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Dianne Ward, EdD

Eating and physical activity habits for a lifetime can develop at an early age, and many children spend most of their days in child-care settings. Researchers from the University of North Carolina at Chapel Hill recently contributed to research that describes and evaluates research addressing opportunities and strategies to prevent obesity among preschool children in child-care settings.

Dianne Ward, professor of nutrition at the UNC Gillings School of Global Public Health and research fellow at the UNC Center for Health Promotion and Disease Prevention (HPDP), co-authored the review article in the September 2011 issue of the issue of the Journal of the American Dietetic Association. The review found room for improvement to the nutritional quality of foods provided to children, the amount of time children are engaged in physical activity, caregiver behaviors that may discourage healthy behaviors, and missed opportunities for education.

Ward leads several projects focused on preventing obesity in preschool children at HPDP, including NAPSACC, which was recently recommended by the Let’s Move Child Care campaign as a way to combat obesity in child care centers. She joined other experts from from the School of Public Health, University of Minnesota, the Gillings School of Global Public Health, and the Duke University Medical Center in conducting the review. The review of existing evidence was funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation.

“Early prevention is considered to be the most promising strategy for reducing obesity and the many serious health conditions that may result as a consequence of excessive weight gain in childhood,” commented lead author Nicole Larson, PhD, MPH, RD, Research Associate in the Division of Epidemiology and Community Health at the University of Minnesota. “Eating and activity behaviors formed during the preschool years have the potential to prevent obesity in the short term, and if carried into adulthood, to set the stage for a lifetime of better health. The majority of U.S. parents depend on child-care providers to support the development of healthful behaviors by providing their young children with nutritious foods and regular physical activity…Significant improvements in the eating and activity behaviors of preschool children will likely depend on the combined strength of interventions and supportive policy changes.”

Conducting a comprehensive review of the research literature, investigators identified and assessed 42 relevant studies that can serve as baselines against which future progress may be measured. These included 4 reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, 2 studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Although research focused on the U.S., interventions implemented in international settings were also included.

While a limited number of interventions have been designed to address the concerns of quality of food, amount of time for physical activity and caregiver behaviors, only 2 interventions showed evidence of success in reducing risk for obesity among child participants.

Child-care facilities in the U.S. are primarily regulated by individual states. Each state establishes its own set of regulations for licensed child-care facilities and sets minimum enforcement standards to assess compliance. However, recent reviews indicated there is a gap between existing state regulations for child-care settings and the standards recommended by public health experts. Most states lacked strong regulations related to healthy eating and physical activity. There was strong variation among states in promoting 8 key nutrition and physical activity measures in child-care settings. For example, while Tennessee covered 6 of the 8 factors, the District of Columbia, Idaho, Nebraska and Washington had none.

Larson added: “These reviews identified a number of opportunities for enhancing state regulations by comparing existing regulations with relevant national standards and recommendations from professional groups, including the American Dietetic Association, the American Academy of Pediatrics, and the American Public Health Association.”

Dr. Larson and Dr. Ward share their insights about how child-care settings can play an important role in establishing healthy eating and exercise habits in preschool children and update the results of their study taking legislation into consideration in a podcast available at

Alice Ammerman, director of HPDP and professor of Nutrition at the UNC Gillings School of Global Public Health, was interviewed about the review article and quoted by WebMD here:

The article is “What Role Can Child-Care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts” by Nicole Larson, PhD, MPH, RD, Dianne S. Ward, EdD, Sara Benjamin Neelon, PhD, MPH, RD, and Mary Story, PhD, RD. The commentary is “Nutrition and the Child-Care Setting” by Margaret Briley, PhD, RD, LD and Michael McAllaster. Both articles appear in the Journal of the American Dietetic Association, Volume 111, Issue 9 (September 2011) published by Elsevier.

The UNC Center for Health Promotion and Disease Prevention is one of 37 Prevention Research Centers funded by the Centers for Disease Control and Prevention.

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