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Promising Policies for Early Obesity Prevention

  • Obesity (S Armstrong and A Patel, Section Editors)
  • Published:
Current Pediatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper aims to highlight policy approaches for obesity prevention in early childhood while also discussing the opportunities for efforts to consider social determinants of health as a core tenet to child investments.

Recent Findings

Efforts to increase access to healthy food, active play, and reduced screen time have been seen through child care licensing regulations, Quality Rating Improvement Systems (QRIS), and federal funding streams; a recent case study of the Minnesota Statewide Health Improvement Partnership (SHIP) shows how the impact of these efforts can be augmented if they are community-driven and paired with proper support.

Summary

It is imperative to employ a health equity lens to policies for early obesity prevention—an approach that will benefit all children. National efforts have focused on improving health in the child care environment. This article discusses three main policy levers to impact obesity in early childhood, specifically through child care: main funding streams, Quality Rating Improvement Systems (QRIS), and child care licensing regulations. These efforts, coupled with a holistic view of health outside of the child care setting, will best support children’s physical and emotional well-being, promote whole-child development, and address fundamental social determinants of health. Lastly, the article discusses unintended consequences that can arise from some of these approaches.

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Notes

  1. Please note that in some states, local governments can also regulate the early care and education setting. For more information, please visit http://www.publichealthlawcenter.org/resources/healthy-child-care.

  2. The Public Health Law Center has analyzed the ECE licensing laws and regulations in all 50 states. For more information, please visit http://www.publichealthlawcenter.org/resources/healthy-child-care.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Rossin-Slater M. Promoting health in early childhood. Futur Child. 2015;25(1):35–64. http://www.jstor.org.ezp1.lib.umn.edu/stable/43267762

    Article  Google Scholar 

  2. Laughlin L. Who’s minding the kids? Child care arrangements 2005/2006. Household Economic Studies, Current Population Reports, US Census Bureau. August 2010. http://www.census.gov/prod/2010pubs/p70-121.pdf. Accessed 21 Feb 2017.

  3. Drafting Effective Policies. The Public Health Law Center at Mitchell Hamline School of Law. 2014. http://www.publichealthlawcenter.org/sites/default/files/resources/Drafting%20Effective%20Policies.pdf. Accessed 3 Apr 2017.

  4. Drafting Effective Policies. The Public Health Law Center at Mitchell Hamline School of Law. 2014. http://www.publichealthlawcenter.org/sites/default/files/resources/Drafting%20Effective%20Policies.pdf. Accessed 3 Apr 2017.

  5. Child Care Aware of the USA. Types of child care. 2016. http://childcareaware.org/families/types-of-child-care/. Accessed 30 Mar 2017.

  6. Child Care Aware of the USA. Types of child care. 2016. http://childcareaware.org/families/types-of-child-care/. Accessed 30 Mar 2017.

  7. 42 U.S.C.A. § 9858e. 2015.

  8. Pub. L. No. 113–186, 128 Stat. 1971.

  9. 42 U.S.C. §9858c (I).

  10. USDA, Food and Nutrition Service. Child and adult care food program (CACFP), https://www.fns.usda.gov/cacfp/child-and-adult-care-food-program. Last Published: January 4, 2017.

  11. Murphy SP, Yaktine AL, Suitor CW, Moats S. Child and adult care food program: aligning dietary guidance for all. Child and adult care food program, vol. 40. Washington DC: National Academies Press; 2011. doi:10.17226/12959.

    Google Scholar 

  12. Child and Adult Care Food Program: Nutrition Standards for CACFP Meals and Snacks. Published January 2017. https://www.fns.usda.gov/cacfp/meals-and-snacks. Accessed 23 Feb 2017.

  13. Child and Adult Care Food Program (CACFP): Nutrition Standards for CACFP Meals and Snacks. United States Department of Agriculture. Food and Nutrition Services. March 2017. Accessed 3 Ap 2017.

