1. Preventing Childhood Obesity: Best 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

2. 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

3. Outline for the Day Morning Overview of Childhood Overweight/Obesity Best Practices: Nutrition and Mealtime Socialization Menu Planning and Mealtime Activities for Early Learning 10:30 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 2:30 Rhubarb/Apple Crisp Break 3:15 Evaluations and Wrap-up

4. 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 %

6. 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 TotalCentersFamily School Age25,61117,2858326 Preschool37,32925,37311,956 Toddlers992361353788 Infants540917853624

7. Childhood Obesity Rates CDC 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.)

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

10. Long Term Health Risks Diabetes Type 2 High Blood Pressure/Hypertension High Cholesterol Heart Disease/Stroke Higher health care costs Quality of Life issues

11. Short Term Health Risks Premature puberty Sleep Apnea Asthma Bone/joint issues social discrimination Depression and low self-esteem Risk for eating disorders

12. “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

13. 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

14. NHLBI Portion Distortion Quiz OEI-NHLBI Slide Show Menu Page http://hp2010.nhlbihin.net/oei_ss/menu.htm#PD2

15. Healthy Weight for Children Infant Feeding Practices Nutrition Mealtime Socialization Screen Time Limits Physical Activity

16. Childhood Obesity Prevention Infants and Toddlers Breastfeed Practice cue feeding No TV, computer or media for babies under 2 Provide many opportunities for activity across the day

17. 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

18. 18 CFOC Standards Infant Feeding Support, encourage and accommodate breastfeeding Moms

19. 19 CFOC Standards Infant Feeding Feed according to baby’s 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

20. Childhood Obesity Prevention Nutrition 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

21. 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 < 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

22. Low fat, low sodium less 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

23. 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 < 2/wk – Fruit and veggies for PM snack Calories – Serve 1% milk – Limit high fat, sugar and sodium foods to < 1/week

24. Rate the Menu

25. Break/Snack

26. “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

27. Childhood Obesity Prevention Mealtime 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)

28. 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 Clip:“When a parent asks for regulation” University of Idaho - Feeding Young Children in Group Settings - videos alphabetical

29. 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 He’s Such a Picky Eater University of Idaho - Feeding Young Children in Group Settings - videos alphabetical

30. I hear and I forget. I see and I remember. I do and I understand and One picture is worth a thousand words.

31. Lunch Time Farm to Child Care Table Puget Sound Food Network Presentation with Emma and Karen www.psfn.org