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Category: News

UGA receives multiyear grant to address obesity in Georgia

A community garden in Calhoun helps provide fresh produce to local residents. (Submitted photo)

December 5, 2023 by Lauren Baggett in UGA Today

The funds will be used to improve access to healthy foods and physical activity

The University of Georgia has been awarded $804,000 by the Centers for Disease Control and Prevention to improve access to healthy foods and physical activity in Georgia counties with high rates of obesity.

Two decades after being named an epidemic, high rates of obesity persist nationwide. In Georgia, one-third of adults are obese, and therefore, are at higher risk for a number of negative health outcomes – heart disease, stroke, Type 2 diabetes, chronic pain and more.

Eating a healthy diet and getting regular exercise, along with sleep and other health promoting behaviors, is the best way to prevent these chronic diseases, but that’s not always easy to do.

“We can teach people to eat healthy every day, but if those people do not have places to buy affordable fruits, vegetables and whole grains, they will never be able to eat healthy foods that nourish their body. Similarly, we can tell people to exercise and ways they can be active, but if they don’t live in communities where they have safe places to be active, it is not going to happen,” said principal investigator Heather Padilla, an assistant professor of health promotion and behavior in the College of Public Health.

This funding will build on the success of CDC’s High Obesity Program in Georgia, which served Calhoun, Clay, Dooly, Stewart and Taliaferro counties. Together with these communities, UGA research and Extension faculty and staff improved food options for nearly 69,000 people, providing access for 31,041 people to purchase or receive healthier foods in 18 locations and implemented healthy nutrition standards in eight community sites. In addition, all five program communities saw improvements to infrastructure that make it easier to exercise.

Led by an interdisciplinary team of faculty in the UGA College of Public Health, College of Environment and Design, College of Family and Consumer Sciences, College of Agricultural and Environmental Sciences, and UGA Cooperative Extension, this new funding will support UGA Extension and its partners to address obesity in more counties and in new ways.

The project will introduce five new counties – Burke, McDuffie, Sumter, Washington and Rockdale – and will introduce new strategies to create social and physical environments where individuals and families can access healthy foods and places to exercise and play.

“We are expanding from community gardens and retail environments to implementing policies and food service guidelines to ensure healthy foods are available where foods are served and sold, for example, in workplaces or at sports events. We are also working with partners to increase fruit and vegetable voucher incentive programs and produce prescription programs,” said Padilla.

Beginning with Rockdale in the first year, counties will undergo landscape assessments, which will include input from community stakeholders and organizations already working in those communities to align resources and priorities. The new counties will follow the model established in the previous funding cycles, working with county UGA Extension agents who will convene community members from multiple sectors to provide input on community needs and priorities.

“UGA Family and Consumer Sciences Extension agents support people in making healthy decisions and meeting the needs of their families. We bring the latest research-based information and programs to the people in Georgia to improve their lives. This project is a great example of how we are extending the newest science and resources from the university to the citizens of Georgia to address critical community needs,” said Alison Berg, associate professor and Extension nutrition and health specialist in the College of Family and Consumer Sciences.

This new grant will build on previous success and explore opportunities to leverage other Extension and public health programs, resources and relationships, including the UGA SNAP-Ed program.

Making change can be an uphill battle, and having community input and collaboration is essential, noted Padilla and Berg.

“We want to get partners from a variety of domains to the table to try to figure out how we can alter the physical and social environment to at least make it a more level playing field, where people have the opportunity to make the healthy choice,” said Padilla.

Additional project partners include Jung Sun Lee, Georgia Athletic Association Professor in Family and Consumer Sciences in the College of Family and Consumer Sciences, and Donnie Longenecker, a senior lecturer in the College of Environment and Design.

Impact of food nutrition labels on retail pricing and consumer purchasing

By Emily Cabrera
Published on 11/20/23, CAES Newswire
Woman checking yogurt food label
For average consumers who make countless food decisions each day, lengthy Nutrition Facts labels are often challenging to review and understand when making quick decisions. But interpretive front-of-package (FOP) labels may have unintended consequences on purchasing behavior that lead to nutritional disparities.

The Nutrition Facts labels on the back of packaged food help consumers by breaking down the ingredients and nutritional value of the product. That information is supposed to help consumers make informed food choices, but do these labels provide a complete picture of what “healthy” really means? And does the way information is provided on food labels change consumers’ perceptions and purchasing behavior?

To answer these questions, Chen Zhen, a University of Georgia professor in food choice, obesity and health in the Department of Agricultural and Applied Economics is leading a study recently funded by a grant from the U.S. Department of Agriculture National Institute of Food and Agriculture. In partnership with international colleagues, Zhen will observe and compare the influence of nutrition labeling systems used in the U.S. and the European Union (EU) to inform future policy decisions in those countries.

The four-year, $794,000 award will help the researchers better understand how the use of supplementary nutrition information on packaged food labels, particularly front-of-package (FOP) labels, have unintended consequences across the socioeconomic spectrum.

Zhen, faculty in the College of Agricultural and Environmental Sciences (CAES), said his work centers on the economics of nutrition and healthy eating. “There’s been a long-standing interest in the causal effect of providing additional information on food labels to consumers, particularly interpretive labeling that communicates more than just numeric facts,” explained Zhen.

The evolution of Nutrition Facts labels

In 1990, the Nutrition Labeling and Education Act (NLEA) mandated standardized Nutrition Facts labels on most packaged foods. However, for average consumers who make countless food decisions each day, these lengthy labels are often challenging to review and understand when making quick decisions, Zhen explained.

In the decade following the passage of the NLEA, the consumer use of labels declined and the obesity epidemic escalated, prompting the search for supplemental labeling strategies to help consumers use the information in a more comprehensive manner. Zhen said that strong international interest to improve diet quality led to the use of FOP nutrition labels that provide a quick summary of the food’s healthfulness.

