# Presentation: 136988

##  Nutrition and Physical Activity in Child Care and Afterschool Settings

**Notes:**
[Note to Speakers: You may insert your own contact information on the bottom of this slide]

- Percent Overweight as defined by a BMI>30
- Approximately 59 million adults are obese.

- Centers for Disease Control and Prevention, 2004

**Notes:**
In the last 10 years, obesity rates have increased by more than 60% among adults. Today approximately 59 million or 30% of adults in the U.S. are obese.

[According to the National Heart Lung and Blood Institute (NHLBI), overweight equals a BMI 25-29.9 and Obese = a BMI of 30 or over (BMI stands for Body Mass Index-which is calculated as a ratio of height and weight).]

## Childhood Obesity

- Since the 1970s, obesity prevalence has:
- Doubled for preschool children aged 2-5 years
- Doubled for adolescents aged 12-19 years
- Tripled for children aged 6-11 years
- More than 9 million children and youth over 6 years are obese
- Similar trends in U.S. adults and adults internationally
- 							-IOM, 2004

**Notes:**
As you can see, the trends in childhood obesity are similar to those in adults. 

Since the 1970s, obesity prevalence has 
Doubled for preschool children aged 2-5 years
Doubled for adolescents aged 12-19 years	
Tripled for children aged 6-11 years

More than 9 million children and youth over 6 years are obese.

## Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years

- -Centers for Disease Control and Prevention, 2004

**Notes:**
This chart demonstrates the growing rates of overweight children ages 6-19 over the past several decades.

Numbers represent percentages of children who are overweight or obese.

## Risk of Overweight and Obesity 

- 1 in 4 children is at risk for overweight.
- More than 60 percent of young people eat too much fat.
- Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day.
- -Centers for Disease Control and Prevention, 2004

**Notes:**
In addition to the increasing numbers of overweight and obese children, many more children are at risk due to improper nutrition and inadequate physical activity: 
More than 60 percent of young people eat too much fat.
Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day. 	

Some additional contributing factors to the rise in childhood obesity include:  
 Less exercise and sports in school
2) Lack of recreational facilities—or they are inaccessible due to transportation issues or violence
3) Influence of computer and video games 
4) Food marketing—it is estimated that children and adolescents watch 40,000 television commercials annually—approximately half of these ads market foods high in sugar and/or fat. 

## Implications for Children and Society 

- _Physical Health_
- Glucose intolerance and insulin resistance
- Type II diabetes
- Hypertension
- High cholesterol
- Fatty liver
- Gallstones
- Sleep apnea
- Orthopedic problems

- _Emotional Health_
- Low self-esteem
- Negative body image
- Depression
- _Social Health_
- Stigma
- Negative stereotyping
- Discrimination
- Teasing and bullying
- Social marginalization

- -Centers for Disease Control and Prevention, 2004
- -IOM, 2004

**Notes:**
In addition to weight gain, unhealthy dietary practices and lack of physical activity are contributing factors in many chronic diseases and conditions, including: 
	-Type II diabetes
	-Hypertension
	-High cholesterol 
	-Sleep apnea.

Many of the ailments listed on the slide have been previously thought of as “adult” chronic diseases, but are now being developed at younger ages and at alarming rates. A good example is Type II diabetes previously referred to as ‘adult-onset’ diabetes. Health care providers are increasingly diagnosing young children with this condition, a disease traditionally diagnosed in adults aged 40 years or older. 

Just as important are the many psychosocial conditions that can result from childhood overweight and obesity. For example, depression sometimes associated with obesity/overweight can lead to social isolation, disinterest in normally enjoyed activities, poor grades in school, low self esteem, and poor body image. 

## Benefits of Proper Nutrition and Physical Activity

- Increased bone density
- Enhanced cardiac wellness
- Longer-term reductions in weight and cholesterol levels
- Improvements in body composition
- Lower risk for many chronic diseases
- Support of child growth and development
- Improved grades in school
- Decreased incidents of tobacco and alcohol use
- -Centers for Disease Control and Prevention, 2004

**Notes:**
We know that there are many benefits from proper nutrition and increased physical activity. 

Results from recent clinical studies on the effects on physical activity on obese children and teens have demonstrated positive health outcomes such as:
	-Increased bone density.
	-Enhanced cardiac wellness.
	-Longer-term reductions in weight and cholesterol levels.
	-Improvements in body composition.
	-Lower risk for many chronic diseases.
	-Support of child growth and development.

