April 2009






Building A Collaboration To Address Childhood Obesity

April 6, 2009, NCCOR

The scope and urgency of the childhood obesity epidemic requires comprehensive efforts to increase both healthy eating and physical activity. The new National Collaborative on Childhood Obesity Research (NCCOR) brings together the expertise and resources of three of the country's leading research funders, the Centers for Disease Prevention and Control (CDC), National Institutes of Health (NIH) and Robert Wood Johnson Foundation (RWJF), to accelerate the nation's progress in reducing childhood obesity.

Although NCCOR launched publicly in February, the momentum for the Collaborative has been building privately since its first 10-person planning committee meeting a little over a year ago.

"The impetus for developing the Collaborative was the recognition of the need to maximize and expedite our knowledge and evidence for population-based obesity prevention," said Laura Kettel Khan, a founding NCCOR member and senior scientist within CDC's Division of Nutrition, Physical Activity and Obesity.

Forming the Collaborative

A year ago, CDC, NIH and RWJF discussed their respective research, practice, and funding priorities in an effort to identify common goals and determine how each organization could benefit and complement the other, and ultimately assist in reversing the epidemic of overweight and obesity among U.S. youth. The planning committee gained support for forming a collaborative from various CDC divisions, NIH centers, and RWJF by stressing that NCCOR would improve the science behind obesity prevention, as well as information sharing.

Grounded by a group of passionate, committed leaders in the field, said Kettel Khan, NCCOR was formed to improve the efficiency, effectiveness and application of childhood obesity research through enhanced coordination and collaboration.

The planning committee engaged a range of leaders to discuss the purpose of NCCOR and what could be achieved by working together.

"Given efforts by each of these three organizations to advance research on obesity, leaders of these organizations were concerned about how we could do more together rather than separately and challenged us to be resourceful and innovative to advance this research and extend its effect," said Rachel Ballard-Barbash, associate director of the Applied Research Program at the National Cancer Institute's Division of Cancer Control and Population Sciences.

"Our primary purpose in forming NCCOR was to increase our collective impact and leverage each other's strengths. We've learned from our tobacco control collaborative that strategically coordinating our goals, efforts and resources will be essential to reversing the childhood obesity epidemic," said C. Tracy Orleans, RWJF's distinguished fellow and senior scientist.

By describing a vision for NCCOR and what it can achieve with collaboration, the planning committee gained the support and commitment from institutional leaders to move forward.

Developing a Common Agenda

NCCOR's foundations were laid at various working meetings. Through a range of strategic planning activities, they developed the following four priority areas:

1. Develop, compile, test, and promote the consistent use of common measures and methods across childhood obesity prevention and weight control research at the individual, community and population levels.

2. Evaluate new and existing obesity prevention and weight control interventions, with an emphasis on those involving multi-level and/or multi-component approaches, and strengthen the capacity (e.g., knowledge, skills, tools) to implement both interventions and evaluations.

3. Accelerate rigorous evaluation of the effects of promising policy, system, and/or environmental changes—at the community, state, and national levels and across multiple settings (e.g., schools, homes, food and dining outlets, health care settings, and communities)—on children's diet, physical activity, energy balance and weight status.

4. Accelerate the adoption or application of effective interventions, programs, policy and evaluation and monitoring systems in states, communities and clinical practice.

With these priorities defined, NCCOR members developed the Collaborative's list of 2009 projects, as well as some of its preliminary goals through 2013. To ensure that project goals are met, NCCOR members with expertise in particular in particular research areas established workgroups, or subgroups, focused on: the creation of a measures registry; the creation of a catalog of surveillance systems; developing an NCCOR Conference Series; promoting strategic communications; and evaluating NCCOR's progress.

Come learn more about the first activity of NCCOR's Conference Series – a four-part webinar series on obesity-related policy evaluation that began on Feb. 27 – on NCCOR's website at www.nccor.org/projects_webinar.html. Learn more about NCCOR's entire ambitious agenda at www.nccor.org/projects.html.

Applying a Model of Success

Forming a collaborative to bring together knowledge, resources, and funding to achieve greater results is not new to CDC, NIH and RWJF. They, along with the American Legacy Foundation and American Cancer Society, previously formed the Youth Tobacco Cessation Collaborative (YTCC) in 1998 and the National Tobacco Cessation Collaborative (NTCC) in June 2005.

When formed in 1998, there were no identified evidence-based treatments for young smokers. Within 10 years after YTCC funded major research programs, proven cessation treatments for youth are now available and recommended in the U.S. Public Health Service's Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline. Similarly, NTCC has had a large impact on the field by identifying strategies to build consumer demand for tobacco cessation products and services. For more information on YTCC and NTCC activities, please visit www.youthtobaccocessation.org, and www.tobacco-cessation.org.

After seeing the success of the tobacco cessation collaboratives, RWJF foresees comparable achievements if able to leverage nutrition/physical activity expertise and other resources across all three partners. Establishing greater transparency and disseminating research findings more rapidly, NCCOR represents a new way of doing the business of obesity prevention and control.


Webinar Series Builds Policy Research Skills

April 6, 2009, NCCOR

Session 2 of a four-part webinar series designed to disseminate approaches for evaluating obesity policies was held on Friday, April 3. It addressed the pitfalls associated with research in real world settings.

