1. The Importance of Nutrition and Physical Activity Standards for Child Care Settings Sara Gable, Ph.D. University of Missouri, Columbia MOCAN Conference (Apr 2015)

2. Topics a.Important background b.Expert recommendations to guide state policies and best practices c.Current state child care regulations for promoting children’s healthy weight. d.Conclusions and future considerations MOCAN Conference (Apr 2015)

3. Obesity in Child * and Adult # Population * NHANES 2011-2012: At or above the 95 th %-tile BMI for age and gender; # BMI at or above 30 (Ogden, Carroll, Kit, & Flegal, 2014) Background Children’s dietary intake Some improvement (e.g., less full fat milk) Concerns: too few fruits and vegetables and too many sugary beverages, sweets, and salty snacks Evidence of extra calories Activity habits Screen time (~ 25 hours per week for 2 to 5 year olds) 33% TVs in the bedroom Sleep * Fox et al., 2010; Kranz et al., 2004; USDA, 2009 MOCAN Conference (Apr 2015) * Nielsen, 2009; KFF, 2006

4. Prevalence of Overweight and Obesity* in Children and Adolescents: 2011-2012 (NHANES) Overweight and obese groups combined: > the 85 th %-tile BMI for age and sex (Ogden, Carroll, Kit, & Flegal, 2014) MOCAN Conference (Apr 2015) *Overweight kindergarteners 4 times more likely to be obese at age 14 than non- overweight peers (Cunningham et al., 2014)

5. MOCAN Conference (Apr 2015) Implications for human capital formation troubling (“The competencies, knowledge, and personality attributes embodied in the ability to perform labor so as to produce economic value.”; Becker) http://www.econlib.org/library/Enc/HumanCapital.html Excess weight during childhood touches every area of human development Academic performance and school functioning

6. Children’s Child Care Arrangements o 61% of young children at least one child care arrangement per week. o 29% have multiple arrangements per week. o Young children with employed mothers: 33 hrs in child care centers, 32 hrs in home-based child care. o Average child experiences 5 different child care settings before kindergarten. o Up to 75% of child daily nutritional needs can be met in child care. o In FY 2014, 3.6 million children were served meals and snacks per day as part of the Child and Adult Care Food Program. MOCAN Conference (Apr 2015) * Laughlin, 2013; Belsky et al., 2007; ADA, 2011

7. MOCAN Conference (Apr 2015) Expert Recommendations (and Rules) to Guide State Child Care Nutrition and Physical Activity Standards CACFP Meal Patterns Proposed Rule: http://www.fns.usda.gov/cacfp/meals-and-snacks June, 2011 2012 April, 2015 June, 2011

8. MOCAN Conference (Apr 2015) National Association for Regulatory Administration. The 50-state child care licensing study: 2011-2013 Edition (Appendix A and Appendix B)

9. MOCAN Conference (Apr 2015) National Association for Regulatory Administration. The 50-state child care licensing study: 2011- 2013 Edition (Appendix A and Appendix B)

10. What Distinguishes Today’s Young Children? o Fewer of them (relative to population) 2013 all-time low general fertility (62.5 births per 1,000 women aged 15-44) o Greater racial and ethnic diversity (just under 50% of people under 18 are members of “minority” groups) o One in 4 children under 6 lives in poverty (14.3% White, 42.3% Black, 36.8% Hispanic). o More than half of infants born in 2013 participated in WIC. o Obesity in young children more prevalent in low income households. o Parents working as hard as ever: 64% of mothers with children under 6 are employed, 72% of them work 35 or more hours per week. MOCAN Conference (Apr 2015)

11. What distinguishes today’s Child Care Providers? o Child care workforce includes ~ 2 million people; 1 million work in centers and 1 million work for wages in home settings. o Child care employment pays poorly (median hourly wage for center staff = $10.60), even for those with a BA (median hourly wage = $14.70) o 46% of child care providers live in households that participate in select public support programs (EITC, Medicaid, SNAP, TANF) compared with 25% of overall US civilian workforce. o Child care workforce at increased risk for obesity and chronic health conditions. National Survey of Early Care and Education Project Team. (2013). Whitebook, M., Philips, D., & Howes, C. (2014).

12. Conclusions o Nutrition and physical activity standards for child care settings more important than ever. o Address adults − parents and child care providers − along with children. o Keep up the good work! MOCAN Conference (Apr 2015) Care2bWell: A Worksite Physical Activity & Wellness Program for Child Care Staff Ward, Dianne Stanton Linnan, Laura A. University of North Carolina Chapel Hill, Chapel Hill, NC, United States Ward, Dianne StantonLinnan, Laura A. University of North Carolina Chapel Hill, Chapel Hill, NC, United States