Trends of increased physical activity also correlate with improved grades in school and decreased incidents of tobacco and alcohol use.

## Recommendations for Nutrition and Physical Activity 

**Energy Balance**
- 	Energy Intake =  Energy Expenditure
**Following the 2005 Dietary Guidelines**

- 	-National Cancer Institute, 2005
- 	-Dietary Guidelines, 2005

**Notes:**
What is proper nutrition and how much physical activity is enough?

To prevent childhood obesity and to improve the health status of our children we should encourage energy balance: where energy intake (calories in) is equal to energy expenditure (calories burned). Of course, to lose weight the energy intake should be less than energy expenditure.

One way to achieve energy balance is to follow the recommendations from the 2005 Dietary Guidelines. Some examples of recommendations for children and adolescents from the dietary guidelines are:
	-Get 60 minutes of physical activity on most if not all days
	-Consume whole-grain products often; at least half the grains should be whole grains. 
	-Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children  	9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. 
	-Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 	percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of 	polyunsaturated and monounsaturated fatty acids, such 	as fish, nuts, and vegetable oils. 

## Child Care and Afterschool Settings: The Perfect Venue to Promote Healthy Lifestyles

- Dietary behaviors and habits of physical activity have their origins in early childhood.
- Child care serves many of the specific groups of children—minorities and those in poverty—most at risk for being overweight.
- School-age children are likely to be sedentary in the afterschool hours if not given active options.
- Providers act as liaisons to parents who make critical nutrition and physical activity decisions for their children.

**Notes:**
So what does all of this have to do with child care and afterschool settings?

Child care and afterschool settings are the perfect venue to promote nutrition and physical activity. Here are just some of the reasons:
Dietary behaviors and habits of physical activity have their origins in early childhood.
	-As more children spend more time in child care settings, the influence that child care providers have on families is 	becoming an important 	aspect of a child’s development.
Child care serves many of the specific groups of children—minorities and those in poverty—most at risk for being overweight.
	-In fact African American, Hispanic, and American Indian adolescents are more at risk to become overweight or 	obese than whites (IOM,	2004).
School-age children are likely to be sedentary in the afterschool hours if not given active options.  
	-Research with youth finds that the most common reason for not participating in sports and other physical activities is 	lack of perceived opportunity to participate and lack of interest.  Child care and afterschool programs can provide 	easy and fun ways for children to become physically active and to eat healthier snacks.
Providers act as liaisons to parents who make critical nutrition and fitness decisions for their children.
	-Research with adolescents finds that parents are the biggest influence on nutrition and physical activity habits.

## Strategies to Promote Nutrition and Physical Activity

- Program
- Policy
- Funding

**Notes:**
Now that you know about the problem, what are some strategies to address it?

There are a variety of strategies and resources to help combat childhood obesity in child care and afterschool settings. I will talk about a few of these strategies around three broad areas: 

1) Incorporating afterschool and child care program elements that promote healthy lifestyles such as implementing activities and curricula.

2) Developing policies to support efforts to promote fitness and wellness in child care and afterschool programs, such as through guidelines and training for providers.

3) Finding resources and developing creative finance strategies, such as public-private partnerships.

Now I will talk more specifically about each of these strategies and provide some examples.

[Note to Speaker: there is a handout outlining examples of program, policy, and funding strategies included in the speaker’s kit] 

## Program Strategies

- Games and Activities
- Curricula and Lesson Plans
- Engaging Parents

**Notes:**
1) Incorporating afterschool and child care program elements that promote healthy lifestyles such as:
	-Incorporating games and activities 
	-Implementing curricula or lesson plans
	-Implementing strategies to engage parents

There are a variety of activities, lesson plans, and materials related to nutrition and physical activity that are often free and easy to implement. 

Several government and government-supported Web sites provide downloadable activities, games, curriculum, and other resources that are relevant to child care and afterschool programs.

