July 2009






CDC Hosts Inaugural Obesity Prevention and Control Conference

The Center for Disease Control and Prevention's Division of Nutrition, Physical Activity, and Obesity (CDC DNPAO) is hosting its inaugural conference on obesity prevention and control – Weight of the Nation (WON) – at the Omni Shoreham Hotel in northwest Washington, DC, from July 27-29. The National Collaborative on Childhood Obesity Research (NCCOR) will host an invite-only reception for leadership in the fields of advocacy, policy, and research at the Omni Shoreham on the second night of the Conference.

Weight of the Nation will provide a forum to highlight progress in the prevention and control of obesity throughout the lifecycle through policy and environmental strategies. Moving away from the typical presentation format, WON aims to encourage discussion between plenary and concurrent session panelists, and the audience. Focused on four intervention settings – community, medical care, school, and workplace – WON will present case studies on the use of strategies within settings and sectors, and in specific contexts.

Woven throughout the Conference's four objectives and presented in case studies are issues relevant to NCCOR members and childhood obesity researchers. The listed objectives are to:

  • Highlight strategies that overcome barriers to the primary prevention of obesity for youth and adults in communities, medical care, schools, and workplaces;
  • Provide economic analysis of obesity prevention and control efforts (e.g., cost burden of obesity on healthcare system and employers, cost effectiveness of prevention);
  • Provide forum to share promising, emerging, and best practices for setting specific policy and environmental initiatives impacting obesity; and
  • Highlight the use of law-based efforts to prevent and control obesity (e.g., legislation, regulation and policies).

On July 28, concurrent sessions that will interest childhood obesity researchers include: overcoming challenges to school-based policies; obesity prevention in the early years; school nutrition policy; and, addressing social determinants of health. Some sessions on July 28 address improving equity and access to food, issues pertaining to menu labeling, and achieving high physical activity and physical education standards. And finally, sessions on the last day of WON include building communities for healthy lifestyles, and social marketing to reduce adolescent obesity.

For more information on the Weight of the Nation inaugural conference, please visit http://www.weightofthenation.org


Help RWJF Choose the Most Influential Childhood Obesity Research by July 10

Nominate the articles that you think will have the most impact.

It's been two years since the Robert Wood Johnson Foundation announced that we would award $500 million in grants to reverse the childhood obesity epidemic by 2015. To accomplish our goal, we have been building the evidence about the problem and what interventions work, as well as turning the evidence into action.

Now, we want to know what you think. After conducting a thorough literature search and consulting with childhood obesity experts, we selected 20 recently published articles that we believe have the potential to influence the field in the coming years. We would like you to nominate the five you think are the most influential.

View the nominees and vote.

Voting ends July 10, so vote now, and feel free to pass this e-mail along to your colleagues and encourage them to vote.

We will publish the voting results in mid-July. Thank you for your participation, and we look forward to seeing your selections.

David C. Colby, Vice President Research and Evaluation



Huang TT, Drewnowski A, Kumanyika SK, Glass TA. A Systems-Oriented Multilevel Framework for Addressing Obesity in the 21st Century. Preventing Chronic Disease 2009;6(3).


Effective or sustainable prevention strategies for obesity, particularly in youths, have been elusive since the recognition of obesity as a major public health issue 2 decades ago. Although many advances have been made with regard to the basic biology of adiposity and behavioral modifications at the individual level, little success has been achieved in either preventing further weight gain or maintaining weight loss on a population level. … Because of the complex system that affects obesity, researchers need to use a systems-oriented approach to address the multiple factors and levels. Whereas multidisciplinary research consists of teams with different expertise that can contribute to the understanding of particular aspects of a larger research question, truly cross-disciplinary research asks a priori questions and poses hypotheses that cut across disciplines and across levels of influence.



Haemer MA, Huang TT, Daniels SR. The Effect of Neurohormonal Factors, Epigenetic Factors, and Gut Microbiota on Risk of Obesity. Preventing Chronic Disease 2009;6(3).


ABSTRACT: Molecular, cellular, and epidemiologic findings suggest that neurohormonal, epigenetic, and microbiologic mechanisms may influence risk for obesity by interacting with socioenvironmental factors. Homeostatic and nonhomeostatic neural controls of energy predispose people to obesity, and this predisposition may be exaggerated by the influence of media, marketing, and sleep patterns. Epigenetic gene regulation may account for the influence of modifiable early life or maternal exposures on obesity risk. Alterations in gut flora caused by infant feeding practices or later diet may influence the absorption and storage of energy. Further exploration of how these molecular-cellular mechanisms might increase obesity risk in response to modifiable socioeconomic factors requires the partnership of laboratory and public health researchers.



Esposito L, Fisher JO, Mennella JA, Hoelscher DM, Huang TT. Developmental Perspectives on Nutrition and Obesity from Gestation to Adolescence. Preventing Chronic Disease 2009;6(3).


ABSTRACT: Obesity results from a complex combination of factors that act at many stages throughout a person's life. Therefore, examining childhood nutrition and obesity from a developmental perspective is warranted. A developmental perspective recognizes the cumulative effects of factors that contribute to eating behavior and obesity, including biological and socio-environmental factors that are relevant at different stages of development. A developmental perspective considers family, school, and community context. During gestation, risk factors for obesity include maternal diet, overweight, and smoking. In early childhood, feeding practices, taste acquisition, and eating in the absence of hunger must be considered. As children become more independent during middle childhood and adolescence, school nutrition, food marketing, and social networks become focal points for obesity prevention or intervention. Combining a multilevel approach with a developmental perspective can inform more effective and sustainable strategies for obesity prevention.



Huang TT, Yaroch AL. A Public-Private Partnership Model for Obesity Prevention [Letter to the Editor]. Preventing Chronic Disease 2009;6(3).


TO THE EDITOR: … In a societal approach to combating obesity, every participant, including the food industry, has a role. Public-private partnerships can enhance rather than hinder the development of effective and sustainable solutions.




