The Role of Child Care Settings in Obesity Prevention

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, USA.
The Future of Children (Impact Factor: 1.98). 02/2006; 16(1):143-68. DOI: 10.1353/foc.2006.0010
Source: PubMed


Mary Story, Karen Kaphingst, and Simone French argue that researchers and policymakers focused on childhood obesity have paid insufficient attention to child care. Although child care settings can be a major force in shaping children's dietary intake, physical activity, and energy balance-and thus in combating the childhood obesity epidemic-researchers know relatively little about either the nutrition or the physical activity environment in the nation's child care facilities. What research exists suggests that the nutritional quality of meals and snacks may be poor and activity levels may be inadequate. Few uniform standards apply to nutrition or physical activity offerings in the nation's child care centers. With the exception of the federal Head Start program, child care facilities are regulated by states, and state rules vary widely. The authors argue that weak state standards governing physical activity and nutrition represent a missed opportunity to combat obesity. A relatively simple measure, such as specifying how much time children in day care should spend being physically active, could help promote healthful habits among young children. The authors note that several federal programs provide for the needs of low-income children in child care. The Child and Adult Care Food Program, administered by the Department of Agriculture, provides funds for meals and snacks for almost 3 million children in child care each day. Providers who receive funds must serve meals and snacks that meet certain minimal standards, but the authors argue for toughening those regulations so that meals and snacks meet specific nutrient-based standards. The authors cite Head Start, a federal preschool program serving some 900,000 low-income infants and children up to age five, as a model for other child care programs as it has federal performance standards for nutrition. Although many child care settings fall short in their nutritional and physical activity offerings, they offer untapped opportunities for developing and evaluating effective obesity-prevention strategies to reach both children and their parents.

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    • "There is evidence that children's diets are established by age four, and are relatively stable throughout middle childhood (Northstone & Emmett, 2005), highlighting the need for better nutrition in the early years. Policies targeting child care settings have the potential to impact large numbers of children (Buttivant & Knai, 2012; Larson et al., 2011; Story et al., 2006 "
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    ABSTRACT: Recent national guidelines call for improved nutrition within early years settings to enhance the quality of foods and beverages provided to children. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and each of the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders in a logistic regression model, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage of these nurseries were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England.
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    • "Finally, recent reviews have pointed to the need for policy and environmental change studies of early childhood obesity prevention [33,37]. Among the top priorities identified for study are PA policy changes, teacher training in PA, modifications of play format and equipment, engagement of parents, and parent support [27,33,38]. "
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    • "They can choose from formal settings, such as pre-school centers or family/home daycares, and can also use more informal arrangements such as relatives or babysitters. The reliance on formal child care settings has increased significantly in recent years and has been attributed to an increase in maternal participation in the workforce and the growing availability of pre-school facilities (Story, Kaphingst, and French 2006). Given this, it is of little surprise that these settings can be a major force in shaping many aspects of children's lives. "
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