National Collaborative on Childhood Obesity Research Efforts to Advance Childhood Obesity Research: Progress and Next Steps
INTRODUCTION
NCCOR has also carried out a series of activities to further advance childhood obesity research (Table 1).
Table 1Elements of the National Collaborative on Childhood Obesity Research’s Tools and Resources
CHWPs, Childhood Healthy Weight Programs.
THE CATALOGUE OF SURVEILLANCE SYSTEMS: THEN AND NOW
The Catalogue provides access to resources maintained by federal, state, academic, and private-sector institutions that provide data related to health behaviors, outcomes, and determinants of obesity. Each system has a 7-page profile, including an At-a-Glance summary and information on sampling design, key variables, data access and cost, geocoding and other linkage variables, selected publications, and resources. Since its launch in 2011, it has been updated regularly through searches for data sources and surveillance systems, with final selection by an NCCOR expert panel. The Catalogue has increased from 79 systems to 114 systems today.
and School Health Policies and Practices Study) exist. Some of the most accessed systems include the National Health and Nutrition Examination Survey and the National Eating Trends, which have been in the top 5 accessed systems for most of the last 11 years. Overall, usage climbed to 18,000-page visits in 2012, with 4,000–10,000-page visits annually in subsequent years. Over the last decade, the Catalogue has provided a model for how to compile and make available listings of data sets for childhood obesity researchers and has proven helpful for students and researchers seeking resources on childhood obesity.
Table 2Key Characteristics for the Catalogue of Surveillance Systems and Measures Registry
THE MEASURES REGISTRY: THEN AND NOW
Each entry in the Registry is a published validation study that includes information on validity and reliability; protocols on the use of the measure; and settings, geographic areas, and populations for which the measure has been used. Users can search and filter by domain, measure type, age, and context. An expert panel developed a search strategy and inclusion criteria for included studies and literature reviews. Updates are conducted by current NCCOR members. Since its launch in 2011, the number of articles in the Registry has increased from 733 to 1,637, representing >100 discrete measures.
In 2013, the National Academy of Medicine (known then as the Institute of Medicine) published a report describing the dearth of measures for high-risk populations and urged researchers to develop new measures for these populations.
The Registry has expanded over the last decade, including increases in measures for small town/rural populations, Spanish-language measures, and the addition of measures for children aged 0–2 years (Table 2).
a screening measure for assessing dietary fat intake among adolescents, and Rodriguez and colleagues,
a comparison of the TriTrac-R3D accelerometer and self-report activity diary with heart rate monitoring for the assessment of energy expenditure in children. It has been disseminated at scientific conferences, workshops, and social media. Links to the Registry can be found on major websites for the nutrition, public health, and childhood obesity fields as well as those of NCCOR partner agencies, state health agencies, and universities.
THE MEASURES REGISTRY RESOURCE SUITE EXPANDS
Figure 1How to use the Measures Registry Resource Suite.
NCCOR members recognized that children and their families at high risk for obesity are often under-represented in instrument validation studies that measure obesity and related psychosocial, behavioral, and environmental factors. Culturally and linguistically appropriate assessments are important to assess effective interventions and for research. The literature suggests that there are 3 ways to use measures in high-risk populations: (1) apply the existing measure as originally developed, (2) adapt an existing instrument, or (3) develop a new instrument.
However, little guidance exists on when each approach is best. To address this gap, NCCOR created a new resource for the suite: “Measures for children at high risk for obesity: Choosing whether to apply, adapt, or develop a measure.” This resource includes a decision tree and 5 real-world case scenarios that describe the rationale for choosing one of the 3 measurement approaches. The Measures Registry Resource Suite tools were moved to a landing page that had 240,000 page views in 2020 and 179,000 in 2021.
FUTURE DIRECTIONS
and an increase in food insecurity in households with children, strongly reinforcing the need to address this public health challenge. Furthermore, there is a need for more granular data on diet, physical activity, and their environmental influences to better respond to challenges such as the pandemic and to evaluate new programs and policies at the local level.
From 2019 to 2020, NCCOR hosted a series of 3 workshops to discuss the future of measurement to advance childhood obesity research and evaluation. Key challenges identified included how to optimally integrate assessment and modeling of 24-hour behavior patterns; enhance measurement methods in children aged <6 years; and balance the tradeoffs between validity and feasibility in measuring diet, physical activity, sedentary time, and sleep. The most valid measures can be expensive or technically demanding to properly collect and analyze (e.g., accelerometry), have a high respondent burden, and can be impossible for younger children to complete without assistance (e.g., multiple 24-hour diet or physical activity recalls). NCCOR members have been working to address several of these gaps. For example, an NCCOR Birth–24 months Diet Assessment Work Group was formed to identify existing measurement tools, methods, and measurement needs.
Importantly, this work and other NCCOR resources are available in Spanish. Further research is needed on other large and growing immigrant communities in the U.S., including African and Asian persons from multiple countries. Third, each of NCCOR’s 4-member organizations has placed an increased emphasis on data modernization. For example, the Centers for Disease Control and Prevention’s Clinical and Community Data Initiative uses modern technology to link individual-level data across clinical and community sectors, and NIH’s All of Us Research Program engages people and communities who have historically been left out of medical research through multiple data sources.
The Catalogue of Surveillance Systems and Measures Registry Resource Suite are tools worthy of celebration after a decade of use. NCCOR’s website highlights the many ways they have been used by academicians, students, and researchers alike. However, despite the contribution of these tools, more work is needed to optimize the use of appropriate measures and increase access to data for surveillance, evaluation, and public health action, ultimately contributing to a reduced prevalence of childhood obesity in the U.S. and around the world.
ACKNOWLEDGMENTS
The authors would like to acknowledge Joan Benson for abstracting the articles in the Measures Registry, Jean Cyr and Bran Handley for information technology support, and the team at Mathematica who helped to develop the Measures Registry in 2009–2010.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of NIH, the Centers for Disease Control and Prevention, the U.S. Department of Agriculture, or the Robert Wood Johnson Foundation.
This work (Contract Numbers 75N91021F00203, 75D30121F12557, and 80234) and the work of the National Collaborative on Childhood Obesity Research are funded by all 4 partners.
No financial disclosures were reported by the authors of this paper.
CREDIT AUTHOR STATEMENT
Amanda S. Sharfman: Conceptualization, Writing – original draft. David Berrigan: Conceptualization, Writing – review & editing. Deborah A. Galuska: Conceptualization, Writing – review & editing. Laura Kettel Khan: Conceptualization, Writing – review & editing. Ellen W. Stowe: Conceptualization, Writing – review & editing. Jill Reedy: Conceptualization, Writing – review & editing.
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Published online: March 18, 2023
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