Preventing Childhood Obesity: Best Practice Strategies in Nutrition and Physical Activity in Early Learning

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Preventing Childhood ObesityBest Practice
Strategies in Nutrition and Physical Activity in
Early Learning

• Cathe Paul, MPH, BSN
• Katy Levenhagen, MS, RD
• Coalition for Safety and Health in Early Learning

This project was made possible by funding from
the Department of Health and Human Services and
Public Health - Seattle King County
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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

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Outline for the Day

• Morning
• Overview of Childhood Overweight/Obesity
• Best Practices Nutrition and Mealtime
  Socialization
• Menu Planning and Mealtime Activities for Early
  Learning
• 1030 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
• 230 Rhubarb/Apple Crisp Break
• 315 Evaluations and Wrap-up

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Childhood Obesity

• Obese BMI-for-age and sex gt 95
• Overweight BMI-for-age and sex gt 85
• Healthy Weight BMI-for-age and sex between 5th
  and less than 85th
• Underweight BMI-for-age and sex less than 5th

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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
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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.)

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• In Washington State 2008
• 14.4 of low income 2 - 5 year olds were obese
• Pediatric Nutrition Surveillance Report, 2008,

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Long Term Health Risks

• Diabetes Type 2
• High Blood Pressure/Hypertension
• High Cholesterol
• Heart Disease/Stroke
• Higher health care costs
• Quality of Life issues

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Short Term Health Risks

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

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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
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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

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NHLBI Portion Distortion Quiz
OEI-NHLBI Slide Show Menu Page http//hp2010.nhlbi
hin.net/oei_ss/menu.htmPD2
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Healthy Weight for Children

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

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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

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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   
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CFOC StandardsInfant Feeding

• Support, encourage and accommodate breastfeeding
  Moms

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CFOC StandardsInfant Feeding

• Feed according to babys 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 Satter
• Oh Baby...Feeding Young Children in Group Settings

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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

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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 lt 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

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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

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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 lt 2/wk
• Fruit and veggies for PM snack
• Calories
• Serve 1 milk
• Limit high fat, sugar and sodium foods to lt 1/week

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Rate the Menu
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Break/Snack
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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
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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)

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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 ClipWhen a parent asks for regulation
• University of Idaho - Feeding Young Children
• in Group Settings - videos alphabetical

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CFOC Meal Time Standards

• Sit with kids
• Eat with kids
• Role Model
• Serve family style
• Let the kids help
• Follow Division of Responsibility
• Watch video clips
• Pouring
• Hes Such a Picky Eater
• University of Idaho - Feeding Young Children in
  Group Settings - videos alphabetical

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I hear and I forget. I see and I remember. I do
and I understand and One picture is worth a
thousand words.
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Lunch Time
Farm to Child Care Table Puget Sound Food Network
Presentation with Emma and Karen www.psfn.org