Presentation on childhood obesity prevention in early childhood settings. Presented April 28, 2011 at the DOD/USDA Family Resilience conference, Chicago, IL.
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Childhood Obesity - FR Conference
1. Engaging Early Learning and CareEngaging Early Learning and Care
Providers in Obesity Prevention Efforts:
Promising Practices and Barriers
Jane Lanigan, Washington State University
Diane Bales, The University of Georgia
2. Today’s AgendaToday’s Agenda
• Definitions of overweight and obesity
• Prevalence of obesity
• Causes and risks of childhood obesityy
• Young children’s eating habits
• ENHANCE frameworkENHANCE framework
• Eat Healthy, Be Active
• What’s next?• What s next?
3. Body Mass Indexy
Overweight and obesity are measured in adults by Body
Mass Index (BMI)Mass Index (BMI)
BMI = weight (in kg) divided by height (in m), squared.
(BMI=kg/m2)(BMI=kg/m2)
An adult who is 5’5” tall and weighs 144 pounds has a
BMI f 24BMI of 24.
4. Obesity Trends* Among U.S. Adults
BRFSS 1990 1999 2009
1999
BRFSS, 1990, 1999, 2009
(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)
1990
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
5. Overweight and Obesity in ChildrenOverweight and Obesity in Children
For children and adolescents (aged 2–19 years),g y
the BMI value is plotted on the CDC growth
charts to determine the corresponding BMI forg
age and gender.
Overweight is defined as a BMI at or above the 85th
percentile and lower than the 95th percentile.
Obesity is defined as a BMI at or above the 95th
percentile for children of the same age and sex.
7. Childhood Obesity: Consequences
Health concerns
Heart disease
An estimated 61% of overweight
children have one risk factor
Type 2 diabetes
It is estimated that 1 in 3American
children born in 2000 will developTypep yp
2 diabetes in their lifetime (JAMA, 2003)
Asthma
O th di blOrthopedic problems
Skin Disorders
Sleep apneaSleep apnea
8. Childhood Obesity: ConsequencesChildhood Obesity: Consequences
Other Concerns
Decreases in school achievement
Positive correlation between childhood
i ht d l t b toverweight and early-onset puberty
Psychological effects
Negative self-conceptNegative self concept
Low self-esteem
Teasing by peersg y p
Loneliness and social isolation
Social discrimination
Depression
9. Causes of Childhood OverweightCauses of Childhood Overweight
Genetic tendency, based on
differences in
Appetite
Activity levelActivity level
Metabolism rate
Proximal cause: taking in more
l h h b dcalories than the body uses
Eating too many calories
Not getting enough physical activityg g g p y y
Lack of physical activity has more
impact
10. Childhood Overweight FactsChildhood Overweight Facts
Negative correlation between birth weight and risk of
childhood overweight
Underweight newborns more
likely to be overweight childrenlikely to be overweight children
Increases in childhood overweight
relate to family feeding practicese ate to a y ee g p act ces
12. Changes in Eating Patterns Changes in PA PatternsChanges in Eating Patterns
•Portion Size
•Marketing Influences
•Processed Foods
Changes in PA Patterns
•ScreenTime
•Safety Issues
•Sedentary LifestyleProcessed Foods
•Fast Food
•Access to Healthy Foods
•Time Famine
y y
•Built Environment
•Reduced Opportunities for PA
•Time Famine
•Low-Nutrition, Calorie-Dense Foods
OBESOGENICOBESOGENIC
ENVIRONMENT
Normalizing Larger Body Size
14. Media and other Sedentary ActivitiesMedia and other Sedentary Activities
Media use
Displacement
Mindless eating
Marketing influences
Child 2 5 d t 5 400Children age 2-5 are exposed to 5,400
food ads per year and 18,000-20,000 paid
ads.
