NutritionChallenges in thePreschool Years

Alice Lenihan, MPH, RD, LDN

Branch Head

Nutrition Services Branch

Division of Public Health

Definition of Overweight and Obesityin Children and Adolescents

Weight Status Category Percentile Range

Underweight Less than the 5th percentile

Healthy Weight5th percentile to less than the85th percentile

Overweight 85th to less than 95th percentile

ObeseEqual or greater than the 95thpercentile

Reference: www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

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Prevalence of overweight1 and obese2 children2 to <5 years of age, NC-PedNSS3 1995 - 2010

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Overweight 12.5% 12.7% 13.1% 12.9% 13.6% 13.9% 14.0% 14.2% 15.3% 15.6% 15.4% 15.7% 15.8% 16.3% 15.8% 16.1%

Obese 9.0% 9.4% 10.0% 10.6% 11.2% 12.2% 12.0% 13.5% 14.4% 14.9% 14.6% 15.2% 15.3% 15.4% 15.4% 15.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

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(3) North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina Public Health Sponsored WIC and ChildHealth Clinics and some School Based Health Centers. Percentiles were based on the CDC/NCHS Year 2000 Body Mass Index (BMI) Reference.

(2) BMI-for-Age Percentiles 95th Percentile(1) BMI-for-Age Percentiles 85th and <95th Percentile

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Prevalence of obesity* by age in yearsNC vs. US—PedNSS** 2010

0

5

10

15

20

<1 1 2 3 4 Total

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Age (years)State Nation

*Obese: > 95th percentile BMI-for-age; CDC Growth Charts, 2000. . 5% of children are expected to fall above the 95th percentile**North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina PublicHealth Sponsored WIC and Child Health Clinics and some School Based Health Centers.

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Trends in prevalence of obesity* in children under 5years by race and ethnicity, NC PedNSS** 2001-2010

0

5

10

15

20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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Year

White Black Hispanic American Indian Asian Total

*Obese: > 95th percentile BMI-for-age; CDC Growth Charts, 2000. . 5% of children are expected to fall above the 95th percentile**North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina PublicHealth Sponsored WIC and Child Health Clinics and some School Based Health Centers.

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Percentage of Overweight1 and Obese2 Children 2 to <5Years of Age by Race and Ethnicity, NC-PedNSS3 2010

White, NotHispanic

Black, NotHispanic

Hispanic American IndianAsian/Pacific

IslanderTotal

Obese >=95th Percentile 12.9% 13.4% 20.4% 16.6% 10.3% 15.6%

Overweight >=85th-<95th Percentile 15.5% 14.4% 18.2% 18.2% 14.8% 16.1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

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(3) North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina Public Health Sponsored WIC and ChildHealth Clinics and some School Based Health Centers. Percentiles were based on the CDC/NCHS Year 2000 Body Mass Index (BMI) Reference.

(2) BMI-for-Age Percentiles 95th Percentile

(1) BMI-for-Age Percentiles 85th and <95th Percentile

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Age-Specific Trends in prevalence of obesity* under5 Years of Age, NC PedNSS** 2001 to 2010

0

5

10

15

20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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Year

Aged <1 Yr Aged 1 Yr Aged 2 Yr Aged 3 Yr Aged 4 Yr Total

*Obese: > 95th percentile BMI-for-age; CDC Growth Charts, 2000. . 5% of children are expected to fall above the 95th percentile**North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina PublicHealth Sponsored WIC and Child Health Clinics and some School Based Health Centers.

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Prevalence of overweight1 and obese2 children2 to <5 years of age, NC-PedNSS3 1995 - 2010

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Overweight 12.5% 12.7% 13.1% 12.9% 13.6% 13.9% 14.0% 14.2% 15.3% 15.6% 15.4% 15.7% 15.8% 16.3% 15.8% 16.1%

Obese 9.0% 9.4% 10.0% 10.6% 11.2% 12.2% 12.0% 13.5% 14.4% 14.9% 14.6% 15.2% 15.3% 15.4% 15.4% 15.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

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ge

(3) North Carolina-Pediatric Nutrition Surveillance System (NC-PedNSS) is limited to data on children seen in North Carolina Public Health Sponsored WIC and ChildHealth Clinics and some School Based Health Centers. Percentiles were based on the CDC/NCHS Year 2000 Body Mass Index (BMI) Reference.