Braveman P. A Health Disparities Perspective on Obesity Research. Preventing Chronic Disease 2009;6(3).


ABSTRACT: Obesity is a major risk factor for chronic disease and can decrease longevity, quality of life, and economic pro¬ductivity. Compelling ethical, human rights, and practical reasons exist for addressing social disparities in obesity, which requires systematically applying a disparities per¬spective to obesity research and relevant policy. A dispari¬ties perspective guides us to consider multiple dimensions and levels of social advantage and disadvantage and how those advantages and disadvantages produce disparities in obesity and its consequences.



Hammond RA. Complex Systems Modeling for Obesity Research. Preventing Chronic Disease 2009;6(3).


ABSTRACT: The obesity epidemic has grown rapidly into a major public health challenge, in the United States and world¬wide. The scope and scale of the obesity epidemic motivate an urgent need for well-crafted policy interventions to prevent further spread and (potentially) to reverse the epidemic. Yet several attributes of the epidemic make it an especially challenging problem both to study and to com¬bat. This article shows that these attributes — the great breadth in levels of scale involved, the substantial diver¬sity of relevant actors, and the multiplicity of mechanisms implicated — are characteristic of a complex adaptive sys¬tem. It argues that the obesity epidemic is driven by such a system and that lessons and techniques from the field of complexity science can help inform both scientific study of obesity and effective policies to combat obesity. The article gives an overview of modeling techniques especially well suited to study the rich and complex dynamics of obesity and to inform policy design.



Keeping Children Healthy in California's Child Care Environments: Recommendations to Improve Nutrition and Increase Physical Activity

Sacramento, 2009; California Department of Education, California Health and Human Services Agency

We are pleased to introduce Keeping Children Healthy in California's Child Care Environments: Recommendations to Improve Nutrition and Increase Physical Activity, and we want to extend our thanks to the Strategic Assessment of the Child Care Nutrition Environment Advisory Group, which guided the report's development. California's children face a future limited by chronic disease and, for the first time in history, shorter life spans than their parents. Children's early years are critical in shaping their physical, emotional, and social well-being. One-third of California's low-income children enter school overweight or obese. Interventions to curb this epidemic must begin before children enter school and before they develop poor health habits that lead to overweight and obesity. Child care settings are ideal environments for promoting healthy eating habits and physical activity.




Pediatric Type 1 Diabetes Linked to Excess Weight

June 25, 2009, MedPage Today

By Crystal Phend
Reviewed by Zalman S. Agus

Children with type 1 diabetes are now more likely to be overweight than their nondiabetic peers, a dramatic difference from their thin, gaunt presentation of the past.

The overall prevalence of overweight was 22.1 percent in type 1 diabetes patients ages 3 to 19 compared with 16.1 percent in those who did not have diabetes (P < 0.05), Lenna L. Liu, MD, MPH, of Seattle Children's Hospital, and colleagues reported online in Pediatric Diabetes.

But obesity rates were similar between type 1 diabetes and nondiabetic groups in the population-based study.

"The really traditional teaching on type 1 diabetes was that children would present at diagnosis very thin and usually had lost a lot of weight," Dr. Liu said. "What's surprising is we're finding type 1 children who are overweight potentially early in their disease."

Dr. Liu chalked up the change to societal shifts. "The childhood obesity epidemic is affecting children with diabetes as well, not just in type 2 diabetes."

She cautioned, though, that the observational, cross-sectional data could not determine causality, including whether diabetes preceded the weight gain or whether weight gain was a result of treatment.

Whatever the cause, the combination of diabetes and overweight or obesity in childhood portends poor outcomes later in life, Dr. Liu noted. "Their risk for cardiovascular disease, high blood pressure, and lipid abnormalities increases even more."

She recommended integration of prevention efforts into care for pediatric type 1 diabetes, "and if they are already overweight or obese that that issue needs to be addressed in addition to management of their diabetes."

Her group's SEARCH for Diabetes in Youth study included a population-based sample of 3,953 diabetic patients ages 3 to 19 for comparison with the same age cohort in the general population National Health and Nutrition Examination Surveys.

The SEARCH study registered youth with nongestational diabetes in geographically defined populations in Ohio, Washington, South Carolina, and Colorado; among health plan members in Hawaii and California; and in health service beneficiaries in three American Indian populations.

As expected, obesity -- body mass index at or above the 95th percentile -- was more common in type 2 diabetes than in type 1 diabetes or in nondiabetic youth (79.4 percent versus 12.6 percent and 16.9 percent).

For overweight – BMI between the 85th and 95 percentiles – though, the opposite was true.

Type 1 diabetes was associated with a 22.1 percent rate of overweight compared with 10.4 percent in type 2 diabetes and 16.1 percent in the general population of nondiabetic youth.

The prevalence of obesity in type 2 diabetes was high across race and ethnic groups -- from 68.2 percent among Asian and Pacific Islanders to 91.1 percent among African-Americans.

But after adjustment for diabetes type, sex, and length of time with the disease, nearly all minority youth were at higher obesity risk than non-Hispanic white teens and children:

  • 2.28-fold higher odds among African-Americans (P < 0.01)
  • 1.49 times higher odds among Hispanics (P < 0.01)
  • 1.53-fold higher odds among Asian and Pacific Islanders (P=0.04)
  • 1.28 times higher odds among American Indians (P=0.37)

The results for overweight were similar except that the difference between African-Americans and non-Hispanic whites was not significant.

The researchers noted that diabetes was classified as reported by the healthcare provider in the study. This may have made the estimate of overweight and obesity in type 1 diabetes conservative since providers may have been more likely to consider type 2 diabetes in the presence of obesity, they said.

"Further study of overweight and obesity among youth with diabetes will be critical to understand how weight influences the diagnosis, management, and prognosis of youth with diabetes," Dr. Liu's group concluded.

The SEARCH for Diabetes in Youth study was funded by the CDC and supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

The researchers provided no information on conflicts of interest.