Fast food restaurants
Sweets, snacks, desserts
Cereals
15. Points of Intervention: Earlier is BetterPoints of Intervention: Earlier is Better
Multi-level approach
Family Context
Community Context
Community supports for healthy eating and PA
Systems with which families interact
WICWIC
Extension nutrition programs
Medical care
E l L i d CEarly Learning and Care
16. RATIONALERATIONALE
• We CAN reverse the trend and counter the current obesogenic
environment
• Need a systems approach
• Approximately half of US children 0-6 spend time in non-
relative (13.9%) or center-based (36.1%) child care making
hi i i l b i ithis a critical obesity prevention context.
17. Community Partners Child Care SettingCommunity Partners Child Care Setting
Head Start
For profit Centers
EOCF
Learning Avenues p
Not-for-profit Community
based child care centers
College/University Lab
Learning Avenues
Innovative Service
YWCA
College/University Lab
schools
Centers serving
l ti ith i lpopulations with special
needs
Family Child Care Homes
19. Health Belief Model
Child id ld b t lik l t d t id b dChild care providers would be most likely to adopt evidence-based
practices related to healthy child eating if they:
viewed the failure of children to meet nutrition standards as potentially damaging
to children’s health and development;
believed they could make a meaningful difference in children’s eating habits;
were given the training and tools to effect change.
Transtheoretical Model
behavior change is conceptualized as a continuum consisting of a five-
stage process.
suggests that child care providers would be in varying stages of
readiness with regards to change and require different kinds ofg g q
support to move them along the continuum.
20. SAMPLESAMPLE
• 663 children ages 3 5 attending• 663 children ages 3 - 5 attending
ENHANCE child care sites
• 50% were from low SES50% were from low SES
• 44% were minority background
• 58% were girlsg
• 99 lead child care providers/teachers
• 59 staff assistants
• Mean age = 35.76; SD = 11.49
• Mean experience = 8.48; SD = 7.07
82% h d ll 31% h d BA• 82% had some college; 31% had a BA
or higher degree
21. INTERVENTIONINTERVENTION
Inclusive SiteWellness Committees identify annual improvementy p
goals.
ENHANCE supports their efforts by providing:
Assessment of current practices and comparison with evidence-
based practices
Training and ResourcesTraining and Resources
Mini-grants
Check-out Kits
Forum for sharing ideas
22. MeasuresMeasures
• Protocol for Mapping Current Policies
and Practices
T1/Baseline
• Child Care Provider Obesity
Prevention Survey
T2/End ofYear 1
Prevention Survey
• Child Role Play/Interview Protocol
Child BMI
T3/End ofYear 2
• Child BMI
23. Child
Interviews
Key Findings and
I li iInterviews
Intervention efforts should help
i
Implications
caregivers:
Become more intentional and
explicit in their communicationexplicit in their communication
related to healthy eating and
physical activity benefits
Develop key messages for
delivery across contexts in
which childrenwhich children
Use evidence-based practices
Self-regulationg
Introducing new foods
24. Child
Interviews
Key Findings and
I li iInterviews
Media use was preferred over active
Implications
leisure pursuits.
Content gaps included:
M ki h lth f d dMaking healthy food and
beverage choices outside
mealtime
Understanding the benefits of
Physical Activity
Young children can guide
intervention efforts by serving as
key informants and reflect thekey informants and reflect the
obesogenic environment
25. Provider
Surveys
Key Findings and
I li iSurveys
• Child care providers are uncertain of
Implications
their role and potential efficacy in child
obesity prevention.
• Understanding and counteringUnderstanding and countering
providers’ misconceptions is
important.important.
F d t i i d d ti d i• Focused training and education during
1st year appeared effective.
