Guest Post: Jim Sallis on Physical Activity and Childcare

Jim Sallis

Jim Sallis is the author of this post.  Sallis is the director of Active Living Research.

I have three reactions to the Healthy Kids, Healthy Future conference thus far:

1. We had a lesson in how easy it is to integrate physical activity into routines.  Mary Story called for a quick activity break to perk up the group.  In about a couple of minutes, we got people up, walking in place, and acting out favorite activities they did as young children.  I was glad for all the childcare experts to experience this, because they could encourage similar activities in childcare centers.  These centers need more easy, quick, and fun activities, in addition to longer structured and unstructured activity times.

2. About 25 years ago, our research group was preparing for a study of activity and nutrition in preschool children.  We visited several preschools to learn how they operated and observe how the day was organized.  What was most striking was the detailed thought and planning that went into keeping the kids quiet and sitting all day.  They devised engaging listening, reading, arts & crafts, and sharing activities, all of which required children to be sitting.  Physical activity was strictly controlled and limited to specific times and places.  Most centers only let the children outdoors once per day.  I have been pleased to hear about “I’m Moving I’m Learning” several times during this meeting.  I would like to see much more research on this topic, with quick dissemination to childcare centers across the country.  A key part of the training needs to prepare teachers to tolerate kids being active in class.

3. There were several encouraging opportunities in Ms Rudisill’s presentation.  The Child Health Bureau provides substantial support for infrastructure in childcare.  A National Center for Physical Development and Outdoor Play is being developed as part of Head Start.  I would like to see both of these efforts to improve the play equipment at childcare centers.  To make sure those funds are well spent, we need more research on the characteristics of play equipment and playgrounds that stimulate active play most effectively.

Using Head Start to Jump Start the Health of U.S. Kids

Shannon Rudisill with the official food pyramid

Head Start, which provides federal grants for child development to economically disadvantaged children and families, serves more than 900,000 children in America each year.  According to Katrina Holt, director of the National Maternal and Child Oral Health Resource Center at Georgetown University, it could be the perfect place to pilot new programs that promote health.

“Head Start is a great vehicle for prevention and early intervention,” Holt explained.  “And it addresses our most vulnerable populations.”

Indeed, many Head Start participants are eligible for Medicaid and, because of their income level, may be at a higher risk for poor health.  Wellness promotion programs to address nutrition, oral health and obesity prevention, Holt said, would be a tremendous benefit to children in the program.

“Rates of obesity are higher with this group,” Holt said.  “They’re the ones we want to reach most.”

In addition to serving this important group, Head Start has a screening and assessment system already in place to track the health of its participants.  For a pilot program to show useable results, these data would be critical, Holt explained.

This potential is not lost on Head Start, which is piloting several health promotion programs among its grantees.  The “I Am Moving, I Am Learning” program, for example, combats childhood obesity with more time for physical activity, more structured play facilitated by trained teachers, and more nutritious food for children each day.

The challenge, according to Shannon Rudisill, associate director of the Child Care Bureau at the Administration for Children and Families, HHS, is to “take the fantastic, well-evaluated ideas in the public domain developed by Head Start and implement them more broadly.”

Building the case for early health interventions with solid results from pilot programs in Head Start, Holt explained, will be essential to expanding such programs to reach all children in the U.S.

Day Two Begins

Welcome to day two of the Healthy Kids, Healthy Future conference here in Washington, D.C.  We’re under way with the first panel, which looks at opportunities for states to promote wellness in early care and education.  Tune in for all-day coverage of the proceedings and contribute your thoughts in the comments.  You can find yesterday’s coverage below.

Day One Wrap-Up: Healthy Kids, Healthy Future

Thanks to all who joined us for the first day of live coverage from Healthy Kids, Healthy Future.  We heard from experts, listened to productive group discussion and wrote a variety of posts on obesity and childcare.  The blog covered:

• President Obama’s request to Secretary Vilsack: “I want our children to have more nutritious food”
• Why one in three preschoolers are overweight or obese, and what we can do about it
• How much physical activity children get in daycare.  The answer: less than you might think
• Early success in New York City to bring healthy food and physical activity to kids in daycare
• How a standing ovation can be good for your health

Tomorrow, we’ll keep the coverage going with a full day of original content.  Highlights will include:

• Conversation with Bill Dietz of CDC on funding opportunities in the American Recovery and Reinvestment Act
• Panel with Kevin Concannon, Under Secretary, Food, Nutrition and Consumer Services at USDA
• Reactions from Administration and Hill staff

We’ll see you here in the morning!

“Preschool is too Late”

Lynn Silver

As a pediatrician, Lynn Silver was shocked when she found out that a quarter of kids in New York City are obese by age two. As assistant commissioner of the NYC Department of Health and Mental Hygiene, she knew she had to do something, and that starting in preschool would be too late.

In 2006, the city issued regulations on nutrition, physical activity and screen time in daycare centers. They include:

• Prohibiting access to sugar-sweetened beverages
• Limiting juice to just 6 ounces per day
• Prohibiting trans fats and reducing sodium in foods
• Ensuring kids get at least an hour of physical activity per day
• Reducing time spent watching TV

Before implementing the policies, the city began training and equipping daycare centers, pre-schools and K-3 teachers — starting in those communities at greatest risk. To date, they’ve trained over 10,000 daycare staff members at nearly 1,400 sites.

Early evaluation indicates that compliance with beverage, physical activity, and TV requirements is high. And while some standards are more difficult to evaluate, such as those regarding specific nutrients like sodium and the quality of physical activity, early signs are encouraging.

The CDC and the Robert Wood Johnson Foundation are funding further evaluations of policy compliance, along with direct observations of participating daycare centers. And the city has begun BMI assessments for students entering kindergarten, to examine the direct impact of these policy changes.