Original Source: http://www.medpagetoday.com/Endocrinology/Diabetes/14861


Early Obesity Ups Risk of Cancer Type; Houston Team Says Chances Grow for Disease in Pancreas

June 24, 2009, The Houston Chronicle

By Todd Ackerman

Obesity is a known risk factor for pancreatic cancer, but Houston researchers have found that people who took on excess weight in early adulthood or even their teens are at greatest risk.

In a study published in June's Journal of the American Medical Association, University of Texas M.D. Anderson Cancer Center scientists reported adults who were overweight between 14 and 19 years old had a 60 percent higher risk of developing pancreatic cancer later in life, and those who were obese in their 20s and 30s had a two to three times' higher risk.

"This shows the importance of weight control in one's younger years to reduce pancreatic cancer risk," said Donghui Li, a professor in M.D. Anderson's department of gastrointestinal medical oncology. "The development of pancreatic cancer is still something of a mystery, but this suggests a preventive step people can take when they're younger."

Weight, stages of life

The study is the first in pancreatic cancer to look at the association between pancreatic cancer and excess weight at different stages of an individual's life span. The method is more common in diabetes studies.

The researchers also found adults overweight or obese around the time of diagnosis have shorter survival times than normal-weight patients. Normal-weight patients in the study lived an average of 18 months after diagnosis, whereas heavier patients lived 13 months.

Li's team matched 841 pancreatic cancer patients and 754 healthy people by age, sex and race. Participants were interviewed about their height and weight starting at ages 14 to 19 until the year prior to their recruitment in the study, as well as their alcohol use, smoking and family history.

The study found the risk of developing pancreatic cancer was not statistically significant when participants only became overweight or obese in their 50s.

Smoking also a factor

Pancreatic cancer is the fourth leading cause of cancer death in the United States. It is diagnosed in more than 42,000 people a year and kills more than 35,000, according to the American Cancer Society. The five-year survival rate is less than five percent.

Obesity and smoking are the major modifiable risk factors associated with the disease. About 25 percent of cases are associated with obesity and 27 percent with smoking.


Original Source: http://www.chron.com/disp/story.mpl/metropolitan/6494550.html


Childhood Obesity Underpins Low Self-Esteem: Study

June 17, 2009, Canwest New Service

By Sharon Kirkey

Obesity not only harms a child's body, but it also causes significant psychological damage to children as young as 10, a large new Canadian study shows.

The study, based on a nationally representative sample of 10- and 11-year olds, found that obese children had almost twice the odds of reporting low self-esteem when compared to normal-weight kids.

And those whose self-esteem was low at the start of the study were more than three times as likely to feel bad about themselves four years later, when they were teens.

Doctors say the findings are troubling on several counts. Low self-esteem increases the risk of anxiety, sadness, loneliness, nervousness and depression, and makes children more vulnerable to drug and alcohol abuse and "self-destructive" behavior, including suicidal thinking, when they are older.

As well, many parents don't recognize when their kids are overweight. Even when their child is obese, one third of mothers and more than half of fathers in one British study saw their child's weight as "about right."

Some parents are reluctant to admit a weight problem in their children, because many are overweight themselves. Others think that with so many other people around them getting fatter, being overweight is normal.

According to the new report by Statistics Canada, childhood overweight has become "pandemic" and prevalence rates continue to rise. In 1978-79, 12 percent of 2- to 17-year-olds were overweight, and three per cent were obese — a combined overweight/obesity rate of 15 percent.

By 2004, the overweight rate for this age group was 18 percent (an estimated 1.1 million), and eight percent were obese (about half a million), for a combined rate of 26 percent, according to Statistics Canada.

The heavier kids are as children, the more likely they are to grow into fat adults and face an early death from heart disease, stroke and other weight-related diseases.

Pediatricians are already seeing an alarming rise in type 2 diabetes, high cholesterol, high blood pressure and "non-alcoholic" fatty liver disease in children.

It seems intuitive that obese children are more likely to suffer low self esteem. But the new study is one of few to measure the mental health consequences of childhood obesity.

The survey began in 1994-95 with 2,879 children aged 10 and 11. All completed a self-esteem scale that included questions such as: "In general, I like the way I am," and "A lot of things about me are good."

Obese kids were more likely than non-obese kids to have low self-esteem.

The children were re-interviewed two years later, when they were 12 and 13, and four years later, when they were 14 and 15. Even when other factors were taken into account, such as school performance, family income, education, and how much time they spent in front of a television or computer screen each day, "baseline body weight was independently associated with self-esteem in subsequent years," according to the Statistics Canada report. The association was strongest in girls.

The researchers also set out to answer the question: Does excess weight affect self-esteem, or are kids with low self-esteem more likely to get fat? "It's not self-esteem that predicts obesity, it's the reverse," says Julie Bernier, chief analyst at Statistics Canada.

The finding means that "really early in life, we should be concerned about obesity problems in kids," she said.

According to the study, children who participated in physical activity five to seven times a week were less likely than those participating no more than twice a week to have low self-esteem four years later.

But many overweight children withdraw from sports, either because they can't do them so easily, or think they can't, or they're too embarrassed to run, says Dr. Glen Berall, chief of pediatrics at Toronto's North York General Hospital.

"We see teasing. We see body image sensitivities. We see kids who won't go swimming because they don't want to take off their shirts," Berall says. "We see an impact on marks with self-esteem.

"Definitely, our kids suffer."


Original Source: http://www.canada.com/Health/Childhood+obesity


Childhood Obesity Increases Early Signs Of Cardiovascular Disease

June 12, 2009, ScienceDaily

By as early as 7 years of age, being obese may raise a child's future risk of heart disease and stroke, even without the presence of other cardiovascular risk factors such as high blood pressure, a new study found. The results were presented at The Endocrine Society's 91st Annual Meeting in Washington, DC.

