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Address correspondence to: Amanda S. Sharfman, MS, MPH, Social Marketing and Communications, U.S. Programs, FHI 360, 1825 Connecticut Avenue, Washington DC 20009.
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GeorgiaOak Ridge Institute for Science and Education (ORISE) Research Participation Program, Oak Ridge, Tennessee
The National Collaborative on Childhood Obesity Research (NCCOR), a public–private partnership of 4 leading childhood obesity research funders—the Centers for Disease Control and Prevention, NIH, Robert Wood Johnson Foundation, and U.S. Department of Agriculture—was formed in 2008 with a goal of accelerating progress to reduce childhood obesity by improving measurement and increasing access to childhood obesity data.
NCCOR has a shared ownership model. Each organization contributes funding, which supports projects as well as coordination by a nonprofit human development organization, FHI 360.
A decade ago, considerably less was known about the macrolevel determinants of childhood obesity, and there was limited knowledge of available data sets and measures suitable for childhood obesity research.
In response to this challenge, NCCOR introduced 2 landmark tools: (1) the Catalogue of Surveillance Systems, 1-stop access to publicly available data sets, and (2) the Measures Registry, a searchable database of diet and physical activity measures across 4 domains relevant to childhood obesity: individual diet, food environment, individual physical activity, and physical activity environment.
NCCOR Catalogue and Registry Working Groups The National Collaborative on Childhood Obesity Research catalogue of surveillance systems and measures registry: new tools to spur innovation and increase productivity in childhood obesity research.
A Guide to Methods for Assessing Childhood Obesity
Aids in selecting the most appropriate method of measuring adiposity in children when conducting population-level research and/or evaluation on obesity
Resources part of the Measures Registry Resource Suite.
Walks researchers and practitioners through a series of questions regarding whether to develop, adapt, or apply an instrument for obesity measures in high-risk populations
A Toolkit for Evaluating Childhood Healthy Weight Programs
Provides an overview of program evaluation and provides guidance on evaluation readiness, process measures, outcome measures, contextual factors, program sustainability, and remote evaluation of CHWPs
This paper reflects on changes in these 2 tools across the decade, additional work NCCOR has done to advance measurement for childhood obesity, and potential next steps for the field. Links to NCCOR resources related to measurement are shown in Table 1, and details of their development are available elsewhere.
NCCOR Catalogue and Registry Working Groups The National Collaborative on Childhood Obesity Research catalogue of surveillance systems and measures registry: new tools to spur innovation and increase productivity in childhood obesity research.
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.
Over the last decade, the Catalogue has expanded to include 83% (from 6 to 11) more schools and 73% (from 11 to 19) more community-level data sources. In addition, there has been a 43% (from 21 to 30) increase in sources with data on Asian and Pacific Islander persons, a 64% (from 11 to 18) increase in sources with data on Native American/Alaskan Native persons, and a 28% (from 40 to 51) increase for sources with data on both Black American and Hispanic American persons (Table 2). Furthermore, more systems with data at the policy level (e.g., Classification of Laws Associated with School Students,
School health policies and practices (SHPPS). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/data/shpps. Updated 2019. Accessed 15 April 2022.
National health and nutrition examination survey. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhanes/index.htm. Updated July 28, 2022. Accessed September 29, 2022.
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
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.
When the Measures Registry was first launched, measures were sparse for small town or rural environments (89) and Spanish language versions (so few that they were not counted); there were no measures for populations under age 2 years.
NCCOR Catalogue and Registry Working Groups The National Collaborative on Childhood Obesity Research catalogue of surveillance systems and measures registry: new tools to spur innovation and increase productivity in childhood obesity research.
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).
Access to the availability of the Measures Registry has ranged from 3,000 to 7,000 visits yearly. Among the top 5 most accessed measures are Prochaska et al.,
Comparison of the TriTrac-R3D accelerometer and a self-report activity diary with heart-rate monitoring for the assessment of energy expenditure in children.