  14. About QRIS. QRIS Resource Guide website. https://qrisguide.acf.hhs.gov/index.cfm?do=qrisabout. Accessed 2 Feb 2017.

  15. About QRIS. QRIS Resource Guide website. https://qrisguide.acf.hhs.gov/index.cfm?do=qrisabout. Accessed 2 Feb 2017.

  16. Kirby G, Boller K, Tout K, et al. Compendium of quality rating systems and evaluations, The Child Care Quality Rating System (QRS) Assessment. April 2010.

  17. QRIS learning network, quality rating and improvement systems framework, http://www.qrisnetwork.org/our-framework. Accessed 2 Feb 2017.

  18. QRIS learning network, QRIS state contacts and map, http://qrisnetwork.org/sites/all/files/maps/QRISMap_0.pdf. Accessed 2 Feb 2017.

  19. Obesity Prevention and Early Care. cdc.gov. https://www.cdc.gov/obesity/downloads/early-care-education-ece-web.pdf. Accessed 9 Feb 2017.

  20. Quality Rating and Improvement System (QRIS). Addressing childhood obesity in the early care and education setting: opportunities for action. eceobesityprevention.org. http://www.eceobesityprevention.org/quality-rating-improvement-system-qris/. Accessed 9 Feb 2017.

  21. Obesity Prevention and Early Care. cdc.gov. https://www.cdc.gov/obesity/downloads/early-care-education-ece-web.pdf. Accessed 9 Feb 2017.

  22. Quality Rating and Improvement System (QRIS). Addressing childhood obesity in the early care and education setting: opportunities for action. eceobesityprevention.org. http://www.eceobesityprevention.org/quality-rating-improvement-system-qris/. Accessed 9 Feb 2017.

  23. State quality rating and improvement systems: strategies to support achievement of healthy eating and physical activity practices in early care and education settings. Nemours Children’s Health System. 2016. https://d3knp61p33sjvn.cloudfront.net/2016/07/State_QRIS_Strategies_to_Support_Achievement_of_Healthy_Eating_and_Physical_Activity_Practice_in_ECE_Settings-June2016.pdf. Accessed 19 Feb 2017.

  24. Summary of obesity prevention standards in state quality rating and improvement systems (qris) and licensing regulations. Qrisnetwork.org. 2016. http://qrisnetwork.org/sites/all/files/resources/2016-04-11%2012%3A26/ObesityPreventionQRISLicensing.pdf. Accessed 19 Feb 2017.

  25. Flynn MAT, Mcneil DA, Maloff B, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes rev. 2006;7(s1):7–66. doi:10.1111/j.1467-789x.2006.00242.x.

    Article  PubMed  Google Scholar 

  26. Idaho Code Ann. § 39–1114 - “A family daycare home providing care for fewer than seven (7) children may elect to comply with the provisions of this chapter and upon a finding of compliance by the department, shall receive a basic daycare license.” Mont. Code Ann. § 52–2-703 “(6) “Family day-care home” means a private residence in which day care is provided to three to six children on a regular basis.”

  27. Del. Code Ann. tit. 31, § 344 - “(a) No person may conduct child care, nor may any institution, agency, association or organization conduct child care, unless first having obtained a license from the Office of Child Care Licensing.” Del. Code Ann. tit. 31, § 342 - “Child care” means and includes: a. Any person, association, agency or organization which: 1. Has in custody or control 1 child or more under the age of 18 years, unattended by parent or guardian, for the purpose of providing such child or children with care, education, protection, supervision or guidance; 2. Is compensated for their services; 3. Advertises or holds himself, herself or itself out as conducting such child care…”.

  28. Mont. Code Ann. § 52–2-721 – “(4)…(b) may not charge a fee to issue a license or registration certificate.”

  29. Code Del. Regs. 9 100 103–12.0 “Anyone who operates a home without a license violates 31 Del.C. §§ 341–345, The Delaware Child Care Act, and shall be fined not more than $100 or imprisoned not more than three months, or both.” Mont. Code Ann. § 52–2-721. Mont. Code Ann. § 52–2-741 “(1) A person, group of persons, or corporation who establishes or maintains a day-care facility or assists in conducting or maintaining a day-care facility without first obtaining a license or registration certificate from the department as provided for in this part is guilty of a misdemeanor and upon conviction is punishable by a fine not to exceed $500.”