The series was developed to disseminate techniques and approaches for evaluating policies intended to reduce obesity prevalence by improving diet and/or increasing physical activity. Rigorous evaluation of these "natural experiments" may be an effective means for the research community to inform policy on the issues of obesity, diet, and activity.

The webinar series is co-sponsored by the National Collaboration on Childhood Obesity Research, a collaboration of the Centers for Disease Control and Prevention, the National Institutes of Health, and the Robert Wood Johnson Foundation. It is taught by Dr. Kathryn Newcomer, co-director of the Midge Center for Evaluation Effectiveness and Professor of Public Policy and Public Administration at The George Washington University in Washington, DC.

Issues covered in Session 2 included: redundancy and contingency plans before going into the field; addressing data quality assurance in real time; addressing limitation to assessment of validity and reliability; addressing problems of measurement influencing behavior (e.g., response set on surveys, Hawthorne effect and Pygmalion effects on performance, etc.); and how to assess the robustness of measures.

The first session of the webinar series (Feb. 27) successfully explored how to evaluate policy interventions. It was attended live by more than 300 people, although several "single" participants signed on were actually rooms of 10 to 12 participants. People from all over the world, from academia to national and local public health agencies, and other professions participated in Session 1. The heightened interest has encouraged talk for a related journal supplement on the issue. Stay tuned for details.

The 600+ others who registered for the session, as well as those interested in the future can watch the recorded sessions at their leisure. The video and downloadable PDF slides are available at www.nccor.org/projects_webinar.html. Details regarding the rest of the webinar series are listed below.

Webinar 3: Enhancing the Usefulness of Evidence to Inform Practice May 1, 2009, 1-2 p.m. EDT

Webinar 4: Communicating Results Effectively June 12, 2009, 1-2 p.m. EDT

To join the mailing list and receive further information on the webinars, e-mail conferences@novaresearch.com.



McKinnon RA, Orleans CT, Kumanyika SK, Haire-Joshu D, Krebs-Smith SM, Finkelstein EA, Brownell K, Thompson JW, Ballard-Barbash R. Considerations for an Obesity Policy Research Agenda, American Journal of Preventive Medicine, April 2009.

ABSTRACT: The rise in obesity levels in the U.S. in the past several decades has been dramatic, with serious implications for public health and the economy. Experiences in tobacco control and other public health initiatives have shown that public policy may be a powerful tool to effect structural change to alter population-level behavior. In 2007, the National Cancer Institute convened a meeting to discuss priorities for a research agenda to inform obesity policy. Issues considered were how to define obesity policy research, key challenges and key partners in formulating and implementing an obesity policy research agenda, criteria by which to set research priorities, and specific research needs and questions. Themes that emerged were: (1) the embryonic nature of obesity policy research, (2) the need to study "natural experiments" resulting from policy-based efforts to address the obesity epidemic, (3) the importance of research focused beyond individual-level behavior change, (4) the need for economic research across several relevant policy areas, and (5) the overall urgency of taking action in the policy arena. Moving forward, timely evaluation of natural experiments is of especially high priority. A variety of policies intended to promote healthy weight in children and adults are being implemented in communities and at the state and national levels. Although some of these policies are supported by the findings of intervention research, additional research is needed to evaluate the implementation and quantify the impact of new policies designed to address obesity.




Study Designs And Analytic Strategies For Environmental And Policy Research

On April 8, 2008, a meeting on "Study Designs and Analytic Strategies for Environmental and Policy Research on Obesity, Physical Activity, and Diet" brought together staff from multiple funding agencies and investigators from diverse fields to identify research priorities based on gaps in the literature and public health needs. The meeting – sponsored by the National Cancer Institute, the National Heart, Lung, and Blood Institute, the Eunice Kennedy Shriver National Institute for Child Health and Human Development, the Office of Behavioral and Social Sciences Research, Active Livin Research, and Healthy Eating Research – was successful in soliciting input from participants to identify study designs, analytic strategies, and needed measures for the next generation of environment and policy studies that can inform improved obesity prevention. The meeting emphasized improving the quality of evidence from the current reliance on cross-sectional studies to prospective and intervention trials that can be more readily translated into changes in policy and practice.



Many U.S. Middle School Kids Physically Unfit: Study

March 25, 2009, Reuters Health

U.S. kids are not only too heavy; they're also out of shape, according to a new study of 5th and 7th grade students in Georgia.

Half didn't reach minimum standards for healthy aerobic fitness, Dr. Kenneth E. Powell, a physician in private practice, and his colleagues found, while nearly a quarter didn't make the grade in terms of muscle fitness, endurance or flexibility.

Powell and his team determined body mass index (BMI) and tested fitness and physical activity levels of 5,248 students from 93 schools across Georgia.

They found that 30 percent of the students were overweight -- their BMI was outside the healthy range -- and 22 percent didn't get the recommended 60 minutes a day of moderate to vigorous physical activity.

Fifty-two percent of the middle school students failed a test of cardiorespiratory fitness, while 23 percent did not meet minimum standards for two out of four tests of strength, endurance and flexibility, according to a report in the American Journal of Preventive Medicine.

