E-Newsletter
June 2012


SPOTLIGHT

PUBLICATIONS

RESEARCH HIGHLIGHTS

CHILDHOOD OBESITY NEWS


SPOTLIGHT

Body Weight Simulator uses new mathematical model to predict weight loss

June 11, 2012, NCCOR

It is difficult to know how much weight loss can be expected from physical activity and diet interventions. This is especially true since most weight loss "calculators" rely on overly simplistic mathematical models that inaccurately predict weight loss. The Body Weight Simulator, an interactive online tool developed by Dr. Kevin Hall and his research team at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), uses a more sophisticated mathematical model to predict body weight changes over time in response to diet and exercise interventions.

"The Body Weight Simulator incorporates the most comprehensive physiological data on how the human body responds to diet and exercise over time," said Hall, also a contributor to NCCOR's Envision project. "In contrast, the vast majority of other weight loss 'calculators' rely on static models based on the '3500 Calorie per pound' weight loss rule of thumb that is now known to be too simplistic and substantially overestimates weight loss."

Users enter baseline information into the Body Weight Simulator about their age, height, sex, starting weight, as well as work and leisure activities. They also select a time frame to achieve their goal weight. The Simulator calculates the diet and exercise intervention needed to achieve the goal.

"Users can thereby plan a personalized weight management program and set their goals to be commensurate with the required behavior changes," said Hall. "Importantly, the Body Weight Simulator calculates the permanent lifestyle changes required to maintain the new weight and avoid weight regain and yo-yo dieting."

The Simulator may also be a helpful tool for nutrition and obesity researchers.

"Researchers can use the Body Weight Simulator to help plan research studies by anticipating the expected time course and magnitude of weight changes resulting from a diet or exercise intervention," said Hall. "[It] can also be used retrospectively to help analyze weight change data and estimate the adherence of the research subjects to the prescribed intervention"

To learn more about the Body Weight Simulator and access the tool, visit http://bwsimulator.niddk.nih.gov/. The Simulator is also available on the NCCOR website under Resources for Members.

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Friend selection after school can increase activity, reduce obesity

May 29, 2012, Vanderbilt University Medical Center News and Publications

By Carole Bartoo

Another tool in the battle against childhood obesity may be careful selection of who a child plays with after school. Vanderbilt's Sabina Gesell, Ph.D., research assistant professor of pediatrics, is first author of a study in the June issue of the journal Pediatrics that examines the group effect of peers on activity levels of children in afterschool care programs.

Eighty children, ages 5 to 12, were observed for 12 weeks during their after-care programs. The programs allowed children to interact with different peers throughout the day. Study participants wore a pager-like device called an accelerometer, which detects activity intensity levels over time. The children were observed and were asked to list the friends they "hung out with" the most.

"We found that children in this age group are six times more likely to adjust to their friends' activity levels, than not. In fact, a network of four to five immediate friends has a significant influence on any individual child regardless of their usual activity level," Gesell said.

The results showed more active groups tended to draw a child up into greater activity levels, while groups that tended toward sedentary activities brought an individual child's levels down.

"The average activity level of the group of friends is what influences an individual child. Children are constantly adjusting their activity levels to match their peer group," Gesell said.

The researchers also examined whether children preferentially select groups based on activity level, perhaps choosing peers whose activity levels were similar to their own, but surprisingly, they found no such association. Children choose friends with other similarities (like being the same gender, age), but activity levels did not seem to be factor.

Gesell said this is exciting because more than 8 million children of working parents typically spend one to three hours per day in afterschool programs, making this an ideal place to get kids to be more active. Adjusting the makeup of playgroups to place children at-risk for obesity into groups with an activity level that is higher than their own is likely to influence them to be more active, too.

Before testing such an intervention in the real world, Gesell will experiment with computer simulations to determine the tipping point at which embedding too many inactive kids in a playgroup will bring down the active kids' activity levels.

"If you look at childhood obesity efforts across the country, many have failed to look at social context. It is important that we look at all the forces in play and intentionally leverage them to have a maximal impact," Gesell said.

