Preventing Childhood Obesity:Best Practice Strategies in Nutrition and

Physical Activity in Early Learning

Cathe Paul, MPH, BSNKaty Levenhagen, MS,

RD

Coalition for Safety and Health in Early

LearningThis project was made possible by funding from the Department of Health and Human Services and

Public Health - Seattle & King County

What are “Best Practices”?

• Defined by Caring for Our Children: Preventing Childhood Obesity in Early Care and Education Programs, 2010

• “CFOC” = Best Practice Standards for Early Learning

Outline for the Day• Morning

• Overview of Childhood Overweight/Obesity• Best Practices: Nutrition and Mealtime Socialization• Menu Planning and Mealtime Activities for Early Learning• 10:30 Smoothie Break

• Lunch - Farm to Workshop• Provided by Maya, Our Beginnings Child Care• Farm to Child Care Table: Presentation by Puget Sound

Food Network• Afternoon

• Wellness for Child Care Providers• Best Practices: Physical Activity and Screen Limits• Physical Activities for Early Learning• 2:30 Rhubarb/Apple Crisp Break• 3:15 Evaluations and Wrap-up

Childhood Obesity

• Obese: BMI-for-age and sex > 95 %

• Overweight: BMI-for-age and sex > 85 %

• Healthy Weight: BMI-for-age and sex between 5th and less than 85th %

• Underweight: BMI-for-age and sex less than 5th %

How Many Kids in Child Care

King County, 2008

• From Department of Early Learning, Child Care Resources, Regional Infant Toddler Planning Assessment King County Report, 10-1364, 10/8/2010

Total Centers Family

School Age 25,611 17,285 8326

Preschool 37,329 25,373 11,956

Toddlers 9923 6135 3788

Infants 5409 1785 3624

Childhood Obesity RatesCDC data, 2008

•2 to 5 yrs has more than doubled (from 5% to 10.4%) during the past 3 decades.

•6 to 11 yrs has more than quadrupled, during past 4 decades (from 4.2% to 19.6%)

•12 to 19 yrs has more than tripled (from 4.6 to 18.1 percent) during the past four decades.)

In Washington State 2008

14.4% of low income 2 - 5 year olds were obese

Pediatric Nutrition Surveillance Report, 2008,

Long Term Health Risks

• Diabetes Type 2• High Blood

Pressure/Hypertension• High Cholesterol• Heart Disease/Stroke• Higher health care costs• Quality of Life issues

Short Term Health Risks

• Premature puberty• Sleep Apnea• Asthma• Bone/joint issues social discrimination• Depression and low self-esteem• Risk for eating disorders

“Thirty years ago, most people led lives that kept them at a healthy weight. Kids walked to and from school every day, ran around at recess, participated in gym class, and played for hours after school before dinner. Meals were home-cooked with reasonable portion sizes and there was always a vegetable on the plate. Eating fast food was rare and snacking between meals was an occasional treat.”

M. Obama, letsmove.gov

Contributing Factors

• Too Many Calories– More added fats, sugar and salt– Too much food/more snacking– Larger servings – Lack of family meals

• Too much sedentary time/screen time• Lack of enough physical activity• Viewing more food advertisements

NHLBI Portion Distortion Quiz

OEI-NHLBI Slide Show Menu Pagehttp://hp2010.nhlbihin.net/oei_ss/menu.htm#PD2

Healthy Weight for Children

• Infant Feeding Practices• Nutrition• Mealtime Socialization• Screen Time Limits• Physical Activity

Childhood Obesity PreventionInfants and Toddlers

• Breastfeed • Practice cue feeding • No TV, computer or media for babies under 2• Provide many opportunities for activity across the

day

Breastfeeding plays an important role in obesity prevention and improving overall health outcomes, and therefore is vitally important to public health.”

United States Breastfeeding Committee, Chair, Joan Younger Meek, MD, MS, RD, IBCLC, Preventing Obesity Begins at Birth through Breastfeeding, Jan. 2011

18

CFOC StandardsInfant Feeding

Support, encourage and accommodate

breastfeeding Moms

19

CFOC StandardsInfant Feeding

• Feed according to baby’s cues– hunger and satiety– need time to explore

• Introduce solid foods:• Make a plan with parents• Preferably closer to 6 mths as

indicated by needs

Matt and Baby – Ellyn SatterOh Baby...Feeding Young Children in Group Settings

Childhood Obesity PreventionNutrition

• Expose children to a wide variety of foods• Eat at home most often• Limit high calorie, highly processed foods• Limit sugar sweetened beverages and juice• Strive for 5-A-Day

CFOC Nutrition Standards

• Serve a 3 component breakfast to all kids• 1% milk to kids over 2/whole for kids

under 2• Limit juice to < 2, 4 oz glasses a week• Limit high fat, sugar and sodium foods• Serve a fruit and/or vegetable at snack• Supplement parent supplied meals• Provide nutrition/education guidance to

parents

Low fat, low sodiumless added sugar

• Less processed foods (canned, box, package)• More whole foods (fruits, veggies, whole

grains)• More foods made from “scratch” • Eat 5 servings of fruits and veggies/day

ABCs of Menu Planning

• Nutrient Adequacy and Food Appeal– Meet CACFP meal pattern

• Balance – Ensure variety, at least 2 week

menu cycle,– limit juice to < 2/wk– Fruit and veggies for PM snack

• Calories – Serve 1% milk– Limit high fat, sugar and sodium foods to < 1/week

Rate the Menu

Break/Snack

“We suggest that helping children attend to internal cues of hunger and satiety should be

promoted as a productive child-feeding strategy and as an alternative to coercive or restrictive

practices”.

Susan Johnson, PhD, Improving Prschoolers Self Regulation of Feeding Pediatrics, 2000

Childhood Obesity PreventionMealtime Environment

• Eat together often (6-19 yrs)• Model healthy eating habits (Preschoolers)• Help children self regulate (infancy on)• Avoid using food for rewards or punishment (all)

Division of Responsibility During Eating

Main goal - self regulation

• Adults decide what, when, where• Kids decide if, what and how much

Ellen Satter, Feeding with Love and Good Sense,

Bull Publishing, 2nd Edition, 2000

Video Clip:“When a parent asks for regulation”University of Idaho - Feeding Young Children in Group Settings - videos alphabetical

CFOC Meal Time Standards

• Sit with kids• Eat with kids• Role Model• Serve family style• Let the kids help• Follow Division of ResponsibilityWatch video clips• Pouring• He’s Such a Picky EaterUniversity of Idaho - Feeding Young Children in Group Settings - videos

alphabetical

I hear and I forget.I see and I remember.

I do and I understand and One picture is worth a thousand words.

Lunch Time

Farm to Child Care TablePuget Sound Food Network

Presentation with Emma and Karen

www.psfn.org