Companies began adopting FOP summary labels, which penalize nutrients and nutrition factors that are generally considered to have unfavorable health effects and reward those that are beneficial to health. One such company was NuVal. At its peak, more than 2,000 grocery and retail stores had adopted the NuVal FOP label. By 2013, Zhen said the algorithm used by NuVal had become more rigorous, assigning a numeric score — with one being the least healthy to 100 being the healthiest — to provide a quick snapshot for busy consumers.

How labeling impacts pricing strategies and consumer behavior

“I had taken great interest in what impacts this change might have down the line,” said Zhen. “Using yogurt as a case study, what my colleagues and I saw was a marked reduction in NuVal scores for most yogurts after the algorithm changed — the products essentially became less healthy overnight.”

Interestingly, NuVal closed its doors just three years after the new algorithm was implemented. Zhen suspected that retailers began opting out of using the FOP summary labels in response to some packaged food products receiving lower ratings.

Zhen and his colleagues observed yogurt sales before and after the algorithm was revised, reporting an obvious decline in sales for products that received lower scores and a reactionary price reduction in the lower-scoring products — a tactic Zhen believes was an effort by retailers to compensate for the loss of sales.

“And that strategy worked to a degree,” he said. “When prices declined, even though the products had received lower scores, sales picked up again.”

Zhen wanted to know whether consumers’ purchasing behaviors were the only factors influenced by perceptions of the healthfulness of foods.

Unintended consequences of creating food disparities

“We are keen to believe there are unintended consequences happening here that negatively impact consumers,” he said.

When less healthy foods become less expensive, people are more inclined to purchase them, regardless of their health score, Zhen said, adding that the inverse is true for higher-scoring foods. In their study of yogurt sales, retailers increased prices for healthier products.

“The implication is that people with more money are able to purchase healthier foods, whereas people with less money are more likely to purchase less healthy foods,” he said. “We call this a nutritional disparity, or health gap, that can be seen in tandem with the wealth gap.”

Published in the American Journal of Agricultural Economics, the research earned the Best Article in Food Safety and Nutrition Award from the Agricultural and Applied Economics Association earlier this summer.

International partnership looking for similar trends in Europe

That research served as the preliminary work for the current study, in which the international team will look at a similar labeling system called Nutri-Score being used throughout Europe. The team is collecting data on all packaged food items to see what potential purchasing changes occur across all food types in response to the revised algorithm.

Joining Zhen from Singapore is Eric Finkelstein, a renowned health economist who has performed groundbreaking research on the economic cost of obesity, and Sinne Smed, an expert on food policy issues in the EU from the University of Copenhagen.

At the beginning of 2023, the EU mandated that Nutri-Score revise its algorithm similarly to the updated system NuVal adopted before going out of business.

Scanner and sales data on packaged products will be used to compare what, if any, differences can be seen before and after the implementation of the new algorithm, Zhen said. The team will also be looking for pricing adjustments made by retailers in response to changes in scores and how price fluctuations may affect purchasing behaviors.

Finkelstein and Smed will compare their findings to the U.S. data to learn whether similar trends play out in terms of consumer behaviors and pricing adjustments.

Implications for food labeling legislation

Zhen said the work has huge implications for the near future, as the U.S. House Committee on Appropriations encouraged the exploration of mandatory FOP labels in its agriculture spending bill for fiscal year 2022. In September 2022, the White House announced that the U.S. Food and Drug Administration would research, develop and propose plans to standardize an FOP labeling system for packaged foods to help consumers, particularly those with lower nutrition literacy, quickly and easily identify foods that are part of a healthy eating pattern.

“Our analysis will help address this concern and provide estimates of the net effects of NuVal and Nutri-Score for both more and less advantaged households in an effort to inform policymakers of the likely effects of a mandatory nutrition label,” explained Zhen.

As more EU member countries and food companies voluntarily adopt the Nutri-Score label, understanding the effect of Nutri-Score on consumer demand and retail prices will benefit U.S. exporters who will eventually need to decide whether to affix the Nutri-Score symbol to products exported to the European market, Zhen added.

Emily Cabrera is a writer and public relations coordinator for the College of Agricultural and Environmental Sciences at the University of Georgia.

Noble named fellow of The Obesity Society

Emily Noble, associate professor in the College of Family and Consumer Sciences’ department of nutritional sciences, has been named a fellow of The Obesity Society, the leading international professional society focused on obesity science, treatment and prevention.

The distinction recognizes Noble’s demonstrated record of contributions to the field of obesity research.

“The Obesity Society brings together clinicians, policy makers, educators, and researchers to address the needs of people living with obesity,” Noble said. “My research focuses on understanding the critical role of the brain in regulating body weight by impacting food intake and energy expenditure. The Obesity Society has been highly supportive of my research in the neuroscience of obesity throughout my training and my career. I am really honored to have been selected as a fellow of The Obesity Society.”

Noble arrived at UGA in 2019, having previously served as a research assistant professor at the University of Southern California. Prior to that role, she served as a postdoctoral fellow in neuroscience at USC.

She has published widely in the field and recently was awarded a five-year, $764,295 Career Development Award from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.

As principal investigator of the grant, Noble and her team are investigating melanin concentrating hormone (MCH) and the neural regulation of feeding.

The Noble Lab at UGA seeks to better understand how the brain controls behaviors such as food impulsivity, food motivation, food preference and food overconsumption, as well as individual variation in energy expenditure and physical activity.

The Obesity Society was founded in 1982 and has approximately 2,800 members worldwide. The organization’s mission is to advocate and promote the highest quality in research, clinical care, education and policy development to address the needs of people living with obesity.

