September 2021

Introducing NCCOR’s Newest Tool and Training Webinar: A Toolkit on Evaluating Childhood Healthy Weight Programs

Improve your program’s effectiveness and sustainability with NCCOR’s newest resource, A Toolkit for Evaluating Childhood Healthy Weight Programs. This comprehensive online tool draws from experts in research, public health, and pediatric medicine to explain the stages of effective evaluation for childhood healthy weight programs.

NCCOR developed the new toolkit to help researchers, practitioners, and community programs gain confidence conducting program evaluations. It reviews key concepts and provides detailed guidance on the following core components of effective evaluations:

• Evaluation readiness
• Process measures
• Outcome measures
• Contextual factors
• Program sustainability
• Remote evaluation

In addition, the toolkit’s website features a resource library, with links to guides, databases, research articles, and other public health toolkits, so users will have access to ready-made resources when they are ready to start an evaluation.

Learn More during Our Upcoming Webinar
Ready to jump in and plan your program evaluation? Join us for a webinar on October 19, from 1:00 p.m. – 2:00 p.m. ET to learn more about our new tool. Hear directly from the subject-matter experts who collaborated to create this new resource:

• Brook Belay, Centers for Disease Control and Prevention
• Ihouma Eneli, Nationwide Children’s Hospital
• Nancy Sherwood, University of Minnesota
• Sandra Hassink, Nemours Obesity Initiative
• Matthew Levy, Medical College of Wisconsin and Children’s Wisconsin

The webinar is free, but you must pre-register to receive the log-in information. Attendance is limited, so tell a colleague and register today!  In addition, please consider sharing 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 www.nccor.org

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NCCOR Toolbox: New Research Article: Economic Impact of the Built Environment Improvements

A link to NCCOR’s newest manuscript is now available on NCCOR’s research article page. The article titled “Economic Impact of the Built Environment Improvements” was recently published in the Journal of Physical Activity and Health and is a product of NCCOR’s Economic Impact of Built Environment Improvements for Physical Activity workgroup. The manuscript identifies key economic indicators to demonstrate the value of promoting physical activity through environmental change.

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New MMWR Points to a Pandemic-Related Increase in Childhood Obesity

Childhood obesity rates appear to be rising, according to a recent report from The Centers for Disease Control and Prevention. The research appeared in the September 17 issue of the MMWR and is titled “Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020.” Researchers found the rate of increase for BMI approximately doubled during 2020. More detailed information, including recommendations for public health practice, can be found in the full report.

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New Economic Data on Household Food Security Reveals Pandemic-Related Impact on Children

The Economic Research Service at the United States Department of Agriculture released a new report titled Household Food Security in the United States in 2020, which contains findings from the Current Population Survey Food Security Supplement. Collected in December 2020, this data captures pandemic related trends. It shows that overall rates of household food access remained stable compared to previous years, but certain subgroups, including children, experienced a significant increase in food insecurity. The full report is available on the USDA website.

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New Tool Shows Benefits of Walkable Communities

Smart Growth America released a new web-based tool to demonstrate the benefits of their Complete Streets initiative. The Benefits of Complete Streets provides a series of simple tools to quantify the benefits of promoting physical activity through the built environment and train local leaders on how to communicate about these benefits. The organization will also host a webinar on October 6 at 3:00 p.m. to introduce its new tool.

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1 in 5 Parents Say Kids Eat Fast Food More Often Since Pandemic

September 20, EurekAlert!

For some families, pandemic times have meant increased screen time, attending class from bedrooms and maybe even more dinners from a drive through.

While many parents say their family has eaten healthier since the start of the pandemic, one in five report their children ate fast food more often, according to the University of Michigan Health C.S. Mott Children’s Hospital National Poll on Children’s Health.

“The pandemic disrupted many family routines, including where and what they eat,” said Gary L. Freed, M.D., M.P.H., poll co-director and Mott pediatrician.

“We know families’ lifestyles can impact children’s diets, and we looked to see how the pandemic may have changed their eating habits.”

Around one in six parents say their child eats fast food at least twice a week, reports the nationally representative poll, which is based responses from 2,019 parents of children aged 3-18.

Families’ views on fast food consumption varied based on parents’ perceptions of their child’s weight. Parents who said their kids are overweight were almost twice as likely to say their children have fast food at least twice a week, compared to those who say their kids are at a normal weight. Parents also identified some barriers to home cooked meals. Around 40% of parents reported being too busy to cook and one in five said they were too stressed. These challenges were also reported more commonly among parents with kids who were overweight.

