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Nutrition and physical activity interventions in preschool & child care

Health Factors: Diet & Exercise
Decision Makers: Educators Employers & Businesses State Government Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Nutrition and physical activity interventions in preschool and child care offer young children opportunities to eat healthy foods and engage in physical activity throughout the day. Nutrition interventions provide fruits, vegetables, and other healthy foods as part of snacks, meals, taste-testing, and food preparation, frequently with basic nutrition education. Physical activity interventions provide opportunities for children to increase their physical activity, typically by training teachers to incorporate physical activity into daily routines, changing the physical environment, or offering more time for physical activity. Government regulations and organizational policies can support these interventions through guidelines for healthy food consumption, physical activity, and screen time, and support for playground improvements (AAP-Early care standards 2012).

Expected Beneficial Outcomes

Improved nutrition
Increased physical activity
Increased fruit & vegetable consumption
Improved physical fitness
Improved weight status

Evidence of Effectiveness

There is strong evidence that nutrition interventions in preschool and child care improve children’s diets (Mikkelsen 2014, Grantham-McGregor 2014, Larson 2011, Robinson 2014) and physical activity interventions increase their activity levels (Gordon 2013, Kreichauf 2012, Larson 2011Ward 2010, Robinson 2014). However, variation in the design, duration, and implementation of these interventions can result in varied effects (Zhou 2014, Mehtala 2014) and additional evidence is needed to determine if these interventions reduce risk of overweight or obesity (Zhou 2014, Jaime 2008, Ward 2010).

Adhering to nutrition guidelines in preschool and child care can decrease children’s fat intake and increase fruit and vegetable intake (Mikkelsen 2014, Jaime 2008). Implementing physical activity interventions can increase participant’s fitness and motor skills (Ward 2010). In some circumstances, nutrition and physical activity interventions have been shown to reduce children’s weight, body fat, or body mass index (BMI) (Mikkelsen 2014, Bluford 2007, Zhou 2014).

Overall, interventions that increase time for physical activity, provide portable play equipment (e.g., balls and other objects), and include playground markings have been shown to increase moderate to vigorous physical activity (Kreichauf 2012, Broekhuizen 2014, Temple 2014). Adding portable play equipment has greater effects on physical activity than adding fixed play structures and equipment, since children tend to gather and stand still on or under fixed structures (Kreichauf 2012).

Researchers recommend that child care centers provide teachers with training in how to integrate physical activity into learning to maximize effects on children's physical activity (Kreichauf 2012, Ward 2010, Mehtala 2014). A culturally sensitive approach is also suggested to increase the effectiveness of obesity prevention efforts such as nutrition and physical activity interventions in preschool and early child care (CDC-Cultural competence, NRC NPAA-Cultural diversity). Culturally sensitive interventions are implemented with a clear understanding of cultural values, generally with the help of bilingual and bicultural facilitators, and often include translated and literacy-appropriate materials, social support, and family-based activities (Mier 2010).

Implementation

United States

The Public Health Law Center's (PHLC) 50-state review of early childhood care and education regulations includes nutrition and physical activity standards; the on-line map is searchable by state (PHLC-Child care regulations). Terms and standards relating to nutrition, physical activity, and screen time vary widely across the country; however, very few states incorporate their standards into their statewide regulations (ALR-Frost 2015). The National Resource Center for Health and Safety in Child Care and Early Education (NRC) identifies 47 potential components for licensing standards that support healthy dietary behaviors and physical activity for young children (AAP-Early care standards 2012). CDC’s 2013 Prevention Status Reports show that no state has regulations that include more than 70% of those 47 components (CDC-NPAO PSR 2013).

Illinois adopted a resolution in 2012 calling for daily, quality physical education in preschool and early child care centers, among other child obesity prevention measures (NCSL Winterfeld-Obesity prevention 2014). In some states, nutrition and physical activity interventions focus on developing curriculum and training early childhood care and education providers through non-profit and public sector partnerships, as in Idaho (CDHD-IdahoSTARS).

Wisconsin

In Wisconsin, child care centers can earn higher quality ratings by adhering to nutrition and physical activity guidelines (WI DCF-YoungStar).

Implementation Resources

AAP-HALF - American Academy of Pediatrics (AAP). Healthy Active Living for Families (HALF) program. Age specific content. Accessed on November 23, 2015
ChangeLab-CA childcare - ChangeLab Solutions. California childcare settings: A webinar on the child care nutrition and physical activity environments. Accessed on January 14, 2016
ChangeLab-Model childcare statute - National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). Model childcare licensing statute for obesity prevention. Oakland: ChangeLab Solutions; 2013. Accessed on March 9, 2017
ESMM NC-NAP SACC - Eat Smart, Move More North Carolina (ESMM NC). Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). Accessed on January 20, 2016
Food Trust-Preschool initiative 2011 - The Food Trust. The preschool initiative: Building a healthy foundation for life. 2011. Accessed on February 16, 2016
HOST-Healthy eating - Healthy Out-of-School Time (HOST) Coalition. Resources: Healthy eating. Accessed on March 7, 2016
HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA). Accessed on March 9, 2017
SHAPE America-PA guidelines - Society of Health and Physical Educators (SHAPE America). Physical activity guidelines. Accessed on March 14, 2016
Together Counts-SFTS - Together Counts. Smart from the start (SFTS). Accessed on February 16, 2016
WI DHS-Early care - Wisconsin Department of Health Services (DHS). Early care and education (early childhood) initiatives. Accessed on November 10, 2015