“Dr. Noble continues to make signification contributions in the area of obesity research and is committed to advancing our understanding of obesity,” said Connie Rogers, head of the FACS department of nutritional sciences. “We’re proud to see her efforts recognized by The Obesity Society.”

Kindler earns Georgia Clinical & Translational Sciences Alliance KL2 award

Joseph Kindler, an assistant professor in the College of Family and Consumer Sciences, has received a Georgia Clinical and Translational Sciences Alliance KL2 award.

Joseph Kindler, an assistant professor in the College of Family and Consumer Sciences

Joseph Kindler, an assistant professor in the College of Family and Consumer Sciences

The goal of the Georgia CTSA KL2-Mentored Clinical and Translational Research Scholars program is to support and enhance career development for junior faculty from a wide variety of disciplines at Emory University, Morehouse School of Medicine, Georgia Institute of Technology and UGA.

The Georgia CTSA KL2 Core is committed to assisting junior faculty at Georgia CTSA partner institutions to become independent, established and ethical clinical and/or translational research investigators.

“From a research and career development standpoint, representing UGA as its KL2 scholar is a tremendous honor,” Kindler said. “It’s an opportunity for me to continue learning and expanding my collaborative reach and technical expertise in different areas by working with esteemed researchers in a variety of disciplines. It is my hope that the KL2 award will catalyze additional opportunities for scientific discovery in my laboratory, while providing students and trainees with dynamic, hands-on learning experiences.”

Kindler’s research focuses on identifying diet and disease-related threats to lifelong bone health, including diabetes and cystic fibrosis, and particularly the role of gut-derived hormones in bone metabolism. Kindler received his doctorate from FACS in 2017.

He directs the FACS Nutrition and Skeletal Health Lab, which uses state-of-the-art bone imaging methodologies for clinical and translational research studies.

Kindler’s KL2 research project is called “Evaluating the Gut-Bone Axis in Cystic Fibrosis.” The project will analyze the interplay between nutrition, diabetes and bone disease in adults with cystic fibrosis, a complex genetic condition that primarily affects the lungs and digestive system. About 30,000 people in the United States and roughly 70,000 people worldwide have cystic fibrosis, Kindler said.

Dr. Kindler was the recipient of the OI Fall 2021 Resubmission Grant in support of this research Defining the “Gut-Bone Axis” in Youth: A Pilot and Feasibility Study. “I am grateful to the Obesity Initiative for providing funding through their ‘Grant Resubmission’ program,” Kindler said. “The Obesity Initiative-funded project allowed my team to gain important foundational knowledge that guided development of the KL2 research in people with cystic fibrosis.”

The project is a multi-institutional collaboration involving resources and expertise from multiple Georgia CTSA institutions, including UGA and Emory, as well as the University of Pennsylvania and Children’s Hospital of Philadelphia.

“Beyond the lungs, cystic fibrosis impacts many other systems in the body, including the skeletal system,” Kindler said. “People with cystic fibrosis tend to break their bones and develop osteoporosis at a more accelerated rate and they also develop a unique form of diabetes. In cystic fibrosis, diabetes and bone disease are associated with increased morbidity and mortality. This project focuses on a unique mechanism, a biological reason, why diabetes and nutritional issues may be involved in the bone health deficits that are evident in cystic fibrosis.”

Georgia CTSA KL2 Scholars receive salary support to enable them to spend at least 75 percent of their professional time on clinical and/or translational research and scientific training, as well as a technical budget of $25,000 per year for research-related expenses. Support in the program will be provided for up to two years depending on performance.

Kindler will be mentored by Brad Phillips, a professor in the UGA College of Pharmacy and director of the Biomedical and Translational Sciences Institute, the Clinical and Translational Research Unit and UGA principal investigator of the Georgia CTSA.

“It is an honor to be part of Joe’s mentorship team and innovative research,” Phillips said. “He will certainly excel as a KL2 Scholar and will be on a clear path to develop a nationally recognized and funded research program.”

Kindler also will receive mentorship from Andrea Kelly of Children’s Hospital of Philadelphia; Jamie Cooper, Director of UGA’s Obesity Initiative and FACS professor; and Tanicia Daley Jean Pierre of Emory University.

“I am honored to represent UGA as its Georgia CTSA KL2 scholar,” Kindler said. “The environment and support afforded by the Georgia CTSA, UGA and my mentorship team, buoyed by Brad Phillips, is truly exceptional. It’s a very unique partnership we have in place here.”

This article was adapted from a UGA FACS News Story.

Researcher finds link between overweight children and heart complications

Dr. Joe Kindler was quoted in the UGA Today article, “Overweight children are developing heart complications”. Dr. Kindler’s research, Visceral fat and arterial stiffness in youth with healthy weight, obesity, and type 2 diabetes, was originally published in Pediatric Obesity. Dr. Kindler credits the Obesity Initiative for providing support for his research. He recently told us “funding from the OI was critical in this project’s success.

Read News Article

Daily self-weighing shown to prevent holiday weight gain

Researchers at the University of Georgia have shown that a simple intervention – daily self-weighing – can help people avoid holiday weight gain.

Participants in a 14-week UGA study who weighed themselves daily on scales that also provided graphical feedback showing their weight fluctuations managed to maintain or lose weight during and after the holiday season, while a control group gained weight.

Researchers speculate that participants’ constant exposure to weight fluctuations – along with being able to see a target or goal weight line (their baseline weight) – motivated behavioral change that led to weight maintenance, or in the case of overweight subjects, weight loss.