Boys were more likely than girls to be outside the healthy BMI range, and they were also less likely to meet standards for cardiorespiratory fitness. Insufficient physical activity was more common among black and Hispanic students than among white students.

"Although there were some significant differences in test scores between demographic subgroups," Powell and his team write, "a more important finding is that none of the subgroups performed very well on any of the measures."

"These data," the conclude, "are consistent with the suggestion that physical inactivity has led to deficient levels of health-related fitness in more areas than just body composition, and that monitoring all components of health-related fitness would provide helpful information about the health of U.S. children and youth."

SOURCE: American Journal of Preventive Medicine, April 2009.

Original source: http://www.reuters.com/article/healthNews/idUSTRE52O5WH20090325


The Endocrine Society Publishes Obesity Supplement

March 23, 2009, Endocrine Today

By Christen Haigh

The Endocrine Society published the results of 10 studies spanning several obesity-related issues in an effort to educate medical professionals about the current research in the field.

The supplement was published in the Journal of Clinical Endocrinology & Metabolism.

"The topics selected were considered to be of interest not only to clinicians but also to basic scientists and public health policy makers," Abhimanyu Garg, MD, a guest editor of the supplement, told Endocrine Today.

Garg is a professor of internal medicine, chief of the Division of Nutrition and Metabolic Diseases and Endowed Chair in Human Nutrition Research at UT Southwestern Medical Center in Dallas.

International experts were invited to write about the selected topics and the papers were peer-reviewed, according to Garg.

"These articles define the state-of-the-art obesity research at present and hope to stimulate clinicians and scientists to fill in the remaining gaps," he said.

Studies in Sum

The first study's findings showed the prevalence of obesity increased in Brazil, Canada, Mexico and the United States. The increase in the presence of obesity may create challenges for public health and medical systems in those countries.

In another study, the researchers examined literature and determined there is a need to conduct large, community intervention programs focusing on exercise and a healthy diet in developing countries to prevent death-related type 2 diabetes and cardiovascular disease.

In a third study, the researchers reviewed data and evaluated the relationship between metabolic complications and childhood obesity. Many children and adolescents exhibited metabolic complications, putting them at risk for early morbidity, according to the researchers. "Understanding the underlying pathogenesis of this peculiar phenotype is of critical importance," they wrote.

The fourth study was a review of literature in which findings showed that understanding the central regulation of food intake may help with finding useful treatment options, according to the researchers.

The high hereditability of adiposity remains unexplained, although advances have helped to explain underlying genetic mechanisms of obesity, according to the findings of another study. "Investigations of forms of variation, such as copy number polymorphism, may extend our understanding of this condition," the researchers wrote.

In the sixth study of the supplement, the researchers measured the functions of various fat depots. The findings showed that there were unique characteristics with regard to fatty acid metabolism among lower and upper body and visceral fat depots.

Another study's results showed that in obesity, inflamed fat-secreted proteins were associated with insulin signaling impairment; however, further studies are needed.

In a study of obesity-associated liver disease, a review of literature demonstrated the most prevalent liver disease in Western countries was of metabolic origin. "Strategies are needed to approach obesity-associated liver disease by behavior programs, motivating people to adopt a healthier lifestyle," the researchers wrote.

Researchers examined literature from PubMed and The Handbook of Obesity 2008 in another study. The data demonstrated surgery was the most robust method for losing weight.

In the final study of the supplement, the researchers examined the results of studies of operations including adjustable gastric banding, gastric bypass and biliopancreatic bypass with duodenal switch. They also evaluated abandoned and current procedures, complications and patient selection. Bariatric surgery should be the therapy of choice until better approaches become available, according to the researchers.

For more information:
Blakemore AIF. J Clin Endocrinol Metab. 2008;93:S51-S56.
Bray GA. J Clin Endocrinol Metab. 2008;93:S81-S88.
Cali AMG. J Clin Endocrinol Metab. 2008;93:S31-S36.
Ford ES. J Clin Endocrinol Metab. 2008;93:S1-S8.
Jensen MD. J Clin Endocrinol Metab. 2008;93:S57-S63.
Marchesini G. J Clin Endocrinol Metab. 2008;93:S74-S80.
Misra A. J Clin Endocrinol Metab. 2008;93:S9-S30.
Pories WJ. J Clin Endocrinol Metab. 2008;93:S89-S96.
Rasouli N. J Clin Endocrinol Metab. 2008;93:S64-S73.
The Endocrine Society. J Clin Endocrinol Metab. 2008;93:(Suppl 1).
Woods SC. J Clin Endocrinol Metab. 2008;93:S37-S50.

Original source: http://www.endocrinetoday.com/view.aspx?rid=38083


Food Taxes And Discounts Affect Weight

March 19, 2009, United Press International

Food prices can affect weight outcomes and pricing interventions can have a significant effect on obesity rates, U.S. researchers said.

Lisa Powell and Frank J. Chaloupka of the University of Illinois at Chicago assessed research published between 1990-2008 that involved weight and body mass index in combination with pricing and taxes.

The study, published in a special March issue of the The Milbank Quarterly that focused on obesity, found that raising the prices of less healthy foods -- fast food and sugary products -- and lowering the prices of healthier foods -- fruits and vegetables -- are associated with lower body weight and lesser likelihood of obesity.

