Day care next frontier in fighting childhood obesity

Tuesday, October 13, 2009
In this photograph taken Friday, Oct. 2, 2009, Jean Carlos Rubell, 3, helps himself to grapes during preschool lunch at the Latin American Community Center in Wilmington, Del. (AP Photo/ Steve Ruark)

WASHINGTON -- Grilled chicken replaced the hot dogs. Strawberries instead of cookies at snack time. No more fruit juice -- water or low-fat milk only. This is the new menu at a Delaware day care center, part of a fledgling movement to take the fight against obesity to pudgy preschoolers.

Day care is the next frontier: New Harvard research shows few states require that child care providers take specific nutrition and physical activity steps considered key to keeping the under-5 crowd fit.

While years of work now have older children starting to get healthier food in schools, more and more kindergarteners show up their first day already overweight or obese.

"We've got to start really early. Elementary school is too late," Dr. Lynn Silver of the New York City Health Department -- a leader in anti-obesity standards for day care -- said at a recent meeting that brought child care specialists together with federal and state health authorities to start learning how.

This isn't about putting youngsters on a diet. It's about teaching them early, before bad habits form, how being active and eating healthy can be the norm.

In this photograph taken Friday, Oct. 2, 2009, preschool teacher Jennifer Rosario serves two-year-olds celery at the Latin American Community Center in Wilmington, Del. (AP Photo/ Steve Ruark)

"This is a whole new way of eating for our kids," said Maria Matos, who heads the Latin American Community Center in Wilmington, Del., and has overhauled what she now knows wasn't an ideal preschool menu even though it fully complied with day care regulations.

It took some adjustment. Matos started serving Latino dishes with brown rice instead of white. The mac-and-cheese got a wheat makeover, too. Many of her youngsters had never even seen honeydew and kiwi, and had to be coaxed to try it.

"You have to get people used to this different type of eating," she said. "Some are there, and some are still getting there."

Two-thirds of Americans are either overweight or obese, and it starts shockingly early. Research last April found almost one in five 4-year-olds already was obese. Rates are highest among American Indian, Hispanic and black children, but the problem affects every demographic.

Nearly three-fourths of children ages 2 to 5 spend at least part of their day in child care, about half in formal day care centers.

In this photograph taken Friday, Oct. 2, 2009, Odette Aguilar, 6, eats a lunch of baked chicken, celery, grapes and bread at the Latin American Community Center in Wilmington, Del. (AP Photo/ Steve Ruark)

That makes day care a vital next front, said Debbie Chang of the Delaware not-for-profit Nemours Health & Prevention, which helped push that state to adopt a list of new child-care licensing requirements to do just that.

"Everybody is always pointing fingers at us parents saying, 'You should do better.' A lot of other people are feeding our kids," said nutrition specialist Margo Wootan at the Center for Science in the Public Interest.

Training providers is key, said Nemours' Chang. Many simply don't know, for instance, that whole milk is unnecessary extra fat for preschoolers while low-fat costs the same.

How much should a preschooler eat? Generally, a preschool serving size is about 1 tablespoon of each food type for every year of age, but specifics can be found at, an easy-to-use website.

Proper portion sizes were a surprise to Matos, who bought serving spoons premeasured for preschoolers so they can dip while teachers tell how a colorful plate is a healthy plate.

Matos said the changes cost a bit more; she hired an extra part-time cook to make more from scratch, and fresh foods can cost more than processed. Chang and Wootan said day cares can make many cheap changes -- swapping water for juice, for instance.

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