Engaging Early Learning and CareEngaging Early Learning and Care
Providers in Obesity Prevention Efforts:
Promising Practi...
Today’s AgendaToday’s Agenda
• Definitions of overweight and obesity
• Prevalence of obesity
• Causes and risks of childho...
Body Mass Indexy
Overweight and obesity are measured in adults by Body
Mass Index (BMI)Mass Index (BMI)
BMI = weight (in k...
Obesity Trends* Among U.S. Adults
BRFSS 1990 1999 2009
1999
BRFSS, 1990, 1999, 2009
(*BMI ≥30, or about 30 lbs. overweight...
Overweight and Obesity in ChildrenOverweight and Obesity in Children
For children and adolescents (aged 2–19 years),g y
th...
Prevalence of Childhood Obesityy
Childhood Obesity: Consequences
Health concerns
Heart disease
An estimated 61% of overweight
children have one risk factor...
Childhood Obesity: ConsequencesChildhood Obesity: Consequences
Other Concerns
Decreases in school achievement
Positive cor...
Causes of Childhood OverweightCauses of Childhood Overweight
Genetic tendency, based on
differences in
Appetite
Activity l...
Childhood Overweight FactsChildhood Overweight Facts
Negative correlation between birth weight and risk of
childhood overw...
Brainstorming Activity
How did we getg
here?
What contributingWhat contributing
factors can you think
fof?
Changes in Eating Patterns Changes in PA PatternsChanges in Eating Patterns
•Portion Size
•Marketing Influences
•Processed...
Portion Distortion
SANDWICHFRENCH FRIES SANDWICHFRENCH FRIES
Calorie Difference: 
500 Calories 
610 calories
6.9 ounces
21...
Media and other Sedentary ActivitiesMedia and other Sedentary Activities
Media use
Displacement
Mindless eating
Marketing ...
Points of Intervention: Earlier is BetterPoints of Intervention: Earlier is Better
Multi-level approach
Family Context
Com...
RATIONALERATIONALE
• We CAN reverse the trend and counter the current obesogenic
environment
• Need a systems approach
• A...
Community Partners Child Care SettingCommunity Partners Child Care Setting
Head Start
For profit Centers
EOCF
Learning Ave...
Style
Food
Preference Intake
Eating
Structured UnstructuredMVPA
Physical Activity
Healthy
W i htWeight
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
pr...
SAMPLESAMPLE
• 663 children ages 3 5 attending• 663 children ages 3 - 5 attending
ENHANCE child care sites
• 50% were from...
INTERVENTIONINTERVENTION
Inclusive SiteWellness Committees identify annual improvementy p
goals.
ENHANCE supports their ef...
MeasuresMeasures
• Protocol for Mapping Current Policies
and Practices
T1/Baseline
• Child Care Provider Obesity
Preventio...
Child
Interviews
Key Findings and
I li iInterviews
Intervention efforts should help
i
Implications
caregivers:
Become more...
Child
Interviews
Key Findings and
I li iInterviews
Media use was preferred over active
Implications
leisure pursuits.
Cont...
Provider
Surveys
Key Findings and
I li iSurveys
• Child care providers are uncertain of
Implications
their role and potent...
Improvement in Feeding Practices and
Nutrition EducationNutrition Education
Baseline-T1
Paired t test
T1-T2
Paired t test
...
Improvement in Physical Activity
PracticesPractices
Baseline-T1
Paired t test
T1-T2
Paired t test
Baseline-T2
GLM Repeat
M...
Improvement in Communicationp
Baseline-T1
Paired t test
T1-T2
Paired t test
Baseline-T2
GLM RepeatPaired t test Paired t t...
Reduced Improved GreaterReduced
Misconceptions
Improved
Efficacy
Feeding
knowledge
Improvements in:
Nutrition Education (R...
I dIncreased
Adult Salience
Leadership
Improvements in
Physical Activity
Practices
Increased Barriers
Observations: ImplicationsObservations: Implications
N i i i l i hNon-prescriptive, inclusive approach appears
effective i...
Observations: ImplicationsObservations: Implications
State policy effectively regulates media useState policy effectively ...
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
an...
Why Eat Healthy, Be Active?y y,
Healthy (and unhealthy) habits
form earlyform early.
Adults create the food
environment fo...
