childhood obesity - fr conference
DESCRIPTION
Presentation on childhood obesity prevention in early childhood settings. Presented April 28, 2011 at the DOD/USDA Family Resilience conference, Chicago, IL.TRANSCRIPT
Engaging Early Learning and Care Engaging Early Learning and Care Providers in Obesity Prevention Efforts:
Promising Practices and BarriersJane Lanigan, Washington State University Diane Bales, The University of Georgia
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?
Body Mass IndexyOverweight 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.
Obesity Trends* Among U.S. AdultsBRFSS 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%
Overweight and Obesity in ChildrenOverweight and Obesity in ChildrenFor children and adolescents (aged 2–19 years), g ythe BMI value is plotted on the CDC growth charts to determine the corresponding BMI for gage 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.
Prevalence of Childhood Obesityy
Childhood Obesity: Consequences
Health concernsHeart disease
An estimated 61% of overweight children have one risk factor
Type 2 diabetesIt is estimated that 1 in 3 American children born in 2000 will develop Type p yp 2 diabetes in their lifetime (JAMA, 2003)
AsthmaO th di blOrthopedic problemsSkin DisordersSleep apneaSleep apnea
Childhood Obesity: ConsequencesChildhood Obesity: ConsequencesOther Concerns
Decreases in school achievementPositive correlation between childhood
i ht d l t b toverweight and early-onset pubertyPsychological effects
Negative self-conceptNegative self conceptLow self-esteemTeasing by peersg y pLoneliness and social isolationSocial discriminationDepression
Causes of Childhood OverweightCauses of Childhood Overweight
Genetic tendency, based on differences in
AppetiteActivity levelActivity levelMetabolism rate
Proximal cause: taking in more l h h b d calories than the body usesEating too many caloriesNot getting enough physical activityg g g p y yLack of physical activity has more impact
Childhood Overweight FactsChildhood Overweight FactsNegative 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
Brainstorming Activity
How did we get ghere?What contributing What contributing factors can you think
fof?
Changes in Eating Patterns Changes in PA PatternsChanges in Eating Patterns•Portion Size•Marketing Influences•Processed Foods
Changes in PA Patterns•Screen Time•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
OBESOGENIC OBESOGENIC ENVIRONMENT
Normalizing Larger Body Size
Portion Distortion
SANDWICHFRENCH FRIES SANDWICHFRENCH FRIES
Calorie Difference: 500 Calories
610 calories6.9 ounces
210 calories2.4 ounces
320 calories 820 calories
Calorie Difference: 400 Calories
Source: NHLBI ‐ OEI
Media and other Sedentary ActivitiesMedia and other Sedentary Activities
Media use DisplacementMindless eating
Marketing influencesChild 2 5 d t 5 400 Children 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
Points of Intervention: Earlier is BetterPoints of Intervention: Earlier is BetterMulti-level approach
Family Context
Community ContextCommunity supports for healthy eating and PASystems with which families interact
WICWIC
Extension nutrition programs
Medical care
E l L i d CEarly Learning and Care
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 i this a critical obesity prevention context.
Community Partners Child Care SettingCommunity Partners Child Care SettingHead StartFor profit Centers
EOCFLearning Avenues p
Not-for-profit Community based child care centersCollege/University Lab
Learning AvenuesInnovative ServiceYWCA
College/University Lab schoolsCenters serving
l ti ith i l populations with special needsFamily Child Care Homes
Style FoodPreference Intake
Eating
Structured UnstructuredMVPA
Physical Activity
Healthy W i htWeight
Health Belief ModelChild id ld b t lik l t d t id b d Child 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 of g g qsupport to move them along the continuum.
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
INTERVENTIONINTERVENTION
Inclusive Site Wellness Committees identify annual improvement y pgoals.
ENHANCE supports their efforts by providing:Assessment of current practices and comparison with evidence-based practicesTraining and Resources Training and Resources Mini-grantsCheck-out KitsForum for sharing ideas
MeasuresMeasures
• Protocol for Mapping Current Policies and Practices
T1/Baseline
• Child Care Provider Obesity Prevention Survey
T2/End of Year 1
Prevention Survey
• Child Role Play/Interview Protocol
Child BMI
T3/End of Year 2
• Child BMI
Child Interviews
Key Findings and I li iInterviews
Intervention efforts should help i
Implications
caregivers: Become more intentional and explicit in their communication explicit in their communication related to healthy eating and physical activity benefitsDevelop key messages for delivery across contexts in which children which children Use evidence-based practices
Self-regulationgIntroducing new foods
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 d Making healthy food and beverage choices outside mealtimeUnderstanding the benefits of Physical Activity
Young children can guide intervention efforts by serving as key informants and reflect the key informants and reflect the obesogenic environment
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 countering Understanding 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.