“Maybe they exercise a little bit more the next day (after seeing a weight increase) or they watch what they’re eating more carefully,” said study author Jamie Cooper, an associate professor in the FACS department of foods and nutrition within the UGA College of Family and Consumer Sciences. “The subjects self-select how they’re going to modify their behavior, which can be effective because we know that interventions are not one-size-fits-all.”

After determining their baseline weight prior to the holidays, participants in an intervention group were told to try not to gain weight above that number, but with no additional instructions as to how to accomplish this goal.

Participants in the control group were given no instructions. A total of 111 adults between the ages of 18 and 65 participated in the study.

Michelle vanDellen, an associate professor in the UGA Department of Psychology and second author on the paper, said the findings support discrepancy theories of self-regulation.

“People are really sensitive to discrepancies or differences between their current selves and their standard or goal,” she said. “When they see that discrepancy, it tends to lead to behavioral change. Daily self-weighing ends up doing that for people in a really clear way.”

Daily self-weighing also has been shown to be effective in preventing weight gain in college freshmen in previous research, but researchers wanted to apply it to another historically dangerous time for weight gain.

With the average American reportedly gaining a pound or two a year, overeating during the holiday season has been identified as a likely contributor to small weight gains that add up over time and can lead to obesity.

“Vacations and holidays are probably the two times of year people are most susceptible to weight gain in a very short period of time,” Cooper said. “The holidays can actually have a big impact on someone’s long-term health.”

Cooper said future research may investigate if daily self-weighing alone – without the graphical feedback – is the driving force behind the behavioral changes that led to weight maintenance.

The fact that subjects knew researchers would be accessing their daily weight data also could have contributed to behavioral change, she said.

What seems clear is the intervention is effective, largely because of its simplicity and adaptability.

“It works really well in the context of people’s busy lives,” vanDellen said. “The idea that people might already have all the resources they need is really appealing.”

The paper, “Daily self-weighing to prevent holiday-associated weight gain in adults,” can be viewed at https://onlinelibrary.wiley.com/doi/10.1002/oby.22454

Sepideh Kaviani of the University of Georgia is first author on the paper.

Researchers find brain circuit linked to food impulsivity

This creates the possibility scientists can someday develop therapeutics to address overeating

You’re on a diet, but the aroma of popcorn in the movie theater lobby triggers a seemingly irresistible craving.

Within seconds, you’ve ordered a tub of the stuff and have eaten several handfuls.

Impulsivity, or responding without thinking about the consequences of an action, has been linked to excessive food intake, binge eating, weight gain and obesity, along with several psychiatric disorders including drug addiction and excessive gambling.

A team of researchers that includes a faculty member at the University of Georgia has now identified a specific circuit in the brain that alters food impulsivity, creating the possibility scientists can someday develop therapeutics to address overeating.

The team’s findings were published recently in the journal Nature Communications.

“There’s underlying physiology in your brain that is regulating your capacity to say no to (impulsive eating),” said Emily Noble, an assistant professor in the UGA College of Family and Consumer Sciences who served as lead author on the paper. “In experimental models, you can activate that circuitry and get a specific behavioral response.”

Using a rat model, researchers focused on a subset of brain cells that produce a type of transmitter in the hypothalamus called melanin concentrating hormone (MCH).

While previous research has shown that elevating MCH levels in the brain can increase food intake, this study is the first to show that MCH also plays a role in impulsive behavior, Noble said.

“We found that when we activate the cells in the brain that produce MCH, animals become more impulsive in their behavior around food,” Noble said.

To test impulsivity, researchers trained rats to press a lever to receive a “delicious, high-fat, high-sugar” pellet, Noble said. However, the rat had to wait 20 seconds between lever presses. If the rat pressed the lever too soon, it had to wait an additional 20 seconds.

Researchers then used advanced techniques to activate a specific MCH neural pathway from the hypothalamus to the hippocampus, a part of the brain involved with learning and memory function.

Results indicated MCH doesn’t affect how much the animals liked the food or how hard they were willing to work for the food. Rather, the circuit acted on the animals’ inhibitory control, or their ability to stop themselves from trying to get the food. “Activating this specific pathway of MCH neurons increased impulsive behavior without affecting normal eating for caloric need or motivation to consume delicious food,” Noble said. “Understanding that this circuit, which selectively affects food impulsivity, exists opens the door to the possibility that one day we might be able to develop therapeutics for overeating that help people stick to a diet without reducing normal appetite or making delicious foods less delicious.”

UGA researchers use modeling to help rural communities eat more fruits, veggies

Researchers at the University of Georgia are using a new statistical model to help guide policy around food access in rural communities.

The study authors wanted to know what conditions needed to be right to increase fruit and vegetable consumption in a rural setting.

The question of how to improve access to fruits and vegetables or even whether increased access translates into higher fruit and vegetable consumption has historically been hard to answer, said corresponding author Janani Thapa, an assistant professor of health policy and management at UGA’s College of Public Health.

“If we know anything, we know that changing behavior is complex, and there isn’t a straight-shot solution,” she said.

Convincing people to add more fruits and vegetables into their daily routine is often met with a variety of barriers, ranging from cost to cultural norms.

Though countless interventions and best practices have been developed to address issues around obesity and access to healthier foods, it can be expensive to get a project off the ground.

And with so many variables at play that could spell an effort’s success or failure, how can rural communities know they are using their resources wisely?

To answer this question, Thapa and her team turned to a new computational technique that can simulate a real-world intervention.

The agent-based model was developed to take into account all the details that can determine a person’s likelihood to engage in a certain behavior, including demographic information, the food local environment, and even health beliefs.

Using participant data from a previous study based in a rural Texas community, the researchers used their model to predict whether they could increase fruit and vegetable consumption by decreasing the driving distance to get to the produce source.

It turns out that they could.

“We found that a five-mile decrease could lead to a 25% increase in fruit and vegetable consumption,” said Thapa.

