Pay­ing off

Ef­forts to lower child­hood obe­sity may be work­ing

Modern Healthcare - - THE WEEK IN HEALTHCARE - Steven Ross John­son

The Ed­u­care early child­hood cen­ter, a Head Start preschool on Chicago’s South Side, opened over a decade ago in­side crime-rid­den Robert Tay­lor Homes hous­ing pro­ject. The chil­dren “couldn’t go out­side, they wouldn’t play, and most of the time they had to hud­dle be­cause there were bul­lets fly­ing,” said Brenda Ei­land-Wil­li­ford, pro­gram and cur­ricu­lum di­rec­tor for the cen­ter. “It was very danger­ous back then.”

It was that lack of ac­cess to phys­i­cal ac­tiv­ity that led to the con­struc­tion of the pro­gram’s cur­rent fa­cil­ity, a large struc­ture that houses 13 class­rooms, two in­door gyms and an out­door play area. In ad­di­tion to the play ar­eas, each class­room is con­nected to an out­door pa­tio where chil­dren can go for un­struc­tured play time.

“We un­der­stand the im­por­tance of phys­i­cal ac­tiv­ity,” she said. “Not only for chil­dren’s weight in terms of obe­sity, but also in terms of their cog­ni­tive abil­i­ties.”

Pol­i­cy­mak­ers, pub­lic health ex­perts and ed­u­ca­tors across the coun­try have come to a sim­i­lar re­al­iza­tion, and there are signs that their ef­forts are pay­ing off. Af­ter ris­ing for years, the child­hood obe­sity rate in the U.S. showed the first signs of fi­nally be­gin­ning to de­cline. A new re­port from the Cen­ters for Dis­ease Con­trol and Preven­tion last week found a slight drop in 19 states among low-in­come chil­dren be­tween the ages of 2 and 4. Illi­nois, how­ever, was not one of those states. Its rate of obe­sity among low-in­come preschool­ers re­mained sta­ble at about 14.7% from 2008 to 2011.

The CDC’s find­ings high­lighted ques­tions about the root causes of high rates of obe­sity found in the coun­try’s low-in­come com­mu­ni­ties, which suf­fer higher rates of child­hood obe­sity than other in­come groups.

For many low-in­come com­mu­ni­ties across the coun­try, the com­bi­na­tion of vi­o­lence and a lack of eco­nomic de­vel­op­ment over the years have re­sulted in a lack of safe parks and limited ac­cess to fresh fruits and veg­eta­bles, both of which have con­trib­uted to the prob­lem of obe­sity in such ar­eas.

“His­tor­i­cally, there has been a pretty strong link be­tween poverty and obe­sity,” said Mar­lene Schwartz, di­rec­tor of the Rudd Cen­ter for Food Pol­icy and Obe­sity at Yale Univer­sity. “There seems to be ex­tra vul­ner­a­bil­ity to obe­sity among low-in­come fam­i­lies par­tic­u­larly be­cause they of­ten don’t have the same kind of ac­cess to healthy food and might not have the sort of time to pre­pare the food. (There) are ex­tra stres­sors that make it par­tic­u­larly dif­fi­cult for low-in­come fam­i­lies,” she said.

Such has been the case for the Grand Boule­vard neigh­bor­hood on Chicago’s South Side, which is filled with empty lots, con­ve­nience food stores stock­ing snack food and fast-food restau­rants but few full-ser­vice supermarkets.

The Ed­u­care cen­ter staff has worked hard to ad­dress that prob­lem. With bright, col­or­ful walls filled with pic­tures show­ing the smil­ing faces of the 149 chil­dren the cen­ter serves, it seems a world away from the pro­gram’s be­gin­nings more than 13 years ago.

The cen­ter has an on­site nurse and nu­tri­tion­ist. Upon en­roll­ment, chil­dren are given a phys- ical as­sess­ment that in­cludes mea­sur­ing height and weight, and they are re­quired to an­swer ques­tions about their eat­ing habits at home.

Those chil­dren found to be over­weight or obese—about 10%, ac­cord­ing to Ei­land-Wil­li­ford — are given an in­di­vid­u­al­ized health plan. Coun­selors work with chil­dren and their fam­i­lies on im­prov­ing eat­ing habits and en­cour­ag­ing more-ac­tive life­styles.

Ei­land-Wil­li­ford and oth­ers are on the front lines of an on­go­ing strug­gle against child­hood obe­sity, whose rate has more than dou­bled in chil­dren over the past 30 years and has been called an epi­demic.

Not un­til last week’s CDC study has there been ev­i­dence point­ing to a de­cline in child­hood obe­sity rates. Many re­searchers and an­tiobe­sity ad­vo­cates found the study en­cour­ag­ing be­cause the de­cline was among preschool chil­dren who came from low-in­come house­holds.

The study in­cluded 12 mil­lion chil­dren from 40 states, and found the most sig­nif­i­cant de­clines in Florida, Ge­or­gia, Mis­souri, New Jersey and South Dakota, where the obe­sity rate in each of those states fell by 1 per­cent­age point. In­creases were found in three states stud­ied— Ten­nessee, New Mex­ico and Penn­syl­va­nia— while 21 states saw no sig­nif­i­cant change.

Schwartz ar­gued that the CDC find­ings most likely re­flect gains made through fed­eral, state and lo­cal pol­icy changes to re­duce obe­sity. A key change is in the types of foods fam­i­lies re­ceiv­ing as­sis­tance un­der the fed­eral govern­ment’s Spe­cial Sup­ple­men­tal Nu­tri­tion Pro­gram for Women, In­fants and Chil­dren are al­lowed to pur­chase.

Ei­land-Wil­li­ford said many par­ents of the chil­dren who at­tend her cen­ter—a ma­jor­ity of whom re­ceive govern­ment as­sis­tance—have ex­pressed dis­may over their lack of ac­cess to fresh veg­eta­bles.

So the Ed­u­care cen­ter did some­thing about that. “We ac­tu­ally got a bus for our fam­i­lies and took them to a nice su­per­mar­ket where there was fresh food avail­able,” Ei­land-Wil­li­ford said. “They had the op­por­tu­nity to buy a va­ri­ety of fresh fruits and veg­eta­bles.” In ad­di­tion, the cen­ter has a gar­den that grows veg­eta­bles for lo­cal food pantries and holds reg­u­lar nu­tri­tion and yoga classes for par­ents.

Such ef­forts have had pos­i­tive re­sults for a ma­jor­ity of the chil­dren, with par­ents tak­ing greater re­spon­si­bil­ity for im­prov­ing the nu­tri­tion of their kids, she said. De­spite the progress, she thinks the cen­ter could play an even larger role in help­ing im­prove the health of par­ents.

“We need to look into do­ing more things that can help fam­i­lies with weight loss,” Ei­land-Wil­li­ford said. “We could do more with our fam­i­lies in ed­u­cat­ing them about the im­por­tance of good nu­tri­tion.”


A preschooler rides a tri­cy­cle on the out­door play­ground at Ed­u­care Chicago, which aims to give chil­dren am­ple op­por­tu­nity for phys­i­cal ac­tiv­ity.

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