The study, conducted by researchers at Nemours Children's Clinic and Dr. Charles DelGiorno, an Endocrine trainee from the Mayo Clinic of Jacksonville, Fla., demonstrates that the unhealthy consequences of excess body fat start very early, said principal investigator and senior author Nelly Mauras, MD, Chief of Pediatric Endocrinology at Nemours Children's Clinic in Jacksonville, Florida. Obesity alone, the study shows, is linked to certain abnormalities in the blood that can predispose individuals to developing cardiovascular disease early in adulthood.

"Our study finding suggests that we need more aggressive interventions for weight control in obese children, even those who do not have the co-morbidities of the metabolic syndrome," Mauras said.

The metabolic syndrome is a cluster of risk factors that raise the risk of developing heart disease, stroke and diabetes. It is increasingly being diagnosed in children as overweight becomes a greater problem. Although debate exists as to its exact definition, to receive a diagnosis of metabolic syndrome, in general you must have at least three of the following: increased waist circumference (abdominal fat), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood glucose (blood sugar).

Mauras and colleagues wanted to know if simple obesity could raise cardiovascular disease risk before the metabolic syndrome develops. They therefore screened more than 300 individuals ages 7 to 18 years and included just those without features of the metabolic syndrome. They included 202 subjects in the study: 115 obese children and 87 lean children as controls ~ half were pre-pubertal and half in late puberty. Obese children had a body mass index (a measure of body fat) above the 95th percentile for their sex, age and height.

To be eligible to participate in the study, the children and adolescents had to have normal fasting blood sugar levels, normal blood pressure and normal cholesterol and triglycerides. Lean controls also could not have a close relative with type 2 diabetes, high cholesterol, high blood pressure or obesity. The latter group proved very difficult to find.

All study participants underwent blood testing for known markers for predicting the development of cardiovascular disease. These included elevated levels of C-reactive protein (CRP), a marker of inflammation, and abnormally high fibrinogen, a clotting factor, among others. Obese children had a 10 fold higher CRP and significantly higher fibrinogen concentrations, compared with age- and sex-matched lean children, the authors reported. These abnormalities occurred in obese children as young as 7-year-olds, long before the onset of puberty.

The results were striking Mauras stated, as the children were entirely healthy otherwise. Although it is not yet known whether early therapeutic interventions can reverse high CRP and fibrinogen, she said it would be prudent for health care providers to advise more aggressive interventions to limit calories and increase activity in "healthy" overweight children, even before the onset of puberty.

"Doctors often do not treat obesity in children now unless they have other features of the metabolic syndrome," she said. "This practice should be reconsidered. Further studies by the growup will offer further insight into the effects of therapeutic interventions in these children."

The Thrasher Research Fund of Salt Lake City supported this study.


Original Source: http://www.sciencedaily.com/releases/2009/06/090611142526.htm


Kid Goes into McDonald's and Orders ... Yogurt?

June 15, 2009, New York Times

By Tara Parker-Pope

The eating habits of American children appear to be shifting. And for a change, the news is good.

Chicken nuggets, burgers, fries and colas remain popular with the under-13 set, of course. But new market research shows that consumption of these foods at restaurants is declining, while soup, yogurt, fruit, grilled chicken and chocolate milk are on the rise.

The findings, based on survey data by the Chicago market research firm NPD Group, follow a report last year that childhood obesity appears to have hit a plateau after rising for more than two decades. That finding, reported by The Journal of the American Medical Association, has been greeted with guarded optimism, and it remains unclear whether efforts to limit junk food and increase physical activity in schools have had a meaningful effect on the way children eat.

But the new data suggest that a number of factors, from the economic downturn to new offerings from fast-food giants, may be influencing a general shift in eating preferences among children.

The data, from NPD's Consumer Reports on Eating Share Trends, are collected from a representative sample of 3,500 households and 500 teenagers who give detailed information on their restaurant habits. The figures are considered highly reliable because the researchers collect answers daily, asking participants what they and their family ate and ordered at restaurants the day before. While this recall method is never 100 percent reliable, the data, collected since 1976, provide a consistent look at long-term trends.

Clearly, the economy is playing a big part in these trends. Orders for kids' meals that included a toy were down 11 percent last year, for example, while "value menu" orders were up 9 percent. More recently, children's orders for cold-cut sandwiches are up 11 percent, a surge that appears to be driven largely by the fast-food chain Subway's "$5 foot-long" campaign. And after more than three years of growth, restaurant birthday parties for children dropped 5 percent in the quarter ending in February, compared with the same quarter last year.

But economics cannot explain the entire shift, said Bonnie Riggs, a restaurant analyst for NPD. Cheeseburgers, fries and colas are all on value menus, but their consumption among children under 13 has fallen while healthier foods are on the rise.

Among the losers in the year ending March 31 were colas (down 10 percent), chicken nuggets and strips (8 percent), French fries (7 percent) and hot dogs (6 percent). Winners included soup (29 percent), grilled chicken sandwiches (26 percent), yogurt (21 percent), carrots (9 percent) and fruit (6 percent).

Even pizza is losing favor. While it is still the most popular food for children in quick-service restaurants, its year-to-year growth is flat, according to NPD. And in full-service restaurants, it has been replaced by pasta as the most popular food among children.

"Kids' tastes and preferences are changing," Ms. Riggs said, adding that they want "more choices and sophisticated fare."

To be sure, pizza, burgers, fries and kids' meals are still the most popular items ordered by children; the percentage gains for items like soup and yogurt are from a smaller base. But the trends bolster an argument that children's health researchers have made for years: if you offer more healthful food, kids will eat it.

And many restaurants are taking the hint. Last month, Burger King announced three new kids' meals that include small burgers, sliced apples that look like French fries, reduced-sodium chicken tenders, calcium-fortified apple juice and fat-free chocolate milk. McDonald's offers apples and yogurt, and Wendy's kids' meals include mandarin oranges.

"The food industry is always saying, 'We're giving people want they want; that's why we're giving you chicken nuggets, burgers and fries for your kids,' " said Leann L. Birch, director of the Center for Childhood Obesity Research at Penn State. "That's not really true. If kids are given different options and if parents make them available and let them choose some of those things, I think quite often we see you do get shifts in eating."

