Promoting Healthy Eating and Physical Activity in CACFP

Transcription

1 Promoting Healthy Eating and Physical Activity in CACFP Presentation to the IOM Committee to Review CACFP February 23, 2010 Lorrene Ritchie, PhD, RD Director of Research The Dr. Robert C. & Veronica Atkins Center for Weight & Health University of California at Berkeley

2 AIMS Conduct literature review to identify best practices for improving nutrition and physical activity practices in childcare Conduct a nutrition and physical activity needs assessment in licensed childcare sites in California Examine differences in nutrition and physical activity practices in CACFP vs. non-cacfp sites Craft recommendations for improving CACFP

3 I. Literature Review Criteria for organizing literature to identify best practices Best practice strategies Shown to be effective in studies of high quality or expert recommendations when RCT not feasible Promising strategies Less studied, studies of weaker design, and/or reported with more mixed findings/often studied in combination with other strategies Evaluation opportunities Strategies that have been considered and sometimes adopted, but have not been evaluated (Source: Ritchie et al. Intervening in Early Childhood to Prevent Obesity: Best Practice for Home and Child Care Settings, Available at:

4 II. OBSERVATION STUDY OF FOODS SERVED IN CACFP AND NON-CACFP CHILDCARE SITES Methods 54 randomly selected childcare sites in LA Conducted by trained WIC staff Observed lunch service Recorded foods & beverages served

5 III. STATEWIDE SURVEY OF CHILDCARE STAFF ON DIET & PHYSICAL ACTIVITY IN 2-52 YEAR OLDS All licensed sites in California >10,000 Centers >42,000 Family Homes Centers 429 surveyed (31% of those contacted) Homes CACFP Non-CACFP CACFP Non-CACFP

6 IV. STAKEHOLDER INTERVIEWS Methods 31 local, state and national administrators, advocates & sponsors 22- question structured interview Benefits & challenges to providing healthy options Opportunities for policy reform

7 FINDINGS

8 Best practices to improve healthy eating in childcare Link changes in food environment with educational messaging Provide repeated exposure to healthy foods Increase the nutritional quality of foods provided Engage parents in providing healthy foods & nutrition messages at home

9 Best practices to improve physical activity in childcare Incorporate physical activity into existing curriculum Provide at least 2 hr/day of physical activity Divide physical activity equally into structured activities and into unstructured free play

10 SITE PROVISION OF MILK CACFP > NON-CACFP* *p<.05

11 SITE PROVISION OF FRUIT, VEGETABLES & MEAT/ALTERNATIVES BREAKFAST & LUNCH CACFP > NON-CACFP* *p<.05

12 SITE PROVISION OF FOODS OF MINIMAL NUTRITIONAL VALUE CACFP < NON-CACFP* Frozen desserts, candy, sweet baked goods, sweet cereals, chips at snack-time Sweetened drinks *p<.05

13 CHARACTERISTICS OF MEALS BROUGHT FROM HOME Observed in ~10% of sites Non-CACFP > CACFP* (data not shown)

14 DIFFERENCES IN THE NUTRITION AND PHYSICAL ACTIVITY PRACTICES IN CHILDCARE CACFP vs. non-cacfp

15 Nutrition-Related Practices Based on Current Recommendations

16 DOCUMENTED NUTRITION- RELATED PRACTICES CACFP AS COMPARED TO NON-CACFP MORE OFTEN CLOSER TO RECOMMENDATIONS Parent education* Nutrition professional* Family style* 3 2 Staff sit with kids* Seconds given Non-CACFP CACFP Staff training* 1 No clean plate* *p<.05 Child education 0 No food as reward Policy on healthy foods No junk food parties* Policy on staff eating* Menus posted* No junk fundraising No vending machines

17 PHYSICAL ACTIVITY PRACTICES BASED ON CURRENT RECOMMENDATIONS Staff training Parent education More active time Structured Outdoors Policy 0 Indoor space Staff play with kids Less screen time No restricting for behavior Portable equipment Fixed equipment

18 DOCUMENTED PHYSICAL ACTIVITY-RELATED PRACTICES

19 RECOMMENDATION S FOR IMPROVING CACFP 19

20 1. SUBSTITUTE LOWER FA MILKS FOR WHOLE MILK Percentage of sites serving whole milk (usually served by 21% of sites)

21 2. INCREASE ACCESS TO DRINKING WATER 22% of sites rarely or never serve water at meal or snack time 31% of sites do not have water easily and visibly available inside for kids to self-serve

22 3. INCREASE AMOUNT AND QUALITY OF FRUITS AND VEGETABLES 25% of sites served fried potatoes 1% provided no fruit or vegetable of any kind Half of the sites provided fruit canned in syrup Nearly two-thirds provided 100% juice

23 4. INCREASE WHOLE GRA 23

24 5. REDUCE OR ELIMINATE FOODS OF MINIMAL NUTRITIONAL VALUE

25 6. INCREASE PHYSICAL ACTIVITY TIME 47% offered < 2 hours/day 65% offered < half of activity as structured 35% offered < half of activity outdoors

26 CALIFORNIA DEPARTMENT OF EDUCATION EXPERT WORKGROUP RECOMMENDATIONS FOR CACFP 3 Minimal Cost Recommendations Only lower fat milks (ages 2 and above) At least one vegetable at lunch and supper (instead of a fruit or a vegetable) No deep fat frying on site Keeping Children Healthy in CA s Child Care Environment: Recommendations to Improve Nutr and Increase PA Recommendations requiring additional reimbursement No sugar-added or diet drinks 1 svg/d 100% juice No fruit canned in syrup FV daily, particularly fresh 1/wk fried potatoes Only low sugar cereals (WIC) 2/wk sweet grains 1 svg/d whole grain or half whole

27 THANKS TO ALL PARTNERS AND FUNDERS (Ken Hecht & Kumar Chandran) (Sarah Samuels & Maria Boyle) (Pat Crawford & Phil Spector) (Shannon Whaley)