Tanya Harvey, M.Ed. Coordinator of Children’s Programs Bureau of Community Food and Nutrition Assistance Missouri Department of Health and Senior Services
Review the obesity trends in the United States.
Provide an overview of Missouri Eat Smart and MOve Smart Child Care programs.
Environmental factors that affect eating behaviors
How to get your homes involved! Learn how to maximize resources to
promote and improve nutrition and physical activity practices.
Childhood Obesity is: Most common nutritional disease
in US children Obese children are 5 times more
likely to be overweight/obese young adults 60% of overweight children 5-10
years of age already have at least one risk factor for heart disease
Obesity Among U.S. Adults by State and Territory has been on the increase for years as noted in the following US maps
The following maps from CDC are
spaced 5 years to show the trend.
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Americans of all ages consume…
Too few:
▪ Vegetables, fruits, whole grains, low-fat/fat-free milk/milk products, seafood
Too much:
▪ Added sugars, solid fats, refined grains, sodium
Added sugars and solid fats contribute
~35% of calories to the American diet!!
(while contributing few, if any, nutrients)
Portions Busy lifestyles Increased meals from away from home Sedentary activities Urban sprawl Marketing
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A Dream A Detour
A Dependency A Disturbing Trend
“Primary prevention of obesity must begin in
childhood. This is the single most powerful public health approach to combating and reversing America’s obesity epidemic over
the long run.”
--Report of the Dietary Guidelines Advisory Committee
According to the 2013 US Census report nearly 11 million children under age 5 in the United States are in some type of child care arrangement every week.
The food and the environment in which children eat their meals have a big impact on future nutrition habits and weight status.
Children who are provided healthy foods during early childhood are more likely to continue healthy eating habits as they get older.
Child care providers are uniquely interested and qualified to support development of healthy habits
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Day Care Home settings already offer the family atmosphere that is the core of programs shown to help reduce the prevalence of obesity.
Establishing sit down meals (Family Style) fits with the home setting and offers children a role model for healthy eating habits.
Smaller capacities mean more opportunity for one on one interaction and education.
Address childhood obesity Encourage providers to be the leaders of
the changes needed!
A program to encourage child care facilities to voluntarily improve nutritional content of meals to exceed those standards required by the CACFP and Child Care Licensing, and adapt best practices in the feeding of children.
Broad dietary recommendations to challenge child care providers to make nutrient dense foods available
Based on 2010 Dietary Guidelines for Americans
Support policies that create a healthy nutrition environment
For any facility, large or small, but not mandatory
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Training provided on healthy options, food labels and atmosphere
Improved health of children
Development of lifelong healthy habits for children and staff
Facilities are recognized as Eat Smart on the website and newsletter
Certificate, banner, window cling and decals
Menu templates and nutrition education materials
Parent letter
Press release
Use of the Eat Smart Logo
Voluntary program Facilities apply by submitting menus and
supporting documentation Training is provided by qualified staff Program staff conduct an on-site assessment Day Care Facilities receive recognition once
they have met the Intermediate or Advanced level.
Eat Smart training is available in many forms In person training with our nutritionists or our
Child Care Health Consultants
On line Eat Smart Training through our Learning Management System
▪ Three modules on line
1. Eat Smart: A Call to Action
2. Eat Smart: A Healthy Nutrition Environment
3. Eat Smart: Nutrition Overview
Minimum Level
Intermediate Level
Advanced Level
Healthfulness
Intermediate more healthful than USDA CACFP req’s Advanced more healthful than Intermediate
Minimum level meets current meal pattern
A group of professionals who work with young children and child care providers created the Eat Smart Guidelines.
Workgroup members involved in the development: Missouri Department of Health and Senior Services -
Child and Adult Care Food Program (CACFP); Section for Child Care Regulation (licensing) Center for Local Public Health Services (county) University of Missouri Extension Service Head Start State Collaboration Office Lincoln University Child Development Department Missouri Council for Activity and Nutrition (MOCAN) A non-profit Missouri child care center
The Dietary Guidelines combine the evidence from current research on nutrition to make recommendations for a pattern of eating that can be adopted by healthy Americans over 2 years of age.
They are used as a resource to make nutrition recommendations for federal programs, such as the CACFP.
They also provide advice how good dietary habits can promote health and reduce risk for major chronic diseases.
Throughout life, prevent and/or reduce overweight and obesity through improved eating, more physical activity and less sedentary behaviors such as TV watching and computer games.
Consume more fat free or low-fat milk Increase consumption of fruits and vegetable Choose whole grains; Limit refined grains Consume lean meats and reduce consumption of
trans fat and saturated fat. Avoid added sugars and sugar sweetened
beverages and reduce sodium.
Increased nutrition standards based on: Institute of Medicine
Dietary Guidelines for Americans
Eat Smart Facilities to follow Guidelines: Menu (Breakfast, Lunch/Supper, Snacks,
Overall)
Meal service
Policy
Environment Intermediate and Advanced levels of
recognition
http://www.cfsan.fda.gov/~dms/foodlab.html
Check Calories
Sample label for macaroni and cheese
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Start
Standards
to Follow
Limit
Amount of sugar in cereals
Sweet breakfast items
Add
Whole grain foods
Fruit and vegetables
CACFP
No requirement to limit sugar in cereal
Intermediate
All ready-to-eat and hot cereals offered contain 9 grams of sugar or less per serving.
