Successful initiatives pursued through any of the opportunities individually can lead to important changes. However, multiple opportunities pursued as part of a coordinated approach will likely be most effective at achieving desired goals concerning the weight and health status of 0- to 5-year-olds. This page includes examples of states that successfully pursued multicomponent initiatives: Delaware and New York.
Delaware (DE) was one of the first states to implement a multilevel approach to prevent childhood obesity in the ECE setting that centered around comprehensive guidelines and standards for nutrition and physical activity including limits on screen time. Successful policy and practice changes were made through the following opportunities:
For more information on these approaches, go to the report Delaware’s Child Care Regulations Promote Healthy Child Development.
These changes were initiated by an array of public and private organizations, including corporations, beginning in 2004 and continuing to the present. Partners were motivated by the high obesity rates in children aged 2 to 5 years and a shared understanding of the importance of promoting healthy lifestyles early in life. One of the first formal efforts was the revision of ECE licensing by the OCCL. Shortly after that effort started, DE’s CACFP leadership (based at DOE) wanted to make DE’s CACFP regulations stronger than those mandated at the federal level. Also, Nemours Pediatric Health System, Division of Health and Prevention Services (NHPS), had identified reducing childhood obesity as a key focus and reached out to OCCL and CACFP to bring the organizations together to champion a multilevel approach to integrate obesity prevention efforts throughout the ECE system. OCCL established an advisory group to recommend new regulations for ECE centers. The legislature approved the proposed regulations for implementation in 2007. Revisions for child care homes were also revised and approved for implementation in 2009. Simultaneously with the OCCL regulatory revisions, DE’s Early Childhood Council, with numerous public and private partners, including the United Way, Nemours, and PNC Bank, began developing and implementing a Quality Rating System. Children and Families First, the ECE information and referral agency, provided technical assistance for ECE facilities who volunteered to participate in the quality rating system.
Several factors facilitated the changes implemented in DE. There was a lot of support for the changes from various sectors. As OCCL was leading a change in regulations, NHPS was supporting and advocating for changes. Additionally, the involvement of CACFP was critical for ensuring stronger regulations around nutrition. The state’s Early Childhood Council and United Way, with funding support from PNC Bank, were developing the Quality Rating and Improvement System (QRIS). Nemours helped these organizations build obesity prevention training and technical assistance into the QRIS. QRIS standards for healthy eating and physical activity were integrated into the Early Learning Foundations adopted by QRIS as curriculum standards.
The organizations realized the importance of training for ECE providers to implement the regulation changes. Funding from Nemours and a grant from USDA’s Team Nutrition allowed CACFP and NHPS to develop and disseminate tools for providers that included Best Practices for Healthy Eating: A Guide to Help Children Grow Up Healthy; First Years in the First State: Improving Nutrition & Physical Activity in Delaware Child Care; Planning Healthy Meals for Child Care; and the Healthy Habits for Life Teachers Tool Kit (in English and Spanish), developed by Nemours and Sesame Street Children’s Workshop. All tools are available for free download at www.healthykidshealthyfuture.org. These tools are used to provide extensive technical assistance and training to ECE providers. Cooperative Extension integrated nutrition and physical activity into their trainings. DE obtained feedback and input from providers at various junctures in the process.
DE faced several challenges when implementing their nutrition and physical activity guidelines. For example, providing healthy foods, developing menus with variety, and modifying recipes to meet new guidelines were challenges for providers as was the perceived higher cost of healthy foods. Technical assistance helped providers learn how to purchase healthier foods with minimal cost increases. For physical activity, making use of public space and limited outdoor play space is a challenge. More nutrition and physical activity challenges can be found in the report, Challenges and Opportunities Related to Implementation of Child Care Nutrition and Physical Activity Policies in Delaware. For an executive summary of the report, click here.
DE’s experience in the development and implementation of a multilevel approach provides lessons learned that may be useful to states moving forward.
Additional information at Delaware’s Child Care Regulations Promote Healthy Child Development.
The New York State (NYS) Department of Health has implemented a multiprong approach to address childhood obesity in ECE settings. The opportunities successfully pursed in NYS include:
To advance policies and practices in support of healthy eating, increased physical activity, reduced screen time, and breastfeeding support, the NYS DOH convened a task force of key leaders in ECE to examine opportunities for systemic improvements. The ongoing work of the task force, now known as the Obesity Prevention in Child Care Partnership, was integrated into the workgroup structure of the Early Childhood Advisory Council (ECAC). Involving key partners such as the NYS Office of Children and Family Services, the CACFP and Obesity Prevention Programs in the Department of Health, the NYS Early Care and Learning Council, the NYS Council on Children and Families, and the Head Start State Collaboration Project has been essential to focus attention on state-level policy change.
With the benefit of both state and federal funding, the NYS DOH implemented several obesity prevention interventions and initiatives focusing on ECE settings, which provided tangible examples of best practice implementation and demonstrated public health’s commitment to work with and invest in the ECE sector. The formation of the Obesity Prevention in Child Care Partnership was essential to engage early childhood stakeholders, including state agencies and organizations, in addressing early childhood obesity collectively and individually. Engaging key partners in guiding the partnership has already yielded proposed policy changes. And, affiliating the Partnership with the Promoting Healthy Development workgroup of the NYS Early Care and Learning Council (ECAC) provides ongoing opportunities to integrate nutrition, physical activity, screen time reduction, and breastfeeding support in the overall development of the state’s early childhood system.
ECE providers in New York identified several challenges to implementing obesity prevention initiatives that include lack of funding for staffing, training, and the purchase healthy foods; lack of space, equipment, and training for physical activity; lack of staff knowledge about how to implement appropriate practices; lack of adult role models among professional caregivers and parents; and a need for greater collaboration between providers and parents.
Having ECE partners and stakeholders engaged in the development and decision-making process is important to the successful implementation of initiatives and advancement of policies.
ECE providers need training and consultation on policy development and environmental and practice changes to successfully implement childhood obesity prevention standards and practices related to nutrition, breastfeeding, physical activity, and screen time limits.
Interventions and initiatives alone are not sufficient to raise the bar on obesity prevention practices in ECE. State-level policy must set the bar for performance. ECE interventions and initiatives targeting nutrition, physical activity, screen time, and breastfeeding support can promote and support ECE practice improvements to achieve state policy objectives.