Day Two Wrap-Up: Healthy Kids, Healthy Future

What a day!  We’ve just concluded the second and final full day (see day one highlights) of the Nemours conference, Healthy Kids, Healthy Future. The site has featured:

• How the Head Start program can promote health
• Jim Sallis’ thoughts on how to incorporate physical activity into kids’ days
• Under Secretary Concannon’s call for innovation
• An a-ha moment from Margo Wootan
• A chat with Bill Dietz
• And much more

All of the speakers’ presentations are now available for download here.  Over the next few days, check back for further updates, including:

• A collective brainstorm on what the next three years will look like
• A Q&A with Joe Thompson, director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity
• Thoughts from Nemours President and CEO Dr. David J. Bailey

As Bill Dietz said at the conclusion of today’s conference, the “original goal for this meeting was having the right mix of people in the room.  Not just the right people to exchange information,” he told the audience, “but the right people to act on it afterwards.”

“I think we’ve accomplished that.”
Original goals for this meeting was having the right mix of people in the room. Not just the right people to exchange information, but the right people to act on it afterwards.

A Much-Needed Policy Perspective

Martha Coven, Dan Christenson, and Kate Coler

This afternoon, conference participants were joined by a panel of representatives from the White House and Senate Committee on Agriculture, Nutrition and Forestry, who heard participant’s priorities and offered their own feedback.

Martha Coven, director of the White House Office of Mobility and Opportunities, Dan Christenson, professional staff member of Committee Chairwoman Blanche Lincoln, and Kate Coler, senior policy director for Committee Ranking Member Saxby Chambliss, provided a much-need policy perspective to the discussion.

Need for Research

Because obesity is influenced by so many factors, and numerous federal agencies have a role to play, the Administration and Hill staff emphasized the need to have solid, specific research at their fingertips. As Christenson put it, “we need data on what’s going on in childcare across the country. We need information on how much physical activity they’re getting, what they’re eating, and how much time they’re spending in front of the TV.” All three panelists expressed enthusiasm for the first waves of research being presented at the conference.

Importance of Collaboration

Several conference participants had questions about how they could most effectively inform the various agencies and Congressional committees on health, education and human services – so that effective policies and recommendations are developed in sync.

Coler emphasized that “innovation starts at the state and local level. We are here to learn from your examples and extend those innovations.” Additionally, Coven noted that, to the extent the researchers and advocates can identify specific barriers to their progress, the policy-makers and Administration can help them break those down. Adding that “we’re here to encourage and reward the programs that are the most promising.”

Moving Forward

Although Christenson noted that Sen. Lincoln is deeply involved in the Finance committee’s markup of health reform legislation, he emphasized that she is still strongly committed to passing a robust reauthorization of the Child Nutrition program. In their closing remarks, the panelists asked conference participants to:

• Continue to push innovative state and local programs and practices,
• Show them how federal programs, and CACFP in particular, can be used to prevent chronic disease, and
• Extend their strong commitment to the issue and begin working more with parents and families as well.

A Chat with Bill Dietz

Bill Dietz

Bill Dietz is director of the Department of Nutrition, Physical Activity, and Obesity at the CDC.

On Vilsack’s speech:

• “He hit the high points. It’s great that the Child Nutrition Act and the Child and Adult Care Food Program are on his priority list.”

On the issue of childcare and obesity prevention:

• “We’ve elevated this issue to a different level. More and more people are thinking about it and acting where they can.”

On the American Recovery and Reinvestment Act:

• “There are opportunities for intervention in childcare programs in the scope of this funding. And there is $373 million to support tobacco cessation programs and nutrition and physical activity programs. ”

On what the CDC hopes to get out of this conference:

• “We want to outline strategies for reaching target behaviors in childcare. Part of why we’re here is to hear what’s working at the state level.”

Update: Dietz had some encouraging words for participants in his closing remarks:

“I’m speaking in two weeks to the Association of State and Territorial Health Officials and I’ll be sure to share with them what I’ve heard here.”

“The cross-departmental collaboration is underway at the federal level, and it’s going to continue.”

“We need to be prepared for the release of the Institute of Medicine’s report on the Child and Adult Care Food Program, and use that to leverage media and other attention to create national standards.”

“Our planning committee needs to have a life beyond this conference. It can move our recommendations forward.”

Ah-Ha Moment: We can’t be Intimidated

“At first, it was daunting to me,” recalls Margo Wootan, describing the challenge of improving nutrition and physical activity for kids in childcare.   Wootan, director of Nutrition Policy at the Center for Science in the Public Interest, said it was a matter of fragmentation.