Citations - Description

AAP-Early care standards 2012 - American Academy of Pediatrics (AAP), American Public Health Association (APHA), National Resource Center for Health and Safety in Child Care and Early Education (NRC). Preventing childhood obesity in early care and education programs: Second edition. 2012. Accessed on February 16, 2016

Citations - Evidence

Bluford 2007 - Bluford DA, Sherry B, Scanlon KS. Interventions to prevent or treat obesity in preschool children: A review of evaluated programs. Obesity. 2007;15(6):1356-72. Accessed on November 24, 2015
Broekhuizen 2014 - Broekhuizen K, Scholten AM, de Vries SI. The value of (pre)school playgrounds for children's physical activity level: A systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2014;11:59. Accessed on February 16, 2016
CDC-Cultural competence - Centers for Disease Control and Prevention (CDC). Addressing obesity disparities: Cultural competence. Accessed on February 16, 2016
Gordon 2013* - Gordon ES, Tucker P, Burke SM, Carron AV. Effectiveness of physical activity interventions for preschoolers: A meta-analysis. Research Quarterly for Exercise and Sport. 2013;84:287-294. Accessed on February 16, 2016
Grantham-McGregor 2014 - Grantham-McGregor SM, Fernald LCH, Kagawa RMC, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Annals of the New York Academy of Sciences. 2014;1308:11–32. Accessed on February 16, 2016
Jaime 2008* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45–53. Accessed on March 1, 2016
Kreichauf 2012* - Kreichauf S, Wildgruber A, Krombholz H, et al. Critical narrative review to identify educational strategies promoting physical activity in preschool. Obesity Reviews. 2012;13(1):96-105. Accessed on February 16, 2016
Larson 2011* - Larson N, Ward DS, Neelon SB, Story M. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts. Journal of the American Dietetic Association. 2011;111(9):1343–62. Accessed on February 16, 2016
Mehtala 2014 - Mehtala MAK, Saakslahti AK, Inkinen ME, Poskiparta MEH. A socio-ecological approach to physical activity interventions in childcare: A systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2014;11:22. Accessed on February 16, 2016
Mier 2010 - Mier N, Ory MG, Medina AA. Anatomy of culturally sensitive interventions promoting nutrition and exercise in hispanics: A critical examination of existing literature. Health Promotion Practice. 2010;11(4):541-554. Accessed on February 16, 2016
Mikkelsen 2014 - Mikkelsen MV, Husby S, Skov LR, Perez-Cueto FJ. A systematic review of types of healthy eating interventions in preschools. Nutrition Journal. 2014;13:56. Accessed on February 16, 2016
NRC NPAA-Cultural diversity - National Resource Center on Nutrition, Physical Activity & Aging (NRC NPAA). Creative solutions: Cultural diversity as part of nutrition education and counseling. Accessed on February 16, 2016
Robinson 2014 - Robinson LE, Webster EK, Whitt-Glover MC, Ceaser TG, Alhassan S. Effectiveness of pre-school- and school-based interventions to impact weight-related behaviours in African American children and youth: A literature review. Obesity Reviews. 2014;15(4):5-25. Accessed on February 16, 2016
Temple 2014* - Temple M, Robinson J. A systematic review of interventions to promote physical activity in the preschool setting. Journal for Specialists in Pediatric Nursing. 2014;19:274-284. Accessed on February 16, 2016
Ward 2010* - Ward DS, Vaughn A, McWilliams C, Hales D. Interventions for increasing physical activity at child care. Medicine & Science in Sports & Exercise. 2010;42(3):526–34. Accessed on November 18, 2015
Zhou 2014* - Zhou YE, Emerson JS, Levine RS, Kihlberg CJ, Hull PC. Childhood obesity prevention interventions in childcare settings: Systematic review of randomized and nonrandomized controlled trials. American Journal of Health Promotion. 2014;28(4):e92-103. Accessed on February 16, 2016

Citations - Implementation

AAP-Early care standards 2012 - American Academy of Pediatrics (AAP), American Public Health Association (APHA), National Resource Center for Health and Safety in Child Care and Early Education (NRC). Preventing childhood obesity in early care and education programs: Second edition. 2012. Accessed on February 16, 2016
ALR-Frost 2015 - Frost N. Promoting physical activity in early care and education. 2015 Active Living Research (ALR) Annual Conference. 2015. Accessed on February 16, 2016
CDC-NPAO PSR 2013 - Centers for Disease Control and Prevention (CDC). Nutrition, physical activity, and obesity: Prevention status reports (PSR). 2013. Accessed on February 16, 2016
CDHD-IdahoSTARS - University of Idaho Center on Disabilities and Human Development (CDHD), Idaho Association for the Education of Young Children (Idaho AEYC), Idaho Department of Health and Welfare (ID DHW). IdahoSTARS: Quality child care matters. Accessed on February 16, 2016
NCSL Winterfeld-Obesity prevention 2014 - Winterfeld A. State actions to reduce and prevent childhood obesity in schools and communities: Summary and analysis of trends in legislation. National Conference of State Legislators (NCSL). 2014. Accessed on February 29, 2016
PHLC-Child care regulations - Public Health Law Center (PHLC). Healthy child care 50-state review. Accessed on February 16, 2016
WI DCF-YoungStar - Wisconsin Department of Children & Families (WI DCF). YoungStar: Wisconsin's child care rating program. Accessed on September 28, 2016

Page Last Updated

June 9, 2015

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