This research was funded through the Vanderbilt Institute for Obesity and Metabolism, the Vanderbilt Clinical and Translational Science Award (NIH), and the American Heart Association. Other authors of this paper are Vanderbilt's Eric Tesdahl, M.S., and Eileen Ruchman, B.A.

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Original source: http://www.mc.vanderbilt.edu/news/releases.php?release=2435

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PUBLICATIONS

National food policy programs improve access to healthy foods

May 23, 2012, Yale News

Access to healthy food in underserved communities has improved significantly after changes in federal nutrition and food assistance programs, according to a study by the Yale Rudd Center for Food Policy and Obesity.

Published in the Journal of the Academy of Nutrition and Dietetics, the study shows that the revisions in food packages for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have increased the availability and variety of healthy foods in WIC-authorized and non-WIC convenience and grocery stores.

The WIC program is designed to help meet the needs of pregnant women and mothers of infants and young children who are at nutritional risk. The program's food packages were revised in 2009 to offer foods that better reflect dietary recommendations for Americans. The Yale researchers looked at inventories of 252 convenience stores and non-chain grocery stores in Connecticut to assess the variety, quality, and prices of WIC-approved foods before and after the new WIC food package implementation.

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Researchers found that within six to eight months of the WIC revisions, the provision of healthy foods, such as whole-grain products and produce, improved significantly in convenience and grocery stores participating in the WIC program. Non-WIC convenience and grocery stores, especially in low-income neighborhoods, also showed some improvement.

The researchers assert that the WIC food package revisions have improved access to healthy foods not only for WIC participants but for communities at large.

According to lead author Tatiana Andreyeva, the Yale Rudd Center's Director of Economic Initiatives, "Stores participating in the WIC program have found ways to deliver new healthy foods when they were required to do so. If the experience in Connecticut is typical of other states, national food policy programs that promote the consumption of healthy foods, but also require changes in stores, can help to improve local food environments for program participants and non-participants alike."

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Original source: http://news.yale.edu/2012/05/23/national-food-policy-programs-improve-access-healthy-foods

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RESEARCH HIGHLIGHTS

Are cesarean sections contributing to childhood obesity?

May 24, 2012, TIME

By Alice Park

The obesity epidemic is claiming children at ever younger ages, and the latest research adds to the evidence that weight issues may begin as soon as birth.

In a study published in the journal Archives of Disease in Childhood researchers found that babies born by cesarean section were more than twice as likely to be obese by age 3 as those born vaginally.

The study involved 1,255 children born in the Boston area between 1999 and 2002, whose mothers agreed to provide their prenatal and gestational weight information, as well as height and weight measurements for their babies at birth and then until they reached 3 years old.

About 23 percent of the babies were born by c-section. Of these children, 15.7 percent were obese by age 3, compared with 7.5 percent of children born vaginally.

The association remained even after the scientists adjusted for other factors that could influence child obesity, including the mother's pregnancy weight and the birth weight of the baby. In fact, when the scientists looked at the mothers according to their BMI, the relationship between cesarean delivery and higher child obesity rates remained even among mothers who were of normal weight, suggesting that maternal weight was not influencing children's obesity at age 3.

"One in 3 babies in the U.S. is now delivered by cesarean," says the study's lead author, Dr. Susanna Huh, director of the growth and nutrition program at Children's Hospital in Boston and an assistant professor of pediatrics at Harvard Medical School. "Mothers need to be aware that our study suggests that children delivered by cesarean section may be at higher risk of obesity."

Why? It might have something to do with how delivery affects the makeup of bacteria that populate infants' digestive tracts.

During their first year of life, infants born by c-section tend to have higher quantities of Firmicutes bacteria in their guts. Studies show that these bacteria can influence weight: obese adults tend to have more Firmicutes than any other species of gut bacteria, and research in mice finds that reducing the amount of gut Firmicutes lowers animals' risk of weight gain.

Infants born vaginally are exposed to their mother's vaginal microbes, while those born by c-section are not. Further, it's possible that the antibiotics used during cesarean delivery also influences the population of infants' gut bugs, which can in turn impact babies' weight.

