Tanya Harvey, M.Ed. Coordinator of Children s Programs Bureau of Community Food and Nutrition Assistance Missouri Department of Health and Senior

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1 Tanya Harvey, M.Ed. Coordinator of Children s Programs Bureau of Community Food and Nutrition Assistance Missouri Department of Health and Senior Services

2 Review the obesity trends in the United States. Provide an overview of Missouri Eat Smart and MOve Smart Child Care programs. Environmental factors that affect eating behaviors How to get your homes involved! Learn how to maximize resources to promote and improve nutrition and physical activity practices.

3 Childhood Obesity is: Most common nutritional disease in US children Obese children are 5 times more likely to be overweight/obese young adults 60% of overweight children 5-10 years of age already have at least one risk factor for heart disease

4 Obesity Among U.S. Adults by State and Territory has been on the increase for years as noted in the following US maps The following maps from CDC are spaced 5 years to show the trend.

5 No Data <10% 10% 14% (*BMI 30, or ~ 30 lbs. overweight for 5 4 person)

6 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

7 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

8 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

9 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

12 Americans of all ages consume Too few: Vegetables, fruits, whole grains, low-fat/fat-free milk/milk products, seafood Too much: Added sugars, solid fats, refined grains, sodium Added sugars and solid fats contribute ~35% of calories to the American diet!! (while contributing few, if any, nutrients)

13 Portions Busy lifestyles Increased meals from away from home Sedentary activities Urban sprawl Marketing

14 A Dream A Detour A Dependency A Disturbing Trend 14

15 Primary prevention of obesity must begin in childhood. This is the single most powerful public health approach to combating and reversing America s obesity epidemic over the long run. --Report of the Dietary Guidelines Advisory Committee

16 According to the 2013 US Census report nearly 11 million children under age 5 in the United States are in some type of child care arrangement every week.

17 The food and the environment in which children eat their meals have a big impact on future nutrition habits and weight status. Children who are provided healthy foods during early childhood are more likely to continue healthy eating habits as they get older. Child care providers are uniquely interested and qualified to support development of healthy habits 17

18 Day Care Home settings already offer the family atmosphere that is the core of programs shown to help reduce the prevalence of obesity. Establishing sit down meals (Family Style) fits with the home setting and offers children a role model for healthy eating habits. Smaller capacities mean more opportunity for one on one interaction and education.

20 Address childhood obesity Encourage providers to be the leaders of the changes needed!

21 A program to encourage child care facilities to voluntarily improve nutritional content of meals to exceed those standards required by the CACFP and Child Care Licensing, and adapt best practices in the feeding of children.

22 Broad dietary recommendations to challenge child care providers to make nutrient dense foods available Based on 2010 Dietary Guidelines for Americans Support policies that create a healthy nutrition environment For any facility, large or small, but not mandatory 22

Training provided on healthy options, food labels and atmosphere Improved health of children Development of lifelong healthy habits for children and staff Facilities are recognized as

23 Training provided on healthy options, food labels and atmosphere Improved health of children Development of lifelong healthy habits for children and staff Facilities are recognized as Eat Smart on the website and newsletter Certificate, banner, window cling and decals Menu templates and nutrition education materials Parent letter Press release Use of the Eat Smart Logo

24 Voluntary program Facilities apply by submitting menus and supporting documentation Training is provided by qualified staff Program staff conduct an on-site assessment Day Care Facilities receive recognition once they have met the Intermediate or Advanced level.

through our Learning Management System Three modules on line 1.

25 Eat Smart training is available in many forms In person training with our nutritionists or our Child Care Health Consultants On line Eat Smart Training through our Learning Management System Three modules on line 1. Eat Smart: A Call to Action 2. Eat Smart: A Healthy Nutrition Environment 3. Eat Smart: Nutrition Overview

26 Minimum level meets current meal pattern Advanced Level Intermediate Level Minimum Level Healthfulness Intermediate more healthful than USDA CACFP req s Advanced more healthful than Intermediate

27 A group of professionals who work with young children and child care providers created the Eat Smart Guidelines. Workgroup members involved in the development: Missouri Department of Health and Senior Services - Child and Adult Care Food Program (CACFP); Section for Child Care Regulation (licensing) Center for Local Public Health Services (county) University of Missouri Extension Service Head Start State Collaboration Office Lincoln University Child Development Department Missouri Council for Activity and Nutrition (MOCAN) A non-profit Missouri child care center

They are used as a resource to make nutrition recommendations for federal programs, such as the

28 The Dietary Guidelines combine the evidence from current research on nutrition to make recommendations for a pattern of eating that can be adopted by healthy Americans over 2 years of age. They are used as a resource to make nutrition recommendations for federal programs, such as the CACFP. They also provide advice how good dietary habits can promote health and reduce risk for major chronic diseases.

