State Regulations for Child-Care Centers Fall Short In Preventing Childhood Obesity

Study finds most states could easily improve regulations aimed at promoting healthy eating and physical activity in young children.

    • December 8, 2009

Most states would get a failing grade if ranked according to model obesity-prevention regulations governing child-care centers, according to a report released today. However, improving such grades should be straightforward for most states because there is strong expert agreement on the model regulations that can best help child-care centers provide healthier foods and more opportunities for physical activity.

“Most states got an F when compared with the model regulations,” said Sara Benjamin, Ph.D., M.P.H., who conducted the study as a research fellow at Harvard Medical School but is now an assistant professor at Duke University. Even when compared with less stringent, less specific standards, most still performed at average or below-average levels—at least when it comes to regulations requiring healthy eating or physical activity for preschool-aged children.

State regulations can compel child-care centers, both those based in facilities and those based in homes, to adopt practices that help prevent obesity, a health condition that has reached epidemic proportions among children in the U.S. This report analyzed child-care regulations on the books in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands and the Department of Defense, and compared them with model regulations that help promote childhood health and fitness.

Benjamin and Jonathan Finkelstein, M.D., M.P.H., from Harvard Medical School, co-authored the report, which was funded by the Robert Wood Johnson Foundation through its national program Healthy Eating Research.

Benjamin encouraged states to adopt specific regulations for child care, using those in this new report as a guide. She also said states should help support child-care facilities through adequate funding and technical assistance.

For this report, experts in nutrition and physical activity assessed state regulations for child-care centers and then graded each state according to healthy eating and physical activity standards. The vast majority of the states got an overall grade of a C—even when the panel used the less than ideal standards as a benchmark. No state received an A, and just eight states got a B. One state, Idaho, still got an F, even when the experts judged the regulations using the less stringent models.

“These findings suggest that most states have a lot of room for improvement in regulations aimed at preventing obesity in young children,” Benjamin said. “This nation must do a better job at promoting healthy eating and regular physical activity in very young children, especially those in lower-income families who are at high risk for obesity.”

Today, 24.4 percent of children ages 2 to 5 are overweight or obese. Statistics for older children and teens are equally alarming, putting an entire generation at risk for serious health conditions like type 2 diabetes and heart disease.

Other key findings from the report include:

  • Compared with the less stringent standards for healthy eating and physical activity, states had an average of just three out of 20 standards.
  • Georgia and Nevada ranked highest for the total number of healthy eating and physical activity requirements for child-care centers and homes.
  • South Dakota, Puerto Rico and Idaho got the lowest marks for the total number of healthy regulations aimed at obesity-prevention in young children.
  • The Department of Defense regulates its own child-care facilities and has done well in previous rankings of health related regulations, such as fire safety and first aid training. In this study, the Department of Defense scored a C- and was fourth from the bottom in ranking.

The report found that no state had all 10 healthy eating or physical activity requirements that met the model guidelines. In fact, most states have weakly worded regulations that leave out important specifics that could help young children stay healthy.

For example, model state regulations specify that young children in child-care centers should get at least 60 minutes of physical activity per day. But according to the less stringent standards experts considered for this evaluation, states were given credit even if they had a regulation that only required “some” physical activity. Such a requirement fails to spell out the need for an hour’s worth of vigorous activity every single day, Benjamin said.

“Stronger state regulations aimed at child-care centers have the potential to reduce the risk of obesity for millions of children in the U.S.,” said Benjamin. Nearly 74 percent of children ages 3 to 6 are in some form of non-parental care, and more than half attend a day care center, she said. “These providers are in a unique position to encourage very young children to eat healthy foods and be active,” she said.

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