However, small taxes on unhealthy food items or small subsidies for healthy foods are not likely to produce substantial changes in weight or obesity prevalence, while nontrivial pricing interventions may have a measurable effect on Americans' weight outcomes, the study said.

"This review provides evidence about the potential effectiveness of using food pricing policies to affect weight outcomes, including the potential impact of excise and other taxes on less healthy products and of subsidies for more healthy products," the authors said in a statement.

Original source: http://www.upi.com/Health_News/2009/03/19/Food_taxes_and_discounts_affect


Parents May Not See Child Obesity Risk

March 19, 2009, United Press International

Seventeen percent of U.S. children ages 2 and 19 are classified as obese, but researchers say parents may not be recognize obesity in their children.

The study, published in the Journal of the American Academy of Nurse Practitioners, showed that parents are likely to misperceive their child's weight -- especially parents who are overweight themselves.

Jessica Doolen, Patricia T. Alpert and Sally K. Miller of the University of Nevada examined several studies which examine parental perceptions of childhood obesity generated from Britain, Australia, Italy and the United States.

The researchers found that in Britain, 1.9 percent of parents with children at risk for overweight and 17.1 percent of parents with overweight children accurately identified their child as being at risk for or overweight.

In another study, the researchers made note of an interesting finding in the study conducted in Westchester County, N.Y. Parents who had concern for their child's excess weight, 76 percent thought this concern was similar to concerns about sunburn, while 67 percent found concerns about weight similar to prolonged television watching.

"If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications," the study authors said in a statement.

Original source: http://www.upi.com/Health_News/2009/03/19/Parents_may_not_see_child


Proximity To Fast-Food Restaurants Increases Obesity Risk For Children, Pregnant Women

March 16, 2009, RWJF Childhood Obesity News Digest

A new study links proximity to fast-food restaurants with increased obesity rates among children and pregnant women, Reuters reports. Released by the American Association of Wine Economics and conducted by researchers at Columbia University in New York City and the University of California-Berkeley, the study assessed obesity rates among 3 million ninth-grade students in California and more than 1 million pregnant women in Michigan, New Jersey and Texas. Researchers found that the presence of a fast-food restaurant within one-tenth of a mile of a school was associated with a 5.2 percent increase in that school's obesity rate. Among pregnant women, the presence of a fast-food restaurant within the same distance of their home was associated with a 4.4 percent increase in the probability of gaining more than 44 pounds during pregnancy.

The report adds support to a December 2008 study suggesting that youth who attend schools within a half-mile of a fast-food outlet eat less fruit and vegetables, consume more soda and are more likely to be obese than their peers attending schools located farther from such restaurants. Noting the strong correlation between fast-food access and obesity rates, the researchers suggest designating fast-food-free zones near schools as a means to curb childhood overweight and obesity.

A spokesperson for the National Retail Federation said that it would "be a dangerous precedent to limit the types of legitimate, important businesses and where they are located in a city," and suggested instead that parents limit when and where children can eat such foods (Gervitz, Reuters, 3/14/09; Currie et al., American Association of Wine Economics working paper, February 2009).

Original source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=9931


Study Shows Obesity Poses Health Risks At Early Age

March 12, 2009, RWJF Childhood Obesity News Digest

New research from a nationwide survey suggests that health problems stemming from childhood obesity may begin in children as young as age 3, the Miami Herald reports. To assess the negative health effects of childhood obesity, researchers from the University of Miami examined data from the National Health and Nutrition Examination Survey, conducted by the Centers for Disease Control and Prevention, on over 3,000 children ages 3 to 6. The researchers examined children's waist circumference, body mass index (BMI), cholesterol levels and inflammation of the arteries. According to the researchers, children with high BMIs and large waist circumferences were more likely to have lower levels of HDL , or "good" cholesterol , and elevated C-reactive protein, which can be an early indicator of heart disease and diabetes. According to the Herald, the survey "sharply lowers the age at which problems" stemming from childhood obesity have been detected. Calling the results important, the chairman of pediatric nutrition at the Children's Hospital at the University of Colorado in Denver says the study suggests that obesity is "having an immediate effect on the health of those children" (Tasker, Miami Herald, 3/11/09; Thomas, HealthDay News, 3/11/09).

Original source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=9901


Sustained Physical Activity Better For Preventing Obesity In Kids

March 5, 2009, Health Behavior News Service

Newswise — Several bursts of exercise that last five minutes or more might be better for preventing childhood obesity than are intermittent physical activity sessions lasting four minutes or less throughout the day.

That is the key message from a four-year study that researchers at Queen's University in Ontario, Canada conducted. The findings appear in the May issue of the American Journal of Preventive Medicine.

"If two children accumulated 60 minutes of daily physical activity, the child who accumulated more activity in bouts is less likely to be obese than the one who accumulated more of their activity in a sporadic manner," said Ian Janssen, Ph.D., lead study author.

For the nearly 2,500 participants, ranging from 8 to 17 years old, 66 percent of physical activity took place in short sessions lasting less than five minutes.

Among those who moved the most throughout the day, 34 percent of the sporadically active were overweight or obese, compared with 25 percent of the 'bout' children.

