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