29 Throughout life, prevent and/or reduce overweight and obesity through improved eating, more physical activity and less sedentary behaviors such as TV watching and computer games. Consume more fat free or low-fat milk Increase consumption of fruits and vegetable Choose whole grains; Limit refined grains Consume lean meats and reduce consumption of trans fat and saturated fat. Avoid added sugars and sugar sweetened beverages and reduce sodium.

30 Increased nutrition standards based on: Institute of Medicine Dietary Guidelines for Americans Eat Smart Facilities to follow Guidelines: Menu (Breakfast, Lunch/Supper, Snacks, Overall) Meal service Policy Environment Intermediate and Advanced levels of recognition

31 Start Check Calories Sample label for macaroni and cheese 31

32 Standards to Follow

33 Limit Amount of sugar in cereals Sweet breakfast items Add Whole grain foods Fruit and vegetables

34 CACFP No requirement to limit sugar in cereal Intermediate All ready-to-eat and hot cereals offered contain 9 grams of sugar or less per serving. Advanced All ready-to-eat and hot cereals offered contain 6 grams of sugar or less per serving. 34

35 CACFP Sweet bread items (i.e. coffee cake, muffins, granola bars, cereal bars, doughnuts, sweet rolls, etc.) not currently limited Intermediate Limit all sweet items (including syrup, table sugar, and jelly) to 1 time per week at breakfast Advanced Limit all sweet items to 2 times per month at breakfast 35

36 CACFP No requirement Intermediate No requirement Advanced A meat/meat alternate is provided at least 2 breakfasts per week. High fat and salty processed meats may not count towards this guideline. 36

37 Limit Processed breaded meats Use of high fat condiments Add Whole grain foods Fruit and vegetables Low-fat milk served

38 Limit Sweet snacks Add Protein at snacks Fruit and vegetables More whole grains

39 CACFP Limiting dessert grains is best practice. Intermediate Sweet snacks and high fat items* are served no more than 1 time per week or less. Advanced Sweet snacks and high fat items* are served no more than 1 time every two weeks or less. 39

40 CACFP All grains/breads must be whole grain or enriched Intermediate A whole grain food is offered at least Advanced 1 breakfast per week and 1 lunch/supper per week A whole grain food is offered at least 3 breakfasts per week and 3 lunches/suppers per week 40

at lunch/supper Advanced Highly processed meat, poultry and fish (including high fat and salty breaded meats)** are limited to 1

41 CACFP Highly processed meat such as hot dogs and sausage products are not best practice. Intermediate Highly processed meat, poultry and fish (including high fat and salty breaded meats)** are limited to 2 times per week at lunch/supper Advanced Highly processed meat, poultry and fish (including high fat and salty breaded meats)** are limited to 1 time per week at lunch/supper **Any item that requires a CN label Includes chicken nuggets, fish sticks, hot dogs, bologna, pepperoni, breakfast sausage & other luncheon meats 41

CACFP No requirement on fresh fruits or vegetables Juice may count up to ½ of the total requirement for lunch or supper Intermediate Fresh fruits or veggies

42 CACFP No requirement on fresh fruits or vegetables Juice may count up to ½ of the total requirement for lunch or supper Intermediate Fresh fruits or veggies are served (no juice) 1 time per week or more* at lunch/supper Advanced Fresh fruits or veggies are served (no juice) 3 times per week or more* at lunch/supper 42

43 CACFP Juice must be 100% full strength fruit or vegetable juice Intermediate 100% juice is served no more than once per day or less Advanced 100% juice is served no more than 3 times per week or less 43