Jocelyn Miller, Ph.D., a child psychologist with Dean Health System in Madison, Wis., agreed that longer sessions are better for preventing childhood obesity. "The real benefits of daily physical activity build the longer the activity is sustained," she said, adding,

"Since videogames first hit the market, many children don't know how to play with toys, do pretend play or build things."

U.S. guidelines recommend that school-aged children participate in 60 minutes of daily physical activity, but those guidelines are open to interpretation. Janssen said there are no stipulations as to how to accumulate the 60-minutes each day.

He added, "If parents, teachers and policy makers believe kids are getting 60 minutes of continuous physical activity in a one-hour physical education class or activities like basketball practice, they are way off base. Children are often inactive during these periods."

James Sallis, Ph.D., a psychology professor at San Diego State University, said, "According to the energy balance model, all energy expenditure should help reduce risk of obesity. I encourage all forms of physical activity, even sporadic activity, which is natural to children."

Miller tells families that if they want children to be active, they have to be active.

"Take a walk or bike with your child. Children often don't notice they are being active if it occurs in a social context."

American Journal of Preventive Medicine: Contact the editorial office at (858) 534-9340 or eAJPM@ucsd.edu.

Reference: Mark AE, Janssen I. Influence of bouts of physical activity on overweight in youth. Am J Prev Med 36(5), 2009.

Original source: http://www.newswise.com/articles/view/549769/


Journal of Public Health Policy: Special Issue on Active-Living Policies Childhood obesity research highlights from volume 30, issue S1

March 4, 2009, Education Week

  • Preventing Childhood Obesity through State Policy: Qualitative Assessment of Enablers and Barriers
    (2009) 30, S161-S176; doi:10.1057/jphp.2008.57
    ABSTRACT: As the prevalence of obesity rapidly climbs among youth in the United States, public health practitioners and policymakers seek effective means of slowing and reversing these trends. Recently, many state laws and regulations addressing childhood obesity have been introduced and enacted. Understanding determinants of such legislation may inform the development and passage of future policies. For this study, key-informant interviews were conducted with 16 legislators and staffers from 11 states in 2005–2006 to examine qualitative factors that enable and impede state-level childhood obesity prevention legislation. Commonly cited factors positively influencing the passage of childhood obesity prevention legislation included national media exposure, introduction of the policy by senior legislators, and gaining the support of key players including parents, physicians, and schools. Noteworthy barriers included powerful lobbyists of companies that produce unhealthy foods and misconceptions about legislating foods at schools. Although the total number of informants was modest, their valuable insights provide policymakers and practitioners with a set of enablers and barriers to be considered when pursuing state-level policy. READ MORE
  • Disparities in Physical Activity and Sedentary Behaviors Among U.S. Children and Adolescents: Prevalence, Correlates, and Intervention Implications
    (2009) 30, S309-S334; doi:10.1057/jphp.2008.46
    ABSTRACT: Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2 percent to 61 percent. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth. READ MORE



Obesity Rates Steady Among American Children

March 30, 2009, Voice of America News

By Carolyn Presutti

Lawmakers on Capitol Hill were briefed on obesity in the United States. About two in three American adults are obese or overweight. But the emphasis for legislators was on childhood obesity.

There Is Good and Bad News

It's bad news and good news for childhood obesity in the United States.

The good news is: childhood obesity has leveled off in the past nine years.

But William Dietz, at the Centers for Disease Control, says it's still an epidemic. "There's a total of 31 percent of children and adolescents in the United States at risk for the complications of obesity," Dietz said.

That equals one in three kids. The CDC found the highest levels among Mexican American boys and African American girls. It says obesity affects medical costs, the economy, and a child's ability to learn. But the main impact is on health.

"We are on a dangerous course in the United States where our children will no longer outlive our lifetime on earth," Republican Congresswoman Jean Schmidt said. "But where we may outlive theirs."

Dietz says diabetes is one consequence of obesity. High school senior Ryan Siegal learned from experience. "I got clinically obese and that led to me being pre-diabetic, and I was taking insulin for it," Siegal said. "But through sports and medication, I lost the weight."

Food: Education Versus Availability of Better Choices

Surprisingly, experts don't think education will make a difference. Instead, they say the availability of good choices is key.

For example, fruits and vegetables are good, not only because they are low in calories, but also because their water content means they are more filling.

But fresh produce is difficult to find, here in the inner city where there are plenty of fast food restaurants, but few grocery stores.

That's why Gwen Gray buys fast food for her children. "We got Giant and Safeway [supermarkets], but they got so expensive and you got to go a little ways to get to them. If you ain't got [don't have] a car, you got to travel by bus or get a ride," she said.

Jotresa Williams says it's cost that drives her to fried foods. "It's very high these days. The grocery store is high," Williams asserts.

150 Calories Per Day, Makes a Difference

A recent study found when fast food restaurants are located within a block of a high school, the student obesity rate is 5 percent higher.

Doctors say the difference between a healthy child and an obese one is about 150 calories a day, equal to half a candy bar. It's an easy choice -- as long as better choices are available.