That doesn’t mean a community has to build a whole new grocery store, she added. That produce source could be something simple, like a farm stand.

The study suggests that this type of modeling can be a cost-effective way to evaluate and guide policymaking around diet-related interventions in rural areas, and Georgia is next.

Thapa and collaborators have begun collecting the data to run a similar simulation in rural Georgia, where they hope their findings will guide residents and policymakers in making changes to improve the health of their community.

Co-authors include Nicole Katapodis and Donglan Zhang with the University of Georgia; Phillipe Giabbanelli with Furman University; Yan Li with the New York Academy of Medicine; and Conrad Iyford with Texas Tech University.

The study appeared in the recent issue of Health Equity and is available online here.

– Lauren Baggett

Posted on August 1, 2019.

Study links work burnout and weight gain

A new study from the University of Georgia has found that feeling overworked contributes to a variety of unhealthy behaviors that can cause weight gain.

Results from the study published in the Journal of Health Psychology point to the role work stress can play in our ability to adopt the necessary strategies to maintain a healthy weight.

“We have so many things coming at us every day, and we only have so much energy,” said lead author Heather Padilla, faculty member and researcher in the Workplace Health Group at UGA’s College of Public Health.

Heather Padilla

“When our energy gets used up, we don’t have the energy to make ideal decisions about what we eat.”

When work gets in the way of wellness
Despite the growing presence of workplace-based wellness and weight management programs, over two-thirds of working adults are overweight or obese.

Most worksite programs focus on things like nutrition education, access to healthy foods or access to a gym.

Job demands are rarely, if ever, incorporated into weight loss interventions.

Padilla and her colleagues began to wonder if work stresses might be depleting the mental and physical energy employees needed make changes to their diets or fit in a workout.

So, she decided to look at how workload and burnout impact a person’s nutrition and physical activity choices.

Lacking the energy to make healthy choices
The researchers recruited 1,000 men and women working in full-time jobs to answer questions about their workloads and exhaustion or burnout. They were also asked to report their eating and exercise habits.

The results of their analysis showed that employees with heavier workloads were more likely to emotionally eat, eat without stopping, and reach for fattier foods, and those who were burned out tended to do the same and exercise less.

“Anecdotally, the findings aren’t shocking,” said Padilla, but she said they do point to a greater need to understand how job demands affect issues like obesity.

“We spend so many of our waking hours at work,” she said. “These findings require us to think about how our work affects our health behaviors and self-care.”

Co-authors include Mark Wilson, Robert Vandenberg, Marsha Davis and Malissa Clark.

UGA, Shanghai researchers find evidence of how obesity programs can work long-term

Childhood obesity is now a global epidemic, and researchers worldwide are searching for sustainable interventions that may halt its progress.

Now, a team of researchers from Fudan University in Shanghai, China, and the University of Georgia have shown that one comprehensive obesity intervention, which integrates family and school participation to encourage healthy eating and exercise habits, can reduce rates of obesity long-term.

The researchers assessed changes to the children’s body mass index one, two and three years following the conclusion of the three-year intervention program.

The initial intervention was based in Shanghai where childhood obesity prevalence ranges between 10 and 15 percent, says Donglan Zhang, one of the study’s authors.

“If you look at childhood obesity problems in China’s megacities, it’s comparable to the U.S.,” said Zhang, who studies health policy at UGA’s College of Public Health.

“This is due to economic development and due to a transition in dietary behaviors. There is a Westernization of food and eating behaviors in China’s big cities.”

The intervention sought to introduce healthy eating behaviors at an early age when habits begin to form.

Like many obesity programs, the intervention began at school. It introduced nutrition education into the classroom, revamped the lunchroom options and established regular exercise for students. The innovation of the program lies with what happened once the students returned home. Acknowledging the role of the home environment, the intervention also trained the students’ parents to support healthy eating habits and exercise outside of school.

The comprehensive nature of the intervention is unique, says Zhang.

“This model in particular recognizes that reducing the obesity rate is not just the responsibility of one institution or environment,” she said. “It should be a joint effort from schools, from families, from communities all together because kids have a lot of [food] environments they’re exposed to.”

In all, almost 1,000 first-grade boys and girls participated in the program. At the end of three years, the program succeeded in helping overweight or obese children lose weight, and it helped children with a healthy weight maintain it.

This is where the story ends for most childhood obesity intervention studies, says Janani Thapa, also with UGA’s College of Public Health. Thapa specializes in childhood obesity interventions and policy.

“What we see in most interventions is a checkmark pattern. The weight tends to decline, and then after the project period ends, we’ll see the weight go back up,” she said.

But that’s not what happened in the three years following the Shanghai intervention.

At each follow-up, the students who participated in the program continued to maintain a healthy BMI compared with students who were not part of the intervention. The effect was even more prominent among girls.

“The current study suggests that it probably requires a minimum of two years to demonstrate a lasting effect,” said Thapa.

Though this work describes the success of an intervention in one setting, the authors say the evidence is strong enough to suggest it could be translated to other settings like the U.S.

“There is the nutrition intervention, there is the physical activity intervention, there are few that have done both,” Thapa pointed out. “The next step would be to try to do the FIS model here in the U.S., and maybe others are trying to do it across the world.”

The study, “A cohort study assessing the sustainable long-term effectiveness of a childhood-obesity intervention in China,” published in the latest International Journal of Epidemiology. It is available online here.

Co-authors include Zhijuan Cao, Jing Hua and Shumei Wang.

– Lauren Baggett

Posted on November 26, 2018.

