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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. Adapted by Betty Williams, MSW

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

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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

Adapted by Betty Williams, MSW

This project was made possible by funding from the Department of Health and Human Services and

Public Health - Seattle & King County

what are best practices
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
outline for the workshop
Outline for the Workshop
  • Overview of Childhood Overweight/Obesity
  • Best Practices: Nutrition and Mealtime Socialization
  • Menu Planning and Mealtime Activities for Early Learning
  • Wellness for Caregivers
  • Best Practices: Physical Activity and Screen Limits
  • Physical Activities for Early Learning
  • Evaluations and Wrap-up
childhood obesity rates cdc data 2008
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 Nutrition Surveillance Report, 2008,

long term health risks
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
Short Term Health Risks
  • Premature puberty
  • Sleep Apnea
  • Asthma
  • Bone/joint issues
  • Social discrimination
  • Depression and low self-esteem
  • Risk for eating 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,

contributing factors
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
nhlbi portion distortion quiz
NHLBI Portion Distortion Quiz

OEI-NHLBI Slide Show Menu Page

healthy weight for children
Healthy Weight for Children
  • Infant Feeding Practices
  • Nutrition
  • Mealtime Socialization
  • Screen Time Limits
  • Physical Activity
childhood obesity prevention infants and toddlers
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
cfoc standards infant feeding
CFOC StandardsInfant Feeding

Support, encourage and accommodate breastfeeding Moms

cfoc standards infant feeding1
CFOC StandardsInfant 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

childhood obesity prevention nutrition
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
cfoc nutrition standards
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
low fat low sodium less added sugar
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
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

“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 Preschoolers’ Self Regulation of Feeding, Pediatrics, 2000

childhood obesity prevention mealtime environment
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)
division of responsibility during eating
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

cfoc meal time standards
CFOC Meal Time Standards
  • Sit with kids
  • Eat with kids
  • Role Model
  • Serve family style
  • Let the kids help
  • Follow Division of Responsibility

I hear and I forget.

I see and I remember.

I do and I understand and

One picture is worth a thousand words.

take good care of yourself keys to wellness
Take Good Care of YourselfKeys to Wellness
  • Sleep
  • Exercise
  • Diet
  • Stress
  • Happiness Factor

By the time a child is 3 the brain has formed 1000 trillion connections…The infant brain thrives on feedback from its environment…which is mostly


Brain Games for Babies, Jackie Silberg, 2nd Edition, 2005

cfoc infant movement standards
CFOC Infant Movement Standards
  • Infants have at least 3, 5 minute sessions of supervised tummy time when they are awake
  • Infant environment is least restrictive at all times
  • Container use is limited to 15 minutes/day
  • Infants go outside 2-3 times a day

For many families, media use has become part of the fabric of daily life.

The Media Family, Electronic Media in the Lives of Infants, Toddlers and Preschoolers and Their Parents, The Kai Family Foundation

media use and young children
Media Use and Young Children
  • Children 6 months – 6 years average 2 hours of media time compared to 40 minutes a day of reading
  • The older a child gets the more media time they spend
    • (40 minutes, 0-1 yrs and 159 minutes 4 – 6 yrs)
  • Among 6 – 23 month olds, about 40% can turn on the TV and change channels by themselves

The Media Family, Kaiser Institute, 2006

cfoc screen time limits
CFOC Screen Time Limits
  • No TV for infants ( < 2 yrs)
  • All ages over 2:
    • 1/2 hr or less per week
    • Limit to educational program
    • Computers mostly for homework
national physical activity guidelines
National Physical Activity Guidelines
  • > 60 minutes of moderate to vigorous activity
  • Several 15 minute bouts of physical activity
  • Daily activity that supports health, wellness, fitness and performance
  • 2 or more hours of inactivity is discouraged
  • Outdoor play 2 or more times/day
  • Limit TV to < 2 hrs/day
  • No TV in Bedrooms

NASPE Statement of Guidelines for Infants and Young Children, 2nd Edition, 2008

cfoc standards for outside play time
CFOC Standards for Outside Play Time
  • All Children in Full Time Care
    • Centers - 2-3 times/day
    • Homes - 2-3 times/day
  • School Age Programs -
      • at least once for children in part time care
benefits of moderate to vigorous play
Benefits of Moderate to Vigorous Play
  • Physical Development
  • Fitness
  • Energy Balance
  • Disease Prevention
  • Social/Emotional Development
fitness an ongoing process
Fitness:An Ongoing Process
  • Endurance
    • muscular/cardiovascular
  • Strength
  • Flexibility

The more active, the more fit.

Rae Pica, Your Active Child, Contempory Books, 2003

cfoc standards for physical activity
CFOC Standards for Physical Activity
  • Moderate to Vigorous Activity
    • Toddlers: 60 - 90 minutes
    • Preschoolers: 90 - 120 minutes
  • School Age: > 20 minutes/3 hours of care
  • Active play is never withheld as a form of punishment

National Resource Center, Motion Moments Video Clips

It All Adds Up!

types of physical activity
Types of Physical Activity
  • Adult Led/Structured Time
    • Motor skill development
    • Balance
    • Guided fun and games w/assists
  • Unstructured Activities
    • Motor skill practice
    • Promote self motivation and exploration
    • Child selected fun and games