Original source: http://www.voanews.com/english/2009-03-30-voa13.cfm


Seven Steps To Help Kids Slim Down

March 26, 2009, Los Angeles Times

By Jeannine Stein

Childhood obesity is a thorny issue without simple solutions, but that hasn't daunted healthcare experts who work diligently to come up with viable proposals to help kids lose weight and get in shape.

The most recent strategy is the "Seven Steps to Success: A handout for parents of overweight children and adolescents," designed by physicians and weight-loss experts to be worked in progressive stages: medical management, education, environmental changes, support groups, two forms of cognitive behavior therapy (clinic or short-term, and long-term) and bariatric surgery.

The steps, published in the February issue of the journal Obesity Management, are a reaction to a detailed article published in the journal Pediatrics in 2007. That article also outlined a multi-pronged approach to obesity, including prevention, structured weight management that includes medical screenings, physical activity and diet; a multidisciplinary intervention with food monitoring and structured exercise; and very-low-calorie diets and bariatric surgery (this updated a less comprehensive plan published in that journal in 1998).

But not everyone in the field of childhood obesity was satisfied with all the suggestions outlined in the Pediatrics paper -- some objected to the education-oriented proposals." An educational approach is very popular in the United States, but it's very ineffective," said Daniel Kirschenbaum, professor of psychiatry and behavioral sciences at Northwestern University Medical School in Chicago and co-author of the Obesity Management article. Providing information about eating more fruits and vegetables may be well-meaning, he added, but it's not so useful for prompting sustainable changes.

The seven steps ratchet up in intensity, requiring more effort and commitment to achieve results. "Try one intervention," he said, "and if in a month you're not making progress, try another one. Science has taught us that you can tell pretty quickly if something isn't working."

The plan presumes that the entire family is involved with the process -- previous studies have shown that better results come from a collaborative effort, not from telling one kid he has to eat chicken breasts and broccoli while the rest of the family gobbles pizza. As children segue into adolescence, he added, they can do more on their own. For behavioral therapy, the plan suggests starting with groups such as Weight Watchers or Take Off Pounds Sensibly that offer support, education and accountability and allow parents and children to work together. "These are very low-cost alternatives where people can come in every week," he said, "but they have to be willing to work." If those don't provide suitable results, parents can opt for more intense group sessions run by trained weight-loss professionals.

Bariatric surgery, Kirschenbaum said, may be a viable option for certain kids and teens, although it's not a decision to enter into lightly. Most clinics require patients to meet parameters such as being quite overweight and providing proof they've tried other weight-loss methods. Support -- before and after surgery -- and behavior modification are also essential components.

How should parents approach the list? Kirschenbaum says they shouldn't go it alone because navigating the steps may prove intimidating and frustrating. "They should take it to their primary care physicians and get some help in making sense of it," he said. It works in reverse, too -- healthcare professionals can show it to their patients to begin a discussion about weight loss. "You should talk about it, see what you think. If you don't set a target for something, you're not going to reach it."

Original source: http://latimesblogs.latimes.com/booster_shots/2009/03/


Students Craft Their Own Cafeteria Offerings

March 22, 2009, The Baltimore Sun

By John-John Williams IV

Erika Henderson winces when she thinks of the food served up in the cafeteria at her Howard County high school - especially the wheat crust pizza.

"It's disgusting," said Henderson, a senior at Oakland Mills High. "It's cheap food with no seasoning."

But on a recent day, as she lunched on microwaveable instant noodles she brought from home, Henderson and the other students in culinary arts class were taking up a challenge to change things. They sliced onions and dipped them in batter, tweaking a dish they hope will win a place on the county's school cafeteria menu next fall.

Over the past decade, school cafeteria food has taken a turn for the healthier, federal officials say, in response to the epidemic of child obesity. But the challenge has been balancing better nutrition with tastes that appeal to students raised in a fast-food world. So Howard's and other school systems in Maryland and across the country are enrolling students in an effort to upgrade cafeteria menus.

Baltimore schools put on a similar contest this year, with bonus points for family recipes and use of locally grown ingredients. A Florida school system invited students to take part in a veggie burger taste-testing. In Ohio, teen chefs were offered college scholarships for cooking up a winning recipe.

And a school system in California relied on research of students' preferences in developing a food court model that includes sushi, stir-fry and deli-style sandwiches.

"I think the lesson for us all is that if we get children to make healthier choices [they] make their own choices and make healthier decisions," said Jean Daniel, a spokeswoman for the U.S. Department of Agriculture.

School lunch is a part of the daily routine for many children. Nationally, 31 million lunches are served daily in public schools, the USDA says. Last academic year, 72 million lunches were served in Maryland public schools, eaten by 45 percent of students.

While the effort in Howard is drawing the attention of other jurisdictions, officials there have had their ups and down with school lunches. The system adopted a stringent "wellness" policy in 2006 that limited the sales of high-fat foods as a la carte items - apple slices were in; french fries were out.

But students balked in droves, and the system's food program budget incurred a $740,000 deficit, school officials said.

Now they're looking at new ways to give students a voice in the process.

"We think that they will try something that was prepared by their peers," said Laurie Collins, an instructional facilitator for the Family and Consumer Science curriculum in Howard schools. "When they do an all-out marketing thing and get kids involved, they will eat it."