Not every choice is resulting in a more healthful meal. For instance, the NPD data show that breaded chicken sandwiches are on the rise while burgers are declining. On the Wendy's kids' menu, the breaded chicken has 340 calories, and a junior cheeseburger has 270.

Among beverage orders, milk consumption is on the rise and colas are down. But orange and grapefruit sodas and root beer are rising.

"The perception might be that orange and grapefruit soda are better for you," Ms. Riggs said.

Still, it is noteworthy that the NPD data are based on orders in restaurants, where children are often allowed to make their own choices.

"We don't know how many choices kids really make," Dr. Birch said. "But my sense is that parents are much more likely to be hands-off in a restaurant situation and allow kids the freedom to make more choices.

"You go to these places where they offer healthy options for adults. But until recently, kids haven't had the opportunity to choose the right thing."


Original Source: http://www.nytimes.com/2009/06/16/health



Living Near Fast Food Outlet Not A Weighty Problem For Kids

June 17, 2009, ScienceDaily

A new study by Indiana University-Purdue University Indianapolis (IUPUI) researchers contradicts the conventional wisdom that living near a fast food outlet increases weight in children and that living near supermarkets, which sell fresh fruit and vegetables as well as so called junk food, lowers weight.

The IUPUI investigators in economics, pediatrics, geography and urban planning compared children's weights over time before and after one of these food purveyors moved near the children's residences. Living near a fast food outlet had little effect on weight and living near a supermarket did not lower it.

The IUPUI researchers also report that residing near certain recreational amenities – fitness areas, kickball diamonds, and volleyball courts – lowers children's body mass indexes (adjusted for normal childhood growth). The researchers estimated that locating one of these facilities near the home of an overweight eight-year-old boy could lower his weight by three to six pounds. Surprisingly, living in proximity to a track and field facility (typically on the campus of a middle or high school) was associated with weight gain.

Reducing obesity in children is a high priority in health care and public policy, yet its causes and, consequently, what medical interventions might be effective, are not well understood.

"This study contradicts anecdotal information and provides scientifically verified insights into a wide range of variables that we hope will help physicians and public policy makers fight childhood obesity more effectively," said the study's first author Robert Sandy, Ph.D., professor of economics and assistant executive vice president of Indiana University.

The IUPUI research, published in the National Bureau of Economic Research's Economic Aspects of Obesity, utilized electronic medical records of visits over 11 years to pediatric clinics in inner city Indianapolis to determine the effects on body mass of environmental changes, such as the opening or closing of a convenience store or the installation of a playground or opening of a recreational trail.

The researchers looked at data for more than 60,000 children between the ages of 3 and 18. The children were 53 percent African-American, 30 percent Caucasian and 12 percent Hispanic. Most were poor, and publically insured.

The effect of each environmental change, for example the closing of a fast food establishment or installation of a baseball diamond, was studied at 0.10 mile, 0.25 mile, 0.50 mile and 1.00 mile from a child's residence.

Earlier studies typically have looked at one moment in time, the so-called snapshot approach, not a decade-long expanse of data.

"Previous studies did not benefit from the wide range of information we acquired such as details of both sick and well doctor visits, changes in a child's address, annual food service establishment inspection data, aerial photographs of neighborhoods and crime statistics over time. And other studies have not taken into account, as we did, families self-selecting their locations – for example families who value exercise may be more likely to live near a park," said Sandy.

Authors of the study are Robert Sandy, Ph.D., Department of Economics, School of Liberal Arts, IUPUI; Gilbert Liu, M.D., Department of Pediatrics, IU School of Medicine, IUPUI; John Ottensmann, Ph.D., School of Public and Environmental Affairs, IUPUI; Rusty Tchernis, Ph.D., Department of Economics, IU-Bloomington and National Bureau of Economic Research; and Jeff Wilson, Ph.D., and O.T. Ford, B.S., both of the Department of Geography, School of Liberal Arts, IUPUI.

This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. In their next study the IUPUI researchers plan to study children in Boston; Wilmington, Del.; Nashville, Tenn.; Jacksonville and Orlando, Fla.


Original Source: http://www.sciencedaily.com/releases/2009/06/090616122115.htm


'Recession Obesity' Impacting U.S. Children

June 4, 2009, RedOrbit

A report issued in June shows how current economic turmoil is causing U.S. parents to feed their children cheaper, fast food meals rather than healthy ones.

This tactic has apparently resulted in an increase in childhood obesity.

"There is concern with 'recession obesity' apart from the general trend toward an increasing number of obese American children," said Kenneth Land, project director of the Child Well-Being Index.

"There is a concern that parents will substitute fast food, high carbohydrate and high sugar-content food, for healthy food and that this will cause an uptick in the rate of overweight children and adolescents," said Land, a sociology professor at Duke University.

Duke University researchers studied a variety of indicators to form the 2009 Child Well-Being Index, which calculates the health and economic status of U.S. children. The new report is the first to reflect how the ongoing recession is impacting children in America.

One year ago, 32 percent of US children were found to be overweight, while 16 percent were obese, according to a study in the Journal of the American Medical Association.

The report attributed the increase in childhood obesity between 1980-1999 to high-sugar and fat diets with a decreased intake of fruits and vegetables, according to AFP, which cited the JAMA study.

Obesity at a young age can increase the risk of health problems such as type 2 diabetes and heart disease later in life.


Original Source: http://www.redorbit.com/news/health/1700617



The National Initiative for Children's Healthcare Quality Receives $3.25 Million Grant from RWJF to Fight Childhood Obesity

June 16, 2009, MarketWire

The National Initiative for Children's Healthcare Quality (NICHQ) today announced it has been awarded a $3.25 million grant from the Robert Wood Johnson Foundation (RWJF) to reverse the childhood obesity epidemic trend across the nation by training, supporting and providing technical assistance to healthcare professionals in becoming advocates for change within their communities.