Views on Fast Food
While almost all parents agree that fast food is unhealthy for their children, more than four in five feel it’s OK in moderation, according to the poll. Three-quarters of parents also agree with the statement that when stressed for time, fast food is a good family option.

A third of parents also say that fast food is good value for the money and 24% feel it is less expensive than making meals at home.

“Parents mostly acknowledge that fast food isn’t an ideal choice but see it as an acceptable ‘sometimes food,’” Freed said.

But parents don’t usually dictate their kids’ food choices at fast food restaurants, with 88% allowing their child to choose what they eat and only 1 in 3 parents reading the nutritional information.

Sixty-seven percent of parents, however, say they encourage their child to choose healthier options and try to limit unhealthy items like fries and milkshakes.

“One fast food meal often exceeds the recommended fat, sodium and calorie intake for the entire day without providing many nutrients,” Freed said. “Parents should consider using nutritional information to help their kids learn how to make healthier choices. Trying to make those meals even a little bit healthier can have an important impact.

Among the least healthy items on the menu are soft drinks and soda, which often contain the single largest source of calories for many fast food meals and have also been associated with childhood obesity.

Parents who said their children were overweight were almost twice as likely to report their child has a soft drink with their fast food compared to other families.

“Consuming sugary drinks poses a real health risk to both kids and adults,” Freed said. “It increases children’s risk of excess weight gain and tooth decay, and preventable conditions such as obesity.”

Encouraging water or milk with their fast food, he said, can help kids moderate the calories and added sugar they consume.

Silver Linings in Pandemic Health Habits
On the other end of the spectrum, the pandemic-era may have been linked to a healthier lifestyle for many families, with half of parents saying their kids had home-cooked meals more often since the COVID shutdowns began in March 2020.

Freed pointed to several contributing factors, including more parents working from home with potentially increased opportunities to make meals, or families possibly feeling unsafe at restaurants.

Financial concerns may have also prompted some families to have more home-cooked meals, allowing parents to shop for bargains and plan additional meals with the leftovers.

This may not be the case, however, for others who don’t have a car or who live far from a grocery store.

“We were encouraged to see that for many families, pandemic-related lifestyle changes seemed to actually prompt healthier eating habits,” Freed said.

“But for others, there were challenges and demands that may have made it difficult to maintain healthy eating, which can negatively impact children’s health.”

Original source

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School Meals Today: Not the Lunch Trays You Remember

September 13, Public Health Post

Over the last 20 years, breakfasts and lunches served in schools have become significantly healthier. What used to be a fried chicken tender with a side of fries is now grilled chicken and a green salad. According to the School Nutrition and Meal Cost Study, a nationally representative survey conducted every 5 years, school breakfasts have become 41% healthier and school lunches 44% healthier since 2010. These changes are largely attributable to the Healthy, Hunger-Free Kids Act (HHFKA) — landmark legislation passed in 2010 which updated nutrition standards for school breakfast and lunch, established nutrition standards for snacks sold in schools, and strengthened requirements for local wellness policies.

Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, supported new analyses of data from the School Nutrition and Meal Cost Study. Results from these studies are collected in a recent special issue of the journal Nutrients. The analyses examine the effects of the HHFKA on the nutritional quality of meals served, quality of students’ diets, and disparities in the school meal environment.

School meals are now one of the healthiest sources of foods for school-aged children. Results from a study by Bardin and colleagues found that the nutritional quality of school meals improved nationwide, and that there are no significant differences in the nutritional quality of school lunches across race/ethnicity and poverty subgroups. High poverty and majority Black and Hispanic schools had more healthful school environments than other school types, likely due to strong local wellness policies. Furthermore, a study by Gearan et al. suggests that school lunches are significantly healthier than meals brought from home, in both lower-income and higher-income subgroups and white and Black students.

Given the important role school meals play in the overall diet quality and nutrition security of school-age children, policies that increase the availability and accessibility of school meals have started to receive significant attention. One such example is universal free meals, or Healthy School Meals for All, whereby all students—regardless of income—receive free school breakfast and lunch. Michael Long’s team evaluated the financial impacts of serving free meals to all students and found that universal free meals are associated with lower meal costs for schools and school districts. This suggests that schools serving universal free meals can provide healthy meals to more students without a financial disadvantage. A systematic review in the special issue found that universal free meals are associated with improved participation in school meal programs, diet quality, food security, and academic performance. These findings suggest that offering universal free meals could have lasting positive impacts on school-age children without having negative impacts on meal costs.