Silver pointed out that the city requirements were discussed, approved and implemented without controversy.  When asked why she thought this might be, she replied that it could be “because we started our training and support first, before enacting the requirements,” emphasizing that engaging daycare directors first could be key to keeping kids active – and healthy.

A Bright Idea: Stand Up When You Applaud

“Stand up when you applaud!”

Jim Sallis, director of Active Living Research, started today’s session with a group stretch and a call to walk the talk around physical activity.  Sitting down for two hours at a time isn’t good for you, he argued.  The solution?  A standing ovation – or several.

Jim’s active applause is motivated by new data showing that sitting is a risk factor for obesity and chronic diseases like diabetes.  “Even at the same amount of sitting,” Sallis said, “breaking it up by standing reduces the physical impact.”

Activity breaks – even brief ones like standing to applaud – can keep the body healthy and the mind awake.

And that, says Sallis, is a good thing.  ”It’s just one way to build physical activity into our daily routines.”

How Active is Your Child at Day Care?

“How active is your child at day care?” researcher Sara Benjamin asked an audience of early childhood experts.  The guesses varied from 15 minutes to an hour, but none were optimistic.

An average eight-hour day of childcare, Benjamin explained, contains “less than one hour” of moderate to vigorous physical activity.  This is according to her study, which she previewed today at the Heathy Kids, Healthy Future conference.

Benjamin’s study aims to assess a new regulation in Massachusetts that requires all childcare centers to provide 60 minutes of physical activity per day.  The centers she measured in Massachusetts – and a control group in Rhode Island – all fell short.

In Massachusetts, children were sedentary (not including eating or sleeping) for 150 minutes per day, and spent 41 minutes engaging in physical activity.  In Rhode Island, children fared worse.  They spent 165 minutes – more than 2.5 hours – in sedentary activities with only 29 minutes out of an eight-hour day devoted to physical activity.  The study methodology considered all activity more vigorous than walking as qualified physical activity.

For the three-quarters of US children who attend day care, half of whom attend centers like the ones Benjamin measured, these findings are indicative of a worrying trend.

“Children are largely inactive,” said Benjamin.  “2, 3, and 4 year-olds should be out running around.”

For parents of these children, the results may be surprising.

“When you ask parents, they think kids are very active,” Benjamin explained.  “Parents would be surprised to learn how inactive their kids are in childcare.”

Photo Post: Around the Conference, Day 1

Read on after the jump for more photos from today’s proceedings.  (Click to enlarge.)
Read more »

“One in Three Preschoolers are Overweight or Obese”

So warned Debbie Chang, Vice President of Policy and Prevention for Nemours, in her opening remarks at today’s Healthy Kids, Healthy Future conference in Washington, D.C.  And overweight preschoolers, she continued, are at greater risk of becoming overweight adults. After laying out these sobering statistics, Chang welcomed participants to the first ever conference to examine the role of early child care  in obesity prevention.

More than a convenience

Three quarters of kids under six spend part of their day in childcare.  For Chang, this means that childcare “is more than a convenience – it’s a partnership.”  She called for an array of programs, policies and environmental changes to make childcare a place where children eat healthier foods and get more physical activity.

She also shared the story of the Latin American Community Center in Wilmington, Del. Since partnering with Nemours, the executive director of the community center, Maria Matos, has transformed the foods the center provides for participating children. They’ve removed vending machines.  They’ve cut out sugar-sweetened beverages, and now serve only water, skim and low-fat milk.  They’ve eliminated fried foods altogether.

Chang used this example to implore those in the room to harness what they know, break down barriers, and spread what works. When, as Chang noted, the most commonly consumed vegetable among kids 15 to 18 months old is French Fries, there is vast potential for improvement.

“Creating the changes we want to see will take planning, direction, energy and motivation,” Chang reminded participants. “And it doesn’t end here, we have to keep it moving after we leave.”

Slides from Debbie Chang’s presentation are available here.

Obama to Vilsack: “I want our children to have more nutritious food.”

Upon accepting a position as Secretary of Agriculture, Tom Vilsack heard a clear directive from his new boss, President Obama:

“I want our children to have more nutritious food.”

With the upcoming reauthorization of the Child Nutrition Act, Vilsack is pursuing numerous initiatives to address the President’s request.  Today, at the Healthy Kids, Healthy Future conference, he announced several priorities:

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

• Additional funding: Ask Congress for an increase in WIC funding from $6.9 billion to $7.7 billion to meet expanded demand for the program, which reaches 49% of children.
• Electronic benefit redemption: $3 million in new grants to allow a number of states to implement systems that will allow WIC recipients to buy food with a card or similar device.
• Computer system upgrades: $5 million for states to make necessary upgrades that will ensure the integrity of the program.

National School Lunch Program and School Breakfast Program

• Expand access: Simplify the ways people qualify for participation.
• Reduce stigma: No child should be tagged as a recipient of subsidized food.
• Improve standards: Implement nutrition standards consistent with the food pyramid.
• Increase activity: Focus on increasing the physical activity that children receive in schools.
• Focus on vending: Make a concerted effort to focus on nutritional value of what’s available in vending machines.

All of this requires investment, Vilsack explained.  But he also emphasized that there is a return on investments in WIC: school nutrition and obesity prevention impacts other parts of the budget favorably.  For every dollar invested in WIC, three dollars are saved from the Medicaid program.  As Vilsack noted to a knowing laugh from the crowd, not many programs in Washington see that kind of return on investment.

Vilsack concluded his talk with a positive outlook on environment for making the changes that President Obama asked for when invited Vilsack to join the USDA.

“The country is ready for this,” Vilsack said.  “There’s a growing sense among folks that this is something we need to be taking far more seriously than we have been.”

Update: The official USDA press release is now available at usda.gov.