These differences prompted Huh and her colleagues to explore whether mode of delivery had any long-term influence on children's weight. Such differences have previously been linked to other childhood conditions. For example, babies born by cesarean section have a higher risk of asthma than vaginally delivered kids, also because of the different microbes that these babies acquire during birth and in their first year of life.

Huh acknowledges that further study is needed to understand the mechanisms that underlie the association between c-section and obesity, but she says expectant mothers who are considering elective c-sections over vaginal delivery may want to think about whether their birth plan will have long-lasting implications for their infants' health. "Mothers considering cesarean delivery in the absence of any medical indication should be counseled that their children could be at higher risk of obesity," says Huh.

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Original source: http://healthland.time.com/2012/05/24/are-cesarean-sections-contributing-to-childhood-obesity/#ixzz1x7OqDmS7

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Obesity intervention needed even before pregnancy, researchers say

June 1, 2012, Los Angeles Times

By Mary MacVean

Most efforts to combat childhood obesity focus on children and adolescents—but perhaps those efforts should start much earlier, even before conception, researchers say.

With 10 percent of U.S. preschoolers obese and another 10 percent overweight, obesity clearly begins early—in fact, before pregnancy, the researchers say in the June issue of Childhood Obesity. Markers for later heart disease appear in 3-year-olds, they say.

A multidisciplinary approach to break the cycle of obesity moving from generation to generation is needed, say the researchers, six experts from institutions across the country who conducted a review of more than 1,000 studies and discussions about efforts underway.

"High-risk adolescent girls become high-risk mothers who have high-risk infants, who in turn become high-risk children and adolescents," the researchers write.

To break the cycle, the researchers propose two ideas: First, intervene before, during and after pregnancy and with very young children. Second, use a "systems" approach that would combine efforts in various settings and account for behavior and environmental factors.

A systems approach "focuses on the interconnections between different aspects of the environment and between individuals and the environment," rather than a traditional approach with several components, the researchers say. That would mean aligning priorities in such settings as schools and health agencies.

They note several "whole community" efforts, such as the Shape Up Somerville (Mass.) program, and say aiming such efforts much earlier should be tested. Behind the efforts is evidence of many contributors to obesity: parental weight, weight gain during pregnancy, rapid weight gain in infancy, lack of activity, and others.

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Original source: http://www.latimes.com/health/boostershots/la-heb-childhood-obesity-20120601,0,6562953.story

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Study: Despite obesity rise, kids' blood pressure dipped

June 5, 2012, Reuters

The rate of childhood obesity in the United States may have soared between the 1970s and the 1990s, but children's blood pressure did not follow the same trend, according to a study.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found that while the obesity rate among children in the state of Louisiana nearly tripled between 1974 and 1993, their blood pressure actually improved a bit.

"I think the take-home from this study is that we should not necessarily assume that increases in childhood obesity will be associated with changes in every risk factor," said lead researcher David Freedman of the CDC's Division of Nutrition, Physical Activity and Obesity.

Among nearly 11,500 children and teens assessed over the 20 years of the study, which appeared in the journal Pediatrics, the rate of obesity rose from 6 percent to 17 percent.

But blood pressure, on average, remained fairly stable. And far fewer children than expected actually had high blood pressure by 1993: about 4 percent of boys and 6 percent of girls.

By comparison, the number with high blood pressure in 1974 was about 6 percent and 8 percent.

None of that means obesity is harmless in children, Freedman said, noting that about 75 percent of obese children are obese as adults—and with an increased risk of chronic conditions like type 2 diabetes, heart disease, and arthritis.

"Maybe the biggest problem is that obese children usually become obese adults," he added.

In the United States, obesity—in adults and children alike—had its biggest surge between the 1970s and 1990s, but since then has leveled off.

Blood pressure does tend to rise along with body mass index (BMI), a measure of weight in relation to height, but previous studies had mixed findings on whether the rise in childhood obesity spurred any increase in blood pressure.

A problem with past research, Freedman said, is that it failed to account for the fact that children have also gotten taller over the years. Height is a stronger influence over children's blood pressure than is weight.

But Freedman said the current study cannot show the reason why blood pressure didn't rise along with obesity. In theory, it could have something to do with improvements in early childhood nutrition, such as rising breastfeeding rates—but that is just speculation at this point.