“You can’t pass one law and fix the food and the physical activity environment in every childcare center,” she said.  “There are so many different childcare settings.”

On the surface, the challenge seems very different than improving health in schools.  Compared with childcare, schools enroll most kids in the U.S. and a federal change in policy can trickle down to affect all of them.  It’s an area where Wootan has worked for more than a decade, and it’s on the cusp of eliminating soda and junk food, she said.

But while there has been much great work done in schools, “the obesity problem starts so young,” Wootan said.  “We also need to focus on the little guys – the kids before they get to school.”

As she listened to the discussions today, she had a realization: schools are a fragmented place too.  “Every district, every state, has a very different way of doing things,” she said.  And that, she says, is promising for the future of healthier childcare.

“If we’ve made such significant progress in schools, despite the fragmentation,” Wootan explained, “we can’t be intimidated to take on nutrition and physical activity in childcare.”

What Does 6 Cents Buy?

Six cents. When the California Department of Education (DoE) and California Food Policy Advocates (CFPA) started working together to help childcare providers offer kids healthier foods, they supported a six cent increase in the state reimbursement rate for each meal, to enable providers to buy more fruits and vegetables, offer healthier cereal and make other changes. But in a state with a $50 billion budget deficit, even that couldn’t make it through a price-conscious legislature.

Kumar Chandran and Phyllis Bramson-Paul

The good news is, the DoE and CFPA have found ways to help get healthier foods to children anyway. Working together, and with other public agencies and private advocacy groups, they developed a plan to strengthen the Child and Adult Care Food Program in the state.

“One thing we realized,” said Phyllis Bramson-Paul, director of Nutrition Services at the California DoE, “was that we needed to provide consistent messaging related to nutrition and physical activity across programs.” Once they recognized this need, several programs, including the state Women, Infants, and Children program, the 5-a-Day program and childcare programs, started working together to develop consistent standards and regulations.

After starting this conversation, they realized that, for little or no cost, childcare programs could switch the milk they serve from full-fat to low-fat or skim. They could improve the nutritional quality of the cereals they provide to kids. And, instead of offering two fruits as a snack, they could provide one fruit and one vegetable.

Kumar Chandran, nutrition policy advocate with CFPA, noted a few specific lessons they learned when trying to get these updated standards passed, as part of the Child Care Nutrition Bill. “The biggest obstacle we faced was the fiscal environment. There were no policy reasons for not improving these nutrition standards.”

“Being able to point to the support of other key stakeholder groups was extremely important when we introduced this language.”

Feeding America’s Hungry and Reducing Levels of Obesity

USDA Under Secretary Kevin Concannon

Kevin Concannon, Under Secretary for Food, Nutrition, and Consumer Services in the United States Department of Agriculture, explained the goal that he, USDA Secretary Vilsack and President Obama share:

“We’re very deeply committed to trying to feed hungry children and adults in this country.  But we want to have a positive impact on reducing obesity in this country as well.”

Accomplishing both goals, Concannon said, will require innovations in the programs he oversees and partnerships with the communities they serve.  He outlined several promising ideas:

New Grocery Stores in New York City Food Deserts

An article in today’s New York Times details a proposal by Mayor Bloomberg’s administration to bring full-service grocery stores – and fresh foods and vegetables – to underserved areas of the city.  For the residents in these communities where obesity and diabetes are prevalent, the change could be a boon for health.

“That’s the kind of innovation that we can encourage and bring to other areas of the country,” Concannon said.

Supplemental Nutrition Assistance Program (SNAP) to Serve Families and Improve the Economy

SNAP, formerly known as Food Stamps, helps 36 million Americans buy healthy food each month.  Simplifying the program to remove barriers and extend access to all eligible people is an important goal, Concannon said.  But increasing aid to children and families is not the only benefit.

“It also benefits the grocery stores, the communities, the families,” Concannon said.  “SNAP brings economic stimulus to cities and regions.”

October Launch of New Food Package for Women, Infants and Children (WIC)

Next month, WIC is rolling out a new food offering for mothers and children across all 50 states.  Concannon says the 9 million participants, which includes 49% of all infants in the US,  will receive more nutritious food, including whole grains, fruits and vegetables.  And, he added, additional stores are joining WIC as suppliers, which could bring healthier foods to all residents in the community.

What’s Next?  Partnerships to Share Innovation

“We do not have all the expertise, and we cannot alone solve the President’s very ambitious and worthy goal of eliminating childhood hunger by 2015,” Concannon said to the audience of early child care and health experts.  “People like you, who are engaged in these issues day to day, are some of the most potent sources of ways for us to introduce innovation.”

To address hunger and obesity in this country, he explained, we’ll need all the good ideas as we can find.

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!