Despite the significant improvements in the nutrition standards for school meals, one major gap remains—added sugar. Fox and colleagues found that most schools exceeded the Dietary Guidelines for Americans recommended limit for added sugars (no more than 10% of calories from added sugars daily) at breakfast (92%) and lunch (69%). In both cases, the leading source of added sugars was flavored milk. There is an urgent need to establish an added sugar limit for school meals and restrict or limit flavored milk at school given the high added sugar consumption documented among school-age children.

Over 30 million children consume school lunches daily and 21.5 million are from low-income families. The findings from the School Nutrition and Meal Cost Study and analyses in the special issue affirm that the National School Meal Programs are a critical nutrition safety net for school-age children. They also emphasize the importance of policies for strengthening nutrition standards and expanding the availability of school meals.

Original source

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Science Update: Pandemic Changes in Screen Time, Physical Activity May Increase Kids’ Obesity Risk, NIH-funded Study Suggests

August 31, NICHD News

In response to the COVID-19 pandemic, American children may have adopted a range of behaviors that increase their risk for obesity, an NIH-funded study suggests. Compared to before the pandemic, children 7- to 12-years old increased their sedentary behavior, screen time, and food intake, while reducing their level of physical activity and adopting a later sleep schedule—all behaviors that increase obesity risk. These behaviors exceed changes traditionally seen during summer breaks.

The study was conducted by Bridget Armstrong, Ph.D., of the University of South Carolina, and colleagues. It appears in Pediatric Obesity. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, and National Institute of General Medical Sciences.

Background
Worldwide, roughly 1.5 billion elementary school age children began virtual learning after widespread school closures in March and April 2020. On-site school attendance minimizes screen time, provides nutritious meals and physical activity and promotes a regular sleep schedule, all factors that reduce the risk of obesity. During summer breaks, the risk of weight gain increases, as healthy eating and physical activity decline. Similarly, children go to bed later and wake up later, a shift in sleeping pattern that previous research also has found increases obesity risk.

Initial studies have suggested the switch to online learning during the pandemic may have led to similar changes. Researchers undertook the current study to verify if the frequency of such obesity-promoting behaviors increased during the COVID-19 pandemic, compared to the two previous years.

To conduct the study, the researchers provided smart watches to children at schools in the southeastern United States and collected data from them during spring and summer over 3 years. Parents responded to questionnaires on children’s screen time and dietary intake. Data was obtained from 182 children in 2018, 127 of these children in 2019, and 74 of them in 2020.

Results
The researchers found that, before the pandemic, obesity promoting behaviors increased slightly from year to year as the children matured. From spring 2018 to spring 2019, sedentary time increased by 25 minutes per day, light physical activity (such as walking slowly) decreased by 17 minutes per day, and moderate to vigorous physical activity (equivalent to brisk walking or cycling) declined by 8 minutes. Total screen time increased by 8 minutes. There were no changes in sleep or diet from 2018 to 2019. For summer 2018 to summer 2019, children had similar trends in physical activity and screen time, but they slept an average 17 minutes less and went to bed 12 minutes later.

The researchers classified food consumption with numbers representing different types of food categories, with healthy food types ranging from 0 to 3 and unhealthy foods from 0 to 14. From summer 2018 to summer 2019, both healthy and unhealthy food consumption increased by .1.

Unhealthy behaviors increased dramatically after the pandemic began. Compared to spring 2019, spring 2020 sedentary behavior increased by 79 minutes, screen time by 97 minutes, light physical activity decreased by 69 minutes, and moderate to vigorous physical activity by 8 minutes. Consumption of healthy foods increased by .3 and unhealthy foods by 1.2. Although children slept an additional 17 minutes per night, they went to bed later and slept later, with the halfway point between the time they went to bed and the time they got up shifting by 124 minutes.

The authors did not distinguish between screen time for remote learning and other screen use, but noted that the spring trend of increased screen time continued into summer.

“While the increase in springtime screen use is largely influenced by virtual learning, patterns established in the spring persisted into summer, even in the absence of virtual school,” the authors wrote. “While high levels of sedentary behavior and screen time along with reduced physical activity levels could be attributed to continued pandemic restrictions and potential relaxed parental rules to allow children to connect with friends virtually, they might reflect new entrenched behavior patterns that persist even in the absence of pandemic restrictions.”

Significance
The authors concluded that the changes in screen time, activity, and diet they observed after the beginning of the pandemic could increase children’s risk for obesity.