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Original source: http://www.reuters.com/article/2012/06/06/us-bloodpressure-idUSBRE85502B20120606

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Fatty liver disease rises among heaviest teens

May 18, 2012, ABC News Medical Unit

By Jane E. Allen

Nearly 10 percent of U.S. teens have nonalcoholic fatty liver disease (NAFLD), a largely silent accumulation of fat in their liver cells that puts them at risk for developing later cardiovascular disease and additional liver problems, new research has found.

Most of the increase in cases of NAFLD (disease not brought on by alcohol-related liver damage) is occurring among the heaviest teens—those considered obese, based on their height, weight and age, said Dr. Miriam Vos, lead researcher and a pediatric gastroenterologist at Emory University in Atlanta.

"We tried to see where the increase was happening and it looks like it's happening in the obese group," she said.

But ill health is not inevitable for obese teens whose livers already have sustained damage, said Vos, an assistant professor of pediatrics. "We think that liver disease is reversible, particularly for a teenager if they can make substantial changes and improve their weight," she added.

Vos determined that the prevalence of fatty liver among U.S. teens has more than doubled in the past two decades, from 3.6 percent to 9.9 percent, outpacing the rise in teenage obesity during that time and suggesting obesity is only a partial explanation for a rise. Vos' findings come from health data collected for 10,359 adolescents who participated in the National Health and Examination Survey (NHANES) from 1988-2008.

Even without fully understanding why numbers are up, "this is a disease that definitely needs attention. We need programs that focus on prevention of both obesity and fatty liver disease," said Vos, who presented her findings at Digestive Disease Week in San Diego, an annual gathering of nearly 16,000 physicians, researchers and academics.

The increase in fatty liver and its associated risks provide strong support for "recommendations to screen for NAFLD in obese adolescents," Vos and her colleagues concluded.

"Fatty liver disease kind of goes with the whole obesity epidemic," said Dr. Joseph A. Skelton, a pediatric gastroenterologist and associate director of the Center for Family Obesity Research at Wake Forest University School of Medicine in Winston-Salem, N.C., who was not involved in Vos' research.

He said that getting youngsters to eat healthier, be more active and maintain a healthy weight is "going to have the biggest impact, because there aren't any good drug treatments for fatty liver disease."

Vos said the researchers undertook the study to see whether there was evidence for a perception among GI specialists that they were seeing more cases of fatty liver disease in young patients. "Doctors are also looking for it more often, so it was difficult to tell if there were more cases because they were looking more often, or because there actually were more cases," she said.

In her own pediatric gastroenterology practice, Vos commonly sees "multiple cases per week" and because of the volume of cases, now runs a clinic for youngsters with fatty liver. Although the NHANES data only looked at youngsters age 12 and older, Vos said fatty liver disease can develop well before that. "We certainly see 7-, 8- and 9-year-olds with it," she said.

Vos calculated the prevalence of teens with probable liver disease by identifying those youngsters who met the statistical definition of being overweight (in the 85th to 95th percentile for body mass index for their age) or obese (above the 95th percentile for BMI) who also had elevated levels of an enzyme called alanine aminotransferase (ALT) in their blood.

When the liver is damaged or diseased, it releases more ALT into the bloodstream. The method "is not perfect," she said, but it's the most sensitive way to get at the information short of doing an invasive liver biopsy, which wouldn't be ethically feasible.

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Original Source: http://abcnews.go.com/Health/Diet/fatty-liver-teens/story?id=16374773#.T8-C07DUOnI

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CHILDHOOD OBESITY NEWS

Promoting nutrition, Disney to restrict junk-food ads

June 5, 2012, The New York Times

By Brooks Barnes

The Walt Disney Company, in an effort to address concerns about entertainment's role in childhood obesity, announced on June 5 that all products advertised on its child-focused television channels, radio stations and websites must comply with a strict new set of nutritional standards.

The restrictions on ads extend to Saturday-morning cartoons on ABC stations owned by Disney. Under the new rules, products like Capri Sun drinks and Kraft Lunchables meals—both current Disney advertisers—along with a wide range of candy, sugared cereal and fast food, will no longer be acceptable advertising material.