## Program Strategies in Action

*VERB: It’s What You Do*
*	*_[http://](http://www.cdc.gov/youthcampaign/)__[www.cdc.gov/youthcampaign](http://www.cdc.gov/youthcampaign/)__[/](http://www.cdc.gov/youthcampaign/)_
*Power of Choice*
*	*_[http://](http://www.fns.usda.gov/tn/resources/power_of_choice.html)__[www.fns.usda.gov/tn/resources/power_of_choice.html](http://www.fns.usda.gov/tn/resources/power_of_choice.html)_
*We Can!*
*	*_[http://](http://wecan.nhlbi.nih.gov/)__[wecan.nhlbi.nih.gov](http://wecan.nhlbi.nih.gov/)_

## Policy Strategies

- Develop physical activity and nutrition guidelines for child care and afterschool programs
- Provide physical activity and nutrition training for child care and afterschool providers
- Help child care and afterschool programs access food nutrition entitlement programs

**Notes:**
This slide outlines a few strategies that policymakers can employ to support the incorporation of nutrition and physical activity into child care settings. 

Supportive policies  can help child care and afterschool providers by: 
Educating them about health, fitness, and nutrition and holding them accountable for incorporating these principles into their programs
Facilitating their access to federal food programs
Informing them of promising practices in the afterschool wellness field and
Involving them in relevant policy discussions 

## Policy Strategies in Action

- Massachusetts Office of Child Care Services: *Healthy Kids Move*
*	*_*[www.qualitychildcare.org](http://www.qualitychildcare.org/)*_
- Children’s Hunger Alliance in Ohio _[http://](http://www.childrenshungeralliance.org/)__[www.childrenshungeralliance.org](http://www.childrenshungeralliance.org/)_

**Notes:**
Here are some examples of the policy strategies discussed on the previous slide:

Several states have been successful in implementing physical activity and nutrition polices such as the Massachusetts Office of Child Care Services. Together with several partners, they were able to develop the Healthy Kids Move training curriculum to educate child care providers on the state’s new health-related licensing requirements.

In Ohio, the Children’s Hunger Alliance provides technical assistance and support to help child care and afterschool programs access U.S. Department of Agriculture nutrition funds.   

[Note to Speakers: to obtain more examples of policy strategies visit www.nccic.org/afterschool]

## Creative Finance Strategies

- Make better use of existing resources
- Create more flexibility in existing categorical funding
- Build public-private partnerships

**Notes:**
Of course it is always challenging to find the resources for developing, operating, and sustaining any initiative....Child care and afterschool programs must be creative in coming up with ways to finance obesity prevention efforts.

This slide provides a few general finance strategies. 
Making better use of existing resources.
Create more flexibility in existing categorical funding.  (Categorical funding supports programs and services for youth or families that meet specific eligibility criteria.)
Build public private partnerships.

## Creative Finance Strategies in Action

- Santa Clara County YMCA blends federal funding streams:
- Steps to a Healthier US Cooperative Agreement
- Carol M. White Physical Education Program

**Notes:**
The YMCA of Santa Clara County in California has used a variety of creative funding strategies including all of the strategies discussed on the previous slide to fund health and wellness curricula in 57 afterschool programs. They use funds from the Carol M. White Physical Education Program, a grant administered through the Department of Education, and also appealed to their county public health department to partner in leveraging Steps to a Healthier US funds. 

 A little more about these funding streams:
Carol M. White Physical Education Program: Through discretionary/project grants this program provides funding support to local education agencies and community-based organizations such as after school programs for children k-12. Monies support innovative approaches to promote the benefits of health and physical activity among youth. The program also provides funding for training and education for teachers and staff, as well as equipment and support. 

Steps to a Healthier US Cooperative Agreement: This initiative, from the Department of Health and Human Services, is designed to help Americans, especially children, live longer, better, healthier lives. One primary goal is the improvement of personal health and fitness by being physically active, eating a nutritious diet, getting preventative screenings, and making healthy choices regarding alcohol, drugs, tobacco, and safety. 

[Note to Speakers: to obtain more examples of finance strategies visit www.nccic.org/afterschool]

## Additional Resources

*Fit Source*: an interactive Web site of nutrition and physical activity resources_[http://](http://nccic.org/fitsource)__[nccic.org/fitsource](http://nccic.org/fitsource)_
*Promoting Fitness and Nutrition in Afterschool Settings: Strategies for Program Leaders and Policy Makers** *_*[http://](http://www.financeproject.org/)*__*[www.nccic.org/afterschool](http://www.financeproject.org/)*_
*Promoting Nutrition and Physical Activity in Child Care Settings* *Speaker’s Kit*
- 	_[http://](http://nccic.org/fitsource)__[nccic.org/fitsource](http://nccic.org/fitsource)_

## Questions and Comments

**Notes:**
[Note to Speakers: You may also add your own contact information to this page]