  30. See efforts in cities such as Philadelphia, PA; Boulder, CO; and Berkeley, CA.

  31. Falbe J, et al. Impact of the Berkeley excise tax on sugar-sweetened beverage consumption. Am J Public Health. 2016;106(10):1865–71. doi:10.2105/AJPH.2016.303362.

    Article  PubMed  Google Scholar 

  32. Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened beverage consumption among U.S. youth, 2011–2014. NCHS data brief, vol. 271. Hyattsville: National Center for Health Statistics; 2017. p. 1–8.

    Google Scholar 

  33. Harding MA, Whelton H, O’Mullane DM, Cronin M. Dental erosion in 5-year-old Irish school children and associated factors: a pilot study. Community Dent Health. 2003;20(3):165–70.

    CAS  PubMed  Google Scholar 

  34. Luo Y, Zeng XJ, Du MQ, Bedi R. The prevalence of dental erosion in preschool children in China. J Dent. 2005;33(2):115–21. doi:10.1016/j.jdent.2004.08.007.

    Article  CAS  PubMed  Google Scholar 

  35. Tandon PS, Tovar A, Jayasuriya AT, Welker E, Schober DJ, Copeland K, et al. The relationship between physical activity and diet and young children’s cognitive development: a systematic review. Preventive Medicine Reports. 2016;3:379–90. doi:10.1016/j.pmedr.2016.04.003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929214/

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jacka FN, Cherbuin N, Anstey KJ, Sachdev P, Butterworth P. Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC med. 2015;13:215. doi:10.1186/s12916-015-0461-x. https://www.ncbi.nlm.nih.gov/pubmed/26349802

    Article  PubMed  PubMed Central  Google Scholar 

  37. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  38. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html

  39. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html

  40. Rasberry CN, Lee SM, Robin L, et al. The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature. Prev Med. 2011;52(1):S10–20. https://www.ncbi.nlm.nih.gov/pubmed/21291905

    Article  PubMed  Google Scholar 

  41. Singh A, Uijtdewilligen L, Twisk JW, van Mechelen W, Chinapaw MJ. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc med. 2012;166(1):49–55. doi:10.1001/archpediatrics.2011.716. https://www.ncbi.nlm.nih.gov/pubmed/22213750

    Article  PubMed  Google Scholar 

  42. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  43. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  44. Carson V, Kuzik N, Hunter S, Wiebe SA, Spence JC, Friedman A, et al. Systematic review of sedentary behavior and cognitive development in early childhood. Prev med. 2015;78:115–22. doi:10.1016/j.ypmed.2015.07.016. https://www.ncbi.nlm.nih.gov/pubmed/26212631

    Article  PubMed  Google Scholar 

  45. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  46. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  47. Public Health Law Center. Healthy eating, active play, screen time best practices. Mitchell Hamline School of Law, Harvard T.H. Chan School of Public Health. http://www.publichealthlawcenter.org/heal/ChildCareMaps.html.

  48. Ogden L, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;219:1–8. https://www.cdc.gov/nchs/products/databriefs/db219.htm

    Google Scholar 

  49. Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(S1):S186–96. doi:10.2105/ajph.2009.166082.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Caprio S, Daniels SR, Drewnowski A, et al. Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of shaping America’s health and the obesity society. Diabetes Care. 2008;31(11):2211–21. doi:10.2337/dc08-9024.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kershaw KN, Albrecht SS, Carnethon MR. Racial and ethnic residential segregation, the neighborhood socioeconomic environment, and obesity among blacks and Mexican Americans. Am J Epidemiol. 2013;177(4):299–309. doi:10.1093/aje/kws372.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev med. 2009;36(1):74–81.e10. doi:10.1016/j.amepre.2008.09.025.

