Early Care and Education Settings Are Vital for Childhood Obesity Prevention

Much has been written about the positive effects of high-quality early care and education (ECE) on children, especially those from low-income households. We know that children who attend high-quality ECE programs are more likely to graduate high school, hold a job, and earn higher incomes. They also commit fewer crimes, ¹ are more likely to attend college, and less likely to become teen parents. ² The six articles presented here suggest that ECE programs can also address childhood obesity given that fewer preschool-aged children who attend ECE programs with policies promoting nutrition and physical activity are identified as overweight or obese. Collectively, the articles encourage policy makers to see ECE as a critical partner in the fight against childhood obesity and highlight the current challenges and opportunities to promote nutritious eating and physical activity in young children.

Together, these articles underscore the importance of three principles I promote and work to uphold as the commissioner of the Connecticut Office of Early Childhood: early is best; training and information are key to achieving policy goals; and, most important, families are our most critical partners. Each of the studies here reference the unique and promising role ECE can play in establishing lifelong habits of eating healthy food and engaging in physical activity among young children.

The earliest years of a child's life are when the brain is most plastic and receptive to enriching environments. ³ In their two articles,^4,5 Schwartz and colleagues highlight how smart policy, such as the Child and Adult Care Food Program (CACFP), coupled with research-based practice have the potential to establish healthy practices in early childhood that can lead to reduced rates of health risks later in life.

Schwartz's first article asks whether ECE programs participating in CACFP serve lunches that meet CACFP guidelines and whether the food children actually consume is aligned with the new proposed rules for CACFP based on recommendations from the Institute of Medicine. ⁴ The study finds that most programs comply with current CACFP program guidelines, but adhering to the proposed new guidelines will be a challenge based on observed food consumption. The second article builds on the observed practice of serving food to young children in a family-style manner to consider whether variations in the order in which foods are offered and the elimination of foods after a first serving lead to an increased consumption of fruits and vegetables. ⁵ Though the study was inconclusive, it suggests that being intentional about what to serve in the first course and when to no longer offer particular foods during mealtime may lead to the consumption of more nutritious foods.

In “Evaluation of nutrition and physical activity policies and practices in child care centers within rural communities,” Foster and colleagues explore the unique challenges rural ECE providers face in supporting the healthy development of young children in their care who are more likely to be overweight than children living in urban communities. ⁶ Geographical isolation, lack of funding, and lack of resources compound to make their work perhaps even more challenging than their colleagues in urban and suburban communities. Policies around geography and other demographic factors should be considered to address the issue of childhood obesity. Educating policy makers, legislators, advocates, and others of existing barriers and challenges is key in making informed and effective policy decisions.

Many young children spend as much of their waking hours in ECE programs as they do at home. One study found that 42% of children under the age of 5 in the United States spend at least 35 hours a week, with nearly another 20% of children spending between 15 and 34 hours, in child care. ⁷ Given this, ECE providers play a central role in establishing healthy eating habits and routine as well as robust physical activity among young children.

One of the best ways to deliver on the promise of providing quality ECE to promote healthy early childhood growth and development is to ensure that caregivers and educators who spend an ever-increasing amount of time with our youngest children have the information, skills, and resources necessary to provide our children not only with enriching early childhood experiences, but also informed comprehensive care, including nutrition. In their studies, Foster and colleagues, ⁶ Joseph and colleagues, ⁸ and Tovar and colleagues ⁹ speak to the need to provide accessible, high-quality training for ECE providers and how to realistically implement a range of strategies to promote healthy eating and physical activity, including how to recognize healthy foods, teach children to identify and choose nutritious snacks, and share this information with parents in a way that will improve nutrition and physical activity at home.

The central role parents play in the battle to decrease the number of children who are overweight or obese is a consistent theme throughout the articles, especially those from Tovar and colleagues, ⁹ Sharafi and colleagues, ¹⁰ and Joseph and colleagues. ⁸ Policy makers can offer the best trainings imaginable to ECE providers, but if parents are not engaged as trusted partners, we will not be fully successful in promoting healthy habits beyond the walls of the ECE classroom.

In “Nutrition and physical activity environments of home-based child care: What Hispanic providers have to say,” Tovar and colleagues explain how Latino family child care providers are fully aware of the important role they play in helping children eat healthy foods and get routine exercise. ⁹ According to Tovar and her team, the challenge is not getting family child care providers to recognize their role, but in working with parents to change practices that lead children to become overweight or obese, such as sending children to ECE programs with sugary drinks and electronic devices that promote sedentary behavior.

In addressing childhood obesity, it is vital that policies promoting healthy eating and physical activity begin early in the child's life, training and resources for ECE providers are available so they have the tools necessary to teach children to be healthy, and parents and families are included as integral partners so that healthy habits continue at home. Through smart policy and education of children, providers, families, and policy makers, we can not only address childhood obesity, but also help set the stage for healthier adults later on in life.