Reference
Burkart, S et al. Impact of the COVID-19 pandemic on elementary schoolers’ physical activity, sleep, screen time and diet: A quasiexperimental interrupted time series study. Pediatric Obesity. 2021.

Original source

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Changes in Body Mass Index Among Children and Adolescents During the COVID-19 Pandemic

August 27, JAMA Network

The COVID-19 pandemic has been associated with weight gain among adults,1 but little is known about the weight of US children and adolescents. To evaluate pandemic-related changes in weight in school-aged youths, we compared the body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of youths aged 5 to 17 years during the pandemic in 2020 to the same period before the pandemic in 2019.

Methods
We conducted a retrospective cohort study using Kaiser Permanente Southern California (KPSC) electronic health record data. Youth between 5 and 17 years with continuous health care coverage were included if they had an in-person visit with at least 1 BMI measure before the pandemic (March 2019-January 2020) and another BMI measure during the pandemic (March 2020-January 2021 with at least 1 BMI after June 16, 2020, ie, about 3 months into the pandemic). Youth with complex chronic conditions were excluded.2,3 Race and ethnicity based on caregiver report or birth certificates were used to compare with the underlying population. Outcomes were the absolute distance of a youth’s BMI from the median BMI for sex and age,4 weight adjusted for height, and overweight or obesity (≥85th or ≥95th percentile of BMI for age, respectively).5,6 We fit mixed-effect and Poisson regression models accounting for repeated measures within each individual, using an autoregressive correlation structure and maximum likelihood estimation of covariance parameters to assess each outcome. Similar to an interrupted time-series design, we included a binary indicator representing the periods before or during the pandemic plus a calendar month by period interaction term. We divided youths into 3 age strata (5.0-<12, 12-<16, 16-<18 years) based on age at the start of the pandemic.

Models were adjusted for sex, race and ethnicity, state-subsidized health insurance, neighborhood education, neighborhood income, and number of parks in the census tract. Mixed-effects models also included BMI-for-age class at baseline. All analyses were performed with α = .05 for 2-sided tests using SAS version 9.4 (SAS Institute Inc). The KPSC institutional review board approved the study and granted a waiver for informed consent.

Results
The cohort (n = 191 509) was racially and ethnically diverse (10.4% Asian and Pacific Islander, 50.4% Hispanic, 7.0% non-Hispanic Black, and 25.3% non-Hispanic White) with 49.6% girls, mean age of 11.6 years (SD, 3.8 years), and mean prepandemic BMI of 20.7 (SD, 5.4). The study population was comparable with the overall KPSC pediatric population with regard to sex, age, race and ethnicity, and socioeconomic factors. Prepandemic, 38.9% of youth in the cohort were overweight or obese compared with 39.4% in the KPSC source population.

Youths gained more weight during the COVID-19 pandemic than before the pandemic (Table). The greatest change in the distance from the median BMI for age occurred among 5- through 11-year-olds with an increased BMI of 1.57, compared with 0.91 among 12- through 15-year-olds and 0.48 among 16- through 17-year-olds. Adjusting for height, this translates to a mean gain among 5- through 11-year-olds of 2.30 kg (95% CI, 2.24-2.36 kg) more during the pandemic than during the reference period, 2.31 kg (95% CI, 2.20-2.44 kg) more among 12- through 15-year-olds, and 1.03 kg (95% CI, 0.85-1.20 kg) more among 16- through 17-year-olds. Overweight or obesity increased among 5- through 11-year-olds from 36.2% to 45.7% during the pandemic, an absolute increase of 8.7% and relative increase of 23.8% compared with the reference period (Table). The absolute increase in overweight or obesity was 5.2% among 12- through 15-year-olds (relative increase, 13.4%) and 3.1% (relative increase, 8.3%) among 16- through 17-year-olds. Most of the increase among youths aged 5 through 11 years and 12 through 15 years was due to an increase in obesity.

Discussion
Significant weight gain occurred during the COVID-19 pandemic among youths in KPSC, especially among the youngest children. These findings, if generalizable to the US suggest an increase in pediatric obesity due to the pandemic.

Study limitations include the observational design and inclusion of only those with in-person appointments. However, the analyses benefited from longitudinal data with prepandemic BMI and in-person well-child visits resuming at 84% of prepandemic levels by June 2020. Furthermore, the sample was comparable in all relevant characteristics with the overall KPSC pediatric membership.

Research should monitor whether the observed weight gain persists and what long-term health consequences may emerge. Intervention efforts to address COVID-19 related weight gain may be needed.

Original source

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