The initiative, which Disney revealed at a Washington news conference with the first lady, Michelle Obama, stretches into other areas. For instance, Disney will reduce the amount of sodium by 25 percent in the 12 million children's meals served annually at its theme parks, and create what it calls fun public service announcements promoting child exercise and healthy eating.

The move follows the announcement of a plan by New York City to ban the sale of large sodas and other sugary drinks amid increasing concern about childhood obesity in America.

Disney said that in adopting the new advertising standards it was largely following recommendations proposed last year by federal regulators. The suggestions were aimed at inducing the food industry to overhaul the way it marketed things like cereal, soda and snacks to children.

Food companies have vociferously fought government regulation on advertising, saying they can take steps on their own. Disney acknowledged it would most likely lose some advertising revenue—it declined to say how much—but said that the benefits outweighed the downside. (Disney Channel does not currently accept traditional ads, although a range of promotions and sponsorships are allowed; other channels like Disney XD are supported by commercials.)

Disney's ad restrictions, which will not take effect until 2015 because of long-term contracts with advertisers, will apply to any programming aimed at children under 12, which includes popular live-action programs as well as cartoons.

Robert A. Iger, Disney's chairman, said he felt strongly that "companies in a position to help with solutions to childhood obesity should do just that," but added: "This is not altruistic. This is about smart business."

Taking steps to combat childhood obesity allows Disney the opportunity to polish its brand as one families can trust—something that drives sales of everything from Pixar DVDs to baby clothes to theme park vacations. In addition, Disney has carefully studied the marketplace and executives say they believe there is increasing consumer demand for more nutritious food.

Iger noted that health food for children had already become "a very, very solid business" for Disney. Since 2006 consumers have purchased about two billion servings of Disney-licensed servings of fruit and vegetables, according to the company.

Margo G. Wootan, director of nutrition policy at the Center for Science in the Public Interest, said Disney's plan put it "far ahead of competitors." At the same time, she cautioned that Disney's guidelines still fell short of what her organization would like to see, particularly for cereal. Disney's new standards require cereal to contain less than 10 grams of sugar a serving, for instance, while Wootan would prefer about six grams.

"This limits the marketing of the worst junk foods, but it won't mean you're only going to see ads for apples, bananas and oranges, either," she said.

As part of its initiative, Disney also introduced what it called Mickey Check in grocery store aisles: Disney-licensed products that meet criteria for limited calories, saturated fat, sodium and sugar can display a logo—Mickey Mouse ears and a check mark—on their packaging. The logos will include the slogan, "Good For You—Fun Too!"

By the end of this year, the White House said in a news release Tuesday, "the Mickey Check will appear on licensed foods products, on qualified recipes on Disney.com and Family.com, and on menus and select products at Disney's Parks and Resorts."

Some elements of Disney's campaign—the Mickey Check, in particular—could revive parental criticism that the company has a way of moving into areas it does not belong, such as approval over what foods children eat.

Moreover, consumers have also come to distrust or ignore healthy eating symbols on packaging because so many food companies have introduced self-serving varieties, said Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.

"Here comes Disney with yet another symbol, and it's too early to say whether this will simply add to the chaos and confusion or actually help steer parents and kids as they shop," Brownell said.

Still, Brownell, who was given an advance briefing of Disney's plans, said the effort was "enormously important." He cautioned that he had not yet deeply examined Disney's nutritional guidelines, but said "they appear quite good."

Disney developed the new nutrition standards with the assistance of two child health and wellness experts: James O. Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center, and Keith T. Ayoob, associate clinical professor of pediatrics at the Albert Einstein College of Medicine in New York.

The company's standards are based on the federal government's Dietary Guidelines for Americans and the Federal Trade Commission's proposed guidelines for food marketing to children. Disney also looked at the Children's Food and Beverage Advertising Initiative, a self-policing effort by food giants like Burger King and Campbell Soup to set their own marketing limits.

Disney's guidelines will be available starting June 5 at www.thewaltdisneycompany.com/citizenship/magic-healthy-living.