Advanced
All ready-to-eat and hot cereals offered contain 6 grams of sugar or less per serving.
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CACFP
Sweet bread items (i.e. coffee cake, muffins, granola bars, cereal bars, doughnuts, sweet rolls, etc.) not currently limited
Intermediate
Limit all sweet items (including syrup, table sugar, and jelly) to 1 time per week at breakfast
Advanced
Limit all sweet items to 2 times per month at breakfast
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CACFP No requirement
Intermediate No requirement
Advanced
A meat/meat alternate is provided at least 2 breakfasts per week.
High fat and salty processed meats may not count towards this guideline.
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Limit
Processed breaded meats
Use of high fat condiments
Add
Whole grain foods
Fruit and vegetables
Low-fat milk served
Limit
Sweet snacks
Add
Protein at snacks
Fruit and vegetables
More whole grains
CACFP
• Limiting dessert grains is best practice .
Intermediate
Sweet snacks and high fat items* are served no more than 1 time per week or less.
Advanced
Sweet snacks and high fat items* are served no more than 1 time every two weeks or less.
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CACFP
All grains/breads must be whole grain or enriched
Intermediate
A whole grain food is offered at least
1 breakfast per week and 1 lunch/supper per week
Advanced
A whole grain food is offered at least
3 breakfasts per week and 3 lunches/suppers per week 40
CACFP Highly processed meat such as hot dogs and sausage
products are not best practice.
Intermediate Highly processed meat, poultry and fish (including high
fat and salty breaded meats)** are limited to 2 times per week at lunch/supper
Advanced Highly processed meat, poultry and fish (including high
fat and salty breaded meats)** are limited to 1 time per week at lunch/supper
**Any item that requires a CN label Includes chicken nuggets, fish sticks, hot dogs, bologna,
pepperoni, breakfast sausage & other luncheon meats
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CACFP
• No requirement on fresh fruits or vegetables
• Juice may count up to ½ of the total requirement for lunch or supper
Intermediate
Fresh fruits or veggies are served (no juice)
1 time per week or more* at lunch/supper
Advanced
Fresh fruits or veggies are served (no juice)
3 times per week or more* at lunch/supper
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CACFP Juice must be 100% full strength fruit or
vegetable juice Intermediate 100% juice is served no more than once per day
or less Advanced 100% juice is served no more than 3 times per
week or less
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CACFP: Not Eat Smart Intermediate Advanced
Monday Tuesday Wednesday Thursday Friday
Breakfast 1% milk Grape Juice Fruit Loops (12 g)
1% milk Orange Juice Doughnut
1% milk Canned peaches (heavy syrup) Oatmeal (sugar)
1% milk Grape Juice Pancake with syrup
1% milk Applesauce (sugar added) Toast (jelly)
Lunch BBQ riblet (CN) Bun Tator tots Fruit cocktail (light syrup) 1% milk
Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk
Chicken tenders Breading (CN) Canned pineapple Canned carrots 1% milk
Beef Ravioli (CN) Cheesy bread(CN) Iceberg salad French dressing Mandarin oranges (light syrup) 1% milk
Hot dog Bun French fries Canned green beans 1% milk
Snack Tortilla chips Salsa Orange juice
Cheez its 1% milk
Sweet roll Apple juice
Frito chips Refried beans
Chocolate Chip Cookies 1% milk
Monday Tuesday Wednesday Thursday Friday
Breakfast 1% milk Banana Honey Nut Cheerios (9 g)
1% milk Orange Juice Bagel with cream cheese
1% milk Blueberries Oatmeal
1% milk Grape Juice Pancake with syrup
1% milk Applesauce (no sugar added) Whole wheat toast
Lunch Turkey w/ BBQ sauce Whole wheat bread Lettuce, tomato Tater tots 1% milk
Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk
Homemade Chicken tenders Bread crumbs Canned pineapple Canned carrots 1% milk
Ground beef Spaghetti noodles Tomato sauce Spinach, tomatoes French dressing 1% milk
Hot dog Bun Sweet potato fries Canned green beans 1% milk
Snack Tortilla chips Salsa Orange juice
Cheez its 1% milk
Cinnamon toast Apple juice
Celery Refried beans
Berry Berry Kix (7 g) 1% milk
Monday Tuesday Wednesday Thursday Friday
Breakfast 1% milk Banana Cheerios (1 g)
1% milk Strawberries Bagel Yogurt
1% milk Blueberries Oatmeal
1% milk Pureed blackberries Pancake (no syrup)
1% milk Applesauce (no sugar added) Whole wheat toast Peanut butter
Lunch Turkey w/ BBQ sauce Whole wheat bread Lettuce, tomato Tater tots 1% milk
Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk
Homemade Chicken tenders Whole wheat bread crumbs Canned pineapple Raw carrots 1% milk
Ground beef Whole wheat spaghetti noodles Tomato sauce Spinach, tomatoes French dressing 1% milk
Gr. Chicken Breast Bun Lettuce, tomato Sweet potato fries Green beans 1% milk
Snack Tortilla chips Salsa Orange juice
Cheez its 1% milk
Apple Peanut butter
Celery Refried beans
Kix (3 g) 1% milk
Menus posted
No other foods brought into the facility
Fundraising cannot include unhealthy foods
Vending machines offer healthy alternatives
TV viewing limited