    Article  PubMed  Google Scholar 

  53. • Kumanyika S. Getting to equity in obesity prevention: a new framework. National Academy of Medicine. 2017. https://nam.edu/wp-content/uploads/2017/01/Getting-to-Equity-in-Obesity-Prevention-A-New-Framework.pdf. Reducing obesity for children does not mean the same thing for each population; a health equity approach requires tailoring efforts and supports to meet the specific needs of communities. This report, published in 2017, outlines some of the specifics of this type of approach.

  54. • Peterson-Hickey M, Ayers J. Advancing health equity in Minnesota: report to legislature. Minnesota Department of Health. 2014. http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020414.pdf Health equity can only be authentically embedded into work when there have been foundationally honest conversations about the state of health disparities, social determinants of health, generational poverty, and institutional racism. This Advancing Health Equity Report has laid some of the important groundwork for this, both in Minnesota and across the country.

  55. LaVeist TA, Gaskin D, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41(2):231–8. doi:10.2190/HS.41.2.c.

    Article  PubMed  Google Scholar 

  56. Subramanian SV, Kawachi I. Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health Place. 2006;12(2):141–56. doi:10.1016/j.healthplace.2004.11.001.

    Article  CAS  PubMed  Google Scholar 

  57. Ip S, Chung M, Raman G, Chew P, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. Rockville: Agency for Healthcare Research and Quality. 2007; 153:1–186.

  58. Munn AC, Newman SD, Mueller M, Phillips SM, Taylor SN. The impact in the United States of the baby-friendly hospital initiative on early infant health and breastfeeding outcomes. Breastfeed med. June 2016;11(5):222–30. doi:10.1089/bfm.2015.0135.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Chuang C-H, Chang P-J, Chen Y-C, et al. Maternal return to work and breastfeeding: a population-based cohort study. Int J Nurs Stud. 2010;47(4):461–74. doi:10.1016/j.ijnurstu.2009.09.003.

    Article  PubMed  Google Scholar 

  60. Blau DM. Unintended consequences of child care regulations. Labour. 2007;14(3):513–38.

    Article  Google Scholar 

  61. Social determinants of health: know what affects health. cdc.gov. 2016. https://www.cdc.gov/socialdeterminants/ Accessed 23 Feb 2017.

  62. Social Determinants. Office of Disease Prevention and Health Promotion. www.healthypeople.gov. 2017. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed 23 Feb 2017.

  63. Personal communication with staff of Minnesota Department of Health—Office of Statewide Health Improvement Initiatives, February 8, 2017.

  64. SHIP: Statewide Health Improvement Partnership. The Minnesota Department of Health. http://www.health.state.mn.us/divs/oshii/ship/index.html. Accessed 23 Feb 2017.

  65. Obesity in Minnesota: quick facts. Minnesota Department of Health. http://www.health.state.mn.us/divs/hpcd/chp/cdrr/obesity/index.html. Accessed 23 Feb 2017.

  66. • Advancing healthy eating, physical activity, and breastfeeding support practices and policies among family and independent child care providers: an evaluation of statewide health improvement partnership (ship) child care training and technical assistance. Minnesota Department of Health, Office of Statewide Health Improvement Initiatives. 2016. http://www.health.state.mn.us/divs/oshii/ship/child-care-report.pdf Published in December 2016, this report outlines a model of technical assistance and support for the child care environment that, coupled with community-driven efforts, has led to significant positive health outcomes for Minnesota children.

  67. Personal communication with staff of Minnesota Department of Health—Office of Statewide Health Improvement Initiatives, February 8, 2017.

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Correspondence to Anna Ayers Looby.

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Anna Ayers Looby and Natasha Frost each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Obesity

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Ayers Looby, A., Frost, N. Promising Policies for Early Obesity Prevention. Curr Pediatr Rep 5, 142–149 (2017). https://doi.org/10.1007/s40124-017-0139-2

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