Posts Tagged: obesity

Food insecurity and childhood obesity: Is there a connection?

A well-nourished population requires that all members of society have access to sufficient amounts of nutritious food. Unfortunately, food insecurity continues to be a staggering problem throughout the world with negative consequences in terms of health and well-being. 

In the United States, millions of households, an estimated 1 in 8 Americans, lack access to enough food. Children growing up in food insecure households face many challenges, such as behavioral problems, lower academic achievement, disrupted social interactions and poor health. The prevailing belief is that children living in a food insecure environment are at greater risk of undernutrition, not obesity. Although this may be true in some cases, food insecurity and childhood obesity also coexist. 

Because childhood food insecurity may increase obesity risk later in life, it is important to better understand the relationship between food insecurity and children's obesity, and how it varies by demographic characteristics in the United States.

A recent study published in the September 2019 issue of The Journal of Nutrition assessed the relationship between household food insecurity and child adiposity-related outcomes. This included variables such as body mass index, waist circumference and diet outcomes. The study, conducted by Lauren Au, a researcher at UC Agriculture and Natural Resources' Nutrition Policy Institute, and colleagues examined associations by age, sex, and race/ethnicity. Data collected in 2013-2015 from 5,138 U.S. schoolchildren ages 4-15 years old from 130 communities in the cross-sectional Healthy Communities Study were analyzed.

Household food insecurity was self-reported using a two-item screening instrument and dietary intake was assessed using a food frequency questionnaire. Information on dietary behaviors, physical activity and demographics was  collected. To assess adiposity, children's weight, height and waist circumference were measured.

Study results support an association between food-insecure households and measures of adiposity. Children from food-insecure households had high body mass index, waist circumference, greater odds of being classified as overweight or obese, consumed more sugar from sugar-sweetened beverages, and less frequently ate breakfast and dinner with family compared to children from food-secure households. When examined by age groups, significant relationships were observed only for older children, however, results did not differ according to sex or race/ethnicity.

These results suggest that household food insecurity is associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children. Clearly, further research is needed to better understand the complexities of food insecurity, childhood obesity, and future health outcomes.

Read the full open access article.

This research was supported by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Children are getting healthier, but the obesity crisis is not over

Real progress has been made in tackling the epidemic of childhood obesity since the first California Childhood Obesity Conference was held 20 years ago, but there is more work to be done.

“Collectively, we have come so far,” UC Nutrition Policy Institute Director Lorrene Ritchie told an audience of 1,025 public health, nutrition education, research, and other professionals at the event in Anaheim in July 2019. NPI was one of six conference hosts.

The vice president of UC Agriculture and Natural Resources, Glenda Humiston, pledged the organization's commitment to community health and wellbeing at the Childhood Obesity Conference. UC ANR is the umbrella organization of the Nutrition Policy Institute, UC CalFresh Healthy Living, UC Cooperative Extension, 4-H Youth Development, the UC Master Gardener Program and the California Naturalist Program, among others.

“Going forward, solutions to the obesity epidemic are multidisciplinary,” Humiston said. “NPI does world class work in conducting research to influence nutrition policy. We need to harness 4-H. Master Gardeners are increasingly focusing on edible gardens. CalNat is getting people out into nature. We are finding synergies in community wellness.”

Humiston has dedicated UC ANR resources to finding and implementing solutions to the obesity crisis.

“I'm looking forward to working with all of you – public and private organizations – to design a way to move forward,” she said.

The opening keynote presentation at the conference featured Patricia Crawford, NPI's Senior Director of Research emeritus, a pioneer in addressing the growing problem of childhood obesity during her long career. Beginning in the 1970s, she recognized that childhood obesity was on the rise and launched several studies to search for the causes and potential solutions.

In one study, Crawford followed a group of 9-year-old African American girls over a period of 10 years to determine why these youth were growing up heavier than other adolescents.

“Finally, we began to get some answers,” Crawford said. “We learned obesity wasn't the children's fault. They were living in environments that made the unhealthy choice cheaper and easier to find. It's so unfair for people who have fewer resources. Health disparities has to be the No. 1 thing we are working on to address chronic disease rates in this country.”

“The solution to obesity is prevention. It's cheaper and more effective than treatment,” Crawford continued. “Healthy food is a taste that is easy to acquire if it is not preempted by junk food.”

Crawford said she honed in on the best strategies for prevention by actively listening to people struggling to make healthy choices 

“There is a chasm between research and community,” Crawford said. “We have to get people together from the research level and the policy level with folks on the ground. We need to learn from people.”