As part of the grant, NICHQ will partner with the American Academy of Pediatrics (AAP), the California Medical Association Foundation (CMA-F) and the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity (CPCO) to facilitate healthcare professionals becoming community advocates for local change, and to build an online network serving as the "go to resource" for healthcare providers looking for solutions to the childhood obesity epidemic.

"We are pleased to support NICHQ in its effort to help clinicians become advocates for policy and environmental changes that will help us reverse the childhood obesity epidemic," remarked Dwayne Proctor, director of the RWJF Childhood Obesity Team. "Health is not just something that happens in the doctor's office. It happens in the places where all of us live, learn, work and play, and NICHQ's work will advance efforts to make all of these settings healthier."

Prevention, screening and treatment of childhood obesity are at the top of NICHQ's Agenda for Improvement. The rise in the prevalence of obesity in children and adolescents is one of the most alarming public health issues facing the world today. Over the past three decades, the prevalence of childhood obesity in the United States has more than tripled. Children in low socioeconomic status families and children in the country's southern region tend to have higher rates of obesity than that of the general population. The current increase is especially evident among African-American, Hispanic, and American Indian populations.

"As a leader in the children's healthcare quality movement in the United States, we are committed to tackling this complex issue," said Dr. Charles Homer, president and chief executive officer of NICHQ. "We look forward to working closely with the AAP and CMA-F, as well as with RWJF, to expand our efforts and make significant changes at the community level so that childhood obesity is no longer an epidemic threatening our children's current and future health and welfare."

NICHQ has long been a leader in the fight against childhood obesity. Since 2003, NICHQ staff and faculty worked directly with practices and programs to facilitate the engagement of clinicians in community change and improve clinical practice in Maine, New Mexico, Delaware, New York, Washington and Massachusetts. In 2007, NICHQ launched the Childhood Obesity Action Network (COAN) to link clinicians and policy makers together, provide tools and materials for clinical and policy change, and promote innovation through social networking.

"Childhood overweight and obesity lead to serious health problems," said David Tayloe MD, FAAP, president, American Academy of Pediatrics. "This program will help us empower pediatricians and families to take action in their homes, offices and communities to prevent childhood obesity and improve the health status of children," Tayloe said.

"The CMA Foundation is honored to work with NICHQ, RWJF, AAP, and CPCO to use this grassroots approach to bring healthcare providers out of the office where the focus is on treating disease and into the community in a public health role, with a focus on prevention," said Dexter Louie MD, chair, CMA Foundation board of directors and physician champion.


Original Source: http://uk.sys-con.com/node/1003977


Ky. Schools' Healthy Example Could Shape a National Policy

June 29, 2009, The Washington Post

By Jane Black

It didn't seem like a radical idea at the time. First, Ginger Gray, the food service director for Kenton County, Ky., schools, took away fried potato chips, offering students baked versions instead. Next, she phased out fruit drinks such as Kool-Aid in favor of 100 percent juices. She considered serving baked French fries. But they got soggy and unappetizing fast. And there's one thing that every school food service director knows: You don't mess with the fries.

It was a calculated effort to encourage students to eat more healthfully. A registered dietician, Gray believes her job isn't just to feed students but also to teach good eating habits.

But there was a risk. The salty snacks and sugary drinks, sold in cafeteria a la carte lines and vending machines, were reliable moneymakers for the 17 schools in Gray's district, where one-third of students eat federally subsidized lunches.

But a funny thing happened. When the numbers came in, Gray found she was making more money, not less. With fewer junk foods available, more students opted for the traditional lunch line, where Gray offers items such as salads, submarine sandwiches and make-your-own tacos. At Simon Kenton High School, revenue rose 61 percent between 2005 and 2007 without a price increase for school meals.

The results in Kentucky could reverberate in Washington. As Congress moves to reauthorize childhood nutrition programs this summer, it is again taking up the issue of whether sugary sodas, chips and candy should be allowed in schools. Legislators have tried to limit junk food in schools since 1994. But each time the measures were blocked by powerful food lobbies, and conventional wisdom has long held that such snacks are a necessary evil because they provide key revenue to supplement the federal school-lunch program and help pay for sports and arts programs.

The result: Foods sold outside the lunch line currently are required only to have "minimal nutritional value," giving tacit federal approval to peanut M&Ms, Flaming Cheetos and Twinkies.

This year could be different. Bills have been introduced in both houses to mandate new standards. President Obama has declared childhood nutrition an integral part of health-care reform, a point first lady Michelle Obama emphasized in a speech at the White House garden.

"To make sure that we give all our kids a good start to their day and to their future, we need to improve the quality and nutrition of the food served in schools," she said on June 16.

Even the food industry is supporting tighter standards in the face of reports that obesity rates have tripled in children and adolescents over the last two decades. One study from the National Bureau of Economic Research concluded that one-fifth of the increase in teenagers' average body mass index was attributable to an "increase in availability of junk foods in schools." And in a year when the country faces a historic deficit, implementing standards may be an economical way to tackle childhood obesity.

Despite such support, history shows that efforts to establish new standards could fail yet again. The measure is likely to be included in the reauthorization of federal child-nutrition programs, which are scheduled to expire at the end of the year. The first step is clearing the Senate Committee on Agriculture, Nutrition, and Forestry, where 10 Democrats have signed onto the bill as co-sponsors.

Kentucky is the seventh-fattest state in the nation, but it has been a pioneer in improving school food. In 2005, following the lead of food service directors such as Gray, Kentucky became one of the first states to impose strict standards for foods sold in cafeteria a la carte lines, school stores and vending machines, not just in the main lunch line as federal mandates require. The new regulations banned soda and sugary drinks, such as Hawaiian Punch, with more than 10 grams of sugar per serving. Twinkies and packaged cinnamon rolls were removed in favor of foods with limited fat, sugar and sodium.