Disney's new guidelines are likely to have a ripple effect through the children's entertainment industry. Rivals like Nickelodeon and Cartoon Network will face pressure to follow Disney's lead. Advertisers spend some $950 million annually on television tailored to children under 12, according to industry estimates.

"With this new initiative, Disney is doing what no major media company has ever done before in the U.S.—and what I hope every company will do going forward," Mrs. Obama said in a statement.

Food companies will also feel the effects. Giants like Pepsi and Kellogg in 2007, trying to squelch calls for government regulation, said they would stop advertising products that failed to meet various nutritional standards to children under 12. Food companies then started pushing healthier items and reformulating junk food products.

Disney has sent similar dominoes falling in the past. In 2006, Disney said it would sharply curtail the use of its name and characters with foods high in sugar, salt and fat. Mickey Mouse stopped appearing on boxes of Pop-Tarts, and Buzz Lightyear and his "Toy Story" pals disappeared from McDonald's Happy Meals. Within months, Nickelodeon and Discovery Kids announced similar restrictions; the 2007 effort by food companies to reel in advertising was also linked to Disney's lead.

As part of its Tuesday announcement, Disney will introduce a tightened version of the nutritional standards it first adopted in 2006, including a required additional 10 percent reduction in sugar in yogurt and flavored milk products.

"We need to motivate consumers to make changes, and Disney, because of its sheer size and brand power, can do that better than anybody," Ayoob said.

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Original source: http://www.nytimes.com/2012/06/05/business/media/in-nutrition-initiative-disney-to-restrict-advertising.html?pagewanted=all

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McDonald's shareholders defeat proposal to weigh impact on obesity

May 24, 2012, Advertising Age

By Maureen Morrison

McDonald's Corp. recently voted down a proposal to assess its impact on public health, particularly childhood obesity.

The proposal was brought by consumer watchdog group Corporate Accountability International (CAI). It requested that McDonald's board "issue a report, at reasonable expense and excluding proprietary information, within six months of the 2012 annual meeting, assessing the company's policy responses to growing evidence of linkages between fast food and childhood obesity, diet-related diseases and other impacts on children's health," according to the McDonald's proxy statement, which recommended shareholders vote against the proposal.

"McDonald's can no longer ignore the spiraling costs of its business practices on our children's health and on our health-care system," said Andrew Bremer, a pediatric endocrinologist and professor of pediatrics at Vanderbilt University in a statement, who spoke on behalf of a shareholder, John Harrington.

Dr. Bremer also spoke in support of the resolution at the annual meeting, saying that there's a growing concern about how McDonald's and chains of its ilk are contributing to obesity and diet-related disease. He added that by not changing marketing and the food it offers, shareholders are unreasonably exposed to risk, and the tactics are "doing the brand no favors."

Outgoing CEO Jim Skinner said during the meeting that McDonald's advertises responsibly to kids and families. He said the company is proud of its food and the nutritional changes it's made to the menu, and that McDonald's, which serves 68 million people a day globally, has done more than anyone else in the fast food industry to improve nutrition and offer healthier food options. The proposal was voted down; only 6.4 percent voted in favor.

"While these are global issues that require actions that go well beyond what our company or any other provider of prepared foods can take on its own, we are committed to being part of the effort to address the relevant issues underlying these concerns," said the company in its opposition statement.

"We offer a variety of food choices to our customers; provide nutrition information about our menu items in a variety of accessible ways so that families can make informed decisions; communicate with children in a responsible manner through age appropriate marketing and promotional activities; and encourage children and families to live balanced, active lifestyles."

Aside from the kids' debate, Skinner, who is retiring at the end of June and will be replaced by Don Thompson, also talked about the company's improved sustainability tactics, as well as operational improvements such as store remodels.

Thompson said the chain's top priorities include continuously innovating its menu globally, including more fruits, vegetables and grains, such as it's done with apples in Happy Meals. He also the chain has a continued investment in promoting core menu items in new ads, such as one by DDB that touts fries. He added that the chain aims to open about 1,300 restaurants this year globally, and noted that around the world the chain has already remodeled 45 percent of store interiors.

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Original source: http://adage.com/article/news/mcdonald-s-shareholders-defeat-obesity-impact-proposal/234961/

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