Joining forces to promote child health and wellness

According to current statistics, approximately 40 percent of school-age children in the U.S. are overweight or obese. This statistic is reflected in rising rates of diabetes, pre-diabetes, and heart disease risk factors. Nearly one-quarter of all children are pre-diabetic or diabetic at the time when they leave high school, a figure that has increased dramatically in the last decade. Dental problems, the other very common health problem of youth, carry the potential for current and future pain, infection, and tooth loss. Although low-income children and children of color are at particular risk for both conditions, risk is unacceptably high for all children.

It is important to note that these all-too-common conditions share the same critical risk factor: consumption of sugary foods and beverages. Unknown to many, over half of the added sugar consumed by children is ingested in liquid form—soda, fruit drinks, sports drinks, energy drinks, and other pre-sweetened beverages including iced teas and others. For teenagers sugar-sweetened beverages are the single largest source of calories in their daily diet. Further, research has demonstrated that liquid sugar is more highly related to obesity than added sugar coming in solid form. 

To improve the medical and dental health of our children we need to help children and families find ways to reduce their consumption of sugar-sweetened beverages.

Fortunately research is being conducted to find effective ways to reduce children's sweetened beverage consumption. 

• Reduce provision of sweetened beverages in the school, after school and childcare settings. UC ANR's Nutrition Policy Institute (NPI) has documented dramatic reductions in sugary beverage consumption after the enactment of state restrictions on the sale of highly sugared beverages in California schools and childcare. While much has been accomplished, more can be done to see that these kinds of restrictions are fully maintained.
• Offering children easy access to water stations and other free tap water sources in childcare settings, schools and recreational facilities provides a healthful alternative to sugary beverages.
• Encourage strong nutrition education programs for children. UC Cooperative Extension's EFNEP and statewide SNAP-Ed programs have been leading efforts to educate children on the value of a healthy diet including the risk of consuming too many sugary beverages.
• Similarly, educating families on healthy eating and on the benefits of reducing sugar-sweetened beverage consumption can support and reinforce the messages to children in the school-based programs.

A consistent message on sugary beverages delivered to families by dental and medical health practitioners, in tandem with other educational and community efforts, can substantially benefit children's health. As respected community members, dental and medical health practitioners are in a position to deliver consistent messages to families and also to work with community agencies and groups, including UC ANR and its affiliates, to initiate and support efforts to reduce children's and families' sugary beverage consumption. Our children deserve a healthy start.

For more information, see:

• Nutrition Policy Institute (http://npi.ucanr.edu)
• National Drinking Water Alliance (http://www.drinkingwateralliance.org/about)
• Dooley D, Moultrie N, Sites E, Crawford P. Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals. Journal of Public Health Dentistry, 16 June 2017. DOI:10.1111/jphd.12229.

UC's Pat Crawford weighs in on childhood obesity

Today marks the start of the 9th Biennial Childhood Obesity Conference. Since it's founding 18 years ago by UC ANR Specialist Pat Crawford, it has grown from a small gathering of California researchers, educators, and health care professionals to the nation's largest gathering on the topic of pediatric obesity/overweight.

So today seems the perfect time to revisit a 2015 conversation with Rose Hayden-Smith, UC's Food Observer, and Crawford, now the Senior Director of Research at UC ANR's Nutrition Policy Institute. As Pat stated in her interview—

“Not changing is risky. The United States – along with Mexico – has the highest obesity rates in the industrialized world. With these extraordinarily high obesity rates, we are on a path toward ever-rising chronic disease rates including not just diabetes, but also heart disease and some cancers, increasing health care costs and reducing productivity.

Even more alarming, is a little known fact that 23 percent of the adolescents in this country currently have pre-diabetes or diabetes as measured by actual blood tests in our largest national study of health (NHANES). Something is seriously wrong in a society such as ours where so many children are growing up with such a high risk of preventable disease.”

You can read the complete interview at the UC Food Observer. You'll also find a recent story about the 45 youth advocates from organizations around California joining this year's conference to bring the voices of youth to this vital conversation.

Does sleep affect child obesity?

One in five Mexican-American children is obese, according to national statistics. While scientists agree that diet and exercise play a role in obesity, studies also suggest that children who don't get enough sleep may also be at increased risk for obesity. Does this mean that children who don't get enough sleep are more likely to become obese due to poor eating habits and being less physically active?

