Preven&ng  Childhood  Obesity:Best  Prac&ce  Strategies  in  Nutri&on  and  

Physical  Ac&vity  in  Early  Learning

Cathe Paul, MPH, BSNKaty 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

What  are    “Best  Prac&ces”?

• Defined  by  Caring  for  Our  Children:  Preven&ng  Childhood  Obesity  in  Early  Care  and  Educa&on  Programs,  2010

• “CFOC”  =  Best  Prac&ce  Standards  for  Early  Learning

Outline  for  the  Day• Morning  

• Overview  of  Childhood  Overweight/Obesity• Best  Prac&ces:  Nutri&on  and  Meal&me    Socializa&on• Menu  Planning  and  Meal&me  Ac&vi&es  for  Early  Learning• 10:30  Smoothie  Break

• Lunch  -­‐  Farm  to  Workshop• Provided  by  Maya,  Our    Beginnings  Child  Care• Farm  to  Child  Care  Table:  Presenta&on  by  Puget  Sound  Food  Network

• AUernoon• Wellness  for  Child  Care  Providers• Best  Prac&ces:  Physical  Ac&vity  and  Screen  Limits• Physical  Ac&vi&es  for  Early  Learning• 2:30  Rhubarb/Apple  Crisp  Break• 3:15  Evalua&ons  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  Nutri&on  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  discrimina&on

• Depression  and  low  self-­‐esteem

• Risk  for  ea&ng  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

Contribu&ng  Factors

• Too  Many  Calories

– More  added  fats,  sugar  and  salt

– Too  much  food/more  snacking

– Larger  servings  

– Lack  of  family  meals

• Too  much  sedentary  &me/screen  &me

• Lack  of  enough  physical  ac&vity

• Viewing  more  food  adver&sements

NHLBI  Por&on  Distor&on  Quiz

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

Healthy  Weight  for  Children

• Infant  Feeding  Prac&ces

• Nutri&on

• Meal&me  Socializa&on

• Screen  Time  Limits

• Physical  Ac&vity  

Childhood  Obesity  Preven&onInfants  and  Toddlers

• Breaseeed  • Prac&ce  cue  feeding  • No  TV,  computer  or  media  for  babies  under  2• Provide  many  opportuni&es  for  ac&vity  across  the  day

Breaseeeding  plays  an  important  role  in  obesity  preven&on  and  improving  overall  health  outcomes,  and  therefore  is  vitally  important  to  public  health.”

United  States  Breaseeeding  Commiaee,  Chair,  Joan  Younger  Meek,  MD,  MS,  RD,  IBCLC,  Preven&ng  Obesity  Begins  at  Birth  through  Breaseeeding,  Jan.  2011

   

18

CFOC  StandardsInfant  Feeding

Support,  encourage  and  accommodate  breaseeeding  Moms

19

CFOC  StandardsInfant  Feeding

• Feed  according  to  baby’s  cues– hunger  and  sa&ety

– need  &me  to  explore

• Introduce  solid  foods:• Make  a  plan  with  parents

• Preferably  closer  to  6  mths  as  indicated  by  needs

Maa  and  Baby  –  Ellyn  Saaer

Oh  Baby...Feeding  Young  Children  in  Group  Senngs

Childhood  Obesity  Preven&onNutri&on

• Expose  children  to  a  wide  variety  of  foods

• Eat  at  home  most  oUen

• Limit  high  calorie,  highly  processed  foods

• Limit  sugar  sweetened  beverages  and  juice

• Strive  for  5-­‐A-­‐Day

CFOC  Nutri&on  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  nutri&on/educa&on  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  paaern

• 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  aaend  to  internal  cues  of  hunger  and  sa&ety  should  be  

promoted  as  a  produc&ve  child-­‐feeding  strategy  and  as  an  alterna&ve  to  coercive  or  restric&ve  

prac&ces”.

Susan  Johnson,  PhD,  Improving  Prschoolers  Self  Regula&on  of  Feeding  Pediatrics,  2000

Childhood  Obesity  Preven&onMeal&me  Environment

• Eat  together  oUen  (6-­‐19  yrs)

• Model  healthy  ea&ng  habits  (Preschoolers)

• Help  children  self  regulate  (infancy  on)

• Avoid  using  food  for  rewards  or  punishment  (all)

Division  of  Responsibility  During  Ea&ng

Main  goal  -­‐  self  regula&on

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

 Ellen  Saaer,  Feeding  with  Love  and  Good  Sense,  

Bull  Publishing,    2nd  Edi&on,  2000

Video  Clip:“When  a  parent  asks  for  regula&on”University  of  Idaho  -­‐  Feeding  Young  Children  in  Group  Senngs  -­‐  videos  alphabe&cal

• 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  Eater

University  of  Idaho  -­‐  Feeding  Young  Children  in  Group  Senngs  -­‐  videos  alphabe&cal

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  

Presenta&on  with  Emma  and  Karen  

www.psfn.org