(2) BMI-for-Age Percentiles 95th Percentile

(1) BMI-for-Age Percentiles 85th and <95th Percentile

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Opportunities for NC to ImpactPreschool Nutrition and Obesity

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•Built Environment•Crime Rates•Neighborhood Safety•Parks and Recreation

Marketing toChildren

•NC Eat Smart Move More•Communities

•Access toHealthyFoods

•WICProgram•NutritionServices(SNAP)•NorthCarolinaBreastfeedingCoalition•NutritionMessaging•NCSUExtension•NC Coalitionto EndHunger

•Early ChildhoodPrograms•CDE•Head tart•Early Head Start•Child CareLicensing

•Smart Start•CACFP

•Maternal ChildHealth•Medicaid•HealthChoice

•Policy•Social Determinants

Community, Demographic, Societal Characteristics

•ParentActivity/Encouragement•of Activity•Crime Rates•Parent ScreenTime/Monitoring• of Screen Time

WorkHours/Leisure Time

Child CareProvider

Health CareProvider

•Breastfeeding•Infant FeedingPractices•Parent DietaryIntake•Eating out•NutritionEducation

•ParentWeight Status•Parent

Smoking

•Socioeconomic•Status

Parenting Behaviors, Family Characteristics

•Motor SkillDevelopment•Physical Activity

•Screen Time

SpecialNeeds

DietaryIntake

Birth weight

•Ethnicity/Race•Age•Gender

Sleep

Child Weight

Status

Child Characteristics, Risk Factors

Adopted from Colorado PAN

Socio Ecological Model Early Childhood Obesity Prevention

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Child and Adult Care FoodProgram (CACFP)

Child Care Centers- 2,100+ Centers

Family Day Care Homes- 2,700+ homes

On going staff training and support of physicalactivity licensing requirements.

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Reimbursable Meal Requirementswww.fns.usda.gov/fns/regulations.htm.

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CACFP Nutrition Requirements

CACFP nutrition requirements are food basednot nutrient based

Daily requirement for food categories andamounts

Established by the U.S. Department ofAgriculture

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General Assembly Obesity Task ForceRecommendations

HB 1726

Division of Child Development shall consider anumber of nutrition standards.

Division of Public Health will examine currentstandards and report to the General Assembly.

Limit or prohibit serving of sweetenedbeverages, other than 100% fruit juice tochildren of any age.

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General Assembly Obesity Task ForceRecommendations

HB 1726

Limit or prohibit the serving of whole milk tochildren two years of age or older or flavoredmilk to children of any age.

Limit or prohibit the serving of more than sixounces of juice a day to children of any age.

Limit or prohibit the serving of juice from abottle.

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General Assembly Obesity Task ForceRecommendations

HB 1726

Division of Child Development shall consider anumber of nutrition standards.

Division of Public Health will examine currentstandards and report to the General Assembly.

Consider

Limit or prohibit serving of sweetenedbeverages, other than 100% fruit juice tochildren of any age.

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General Assembly Obesity Task ForceRecommendations

HB 1726

Creating an exception from the rules for parentsof children with medical needs, special diets orallergies.

Create an exception to allow a parent/guardianto allow upon request foods that do not meetthe nutrition standards.

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DPH Listening Sessions

To gather input for on Nutrition StandardsRecommendations

Charlotte- October 11, 2010

Greensboro- October 14, 2010

Ashville- October 18, 2010

Greenville- October 25, 2010

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Listening Sessions FeedbackBest Practices- Ashville

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Healthy Futures Starting in theKitchen- Mecklenburg County

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Nutrition and Physical Activity Assessment forChild Care (NAP-SACC)- Guilford County Model

•Child Care Health Consultants

•Smart Start Partnership withLocal Health Departments

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Institute of Medicine (IOM) Report

•Dietary Guidelinesfor Americans

•PreventionChildhood Obesity inEarly Care andEducation Programs

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Challenges of Child Care Meals

Cost of foods

Availability of foods

Children’s preference- parents

Self prep/vend meals

Facility kitchen, storage, skills

Meal reimbursement

Training needs

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DPH Report Recommendations

Phase Approach

Phase I

Cost-neutral

Minimal training required

Phase II

Additional collaboration DPH & DCDEE

Work with food vendors to ensure availability of foods

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DPH Report Recommendations

Phase II Prohibit the serving of sweetened beverages, other than

100% fruit juice, to children of any age.

Prohibit the serving of more than six ounces of juice perday to children of any age.

Prohibit the serving of juice from a bottle.

Prohibit the serving of whole milk to children two yearsof age or older.

Prohibit the serving of flavored milk to children of anyage.

Create an exception from the rules for parents ofchildren who have medical needs, special diets, or foodallergies.

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DPH Report Recommendations

Phase II

Limit the number of grains containing addedsugars and increase the number of wholegrains.

Limit foods high in fat and salt.

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Steps to Support Changes

Kids Eat Smart Move More USDA Grant to DPH Nutrition Services Training statewide

On line training for staff and parents

Outreach campaign

Mini grants to child care providers

Division of Public Health Trainings Statewide Conference- September 2011

Regional Trainings- ongoing

Continued collaboration with the Division ofChild Development and Early Education

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