In addition to the recipe contest, the school system will use feedback from an annual tasting of prospective food items by students in making menu decisions. At the January taste-testing of 66 "healthy food items" at Howard High in Ellicott City, 12 students sampled everything from fruit smoothies to teriyaki chicken.

The event was attended by representatives from all 12 counties that take part in a food purchasing cooperative that includes Howard County. Students' feedback will factor into decisions on what food is purchased, said Mary Klatko, the system's administrator of food and nutrition services.

Though aimed at yielding a menu with taste appeal, the recipe contest is posing a challenge, students say. Aside from making items that are tasty, the participants must adhere to nutritional and cost limits. For example, a dish cannot exceed 750 calories (no more than 30 percent of the calories from fat) or 150 milligrams of sodium. Deep fried is a no-no, and an item must cost no more than $1.22 to make.

Classes in five of the county's 12 high schools are busy working on dishes for the competition, which will conclude with judging on April 1, Collins said. The items range from sandwich wraps to pizza bagels to baked sweet potato wedges.

The Oakland Mills students have been testing recipes and food combinations, and on a recent day were working on a recipe for baked onion rings. They were making them the old-fashioned way - fried in oil in a sauce pan - for comparison with the baked ones.

Zenoba Stephens, who teaches Henderson's culinary arts class, said the project has struck a chord with the students, adding, "They actually have some input as to what they will have during lunch."

As they sliced onions, the students talked of how cafeteria food has plenty of room for improvement.

"You can only eat two things on the menu - chicken nuggets and french fries," Larissa Lopez said.

Her classmates complained about the costs of lunch - tied for highest in Maryland at $3 - the "nasty" vegetables, and the wheat crust pizza that they likened to "cardboard."

School officials say they recognize it's a tall order to serve meals that are healthy and satisfy the taste bud of today's teen.

"Not everything will be pleasing to everybody," Klatko said. "A family of six might not agree. When we have 18,000 students, not everyone will like all the menu items. That is why we have choices."

Part of what's at work is the growing sophistication of the teenage palate, Collins said. The surge in popularity in the culinary arts - exemplified by TV shows such as Top Chef and Hell's Kitchen and the personas of celebrity cooks Emeril Lagasse, Rachel Ray and Paula Deen - has resonated with teens.

"They are eating different things," Klatko said. "There is a comfort and an excitement about food that didn't exist before."

Culinary Challenge

Students participating in the Howard County recipe competition must create items that adhere to stringent cost and nutrition guidelines:

Cost to Make
Entree: No more than 58 cents
Fruit: 16 cents
Vegetable: 16 cents
Bread: 11 cents
Milk: 11 cents
Condiments: 10 cents

No more than:
750 calories
30 percent of calories from fat
10 percent of calories from saturated fat
150 mg of sodium


Original source: http://www.baltimoresun.com/news/local/annearundel/


U.S. Program Aims To Help Babies Beat Obesity Odds

March 16, 2009, Reuters

By Julie Steenhuysen

Elena Nieves hardly looks like a poster girl for an obesity program for pregnant moms.

The 5-foot-8 (1.7-meter) 23-year-old recently lost more than 50 pounds (23 kg) and looks healthy. But 15 weeks into her third pregnancy, she was gaining the weight back -- too fast.

"I found out I was pregnant in December. I didn't go to the doctor until mid-January and I had already gained 15 pounds (7 kg)," said Nieves. Having struggled with excess weight in her last pregnancy, she decided to take action.

Nieves became the newest member of an experimental program at Northwestern Memorial Hospital in Chicago designed to help pregnant mothers keep their weight in check.

It is based on new research suggesting that excessive weight gain in pregnancy hurts both the mother and her fetus, raising the risk of complications during pregnancy and putting the child at risk for obesity and diabetes later in life.

"We've known for a long time that children of overweight mothers are more likely to be overweight themselves," said Dr. Robert Kushner, who directs the Northwestern Comprehensive Center on Obesity.

But he said researchers had assumed that was simply because the mother passed along her bad eating and lifestyle habits to her child after birth. Now, animal studies suggest the environment the fetus is growing in influences the genes.

"The whole idea is, as that child comes out of the birth canal, you've already imprinted that child's vulnerability to be overweight," Kushner said.

"It's like being born with handcuffs on. In this environment, how do they have a fighting chance?" said Kushner, referring to the growing obesity epidemic that affects a third of adults and nearly 17 percent of children in the United States.

U.S. Centers for Disease Control and Prevention estimates nearly one quarter of the 4 million births each year in the United States involve obese women.

Obesity raises the risk for diabetes, hypertension, heart disease, osteoarthritis, stroke, gallbladder disease, sleep apnea, respiratory problems and even some cancers. A 2000 report by the U.S. Surgeon General estimated the direct and indirect cost of obesity at $117 billion each year.

Kushner said the program at Northwestern is among the first in the country to tackle obesity in pregnancy. He said pregnant women have often been considered hands off because of fear of harming the developing baby.

But it now seems doing nothing may be doing more harm.

No More Hands Off

Doctors have referred about 20 women since the program started in November, and new ones come in each week.

Women meet for classes every other week on nutrition, stress and exercise and keep daily logs of their diet and activity levels. That is proving difficult for some women, who are already juggling work, child care and weekly appointments with their obstetrician.