26. Improvement in Feeding Practices and
Nutrition EducationNutrition Education
Baseline-T1
Paired t test
T1-T2
Paired t test
Baseline-T2
GLM Repeat
Measures
t = 3.51; p = .003 t = 2.38; p = .036 F = 5.72; p = .005
27. Improvement in Physical Activity
PracticesPractices
Baseline-T1
Paired t test
T1-T2
Paired t test
Baseline-T2
GLM Repeat
MeasuresMeasures
t = 2.73; p = .010 t = 2.84; p = .007 F = 3.91; p = .031
28. Improvement in Communicationp
Baseline-T1
Paired t test
T1-T2
Paired t test
Baseline-T2
GLM RepeatPaired t test Paired t test GLM Repeat
Measures
t = 2 29; p = 028 t = 1 95; p = 059 F = 3 05; p = 061t 2.29; p .028 t 1.95; p .059 F 3.05; p .061
32. Observations: ImplicationsObservations: Implications
State policy effectively regulates media useState policy effectively regulates media use.
Center policy assists providers
Id tif t f f di d h i l ti it th tIdentify aspects of feeding and physical activity that
are amenable to regulation
Small changes add up to culture change
Process matters
The potential for child care providers to serve as
trusted advisors and conduits for information
dissemination has yet to be fully realized.
33. Eat Healthy, Be Active:y,
Addressing Childhood Overweight by Educating
Parents and Young Childreng
34. What Is Eat Healthy Be Active?
A multi-level educational program for preschoolers
What Is Eat Healthy, Be Active?
p g p
and their teachers
Goal: to reduce childhood obesity in preschoolers by: y p y
increasing children’s knowledge of healthy habits
Topics: nutrition and physical activityTopics: nutrition and physical activity
Methods: hands-on activities for children; family
involvement teacher traininginvolvement; teacher training
35. Why Eat Healthy, Be Active?y y,
Healthy (and unhealthy) habits
form earlyform early.
Adults create the food
environment for childrenenvironment for children.
Children learn by watching
adults.adults.
Children can influence adults’
behaviors.
Two-pronged approach:
Educate adults
Educate children
36. Why Eat Healthy, Be Active?y y,
The early childhood classroom is an ideal place toy p
teach about healthy habits.
Preschoolers have the cognitive capacity to learn about
nutrition and physical activitynutrition and physical activity.
Young children need hands-on exploration to learn essential
concepts.
C t h ld b i l d ifiConcepts should be simple and specific.
An integrated approach is most appropriate for ages
3 – 5.3 5.
The daily curriculum structures children’s learning.
Preschoolers need multiple opportunities to practice the same
conceptconcept.
37. Key Concepts for PreschoolersKey Concepts for Preschoolers
Eat breakfast
Eat a variety of foods (no “bad” food!)
Stop when you’re fullStop when you re full
Drink water
Be physically active
38. Key Methods for Teaching
P h lPreschoolers
Reinforce the key conceptsy
Keep it simple!
Infuse concepts into everyInfuse concepts into every
part of the curriculum
Repeat repeat repeatRepeat, repeat, repeat
Be a positive role model
39. Components of Eat Healthy, Be
A i
Integrated curriculum unit for ages
Active
g g
3- 5
Family involvement materialsy
Training workshops for early
childhood teachers and trainerschildhood teachers and trainers
Resource kit of non-consumable
suppliessupplies
DVDs of songs for classroom use
40. Integrated Curriculum Unit
Developmentally appropriate for ages 3 – 5
Integrated Curriculum Unit
y g
Hands-on activities in all curriculum areas
Activities pilot-tested with preschoolers and theirActivities pilot tested with preschoolers and their
teachers
Meant to be incorporated into the weeklyMeant to be incorporated into the weekly
curriculum
Fl ibilit f t h i h i ti itiFlexibility for teachers in choosing activities
41. Large Group ActivityLarge Group Activity
H lth B S “E t B kf t”Healthy Bear Says,“Eat Breakfast”
Key Concept: Eat breakfast
Materials: Bear puppet, food models, paper and
marker
45. “Stretch down and draw behind you ”Stretch down and draw behind you.
46. Outdoor ActivityOutdoor Activity
“IWant to Be Active” Obstacle Course
Key Concept: Move your body
Materials: Moveable materials available on the
playground (hula hoops, cones, large blocks, etc.)