Toys motivate children to eat a healthier diet

Most children in the U.S. do not eat enough fruits and vegetables, some eating less than one serving of fruits and vegetables a day, according to the Centers for Disease Control and Prevention. Though there are multiple federal-level policies in place to ensure healthy options in school lunchrooms, these measures can’t guarantee that kids will choose the fruit or vegetable option, let alone eat it.

Now, new research from the University of Georgia suggests that fun can motivate kids to try new foods at lunchtime and ultimately eat more fruits and vegetables.

“There are many ways fun can be brought into the lunchroom,” said Janani Rajbhandari-Thapa, assistant professor of health policy and management at UGA’s College of Public Health and lead author on the study. “The lunchroom is not always thought of as a place where fun can be incorporated.”

Food marketers have been harnessing the power of play and fun for decades. Anyone who has seen an advertisement for kids’ foods—from Happy Meals to cereal—is familiar with how these companies use kid-friendly images and toys to make their products more appealing to children.

Public health interventions are beginning to adopt these tactics by associating healthy foods with kid-friendly images and objects, said Thapa.

Thapa’s study used stickers and small, inexpensive toys to incentivize kids at two low-income elementary schools to choose and eat more servings of fruits and vegetables. Over two weeks, Thapa and her team offered a token to students who selected and ate a fruit or vegetable serving that could be redeemed for a toy.

The students ate 2 1/2 times more servings of fruits and vegetables when the stickers and toys were introduced than they did before the study began.

The important question was whether the students would continue to select and eat more fruits and vegetables after the stickers went away. Thapa designed her intervention so that kids would try new foods and hopefully develop a taste for them.

“After the intervention, they went back to their original lunchroom environment, and we still saw an effect,” said Thapa, suggesting that the students formed a new eating habit that would stay with them for the long term.

Helping kids make the healthier choice in the split second it takes to grab an apple or a cookie is the philosophy of the smarter lunchroom approach, which uses simple, low-cost changes to the lunchroom that will help children make healthier choices.

It’s important to know how effective these policies are, said Thapa, especially in areas where the school is potentially the only place where students can access fresh, healthy foods. The lunchroom plays a vital, day-to-day role in students’ eating habits, and she would like to see more schools incorporate healthy eating interventions into the lunchrooms.

“Having this fun type of atmosphere and learning environment can promote healthy consumption as well as teach them at the same time,” said Thapa.

Thapa is one of eighteen researchers who has received grants from the Cornell Center for Behavioral Economics in Child Nutrition Programs to evaluate Smarter Lunchroom Movements nudge techniques, and she plans to do more studies.

The study, “Nudges to Increase Fruits and Vegetable Consumption: Results from a Field Experiment” appeared in the Journal of Child Nutrition and Management. It is available online here.

Conrad P. Lyford was a co-author on this study.

– Lauren Baggett

Posted on May 29, 2018.

Georgia Study Shows Training Prompts School Cafeteria Staff to Promote Healthier Foods School Lunchrooms

Almost one in three 10-year-olds in Georgia is overweight or obese. With childhood obesity on the rise across the U.S., states and other stakeholders have been exploring policies that may help curb its growth.

A recent study from the University of Georgia has shown that training school cafeteria staff in smarter lunchrooms concepts is a promising first step.

“Federal-level policy makes sure the health foods are served in the school lunchroom, but being served doesn’t translate into being consumed,” said Dr. Janani Thapa, assistant professor of health policy and management at University of Georgia College of Public Health and lead author on the study.

“That’s where the smarter lunchroom idea kicks in, asking can we do basic, low-cost steps that translate nutrition being served into nutrition being consumed.”

Children’s Healthcare of Atlanta’s Strong4Life School Nutrition Program teaches school nutrition managers and staff members how to make changes in the lunchroom that will “nudge” children to make healthier choices. Based partly on marketing principles, the approach aims to make the healthier choices easier to make.

“The steps are as simple as changing where plain milk versus chocolate milk is placed in the lunchroom affects how kids make their choices,” said Dr. Thapa.

Displaying plain milk in front of the other milks in the cooler, for example, has been found to increase the consumption of plain milk. Smarter lunchrooms aim to promote healthy eating one small change at a time, adding up to major reductions in sugar and sodium consumption.

Strong4Life developed a training kit based on smarter lunchroom strategies and launched in-person training for over 800 Georgia public school nutrition managers and staff in 2015. The program packages proven smarter lunchroom techniques into five focus areas that managers can apply easily at no or low cost.

Dr. Thapa’s study evaluated how well the training worked in educating lunchroom staff as well as empowering them to make changes. She found that the majority staff members retained key smarter lunchroom principles three months after receiving training, and most felt capable of applying the techniques in their schools.

Following the training, over 325 staff reported already making significant changes to their lunchroom environment. One fifth had moved plain milk in front of flavored milks, juice and sports drinks in drink coolers, while 12 percent of cafeterias were using signs or stickers to identify healthy choices, and up to 14 percent of lunchrooms were offering some form of price incentives for heathy foods.

It’s important to know how effective these policies are, says Dr. Thapa, especially in areas where the school is potentially the only place where students can access fresh, healthy foods. Yet, the availability of healthy foods is moot if kids aren’t eating it.

“Training school lunchroom staff is just one step in a larger effort to make our school lunchrooms and health eating attractive to kids,” she said

Georgia Obesity Initiatives

Adult obesity rate in the nation according to a recent report by The State of Obesity project. The University of Georgia College of Public Health is actively engaged in research and outreach aimed at combating the obesity epidemic, particularly in low-income, rural, and minority communities, where the burden is the greatest.

Empowering Rural Communities to Reduce Obesity

Calhoun and Taliaferro are two rural counties in Georgia that, like most rural counties, experience high rates of poverty, chronic disease and obesity. In fact, around half of the people living in Calhoun and Taliaferro counties are obese.