"Everyone told us, 'You just can't do this. Schools won't survive. We won't have sports programs,' " said Anita Courtney, a consultant for child-nutrition programs who lobbied for the state law. "There was so much fear and in reality, it didn't make much difference."

Kenton County isn't the only district to benefit financially from cutting out junk food. In Hardin County, just south of Louisville, phasing out junk food helped push more students into the school meal program: 83 percent of students participated this year, up from 68 percent in 2000-2001. Meals are more profitable since the federal government kicks in money for every school lunch sold.

In California, where nutrition standards for competitive foods went into effect in 2007, a University of California at Berkeley survey of 20 schools revealed that revenues at 65 percent of schools increased more than enough compensate for the loss of sugary and salty snacks.

Washington politics will have as much to do with a passage of new standards as new evidence emerges in support of restricting unhealthful snacks. Food and beverage companies including Mars and the American Beverage Association support federal standards, which have not been updated in 30 years. Indeed, the association is implementing voluntary standards that cut calories and portion sizes and ban full-calorie soft drinks.

"We recognize that childhood obesity is a complex problem that will take comprehensive solutions. And our industry is stepping up to do our part," said Kevin Keane, senior vice president of public affairs at the beverage group.

It's a radical change from 15 years ago, when industry lobbyists opposed even voluntary standards. Several factors have fueled the shift. For one, childhood obesity rates have reached crisis levels.

More practically, large food corporations now have far broader portfolios. So for example, even if Coca-Cola cannot push Coke, it can sell Dasani water, VitaminWater and Powerade. Companies also would rather deal with national standards than patchwork of state and city regulations, which make it difficult for companies to standardize nutritional content and serving sizes.

Only 12 states, none in the D.C. area, have comprehensive rules for foods sold outside the lunch line. In a 2007 school food report card, the Washington-based Center for Science in the Public Interest graded the District of Columbia, Maryland and Virginia C, D-plus and D respectively for their school nutrition policies.

Some lobbies still oppose federal standards. The Alexandria-based National School Boards Association argues that local communities should make decisions about what children are fed in schools. Some public health advocates worry that weaker federal standards could undercut some more stringent state and local regulations.

If Congress mandates new standards, they might look like Kentucky's. The Agriculture Department official charged with writing new rules would be Undersecretary for Food and Nutrition Services Janey Thornton. Before arriving in Washington, she served as nutrition director for schools in Hardin County, Ky.


Original Source: http://www.washingtonpost.com/wp-dyn/content/story/


Asian American Childhood Obesity on the Rise

June 12, 2009, Balita Online

The Asian Pacific Fund held a briefing and panel discussion on the dramatic rise in childhood obesity among Asian Americans in California.

According to experts, the percentage of Asian American children in California who are at risk of obesity has risen faster than the rest of the population over the past two years. Nearly 11 percent of California children who are overweight are Asian or Pacific Islander.

The briefing and discussion, featuring experts on nutrition and weight-related diseases, was hosted by the Asian Pacific Fund, a community foundation based in the San Francisco Bay Area, and was held in conjunction with the 5th Biennial Childhood Obesity Conference, organized by the California State Departments of Health and Education. It was the first time the conference included a panel on an issue affecting Asian Americans.

"It's very important that we address the rapid increase in childhood obesity rates among Asian Americans," said Associate Professor May Wang of the UCLA School of Public Health. "Obese children are more likely to suffer from sleeping problems, bone joint problems, and to have serious health conditions such as high blood pressure or type 2 diabetes than children of normal weight." Wang said there is research that suggests that health conditions such as type 2 diabetes may develop at lower levels of fatness among Asians. One national study found that the prevalence of type 2 diabetes is 60 percent higher in Asian Americans than in non-Hispanic Caucasians, she said.

Gail Kong, president and executive director of the Asian Pacific Fund, echoed the importance of the findings, saying, "We want to help Asian parents learn about the serious health problems their children will face if they don't change some of their daily habits. More time in front of the computer is not necessarily a good thing."

According to the California Department of Public Health, 43 percent of Asian American teens consume fast food on a daily basis compared to 35 percent of white teens, and only one out of three Asian American children eats the recommended daily portion of fruits and vegetables. In addition to their poor eating habits, Asian American children are not as physically active as their peers. Based on the U.S. Department of Education, only 39 percent of tenth-grade Asian boys participated in after-school sports, the lowest participation rate of any ethnic group. Similarly, only 34 percent of tenth-grade Asian girls participated in sports, second only to Hispanic girls at 32 percent.

Health experts shared their research and findings in a panel called "Childhood Obesity in Asians, a problem or not? Research and Community-based Programs."

"We are very pleased to be guided in this effort by several Asian health education and medical experts," said Kong. "We're also grateful for the support we have received from Kaiser Permanente and The California Wellness Foundation for this work."

The panel of speakers described the dangerous risks Asian Americans face, which was supported by available data about specific ethnic groups and the habits and customs of some Asian groups that can cause health problems. Speakers included Dr. May C. Wang (Doctor of Public Health and Associate Professor at the Community of Health Sciences at the UCLA School of Public Health); Dr. Patsy Wakimoto (Doctor of Public Health, Assistant Scientist, Co-Director of Community Outreach at National Center for Minority Health Disparities at Children's Hospital Oakland Research Institute, and Associate Researcher at UC Berkeley's School of Public Health); Dr. Scott Gee, M.D., from The Permanente Medical Group of Kaiser Permanente; Dr. Gilbert Gee, (PhD, Associate Professor at UCLA School of Public Health; Eliza Chan, a registered dietician at Asian Health Services; and Dr. Jyu Lin Chen (PhD, RN, and Associate Professor at UCSF School of Public Nursing).

Speakers who have been extensively involved in Asian American health education also offered ideas for parents and families to encourage children to have healthier eating habits.

The Childhood Obesity Conference – attended by thousands of healthcare professionals and policymakers, urban and rural planners, civic, parent, and youth leaders and organizers, researchers, parks and recreation personnel, early childhood and after school professionals, business leaders and media professionals from around the nation – took place June 9-12.


