Preventing Childhood Obesity:
Best Practice Strategies in Nutrition and
Physical Activity in Early Learning
Adapted by Betty Williams, MSW
Betty.Williams@seattlecolleges.edu
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
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
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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
•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
• Diabetes Type 2
• High Blood
Pressure/Hypertension
• High Cholesterol
• Heart Disease/Stroke
• Higher health care costs
• Quality of Life issues
Short Term Health Risks
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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, letsmove.gov
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
OEI-NHLBI Slide Show Menu Page
http://hp2010.nhlbihin.net/oei_ss/menu.htm#PD2
Healthy Weight for Children
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Infant Feeding Practices
Nutrition
Mealtime Socialization
Screen Time Limits
Physical Activity
Childhood Obesity Prevention
Infants and Toddlers
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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
Support, encourage
and accommodate
breastfeeding Moms
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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
15
Childhood Obesity Prevention
Nutrition
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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
• 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
• 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 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
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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
Main goal - self regulation
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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
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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
• 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
YOU!
Brain Games for Babies, Jackie Silberg, 2nd Edition, 2005
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 Kaihttp://www.kff.org/entmedia/upload/7500.pdfser Family Foundation
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
• 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
• > 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
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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
• Physical Development
• Fitness
• Energy Balance
• Disease Prevention
• Social/Emotional Development
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
• 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
http://video.ucdenver.edu/users/lfields/c413a27e-b88f-4899-a6a29d2108041553.html
It All Adds Up!
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