1. Childhood Obesity

2. Childhood Obesity Since the 1970s, obesity prevalence has:
Doubled for preschool children aged 2-5 years
Doubled for adolescents aged years
Tripled for children aged 6-11 years
More than 9 million children and youth over 6 years are obese
Similar trends in U.S. adults and adults internationally
-IOM, 2004
As you can see, the trends in childhood obesity are similar to those in adults.
Since the 1970s, obesity prevalence has
Doubled for preschool children aged 2-5 years
Doubled for adolescents aged years
Tripled for children aged 6-11 years
More than 9 million children and youth over 6 years are obese.

3. Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years
This chart demonstrates the growing rates of overweight children ages 6-19 over the past several decades.
Numbers represent percentages of children who are overweight or obese.
-Centers for Disease Control and Prevention, 2004

4. Risk of Overweight and Obesity
1 in 4 children is at risk for overweight.
More than 60 percent of young people eat too much fat.
Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day.
-Centers for Disease Control and Prevention, 2004
In addition to the increasing numbers of overweight and obese children, many more children are at risk due to improper nutrition and inadequate physical activity:
More than 60 percent of young people eat too much fat.
Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day.
Some additional contributing factors to the rise in childhood obesity include:
Less exercise and sports in school
2) Lack of recreational facilities—or they are inaccessible due to transportation issues or violence
3) Influence of computer and video games
4) Food marketing—it is estimated that children and adolescents watch 40,000 television commercials annually—approximately half of these ads market foods high in sugar and/or fat.

5. Implications for Children and Society
Physical Health
Glucose intolerance and insulin resistance
Type II diabetes
Hypertension
High cholesterol
Fatty liver
Gallstones
Sleep apnea
Orthopedic problems
Emotional Health
Low self-esteem
Negative body image
Depression
Social Health
Stigma
Negative stereotyping
Discrimination
Teasing and bullying
Social marginalization
In addition to weight gain, unhealthy dietary practices and lack of physical activity are contributing factors in many chronic diseases and conditions, including:
-Type II diabetes
-Hypertension
-High cholesterol
-Sleep apnea.
Many of the ailments listed on the slide have been previously thought of as “adult” chronic diseases, but are now being developed at younger ages and at alarming rates. A good example is Type II diabetes previously referred to as ‘adult-onset’ diabetes. Health care providers are increasingly diagnosing young children with this condition, a disease traditionally diagnosed in adults aged 40 years or older.
Just as important are the many psychosocial conditions that can result from childhood overweight and obesity. For example, depression sometimes associated with obesity/overweight can lead to social isolation, disinterest in normally enjoyed activities, poor grades in school, low self esteem, and poor body image.
-Centers for Disease Control and Prevention, 2004
-IOM, 2004

6. Benefits of Proper Nutrition and Physical Activity
Increased bone density
Enhanced cardiac wellness
Longer-term reductions in weight and cholesterol levels
Improvements in body composition
Lower risk for many chronic diseases
Support of child growth and development
Improved grades in school
Decreased incidents of tobacco and alcohol use
-Centers for Disease Control and Prevention, 2004
We know that there are many benefits from proper nutrition and increased physical activity.
Results from recent clinical studies on the effects on physical activity on obese children and teens have demonstrated positive health outcomes such as:
-Increased bone density.
-Enhanced cardiac wellness.
-Longer-term reductions in weight and cholesterol levels.
-Improvements in body composition.
-Lower risk for many chronic diseases.
-Support of child growth and development.
Trends of increased physical activity also correlate with improved grades in school and decreased incidents of tobacco and alcohol use.

7. Recommendations for Nutrition and Physical Activity
Energy Balance
Energy Intake = Energy Expenditure
Following the 2005 Dietary Guidelines
What is proper nutrition and how much physical activity is enough?
To prevent childhood obesity and to improve the health status of our children we should encourage energy balance: where energy intake (calories in) is equal to energy expenditure (calories burned). Of course, to lose weight the energy intake should be less than energy expenditure.
One way to achieve energy balance is to follow the recommendations from the 2005 Dietary Guidelines. Some examples of recommendations for children and adolescents from the dietary guidelines are:
-Get 60 minutes of physical activity on most if not all days
-Consume whole-grain products often; at least half the grains should be whole grains.
-Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.
-Keep total fat intake between 30 to 35 percent of calories for children 2 to 3 years of age and between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
-National Cancer Institute, 2005
-Dietary Guidelines, 2005

8. Child Care and Afterschool Settings: The Perfect Venue to Promote Healthy Lifestyles
Dietary behaviors and habits of physical activity have their origins in early childhood.
Child care serves many of the specific groups of children—minorities and those in poverty—most at risk for being overweight.
School-age children are likely to be sedentary in the afterschool hours if not given active options.
Providers act as liaisons to parents who make critical nutrition and physical activity decisions for their children.
So what does all of this have to do with child care and afterschool settings?
Child care and afterschool settings are the perfect venue to promote nutrition and physical activity. Here are just some of the reasons:
Dietary behaviors and habits of physical activity have their origins in early childhood.
-As more children spend more time in child care settings, the influence that child care providers have on families is becoming an important aspect of a child’s development.
Child care serves many of the specific groups of children—minorities and those in poverty—most at risk for being overweight.
-In fact African American, Hispanic, and American Indian adolescents are more at risk to become overweight or obese than whites (IOM, 2004).
School-age children are likely to be sedentary in the afterschool hours if not given active options.
-Research with youth finds that the most common reason for not participating in sports and other physical activities is lack of perceived opportunity to participate and lack of interest. Child care and afterschool programs can provide easy and fun ways for children to become physically active and to eat healthier snacks.
Providers act as liaisons to parents who make critical nutrition and fitness decisions for their children.
-Research with adolescents finds that parents are the biggest influence on nutrition and physical activity habits.

9. Strategies to Promote Nutrition and Physical Activity
Program
Policy
Funding
Now that you know about the problem, what are some strategies to address it?
There are a variety of strategies and resources to help combat childhood obesity in child care and afterschool settings. I will talk about a few of these strategies around three broad areas:
1) Incorporating afterschool and child care program elements that promote healthy lifestyles such as implementing activities and curricula.
2) Developing policies to support efforts to promote fitness and wellness in child care and afterschool programs, such as through guidelines and training for providers.
3) Finding resources and developing creative finance strategies, such as public-private partnerships.
Now I will talk more specifically about each of these strategies and provide some examples.
[Note to Speaker: there is a handout outlining examples of program, policy, and funding strategies included in the speaker’s kit]

10. Program Strategies Games and Activities Curricula and Lesson Plans
Engaging Parents
1) Incorporating afterschool and child care program elements that promote healthy lifestyles such as:
-Incorporating games and activities
-Implementing curricula or lesson plans
-Implementing strategies to engage parents
There are a variety of activities, lesson plans, and materials related to nutrition and physical activity that are often free and easy to implement.
Several government and government-supported Web sites provide downloadable activities, games, curriculum, and other resources that are relevant to child care and afterschool programs.

11. Policy Strategies
Develop physical activity and nutrition guidelines for child care and afterschool programs
Provide physical activity and nutrition training for child care and afterschool providers
Help child care and afterschool programs access food nutrition entitlement programs
This slide outlines a few strategies that policymakers can employ to support the incorporation of nutrition and physical activity into child care settings.
Supportive policies can help child care and afterschool providers by:
Educating them about health, fitness, and nutrition and holding them accountable for incorporating these principles into their programs
Facilitating their access to federal food programs
Informing them of promising practices in the afterschool wellness field and
Involving them in relevant policy discussions

12. Questions and Comments