Original Source: http://www.balita.com/index.php?option=com_content&view



Surgeon Generals Weigh in on Childhood Obesity

June 10, 2009, Flesh and Stone

By Kathlyn Stone

With one-in-five children in the United States considered obese, this generation may be sicker and die younger than their parents. This would be the first time in national history that a coming generation was less healthy than the previous generation.

Acting U.S. Surgeon General Steven Galson and predecessors C. Everett Koop, Antonia Novello, Audrey Manley, Richard Carmona, David Satcher and Kenneth Moritisugu gathered for an unusual joint appearance to address the childhood obesity epidemic before a health care justice summit in Washington, DC, this spring.

They focused on the epidemic's implications for chronic disease, health care costs and the future of a generation of children with the highest obesity rates in U.S. history. As a group, they called for concerted action by government, communities, business and industry, education and families.

Today, more than 17 percent of children in the United States – 12.5 million – are overweight. Overweight children are at greater risk for many serious health problems. This initiative promotes the importance of healthy eating and physical activity at a young age to help prevent overweight and obesity in this country.

Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, which sponsored the summit, May 7, said that "circumstances, forces and conditions ... dictate and define our lives." Among those:

  • where you live predicts how well and how long you live;
  • children in the poorest families experience the worst health; and
  • families in poor neighborhoods have no regular access to decent supermarkets and healthy foods.


Original Source: http://fleshandstone.net/healthandsciencenews/1534.html


BMI Registries Eyed as Promising Tool for Fighting Childhood Obesity

June 8, 2009, American Medical Association News

By Pamela Lewis Dolan

Data have been collected to show the rise in childhood obesity – to 16 percent of children between the ages of 2 and 19 in recent years, up from 5 percent for the period of 1971 to 1974.

Now a growing number of public health officials see data being useful not just to measure the obesity rate, but as a means to lower it. Body mass index registries are emerging nationwide as the newest tool in the fight against childhood obesity. The latest attempt – and the most ambitious – is in Michigan, where doctors are expected to begin submitting height and weight information on children to the state's health department. Once funding is secured as expected by year's end, a date will be set for doctors to begin reporting.

BMI traditionally has been measured in schools, using the Centers for Disease Control and Prevention's statewide Nutrition, Physical Activity and Obesity Program, a system registry backers find to be somewhat inefficient.

Lag time prevents the CDC from getting the most up-to-date data. It also can't use the data to pinpoint trends in small geographic areas. Public health officials hope physician-reported registries will solve these inefficiencies.

They say their goal is twofold. First, registries will help public health researchers identify societal and environmental issues contributing to childhood obesity, and help them evaluate existing programs aimed at reducing the numbers – right down to the individual physician practice. Second, registries can help physicians keep the problem front and center by using an objective measure to prompt what can sometimes be a difficult conversation with the parents of an overweight child.

"We have done heights and weights for years and years and years. What we have not done, and still are probably not doing well, is also calculating BMIs," said Karen Mitchell, MD, past president of the Michigan Academy of Family Physicians and the program director for Providence Family Medicine Residency in Southfield, Mich.

"We do need to raise physician awareness of the importance of BMIs, and so [the registry] can become that tool to calculate BMI," she said.

The registry in Michigan, where the CDC says 12 percent of high school kids were obese in 2007, will be an expansion of the state's immunization tracking, a registry that includes 4.7 million children.

When physicians in Michigan enter immunization records for patients older than 2, the database will prompt them to enter height and weight, as well. The system, when it is up and running, will calculate BMI rates, assess the child's risk level, and link to information the physician can use as discussion points with the parents or print out for them to take home.

The registry's ability to automatically calculate risk levels is one way of prompting doctors to address the issue of obesity head-on at the point of care, said David Share, MD, MPH, who sits on the board of the Michigan State Medical Society and is the medical director of the Corner Health Center, a clinic for teens and the children of teens, in Ypsilanti, Mich.

Share said because there are many issues physicians need to address in the short time span of a typical clinical visit, talking to overweight patients or their parents about risk levels doesn't always happen.

Arkansas, San Diego County track data

Other states, counties and school districts across the country have created registry programs.

Arkansas started a statewide BMI surveillance program in 2003. It was the first statewide program in the country, but it is facilitated through schools rather than physicians.

Matt Longjohn, MD, MPH, executive director of the Consortium to Lower Obesity in Chicago Children and a consultant to the Michigan Dept. of Community Health, which is heading the state's BMI registry, said until Michigan's program is up and running, Arkansas is the best example of how a statewide program can work.

Even though obesity rates have not declined in Arkansas, Dr. Longjohn said the program is important because it demonstrated that statewide data on obesity trends could be collected in real time in a cost-effective way.

San Diego County, where CDC data show that 12 percent of high school kids were obese in 2007, added height and weight fields to its immunization registry to begin BMI surveillance in 2006. Cheryl Moder, director of the San Diego County Childhood Obesity Initiative, said her organization's goal is to have physicians look at this data, recognize there is an epidemic, and look for changes they can spearhead in their practices and their communities.

San Diego's immediate goal, said Anne Cordon, manager of the San Diego Regional Immunization Registry, was to create a connected system that would act as a central repository for obesity data. But the challenge has been getting physicians to use the registry, she said.

California does not require physicians to report to the immunization registry, so success will be found when a more simple system for doctors is created, said Philip R. Nader, MD, emeritus professor of pediatrics at the University of California, San Diego, who helped create the registry there.

"Making it easier for physicians is really critical," Nader said.

Ethan Berke, MD, MPH, assistant professor of community and family health at Dartmouth Medical School in New Hampshire, said registries have the power to measurably improve the population.

"With good, objective measurements, looking at outcomes, seeing how different interventions work, identifying particular parts of your state or your community that require more help, finding out what is working well so you can emulate it elsewhere – then you can really start to effect change."


Original Source: http://www.ama-assn.org/amednews/2009/06/08/bil20608.htm