Charlotte Niznik, an advanced practice nurse who coordinates the program, said the team may start offering some of the services online. "Everything is flexible. If we're rigid, we'll never get participation."

A three-year grant allows the team to offer the program for free. They hope to attract more black and Hispanic women, who are at highest risk for obesity and its complications.

Niznik said several women in the program have had gastric bypass surgery and fear gaining too much weight.

"They are motivated to maintain a normal weight gain in pregnancy, which is no more than 15 pounds (7 kg), because these women are obese," Niznik said. "They are 300 (136 kg) to 400 pounds (180 kg)."

At 195 pounds (90 kg), Nieves weighs considerably less than that, but her previous weight battles and rapid weight gain -- 20 pounds (9 kg) so far -- make her a candidate.

During her last pregnancy, Nieves felt pressured by her obstetrician to gain weight. "I was about 220 pounds (100 kg). I would tell him, 'I'm already overweight. I don't want to gain the weight,'" she said.

"He would just tell me, 'You have to gain a pound a week.' That's 40 pounds at the end of the pregnancy!"

She hopes the program will give her ammunition to resist some of the pressure she is getting to gain weight.

"My background is Hispanic," she said. "My mother-in-law is like, 'Oh my God, you are pregnant. Eat, eat, eat. The baby has to be nice and fat.'"

Dr. Alan Peaceman, an obstetrician who co-directs the pregnancy and obesity program, said the near-term goal is to help women like Nieves have healthy pregnancies. Down the road, they hope to gather data to see if it helped reduce complications for mothers and gave babies a better shot at having a healthy weight.

"If we can show that weight control during pregnancy reverses these trends, this is going to be one of the first successful approaches toward reducing childhood obesity, and that will be a major accomplishment," he said.

Original source: http://news.yahoo.com/s/nm/20090316/us_nm/us_obesity_pregnancy


North Carolina School Posts Calorie Information On Digital Cafeteria Menu Boards

March 9, 2009, RWJF Childhood Obesity News Digest

To give students more information about the nutritional content of the food choices in its cafeteria, Crest Middle School in Shelby, N.C., has installed digital menu boards that feature the calorie content of the cafeteria offerings, News 14 reports. The menu boards resemble those stationed at drive-through restaurants, but feature the calorie value of each item served rather than the price. A separate board in the cafeteria broadcasts information on nutrition and anti-obesity messages featuring the school's mascot and colors. Teachers will reinforce the healthy messages by incorporating nutrition curriculum into classroom activities.

School officials say inspiration for the menu boards came from the demonstrable success and educational value reaped from menu labeling requirements for fast-food menu boards. The menu boards, which cost between $10,000 and $12,000 to install and $150 per month to maintain, were paid for by the school system, Cleveland County Health Department and Cleveland Regional Medical Center. School administrators plan to install the menu boards at Crest County middle and high schools this school year and in Burns, Kings Mountain and Shelby middle and high schools during the summer break. According to the Childhood Obesity Action Network, an estimated one in three North Carolina children between ages 10 and 17 are overweight (Gaier, News 14, 3/5/09; Cleveland County Schools Web site, accessed 3/9/09).

Original source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=9842


Unique Intergenerational Approach Battling Childhood Obesity

March 5, 2009, PNNOnline

A unique, intergenerational program developed by OASIS to enlist older adults in the fight against childhood obesity will be expanded to eight cities during the next two years with a $313,000 grant from the WellPoint Foundation, Inc.

Active Generations promotes physical activity and healthy eating for low-income children and their families. The program reaches children in grades 3 to 5 in after-school settings using teams of volunteers age 50 and older who offer weekly sessions on healthier lifestyles. Sessions include a lesson, vigorous physical activity and a healthy snack.

"The WellPoint Foundation is dedicated to working with organizations to identify and target public health concerns," said Caz Matthews, president, WellPoint Foundation. "With Active Generations, OASIS takes aim at childhood obesity, a serious and costly public health care epidemic, using a resource that is not only plentiful, but also extremely powerful in this country: mature adults who want to make a difference."

Active Generations uses CATCH – Coordinated Approach to Child Health, an evidence-based, nationally-recognized curriculum to measure outcomes for children, including their knowledge before and at the end of the program about healthy food choices and physical activity.

"The CATCH curriculum has been proven to impact healthy behaviors in children, which is why we chose to use the program as part of Active Generations," said Danilea Werner, National Health Director at The OASIS Institute. "OASIS has a strong commitment to provide health promotion programs for older adults that result in positive long-term health changes."

Active Generations, which was successfully piloted in Pittsburgh, Pennsylvania and San Antonio, Texas, will be expanded to OASIS centers in St. Louis, Missouri; Albany, New York; Los Angeles, California; and San Diego County, California during the first year. During the second year, OASIS will introduce the program in additional cities including Syracuse, New York; Indianapolis, Indiana; and Denver, Colorado.

During the last three decades, obesity rates in the United States have more than tripled among children ages 6 to 11. Many obese children will carry those extra pounds into adulthood, increasing the incidence of heart disease, diabetes, stroke and cancer.

By the end of the two-year grant period, an estimated 3,600 children and volunteers will have participated in the Active Generations program.

Original source: Link no longer working