Why Eat Healthy, Be Active?y y,
The early childhood classroom is an ideal place toy p
teach about healthy habits.
Preschoo...
Key Concepts for PreschoolersKey Concepts for Preschoolers
Eat breakfast
Eat a variety of foods (no “bad” food!)
Stop when...
Key Methods for Teaching
P h lPreschoolers
Reinforce the key conceptsy
Keep it simple!
Infuse concepts into everyInfuse co...
Components of Eat Healthy, Be
A i
Integrated curriculum unit for ages
Active
g g
3- 5
Family involvement materialsy
Traini...
Integrated Curriculum Unit
Developmentally appropriate for ages 3 – 5
Integrated Curriculum Unit
y g
Hands-on activities i...
Large Group ActivityLarge Group Activity
H lth B S “E t B kf t”Healthy Bear Says,“Eat Breakfast”
Key Concept: Eat breakfas...
Healthy Bear Says “Eat Breakfast”Healthy Bear Says, Eat Breakfast
Art ActivityArt Activity
Sill St t h A tSilly Stretch Art
Key Concept: Stretch your body
Materials: Large sheets of paper,...
“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
“IWant to Be Active” Obstacle Course
Key Concept: Move your body
Materials: Moveable mate...
Family Involvement Materials
Intended to help families reinforce nutrition and
physical activity messages with children
y
...
Training Workshops
Designed to prepare teachers to use Eat Healthy,Be
Training Workshops
Active in their classroom
Backgro...
Resource Kits
Designed to make implementation easy
Resource Kits
and cost-effective.
Contain most non-consumable
materials...
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...
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...
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 car...
Key Evaluation Findings
Teachers’ knowledge of healthy habits increased
during the training
y g
during the training
Teache...
Challenges and BarriersChallenges and Barriers
Wide variation in the number of activities
implemented and the quality of i...
Revisions Currently Underwayy y
Additional activities to reinforce all five key
conceptsconcepts
2-week implementation sch...
So What?So What?
How are you already addressingy y g
childhood obesity within the early
childhood community?
What more cou...
Jane Lanigang
Assistant Professor and Human Development Specialist
Washington State UniversityVancouverg y
jlanigan@vancou...
Childhood Obesity - FR Conference
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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. 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. 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. 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. 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. 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.
  6. 6. Prevalence of Childhood Obesityy
  7. 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. 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. 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. 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
  11. 11. Brainstorming Activity How did we getg here? What contributingWhat contributing factors can you think fof?
  12. 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
  13. 13. Portion Distortion SANDWICHFRENCH FRIES SANDWICHFRENCH FRIES Calorie Difference:  500 Calories  610 calories 6.9 ounces 210 calories 2.4 ounces  320 calories 820 calories Calorie Difference:  400 Calories  Source: NHLBI ‐ OEI
  14. 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. 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. 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. 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
  18. 18. Style Food Preference Intake Eating Structured UnstructuredMVPA Physical Activity Healthy W i htWeight
  19. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  29. 29. Reduced Improved GreaterReduced Misconceptions Improved Efficacy Feeding knowledge Improvements in: Nutrition Education (R2 = .69) Family Communication (R2 = .30). F di P i (R2 27)Feeding Practices (R2 = .27)
  30. 30. I dIncreased Adult Salience Leadership Improvements in Physical Activity Practices Increased Barriers
  31. 31. Observations: ImplicationsObservations: Implications N i i i l i hNon-prescriptive, inclusive approach appears effective in promoting healthy change.
  32. 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. 33. Eat Healthy, Be Active:y, Addressing Childhood Overweight by Educating Parents and Young Childreng
  34. 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. 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. 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. 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. 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. 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. 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. 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
  42. 42. Healthy Bear Says “Eat Breakfast”Healthy Bear Says, Eat Breakfast
  43. 43. Art ActivityArt Activity Sill St t h A tSilly Stretch Art Key Concept: Stretch your body Materials: Large sheets of paper, drawing tools
  44. 44. “Stretch forward and draw a circle ”Stretch forward and draw a circle.
  45. 45. “Stretch down and draw behind you ”Stretch down and draw behind you.
  46. 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. 47. 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
  48. 48. 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
  49. 49. 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
  50. 50. 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
  51. 51. 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
  52. 52. 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)
  53. 53. 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
  54. 54. 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
  55. 55. 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
  56. 56. 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?
  57. 57. 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
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