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
Even with the availability of the Measures Registry, it can be difficult for users to choose the most appropriate measure because the best measure depends on the research question and type of research. To address this challenge, NCCOR has developed resources to provide guidance on selecting measures, identifying key research questions, and adapting and tailoring measures for different populations (Table 1).
Two key additional resources include the Measures Registry User Guides (2017) and the Measures Registry Learning Modules (2019). The Guides are organized by the same 4 domains as the Measures Registry and provide monograph-length overviews of how to select measures for childhood obesity in these domains. The Measures Registry Learning Modules are designed for students, faculty, and users who were newer to research and evaluation in diet and physical activity. They complement the information in the User Guides but are shorter and include quizzes to enhance classroom learning and understanding of key concepts (Figure 1).
Figure 1How to use the Measures Registry Resource Suite.
In 2020, in collaboration with academic researchers, NCCOR published a review on measures available for high-risk populations detailing progress and highlighting research gaps.
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
Assessing childhood obesity and its determinants remains as important as it was when the Registry and Catalogue were first released. Concurrently with the pandemic, the U.S. has seen an increase in childhood obesity rates in some groups
Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years — United States, 2018–2020 [published correction appears in MMWR Morb Mortal Wkly Rep. 2021;70(38):1355].
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.
NCCOR has been actively engaged in 3 further challenges related to measurement and data informed by the Catalogue and Registry. First, NCCOR has helped to advance the measurement of indicators by updating the Youth Compendium for Physical Activities, developing economic metrics for community-level interventions, addressing needs for surveillance of active transportation to schools, and working to add sleep data sets to the catalog. Second, the childhood obesity epidemic in the U.S. affects diverse communities with different immigration histories. NCCOR collaborated with the NIH Fogarty International Center to organize and disseminate the results of a workshop focusing on childhood obesity and measurement issues across the Americas.
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
engages people and communities who have historically been left out of medical research through multiple data sources.
Attention must also be paid to the interplay of measurement and equity, the social determinants of health, and community engagement. There is still a dearth of measures for different racial and ethnic populations; for children with increased risk for obesity, such as those with special healthcare needs; and for relevant factors such as language, country of origin, and acculturation. Furthermore, the balance between tailoring measures for diverse populations and having standard measures can also be explored. Moving forward, measure development and data collection could include efforts to engage communities in concrete ways, such as reimbursement for their time and inclusion of key informants and community leaders in both the design and implementation stages of research projects.
Advancing measurement for high-risk populations and communities related to childhood obesity, October 2020, National Collaborative on Childhood Obesity Research; Washington, DC. https://www.nccor.org/wp-content/uploads/2020/10/HiRisk-WP_Final-4.pdf. Published October 2020. Accessed June 20, 2022.
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.
REFERENCES
NCCOR Tools. National Collaborative on Childhood Obesity Research. https://www.nccor.org/nccor-tools/. Updated 2016. Accessed April 15, 2022.
The National Collaborative on Childhood Obesity Research catalogue of surveillance systems and measures registry: new tools to spur innovation and increase productivity in childhood obesity research.
School health policies and practices (SHPPS). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/data/shpps. Updated 2019. Accessed 15 April 2022.
National health and nutrition examination survey. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhanes/index.htm. Updated July 28, 2022. Accessed September 29, 2022.
Comparison of the TriTrac-R3D accelerometer and a self-report activity diary with heart-rate monitoring for the assessment of energy expenditure in children.
Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years — United States, 2018–2020 [published correction appears in MMWR Morb Mortal Wkly Rep. 2021;70(38):1355].
Advancing measurement for high-risk populations and communities related to childhood obesity, October 2020, National Collaborative on Childhood Obesity Research; Washington, DC. https://www.nccor.org/wp-content/uploads/2020/10/HiRisk-WP_Final-4.pdf. Published October 2020. Accessed June 20, 2022.
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