For the past year, UGA’s College of Public Health, Cooperative Extension, and College of Family and Consumer Science been working with community leaders and stakeholders to boost obesity prevention efforts in these counties through the Healthier Together project.

The effort is funded by a two-year, $1.25 million grant from the Centers for Disease Control and Prevention. Dr. Marsha Davis, associate dean for outreach at the College of Public Health, is the project’s principal investigator and Dr. Courtney Still, a postdoctoral research associate in the College, serves as Healthier Together’s program coordinator.

UGA Extension staff in both counties gathered interested community members to form coalitions to create strategies to reduce and prevent obesity in their communities through education, promotion, and policy and environmental change. These coalitions then developed action plans for their communities, which included projects that would not only increase healthy eating and physical activity in the short term, but would also include environmental and policy changes that support health in the long term.

When the Healthier Together project began, the only place to buy food in Calhoun county was a convenience store. In July, the county installed its first community garden. Taliaferro held its first Bike Rodeo event, and the local school now has raised garden beds. In November, the coalitions met with a representative from Fresh Stop Markets, a CSA-type program designed to connect local farmers with communities lacking access to fresh produce. Future projects will include a visit from an expert on building pedestrian-friendly infrastructures and a lesson on smarter lunchrooms.

Helping Kids Make Healthier Food Choices

Dr. Janani Thapa, assistant professor of health policy and management, is working to help kids access, and eat, more healthy foods. Her research examines how policies and programs promote fruit and vegetable consumption among school-age children.

In an effort to combat childhood obesity and ensure access to healthy foods, new National School Lunch Program guidelines require that school lunches include more fruit, vegetables, and whole grains, while limiting sugar and sodium. However, increasing the availability of healthy foods is moot if kids aren’t eating it.

“Federal-level policy makes sure the healthy foods are served in the school lunchroom, but being served doesn’t translate into being consumed,” said Dr. Thapa, so states and other institutions are exploring creative approaches to encourage more kids to choose and eat healthy foods.

Dr. Thapa is one of eighteen researchers who has received grants from the Cornell Center for Behavioral Economics in Child Nutrition Programs to evaluate the ‘nudge’ techniques from Smarter Lunchroom Movement. Her current project compares the success of using table talkers to promote fruit and vegetable (F&V) consumption at elementary and middle schools in two adjacent Georgia counties. Table talkers, displayed on lunch tables, are designed to associate F&V with fun activities, such as children’s literature, science, math and sports. Findings for this study will be published soon.

Evaluating Childhood Obesity Policy in Georgia

A team of researchers from the College of Public Health has partnered with the Georgia Department of Public Health to evaluate the implementation and impacts of Georgia’s policy to prevent childhood obesity – the Georgia Student Health and Physical Education (SHAPE) initiative.

Launched in 2012 by Georgia Governor Nathan Deal, Georgia SHAPE is a statewide, multi-agency and multi-dimensional initiative that brings together governmental, philanthropic, academic and business communities to address childhood (0 – 18) obesity in Georgia.

The SHAPE policy evaluation project, now approaching year two, is funded by a three-year, $1.5 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health. Dr. Phaedra Corso, UGA Foundation Professor of Human Health and director of the UGA Economic Evaluation Research Group, Dr. Marsha Davis, associate dean for outreach and professor of health promotion and behavior, and Dr. Janani Thapa, assistant professor of health policy and management, are leading the evaluation.

The evaluation aims to assess parental awareness, attitudes, and activities associated with the SHAPE policy; school implementation and costs of the SHAPE policy; and what variables impact school implementation of the SHAPE policy and how that implementation impacts school-level obesity and fitness levels.Secure Tabs

Currently, the research team is visiting elementary schools across the state to interview principals and physical education teachers about the SHAPE policy. The team will visit a total of 100 elementary schools in the state before the end of 2018. Additionally, a random-digit-dial telephone survey of approximately 1,000 parents throughout the state of Georgia is set to begin in the coming weeks. Analysis of secondary data is also underway to look at the impacts of policy implementation in schools.

Ultimately, the results of these analyses will provide information to policymakers at the state, public-private partners supporting implementation, and other states interested in implementation of a similar policy initiative to combat childhood obesity.

Childhood obesity: UGA experts are on the front line

In the U.S., 17 percent of children are obese with certain groups more affected than others. National Childhood Obesity Awareness Month in September is designed to provide opportunities for learning about how to battle this serious health concern.

One of the University of Georgia’s primary research emphases is on improving human health. UGA has assembled faculty research teams that directly address child obesity.

Here are six UGA faculty members with unique expertise in the field ready to discuss child obesity with the media.

Caree Cotwright
Assistant Professor
Department of Foods and Nutrition
College of Family and Consumer Sciences
cjcot@uga.edu
706-542-3073

The overall goal of Cotwright’s work is to create healthy early care and education environments to prevent obesity in our youngest children, ages 0-5, while working to decrease health disparities among low-income and minority populations.

Cotwright’s research focuses on promoting nutrition and physical activity best practices and policies in the early care and education setting. The aim of her work is to create training and interventions for young children, their parents, child care providers and child care food service staff to increase healthy eating, wellness education and physical activity in the ECE setting; assist ECE settings with creating wellness policies and plans of action to sustain changes long term; and using innovative approaches such as entertainment education and mobile fruit and vegetable markets to engage families and child care providers in healthy living.

