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

Tanya.Harvey@health.mo.gov

Website:

www.health.mo.gov/eatsmart

www.health.mo.gov/movesmart