Training Staff of Afterschool Programs on Healthy Eating and Physical Activity: Opportunity to Reduce Childhood Obesity

Childhood obesity is among the leading health concerns in the United States. The prevalence of childhood obesity in the United States has reached epidemic proportions, with nearly one third of children overweight or obese (Steele, Steele, & Cushing, 2102). Current estimates indicate that in the United States more than 20% of children aged 2 to 5 years are already overweight or obese (Ward et al., 2011). Even more troubling is that overweight developed in early childhood is likely to persist through adolescence and adulthood (Bender, Nader, Kennedy, & Gahagan, 2013; James, Connelly, Garcia, Mareno, & Baietto, 2010).

Now more than ever the role of staff in our afterschool programs can play an important role to support health and wellness of children and adolescence (Afterschool Alliance, 2018). Afterschool programs are being implemented to provide more focused curriculum to promote healthy eating and physical activity (HEPA) standards to the children they serve. Standards address snack content and quality, physical activity, staff training, social support, program support, and environmental support (National AfterSchool Association, 2010). These HEPA standards outline key behaviors that frontline staff model (Weaver, Beets, Saunders, Beighie, & Webster, 2014). However, one should ask if afterschool staff have been trained and do they have knowledge of these HEPA behaviors and understand the importance of modeling these behaviors to the children participating in the programs.

An estimated 8.4 million children in the United States attend afterschool programs. Most programs are available for children K-6 grade and operate from 3:00 to 6:00 p.m. The role of afterschool programs has evolved from providing a safe and supervised environment to a resource that supports helping children reach their full potential in school, career, and life (Afterschool Alliance, 2018; Gesell et al., 2013). Staff members have little or no formal training in role modeling to children, and staff need guidance to become agents of change (Weaver et al., 2014). Expecting afterschool program staff to be role models in keeping the family lifestyle healthy takes for granted that the staff have the knowledge to fulfill this role (James et al., 2010). Childhood is an important time for the prevention of overweight and obesity, as many dietary and physical activity behaviors are learned during this period and carried into adulthood (Hodges, 2003; Kinra, Nelder, & Lewendon, 2000). As children grow, individual dietary choices and perceptions of activity become critical as children grow and gain more autonomy (Branscum, Housley, Bhochhibhoya, & Hayes, 2016; Gesell et al., 2013). The majority of children in the United States consume diets that do not meet the U.S. Department of Agriculture 2015 Dietary Guidelines for Americans (U.S. Department of Health and Human Services, & U.S. Department of Agriculture, 2015), nor do they achieve adequate levels of daily physical activity (Davison, Jurlowski, Li, Kramz, & Lawson, 2013). Staff engagement of HEPA promoting behaviors could potentially have positive effects on health outcomes of the children in afterschool program.

Recent national directives called for investigations to identify effective approaches to sustain and integrate childhood obesity interventions in health, education, and care systems taking into consideration measures of equity and long-term impact (National Heart, Lung, and Blood Institute, 2018; Rhee, De Lago, Arscott-Mills, Mehta, & Davis, 2005; Waters et al., 2011). Findings from studies involving multicomponent interventions (i.e., parent included and not included, paper handouts, recorded modules, small group, one-on-one) indicate that it is possible to achieve multiple health-promoting changes in schoolchildren (Jones et al., 2011; McAlister, Perry, & Parcel, 2008; Nerud & Samra, 2016). However, outcomes are limited by lack of readiness of both leaders and staff to implement these interventions; it remains unclear which intervention component(s) has the most impact on behavior change (Waters et al., 2011).

Escalating obesity rates among children across the nation has prompted interest in investigating the role of afterschool programs in the promotion of healthy eating and physical activity among participating children. This approach facilitates intervention programs that can be rooted in daily routines by frontline staff. Parents are key in providing education and modeling in the home (Nerud & Samra, 2016); they are a strong if not the strongest influence. However, afterschool staff can be a valued partner in helping promote HEPA to children. Children need positive role models; the work could be a challenging process and will require motivating staff.

For example, The Boys & Girls Club of America (afterschool program for youth, which focuses on improving academic success, developing good character and citizenship, and establishing healthy lifestyles) from the Midwest Region collaborated with the Centers for Disease Control and Prevention to provide training to selected staff to teach them how to train other staff and faculty members on implementing HEPA. The plan will include using HEPA standards in their afterschool program and to other surrounding community programs. By using role modeling, peer-to-peer, and fun activities in their afterschool programming, staff could create healthy norms that young children could develop, and it would bridge the gap between what children may not be receiving at home, or outside of the schools and at these afterschool programs.

The success of HEPA standards is dependent on the staff’s willingness and acceptability of self-refection of their own feelings of healthy eating and physical activity habits. Involvement in service-learning programs for staff, such as HEPA, can also serve as socializing agents as staff acquire the beliefs and knowledge about the role of frontline staff (Gaudreault, Shiver, Kinder, & Guseman, 2016). Staff need to have an accurate understanding of health nutrition before this understanding can be passed on to the afterschool program participants. Research supports the premise that children who receive adult supervision and additional learning opportunities outside of the traditional school day are less likely to engage in unhealthy behaviors (Clark et al., 2014).

This work can be challenging, so organizations need to start the discussion on HEPA standards by encouraging confident youth development and positive staff role modeling. Strategies for adaptation and implementation in afterschool programs must be a collaborative effort of administration, staff, and parents. Changing environments is a challenging process and requires role models within the environment to champion the cause. However, future training and collaboration to help promote improvements in knowledge, attitudes, and behavioral health intentions as well as personal health behaviors for other topic areas related to obesity for afterschool program staff are warranted.