44 CACFP: Not Eat Smart Intermediate Advanced

45 Breakfast Lunch Snack Monday Tuesday Wednesday Thursday Friday 1% milk Grape Juice Fruit Loops (12 g) BBQ riblet (CN) Bun Tator tots Fruit cocktail (light syrup) 1% milk Tortilla chips Salsa Orange juice 1% milk Orange Juice Doughnut Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk Cheez its 1% milk 1% milk Canned peaches (heavy syrup) Oatmeal (sugar) Chicken tenders Breading (CN) Canned pineapple Canned carrots 1% milk Sweet roll Apple juice 1% milk Grape Juice Pancake with syrup Beef Ravioli (CN) Cheesy bread(cn) Iceberg salad French dressing Mandarin oranges (light syrup) 1% milk Frito chips Refried beans 1% milk Applesauce (sugar added) Toast (jelly) Hot dog Bun French fries Canned green beans 1% milk Chocolate Chip Cookies 1% milk

46 Breakfast Lunch Snack Monday Tuesday Wednesday Thursday Friday 1% milk Banana Honey Nut Cheerios (9 g) Turkey w/ BBQ sauce Whole wheat bread Lettuce, tomato Tater tots 1% milk Tortilla chips Salsa Orange juice 1% milk Orange Juice Bagel with cream cheese Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk Cheez its 1% milk 1% milk Blueberries Oatmeal Homemade Chicken tenders Bread crumbs Canned pineapple Canned carrots 1% milk Cinnamon toast Apple juice 1% milk Grape Juice Pancake with syrup Ground beef Spaghetti noodles Tomato sauce Spinach, tomatoes French dressing 1% milk Celery Refried beans 1% milk Applesauce (no sugar added) Whole wheat toast Hot dog Bun Sweet potato fries Canned green beans 1% milk Berry Berry Kix (7 g) 1% milk

Breakfast Lunch Snack Monday Tuesday Wednesday Thursday Friday 1% milk Banana Cheerios (1 g) Turkey w/ BBQ sauce Whole wheat bread Lettuce, tomato Tater tots 1% milk Tortilla chips Salsa Orange juice

47 Breakfast Lunch Snack Monday Tuesday Wednesday Thursday Friday 1% milk Banana Cheerios (1 g) Turkey w/ BBQ sauce Whole wheat bread Lettuce, tomato Tater tots 1% milk Tortilla chips Salsa Orange juice 1% milk Strawberries Bagel Yogurt Cheese pizza (CN) Pizza crust Canned corn Tomato sauce on side 1% milk Cheez its 1% milk 1% milk Blueberries Oatmeal Homemade Chicken tenders Whole wheat bread crumbs Canned pineapple Raw carrots 1% milk Apple Peanut butter 1% milk Pureed blackberries Pancake (no syrup) Ground beef Whole wheat spaghetti noodles Tomato sauce Spinach, tomatoes French dressing 1% milk Celery Refried beans 1% milk Applesauce (no sugar added) Whole wheat toast Peanut butter Gr. Chicken Breast Bun Lettuce, tomato Sweet potato fries Green beans 1% milk Kix (3 g) 1% milk

48 Menus posted No other foods brought into the facility Fundraising cannot include unhealthy foods Vending machines offer healthy alternatives TV viewing limited Parent involvement encouraged Curriculum includes nutrition education Family Style Meal Service

49 Meal time environment Family style meal service Adult interactions with children Meal length

50 CACFP No requirement Intermediate At least one item is served family style at each meal Child sized serving utensils are available and used Advanced Most foods are served family style 50

51 Division of Responsibility Adults decide the when and where of eating Children decide whether to eat and how much Staff Avoid power struggles relating to food Encourage children to try new foods Do not use food as a reward or punishment 51

52 Intermediate Children help clear dishes after meal is finished Advanced Children help set the table and clear dishes after meal is finished 52

CACFP/Licensing/Minimum No outside/parent provided foods are brought in for meal service, celebration snacks must be pre-packaged Intermediate Parents are provided a written policy prohibiting any

53 CACFP/Licensing/Minimum No outside/parent provided foods are brought in for meal service, celebration snacks must be pre-packaged Intermediate Parents are provided a written policy prohibiting any foods brought from home or outside sources Advanced Parents are provided a written policy prohibiting any foods brought from home or outside sources Celebrate with non-food treats Facility offers healthy foods 53