47.
48. Family Involvement Materials
Intended to help families reinforce nutrition and
physical activity messages with children
y
physical activity messages with children
Educational family handouts
Interactive bulletin boards
Family night workshop
Activity calendar
Family backpack activitiesFamily backpack activities
49. Training Workshops
Designed to prepare teachers to use Eat Healthy,Be
Training Workshops
Active in their classroom
Background on childhood obesity
Activity demonstrations
Hands-on experience of activities
Exploration of family involvement materials
Discussions of the teacher’s role during meals andg
outdoor play
Participants receive the complete curriculum
50. Resource Kits
Designed to make implementation easy
Resource Kits
and cost-effective.
Contain most non-consumable
materials needed for the curriculum
activities
O d d l b l d bOrganized and labeled by activity
Can be checked out by trainers or child
idcare providers
Borrower is responsible for return
tpostage
51. Music DVDs
S d h l f h
Music DVDs
Songs and rhymes are an integral part of the
curriculum
T h t iti d ti itTeach nutrition and activity messages
Repeat key messages
DVD bl t h t t h th i klDVDs enable teachers to teach the songs quickly
and easily
Performed and recorded by a Georgia children’sPerformed and recorded by a Georgia children s
artist
Distributed at early childhood conferences andDistributed at early childhood conferences and
directly to child care centers
52. E l ti f E t H lth B A ti
Multi-stage evaluation of the curriculum unit,resource kit,
Evaluation of Eat Healthy, Be Active
and 3-hour training session
Measures
Pre-post measure of teachers’ nutrition and physical
activity knowledge
Teachers’ evaluation of curriculum features
Teachers’ self-reported use of curriculum
Observation of teachers’ curriculum implementation
Children’s knowledge of basic concepts about breakfast
Children’s ability to sort foods into basic food groups
53. E l ti f E t H lth B A ti
Participants
Evaluation of Eat Healthy, Be Active
44 teachers and 175 children from 19 child care centers
9 experimental centers
10 control centers
MeasurementTimes
Preliminary center visit
Training workshop (pre- and post-surveys)
Implementation visit (experimental group only)
Follow-up visit (about a month after implementation)
54. Key Evaluation Findings
Teachers’ knowledge of healthy habits increased
during the training
y g
during the training
Teachers described the curriculum and resource
kit as flexible easy to use and developmentallykit as flexible, easy to use, and developmentally
appropriate for preschoolers
T h lik l i l hTeachers were most likely to implement the
activities they practiced in training
55. Challenges and BarriersChallenges and Barriers
Wide variation in the number of activities
implemented and the quality of implementation
Teachers were unlikely to try activities that they did
t ti d i t i inot practice during training
Teachers did not read the curriculum!
S t did t “d i l ” iSome centers did not “do curriculum” in summer
Few food-related words used during mealtimes
N t h ti iti t t h h l b tNot enough activities to teach preschoolers about
breakfast and food groups
56. Revisions Currently Underwayy y
Additional activities to reinforce all five key
conceptsconcepts
2-week implementation schedule, with
recommended activities each dayrecommended activities each day
Simplified curriculum “cheat sheets” that teachers
can keep nearby during the daycan keep nearby during the day
Multi-session training with more hands-on
activity practicey p
Follow-up evaluation of curriculum effectiveness
Additional family involvement toolsAdditional family involvement tools
57. So What?So What?
How are you already addressingy y g
childhood obesity within the early
childhood community?
What more could you do?
How could these ideas and resourcesHow could these ideas and resources
help you?
What other supports do you need?What other supports do you need?
58. Jane Lanigang
Assistant Professor and Human Development Specialist
Washington State UniversityVancouverg y
jlanigan@vancouver.wsu.edu
360-546-9715
Diane Bales
Associate Professor and Human Development Specialist
University of Georgia Cooperative Extension
dbales@uga.edu
706-542-7566
