AP article on the important role of child care in obesity prevention

The Associated Press recently published an article focusing on the important role child care centers play in teaching children healthy habits at a young age. It spotlights the partnership of Nemours Health and Prevention Services and the Latin American Community Center in Wilmington, DE.

Go to the article – “Day care next frontier in fighting kids’ obesity”

A Few Minutes with Dr. David Bailey, CEO of Nemours

From left to right - Dr. David Bailey, CEO of Nemours, with Dr. Bill Dietz of the CDC. Debbie Chang, VP of Policy and Prevention, Nemours, in background.

Nemours CEO David Bailey, MD, MBA, talks about why Nemours is making the investment in early childhood health promotion.

With so many other issues at stake in health care and health reform, why convene this meeting of experts on early childhood and obesity prevention?

First of all, Nemours is invested in prevention services for children.  Six years ago, we changed our mission statement to reflect the pursuit of optimal health for all children, in addition to excellence in health care and treatment. Since launching the division that focuses on population health, Nemours Health and Prevention Services, we’ve always had child care as one of four pillars of our prevention strategy.

If we can reach kids at home and in their communities, in school, in their doctor’s office, and in child care, we can provide a surround sound approach that significantly improves the chance that kids will grow up healthy.

We’ve found that when it comes to health promotion and obesity prevention, not as much attention is being paid to child care as it is to other areas, such as schools, transportation and mobility, land use, food labeling and marketing, etc.  So along with our colleagues at CDC, RWJ Foundation, and the Maternal and Child Health Bureau, we decided to create a forum where leading edge people in child care quality and obesity prevention at the state and national levels could get together and learn from each other and identify promising practices to move the field of child health promotion forward.

What was the most important outcome of this meeting?

I think the attendance and recognition by Secretary Vilsack about the importance of early nutrition and health promotion; the face-to-face dialogue among the experts; the examples of successful programs from the states that were presented; and the emphasis on health as a part of high quality child care that can be tied to states’ quality rating systems and incentives. This means setting limits and rules for foods and beverages and balancing active time and sedentary time. In other words, when child care does a good job of not only teaching, nurturing and ensuring kids’ safety, but also of addressing nutrition and fitness for young children, they should be recognized and rewarded for it.

It’s interesting that Nemours, a children’s health system based in Delaware and Florida, has this national agenda. It seems unusual – is it?

Completely. In fact, Nemours is the only children’s health network, to our knowledge, that is working to effect change at the population level and is lobbying in the interests of kids everywhere, not just their constituents. As Congress works to reform our health system, there is an opportunity to focus on wellness and establish a funding stream for disease prevention and health promotion, especially when those services are linked to traditional health care services. This ensures that the systems of care and all the practitioners who care for children are coordinated in supporting the health of kids and their families. Nemours is a pioneering example of an integrated health care organization that links community-based prevention with clinical care.

2012: Predictions for Healthier Childcare

Group brainstorm: The Year is 2012

Before the conference participants went their separate ways, they came together for a final group brainstorm.  The question: The year is 2012.  What progress and policy change can we hope to have achieved toward the goal of healthier childcare environments?

Physical activity

• A dedicated indoor space for physical activity and play in all child care facilities
• Joint-use agreements for use of school facilities after hours

Nutrition:

• A strong, balanced Child Nutrition Act reauthorization
• Consistent nutrition standards for Head Start, Women, Infants and Children (WIC), Child and Adult Care Food Program (CACFP), and others
• A single entry point for each family into all federally-funded health, nutrition and cash assistance — potentially using the U.S. Post Office as the point of entry

Oral health:

• BMI and dentist visits within the last 12 month added to the immunization registry

Research gaps:

• A conference of physical activity and healthy eating experts to examine the research that exists, identify gaps, and develop a research agenda for gathering the cost-effectiveness data we need

Collaboration:

• Assemble a wide array of partners — including those normally left out — to adopt and implement a common set of nutrition standards for childcare

Joe Thompson’s Reactions

Below is a brief interview with Joseph Thompson, MD, MPH, director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity.

Joe Thompson

What did you think of Secretary Vilsack’s opening remarks, particularly any of the USDA programs or cross-departmental collaboration?

Secretary Vilsack laid out an exciting and forward looking agenda to improve, coordinate, and integrate programs benefiting children and families supported by Federal programs. The USDA operates many programs supporting the nutritional needs of American families—the Supplemental Nutrition Assistance Program (SNAP), the Women, Infants, and Children’s program (WIC), Child and Adult Care Food Program (CACFP), and school breakfast and lunch programs through the Child Nutrition Act (CNA). He also clearly identified opportunities to work across Departments including Health and Human Services and Education to identify opportunities to improve the programs and maximize their impact. We clearly have an opportunity through the reauthorization of the Child Nutrition Act to enhance these important programs and promote healthy choices – especially for those most in need – and the Secretary has laid out our charge well.

In the Q&A following his remarks, you asked Secretary Vilsack about how to best identify and overcome the existing barriers to progress. What did you think of his response?

Clearly we are entering into a fiscally conservative period. Secretary Vilsack acknowledged both the need for and the challenge of increasing funding for critically needed programs. However, he also asked us to examine the programs and identify ways to make them more efficient and effective. By achieving healthy nutrition, the opportunity to enhance educational outcomes and reduce healthcare costs is real. Through the integration across programs, he envisions opportunities to take suggestions from this meeting and others to improve efficiency and build support for needed changes. The Secretary identified the barriers – now it is up to us to collectively do what we can to move forward with a better understanding of the existing challenges and potential solutions.

There has been a lot of emphasis on schools and their role in combating childhood obesity – what are your perspectives on the importance of child care and early childhood on obesity prevention?

Clearly from the history of prevention and developmental pediatrics, we know that the earlier we start the better the outcomes. We know that giving children a healthy and stimulating environment through good nutrition and physical activity is a key indicator for developmental and educational success. By investing in early childcare, we build good health habits that avoid the risks of obesity, and help children optimize their education and lifelong potential.

Is there anything in particular about this conference that got you excited or that you think is promising?

I find it very promising that there is an increasing base of evidence that what kids eat and how physically active they are makes a difference in combating the obesity epidemic. The influence that early childcare has on the food exposure and levels of physical activity is increasingly well understood. The impact of wide ranges in sedentary time and activity levels has been documented, yet no standard exists despite massive amounts of federal funding. It is time for us to use the knowledge we have and provide guidance to both caregivers and parents to improve the health of their children and reverse the nation’s obesity epidemic.

What do you hope to come out of this? What’s the next step after everyone leaves?

I hope we see an action plan that has specific steps to be immediately implemented, as well as longer term strategies to guide policymakers and leaders.

What role is the Center playing in this discussion, or what role do you envision it will play?

The RWJF Center hopes to build off this discussion in our work to change the environments in which children live, grow, and learn every day. Only by ensuring that healthy choices are the easiest choices will we assure all children across the country—those in low income communities, communities of color, and geographically isolated communities—will have a healthy childhood and productive future.

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.”

Photo Post: The conference so far

Read on after the jump for more photos from the conference.  (Click to enlarge.)
Read more »

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.”