Parent involvement encouraged
Curriculum includes nutrition education
Family Style Meal Service
Meal time environment
Family style meal service
Adult interactions with children
Meal length
CACFP No requirement Intermediate At least one item is served family style at each meal Child sized serving utensils are available and used Advanced Most foods are served family style
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Division of Responsibility Adults decide the when and where of eating Children decide whether to eat and how much
Staff Avoid power struggles relating to food Encourage children to try new foods Do not use food as a
reward or punishment
Intermediate Children help clear dishes after meal is finished Advanced Children help set the table and clear dishes after meal is finished
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CACFP/Licensing/Minimum
No outside/parent provided foods are brought in for meal service, celebration snacks must be pre-packaged
Intermediate
Parents are provided a written policy prohibiting any foods brought from home or outside sources
Advanced
Parents are provided a written policy prohibiting any foods brought from home or outside sources
Celebrate with non-food treats
Facility offers healthy foods
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Children may have a hard time becoming accustomed to the new meals (at first)
Parents and providers may feel they are depriving children of sweet food treats
Increased Cost – fresh fruit, vegetables, and increased lean protein may add to the meal cost (and must be purchased more often)
More time to prepare the “fresh” meals Fresh meals take more thought and advanced planning
140 recognized child care facilities
A program to encourage child care facilities to adopt practices that improve the amount and quality of physical activity children receive in care.
Goals:
Fight obesity
Establish healthy habits early
Create attentive learners
Voluntary program Facilities apply by submitting an application
and supporting documentation (photos) Training is provided by qualified staff Self-assessment completed by child care Day Care Facilities receive recognition once
they have met the Intermediate or Advanced level.
Physical activity standards for children 2 to 5 Based on:
American Academy
of Pediatrics
Let’s Move Child Care
I am Moving,
I am Learning (IMIL)
Standard guidelines address:
Amount and type of physical activity
Reduce sedentary time
Activity Policy
Environment encourages activity
Having at least 90 minuets of Physical Activity per day
30 structured
Physical Activity not withheld as punishment
Equipment Available for activity
Indoor Physical Activity Learning Integrated Limited Screen Time Written Policy for Physical
Activity Staff Education & Training Sedentary Time Limited Visual Promotion of Physical
Activity Staff Participation & Role
Modeling Additional physical activity
Framed certificate
Permission to use the MOve Smart logo
A sample press release
Parent informational brochure on MOve Smart
Recognition on the MOve Smart website and The MO Healthy Child Care newsletter
MOve Smart is a new program in Missouri. There are currently 14 facilities that have
been recognized as MOve Smart, but several more have submitted applications!
Missouri Department of Social Services
2010 ARRA Funding – provided mini-grants to child care centers to help meet the Eat Smart Guidelines
United States Department of Agriculture CACFP Child Care Wellness Grant
Team Nutrition Coaching Program
University of Missouri Extension Service
▪ Eat Smart/MOve Smart Coaching Program
▪ Eat Smart/MOve Smart Training
Centers for Disease Control and Prevention – Obesity Prevention Grant
▪ I am Moving, I am Learning Training for MOve Smart
Missouri Foundation for Health
Healthy Schools, Healthy Communities Grant
Local Public Health Agencies - Child Care Health Consultants
Eat Smart/MOve Smart training and consultation
Child Care Aware of Missouri - National Early Care and Education Learning Collaborative
▪ Taking Steps to Healthy Success
Missouri Council for Activity and Nutrition (MOCAN)
Missouri Accreditation of Programs for Children and Youth
Incorporate Eat Smart standards into After School Care Programs and Early Learning Center accreditation standards
Eat Smart and MOve Smart facilities, whether recognized or not, have been shown to continue good habits:
▪ Reduce use of high sugar foods
▪ Increase adults eating with children
▪ Increase use of no-sugar added fruits and vegetables at breakfast, lunch and snack
▪ Increase healthy celebrations
▪ Increase the prevalence of family style dining
▪ Increase the use of whole grains at
breakfast, lunch and snack
▪ Increase physical activity
Obesity is a major issue affecting children in the United States.
Small changes in meals and in the child care environment can make big differences.
Missouri has found great success with the Eat Smart Program and is anticipating great success with the MOve Smart Program.
Partners are out there and are willing to help in this struggle for change.
….Much harder to change established habits
than to shape good habits from the start
Website:
www.health.mo.gov/eatsmart
www.health.mo.gov/movesmart