Children may have a hard time becoming accustomed to the new meals (at first) Parents and providers may feel they are depriving children of sweet food treats Increased Cost fresh fruit,

54 Children may have a hard time becoming accustomed to the new meals (at first) Parents and providers may feel they are depriving children of sweet food treats Increased Cost fresh fruit, vegetables, and increased lean protein may add to the meal cost (and must be purchased more often) More time to prepare the fresh meals Fresh meals take more thought and advanced planning

55 140 recognized child care facilities

58 A program to encourage child care facilities to adopt practices that improve the amount and quality of physical activity children receive in care. Goals: Fight obesity Establish healthy habits early Create attentive learners

59 Voluntary program Facilities apply by submitting an application and supporting documentation (photos) Training is provided by qualified staff Self-assessment completed by child care Day Care Facilities receive recognition once they have met the Intermediate or Advanced level.

60 Physical activity standards for children 2 to 5 Based on: American Academy of Pediatrics Let s Move Child Care I am Moving, I am Learning (IMIL)

61 Standard guidelines address: Amount and type of physical activity Reduce sedentary time Activity Policy Environment encourages activity

62 Having at least 90 minuets of Physical Activity per day 30 structured Physical Activity not withheld as punishment Equipment Available for activity

63 Indoor Physical Activity Learning Integrated Limited Screen Time Written Policy for Physical Activity Staff Education & Training Sedentary Time Limited Visual Promotion of Physical Activity Staff Participation & Role Modeling Additional physical activity

64 Framed certificate Permission to use the MOve Smart logo A sample press release Parent informational brochure on MOve Smart Recognition on the MOve Smart website and The MO Healthy Child Care newsletter

65 MOve Smart is a new program in Missouri. There are currently 14 facilities that have been recognized as MOve Smart, but several more have submitted applications!

Eat Smart Guidelines United States Department of Agriculture

66 Missouri Department of Social Services 2010 ARRA Funding provided mini-grants to child care centers to help meet the Eat Smart Guidelines United States Department of Agriculture CACFP Child Care Wellness Grant Team Nutrition Coaching Program

67 University of Missouri Extension Service Eat Smart/MOve Smart Coaching Program Eat Smart/MOve Smart Training Centers for Disease Control and Prevention Obesity Prevention Grant I am Moving, I am Learning Training for MOve Smart

68 Missouri Foundation for Health Healthy Schools, Healthy Communities Grant Local Public Health Agencies - Child Care Health Consultants Eat Smart/MOve Smart training and consultation

69 Child Care Aware of Missouri - National Early Care and Education Learning Collaborative Taking Steps to Healthy Success Missouri Council for Activity and Nutrition (MOCAN)

70 Missouri Accreditation of Programs for Children and Youth Incorporate Eat Smart standards into After School Care Programs and Early Learning Center accreditation standards

and vegetables at breakfast, lunch and snack Increase healthy celebrations Increase the prevalence of

71 Eat Smart and MOve Smart facilities, whether recognized or not, have been shown to continue good habits: Reduce use of high sugar foods Increase adults eating with children Increase use of no-sugar added fruits and vegetables at breakfast, lunch and snack Increase healthy celebrations Increase the prevalence of family style dining Increase the use of whole grains at breakfast, lunch and snack Increase physical activity

Obesity is a major issue affecting children in the United States. Small changes in meals and in the child care environment can make big differences.

72 Obesity is a major issue affecting children in the United States. Small changes in meals and in the child care environment can make big differences. Missouri has found great success with the Eat Smart Program and is anticipating great success with the MOve Smart Program. Partners are out there and are willing to help in this struggle for change.

73 .Much harder to change established habits than to shape good habits from the start

Tanya.Harvey@health.mo.gov Website: www.

74 Website:

DESCRIPTION PORTION CALS CARBS SACK LUNCH Breakfast Bar-Ban Choc 1 each Ham & Cheese/Bun 1 each Breakfast Bar - French Tst 1 each

DESCRIPTION PORTION CALS CARBS SACK LUNCH Breakfast Bar-Ban Choc 1 each 280 48 Ham & Cheese/Bun 1 each 247 29.99 Breakfast Bar - French Tst 1 each 290 47 Turkey & Cheese/Bun 1 each 299 28.58 Breakfast