Improvement in Feeding Practices and Nutrition EducationNutrition Education
Baseline-T1Paired t test
T1-T2Paired t test
Baseline-T2GLM Repeat
Measurest = 3.51; p = .003 t = 2.38; p = .036 F = 5.72; p = .005
Improvement in Physical Activity PracticesPractices
Baseline-T1Paired t test
T1-T2Paired t test
Baseline-T2GLM Repeat
MeasuresMeasurest = 2.73; p = .010 t = 2.84; p = .007 F = 3.91; p = .031
Improvement in Communicationp
Baseline-T1Paired t test
T1-T2Paired t test
Baseline-T2GLM Repeat Paired t test Paired t test GLM Repeat
Measurest = 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
Reduced Improved Greater Reduced
Misconceptions
Improved
EfficacyFeeding
knowledge
Improvements in:
Nutrition Education (R2 = .69)
Family Communication (R2 = .30).
F di P i (R2 27)Feeding Practices (R2 = .27)
I d Increased Adult Salience
Leadership
Improvements in Physical Activity
Practices Increased Barriers
Observations: ImplicationsObservations: Implications
N i i i l i h Non-prescriptive, inclusive approach appears effective in promoting healthy change.
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 t Identify 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.
Eat Healthy, Be Active: y,Addressing Childhood Overweight by Educating
Parents and Young Childreng
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 yincreasing 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
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 adultsEducate children
Why Eat Healthy, Be Active?y y,
The early childhood classroom is an ideal place to y pteach 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.
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
Key Methods for Teaching P h lPreschoolers
Reinforce the key conceptsy
Keep it simple!
Infuse concepts into every Infuse concepts into every part of the curriculum
Repeat repeat repeatRepeat, repeat, repeat
Be a positive role model
Components of Eat Healthy, Be A i
Integrated curriculum unit for ages Activeg 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
Integrated Curriculum UnitDevelopmentally appropriate for ages 3 – 5
Integrated Curriculum Unity g
Hands-on activities in all curriculum areas
Activities pilot-tested with preschoolers and their Activities pilot tested with preschoolers and their teachers
Meant to be incorporated into the weekly Meant to be incorporated into the weekly curriculum
Fl ibilit f t h i h i ti itiFlexibility for teachers in choosing activities
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
Healthy Bear Says “Eat Breakfast”Healthy Bear Says, Eat Breakfast
Art ActivityArt Activity
Sill St t h A tSilly Stretch ArtKey Concept: Stretch your body
Materials: Large sheets of paper, drawing tools
“Stretch forward and draw a circle ”Stretch forward and draw a circle.
“Stretch down and draw behind you ”Stretch down and draw behind you.
Outdoor ActivityOutdoor Activity“I Want to Be Active” Obstacle CourseKey Concept: Move your body
Materials: Moveable materials available on the playground (hula hoops, cones, large blocks, etc.)
Family Involvement MaterialsIntended 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
Training WorkshopsDesigned to prepare teachers to use Eat Healthy, Be
Training Workshops
Active in their classroomBackground on childhood obesityActivity demonstrationsHands-on experience of activitiesExploration of family involvement materialsDiscussions of the teacher’s role during meals and goutdoor playParticipants receive the complete curriculum
Resource KitsDesigned to make implementation easy
Resource Kits
and cost-effective.Contain most non-consumable materials needed for the curriculum activitiesO d d l b l d b Organized and labeled by activityCan be checked out by trainers or child
idcare providersBorrower is responsible for return
tpostage
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 it Teach nutrition and activity messagesRepeat key messages
DVD bl t h t t h th i kl DVDs enable teachers to teach the songs quickly and easilyPerformed and recorded by a Georgia children’s Performed and recorded by a Georgia children s artistDistributed at early childhood conferences and Distributed at early childhood conferences and directly to child care centers
E l ti f E t H lth B A tiMulti-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
E l ti f E t H lth B A tiParticipants
Evaluation of Eat Healthy, Be Active
44 teachers and 175 children from 19 child care centers9 experimental centers10 control centers
Measurement Times
Preliminary center visit
Training workshop (pre- and post-surveys)
Implementation visit (experimental group only)
Follow-up visit (about a month after implementation)
Key Evaluation FindingsTeachers’ 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 developmentally kit as flexible, easy to use, and developmentally appropriate for preschoolers
T h lik l i l h Teachers were most likely to implement the activities they practiced in training
Challenges and BarriersChallenges and BarriersWide variation in the number of activities implemented and the quality of implementationTeachers were unlikely to try activities that they did
t ti d i t i inot practice during trainingTeachers did not read the curriculum!S t did t “d i l ” i Some centers did not “do curriculum” in summerFew food-related words used during mealtimesN t h ti iti t t h h l b t Not enough activities to teach preschoolers about breakfast and food groups
Revisions Currently Underwayy yAdditional activities to reinforce all five key conceptsconcepts2-week implementation schedule, with recommended activities each dayrecommended activities each daySimplified curriculum “cheat sheets” that teachers can keep nearby during the daycan keep nearby during the dayMulti-session training with more hands-on activity practicey pFollow-up evaluation of curriculum effectivenessAdditional family involvement toolsAdditional family involvement tools
So What?So What?How are you already addressing y y gchildhood obesity within the early childhood community?
What more could you do?
How could these ideas and resources How could these ideas and resources help you?
What other supports do you need?What other supports do you need?
Jane Lanigang
Assistant Professor and Human Development Specialist
Washington State University Vancouverg y
360-546-9715
Diane Bales
Associate Professor and Human Development Specialist
University of Georgia Cooperative Extension
706-542-7566