The National Institutes of Health has awarded $895,620 to Suzanna Martinez, Ph.D., assistant researcher for UC Nutrition Policy Institute (NPI) in the UC Division of Agriculture and Natural Resources, to try to answer that question. This will be the first pediatric study to examine health behaviors that link sleep to obesity in Mexican-American children.

Studies have shown that adults who are short on sleep may experience a change in metabolism and hormones, causing the person to eat more and to be more sedentary the following day.

To explore how sleep affects child obesity, Martinez will examine social and cultural factors that may impact Mexican-American children's sleep and, in turn, how sleep affects their diet and physical activity.

Martinez hopes to provide guidance for which behaviors to target to prevent obesity.

“Some researchers just focus on diet, some researchers just focus on physical activity, while other researchers say it's all about the environment so we have to improve the environment in terms of food environment and opportunities to be active,” Martinez said. “There's very little research that tries to target all three aspects of health behavior – sleep, diet and physical activity – because there are so many factors to consider. We have to know which will make the biggest impact on obesity prevention. Is it sleep, diet or physical activity or a combination of all three?” Currently, programs are heavily focused on diet and/or physical activity.

Social and cultural factors may affect sleep

Martinez is essentially combining three different studies into one to evaluate the context of sleep and how it impacts obesity. The five-year study will occur in two phases.

She'll begin by looking at the culture, environment and socioeconomic status of the Mexican American families to see which factors may relate to sleep duration.

For example, Martinez said, “If less acculturated Mexican-American parents have stricter or earlier bedtimes for their children, is that protective for getting optimal sleep, less protective or does it even matter?”

Living in crowded housing or in neighborhoods with high crime, homelessness and drugs can impact sleep for urban Latino families, Martinez learned from interviews with Latino parents for a study she published in 2015. 

Sleep and physical activity and diet

The second phase of the study will involve evaluating the sleep duration of 40 Mexican American kids, ages 8 to 10, in the San Francisco Bay Area over two summers.

To record their sleep and physical activity, the participating kids will wear accelerometers during the day and while they sleep. The small, pedometer-like devices are worn on a belt around the hip.

For the first week of the three-week study, the children will be asked to get their normal sleep. During the second week, half of the children will be asked to sleep for less than 8 hours and the other half will be asked to sleep at least 10 hours. The third week, the two groups will switch over to the other sleep schedule.

Their diets will be measured using 24-hour dietary recalls. On Friday and Saturday, children will be asked what he or she ate the day before (Thursday and Friday). Starting with breakfast, the children will report what they ate and drank for meals and any snacks.

Martinez will evaluate whether healthy sleep or restricted sleep the previous night impacts the children's diet and physical activity the next day.

“With the crossover study, we will be able to see how kids compare when they get their usual sleep, healthy sleep or not  enough sleep  and how that impacts how much they eat and how much they move the next day,” she said.

No U.S. sleep guidelines

To maintain a healthy weight, U.S. Office of Disease Prevention and Health Promotion recommends that children get at least 30 minutes of physical activity daily and the Dietary Guidelines for America recommend that children eat a nutrient-dense and calorically balanced diet. The government office currently has no national sleep guidelines for Americans.

In a 2014 study, Martinez found that 82 percent of Mexican-American children ages 8 to 10 obtained less than the 10 to 11 hours of sleep the National Sleep Foundation recommended before 2015. Under the network of sleep researchers' new sleep recommendation of 9 to 11 hours for this age group, 20 percent of children received less than adequate sleep.

“There needs to be more research on sleep duration before we can say, ‘Sleeping this amount of time will help prevent obesity,'” Martinez said.

If her hunch is correct, promoting optimal sleep (at least 10 hours for school-age children) may be an effective way to reduce childhood obesity, and understanding the role of culture in obesity among Mexican-American children who have some of the highest rates obesity will be a key to designing effective solutions.

Research has shown that obesity contributes to numerous lifelong health problems, including heart disease, stroke, diabetes and high blood pressure. One in four overweight children become obese as an adult, and diseases like diabetes are presenting earlier than adulthood. National data show that 14 percent of white children are classified as obese, while 21 percent of Latino children are obese. With Latino children at increased risk, Martinez is committed to finding the causes of this disparity and to develop effective ways to reduce obesity among Mexican-American children.

This child obesity study is funded by a K01 Career Development Award from the National Institutes of Health National Heart, Lung and Blood Institute. Martinez has also been accepted into the K Scholars Program at UC San Francisco, which will provide her with peer support and mentorship to conduct the study.

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