On what the nation should do: “What we need to do as a nation to battle childhood obesity is to start early in teaching healthy habits to children. Starting with children ages 0-5 is the best way to prevent childhood obesity and build a foundation for healthy habits. We are making great strides on tackling this problem and we need to continue building in daily activities that make healthy choices normal, easy, desirable and fun for children.  As we teach children, adults become role models for healthy behavior.  We should also strive to create and sustain partnerships with families, schools, child care programs and health care providers to create policies, systems and environments that support the development of lifelong health habits.  For example, I train child care providers on how to implement policies such as making water available for self-serve in the classroom, eliminating sugar-sweetened beverages, and not allowing children to sit for more than 15 minutes at a time. Small changes can make a difference in preventing weight gain and promoting healthy habits. We all have role to play in promoting health to sustain quality of life for future generations.  If everyone does their part we will become a healthier nation.”

Phaedra Corso
UGA Foundation Professor of Human Health
Director of the Economic Evaluation Research Group
College of Public Health
pcorso@uga.edu
706-713-2708

Corso is known both nationally and internationally for her research in economic evaluation and economic impact assessment, primarily in the areas of child maltreatment, substance use prevention and childhood obesity.  She is one of a number faculty at the College of Public Health working with the Georgia Department of Public Health to evaluate the Georgia Student Health and Physical Education policy, a statewide comprehensive policy adopted in 2009 that combines physical activity requirements, assessment and support for all public elementary schools.

On obesity in Georgia: “The prevalence of being obese or overweight has been on the rise in the United States over the last four decades, reaching 30 percent in the state of Georgia. Childhood obesity is one of the biggest concerns in this epidemic, which is associated with a variety of poor health outcomes, lost productivity and staggering health care costs.”

Leann Birch
William P. “Bill” Flatt Childhood Obesity Professor
Department of Foods and Nutrition
College of Family and Consumer Sciences
llb15@uga.edu
706-542-2899

As a developmental psychologist, Birch’s research has focused on individual and contextual factors that influence the developing controls of food intake and obesity risk among infants, children and adolescents. Early research from Birch’s laboratory on factors affecting the developing controls of food intake, including food preferences and responsiveness to portion size and energy density, have contributed to the evidence base on behavioral factors implicated in the development of childhood obesity. These findings laid the groundwork for exploring individual, familial and contextual factors that shape the development of differences in eating behavior and obesity. Author of over 200 publications, Birch is internationally recognized for her research.

On early obesity: “Obesity begins early. About 25 percent of preschool children are already overweight. In addition, because most obesity treatment is not successful, research is needed to develop and evaluate prevention strategies to reduce risk of childhood obesity. Potentially modifiable early risk factors for obesity include excessive weight gain and short sleep duration in infancy. The research we are conducting has shown that providing guidance on responsive parenting and feeding to new mothers can prevent rapid growth in infancy and promote longer infant sleep duration, reducing overweight at 1 year.”

Michael Schmidt
Associate Professor
Department of Kinesiology
College of Education
schmidtm@uga.edu
706-542-6577

As a physical activity epidemiologist, Schmidt’s research broadly focuses on examining associations between physical activity and human health and well-being from a public health perspective. More specifically, much of his research pertains to the following three concentration areas: the prevention and health consequences of obesity, improving methods to measure physical activity in diverse populations, and the effects of physical activity during pregnancy on maternal and child health.

Schmidt was the lead author on a recent study from a group of international researchers that identified a potentially effective tool to reduce the long-term health risks of childhood obesity: aerobic exercise.

The researchers found that higher aerobic fitness in childhood, independent of abdominal fat, reduced the risk of developing metabolic syndrome in early adulthood by 36 percent compared to those with lower childhood fitness levels.

“While a number of studies have found that higher levels of aerobic fitness can substantially reduce the cardiovascular disease risks associated with adult obesity, few studies have looked to see whether this might also be true regarding childhood obesity,” Schmidt said.

More news about the study: news.uga.edu/releases/article/childhood-fitness-obesity-0516/

Marsha Davis
Associate Dean for Outreach and Engagement
Professor
Department of Health Promotion and Behavior
College of Public Health
davism@uga.edu
706-542-4369

Davis has worked on several landmark community- and school-based interventions nationally. She is actively involved with the Georgia Student Health and Physical Education (SHAPE) policy. Davis has been instrumental in the formation and work of community collaboratives for childhood obesity prevention in Georgia. She is currently leading a childhood obesity prevention project for elementary school children in rural Georgia. She is also a co-leader on the national Policy, Systems, and Environment, Nutrition and Obesity Prevention Center for Excellence.

On obesity in Georgia: “Limited progress has been made in reducing childhood obesity rates. Obesity is a complex issue. The behaviors of individuals and families are shaped and supported by the environments in which they live; the reciprocal is also true. Solutions to the obesity epidemic must come from multiple sources, involve multiple levels and sectors in the communities (business, education, nonprofits, government, county and city officials), and take into account the synergy of multiple strategies. In  the last year, we have seen a decline in childhood obesity for grades 1-12 in certain cities, counties and states. The places that are taking a multi-sector and comprehensive policy, systems and environmental approach are the ones making progress.”

Janani Thapa
Assistant Professor of Health Policy and Management
College of Public Health
jrthapa@uga.edu
706-713-2700

Thapa develops, implements and evaluates field experiments on innovative strategies to promote healthy food choices. Her area of interest and expertise is obesity prevention. She also works on obesity policy and policy evaluation.

On obesity impacts: “Research has found that children who are obese as a child have higher probability of becoming an obese adult. Obesity has tolls both at the individual and societal level. At the individual level it is a risk factor for several chronic diseases including cancer. My own research has found that the awareness on obesity as a risk factor for cancer is very low compared to other risk factors such as smoking. At the societal level our national health care spending is rising rapidly and obesity plays a role on this. Moreover, I feel heavy hearted to see obese children because as a child they are unable to decide for themselves and yet are facing the consequences of obesity. Childhood is the best time to develop healthy habits for life and we as a society must address childhood obesity as an issue and play our part in addressing it.”