From The Field N O V E M B E R 1 7 , 2 0 1 4 Starting Early: Obesity Prevention in Early Childhood ALLISON F. BAUER, JD, LICSW Program Director, Health and Wellness, The Boston Foundation I n late 2009 The Boston Foundation, Greater Boston’s Ogden et al. 2014). These studies are further supported by community foundation and one of the largest community the fact that one in eight U.S. preschoolers are obese, with foundations in the nation, shifted its health grantmaking rates notably worse among African-American (one in five) focus from access to prevention in order to address the rising and Hispanic (one in six) preschoolers (Ogden et al. 2014). tide of preventable chronic illness and the escalating health A child who enters kindergarten overweight has nearly four care costs stemming from the obesity epidemic. This times the risk of becoming obese (32 percent vs. 8 percent). epidemic poses a threat not only to the public health of the “Weight fate” is set by age five and reflects the fact that Commonwealth of Massachusetts, but also its fiscal stability half of obese 14-year-olds were already overweight by the and economic competitiveness. While progress has been made age of five. in programs and policy over the last five years, it has become increasingly clear that efforts to address obesity need to begin ACTION-ORIENTED RESEARCH AND POLICY at earlier ages. The recent and significant upward trend in In 2010 The Boston Foundation and New England body mass index among children under the age of five in the Healthcare Institute launched the Healthy People/Healthy last decade is cause for concern. In Massachusetts, where adult Economy coalition with the goal of shifting the state’s focus obesity rates are among the lowest in the nation, the rate from health care to health and making Massachusetts the among low-income, two- to five-year-olds (16.5 percent) is national leader in health and wellness. In June 2013 the the fourth highest in the country (Levi et al. 2014). coalition flagged the issue of early childhood as a priority. The coalition’s annual report card cited brain research demon- BACKGROUND strating that learning and nurturing social supports in early Early childhood is a critical window of time for obesity pre- childhood create biological “memories” that heavily influence vention. Children are developing taste preferences, learning to the child’s health and health habits over the course of an entire walk and play, and eagerly mimicking both healthy and lifetime (Healthy People/Healthy Economy 2013). The 2014 unhealthy behaviors of their caregivers (Obesity Prevention report card further lifted early childhood as needing to be the Source 2014). For many chil- dren, those caregivers may be someone other than parents or A child who enters kindergarten overweight has nearly four times the risk of guardians. An estimated 75 becoming obese. “Weight fate” is set by age five and reflects the fact that half of percent of children in the obese 14-year-olds were already overweight by the age of five. United States spend time in child care for an average of 35 hours per week. Children’s early-life experiences, such as lack of breastfeeding, too-little key focus area for both education and care, stating that invest- sleep, and too-much television, can increase the risk of obesity ment in childhood health and education may be the single later in life (AAP et al. 2010). Intervening early in the life of most significant effective way to reduce health problems over children by engaging parents and early child care and educa- the course of a lifetime (Healthy People/Healthy Economy tion providers is crucial to turning around the obesity 2014). epidemic. Early childhood providers are in a unique position to edu- Recent studies reported in The Journal of the American cate parents and guardians about healthy eating and physical Medical Association and The New England Journal of Medicine activity habits and provide a healthy environment for children clearly indicate that funding and policy initiatives to fight to eat, play, and grow. They can serve children age-appropriate obesity must “think younger” (Cunningham et al. 2014; healthy foods and limit consumption of junk food, sugary drinks, and juice. They can also offer children ample oppor- obesity and health disparities, will be engaged as the pilot sites tunities for fun, active play throughout the day and keep for the project. If proven successful, this collective impact televisions turned off and away from areas where children approach may provide a blueprint for the necessary systemic sleep. When parents are encouraged to reinforce these changes needed to address obesity in early childhood in the practices at home, children are assured the best chance of very segments of the U.S. population needing it most. growing into a healthy weight. A NEW APPROACH AND PHILANTHROPY’S ROLE Elsie Taveras, Chief of Pediatrics at Massachusetts General Hospital for Children and a leader in early childhood obesity SOURCES prevention, has noted: Substantial evidence points to early childhood as a piv- American Academy of Pediatrics (AAP), American Public otal time for preventing young children from an obesity Health Association, and National Resource Center for Health trajectory that is hard to alter by the time they enter and Safety in Child Care and Early Education. Preventing middle school. Until recently, many of our national Childhood Obesity in Early Care and Education: Selected obesity prevention efforts have not leveraged opportuni- Standards from Caring for Our Children: National Health and ties to change the early “obesogenic” systems that Safety Performance Standards; Guidelines for Early Care and increase children’s risk for obesity. Putting existing Education Programs, Third Edition. 2010. http://nrckids.org/ evidence into practice, leveraging systems that influence CFOC3/PDFVersion/preventing_obesity.pdf childhood obesity, and testing innovative multisector Cunningham, Solveig A., Michael R. Kramer, and K.M. Venkat interventions for prevention of obesity in early childhood Narayan. “Incidence of Childhood Obesity in the United would have beneficial effects for the entire population. States.” The New England Journal of Medicine 370 (2014): It would be particularly effective in reducing the burden 403-411. doi 10.1056/NEJMoa1309753. of obesity and related chronic diseases among dispropor- tionately affected U.S. populations such as racial/ Healthy People/Healthy Economy. Annual Report Card. June ethnic minorities and children living in disadvantaged 2013. http://www.tbf.org/~/media/TBFOrg/Files/Reports/ communities (Taveras 2014). HPHE%203rd%20Report%20Card.pdf. Healthy People/Healthy Economy. Annual Report Card. June With this in mind, The Boston Foundation was seeking an 2014. http://www.tbf.org/~/media/TBFOrg/Files/Reports/ innovative approach to address early childhood obesity. HPHE%204thReport%20Card.pdf. Substantial evidence suggests that conception through 24 months of age is a crucial period for the development and Levi, Jeffrey, Laura Segal, Rebecca St. Laurent, and Jack prevention of obesity and its consequences in mother-infant Rayburn. The State of Obesity: Better Policies for a Healthier dyads and their families. Working with Dr. Taveras, The America 2014. September 2014. http://healthyamericans.org/ Boston Foundation will invest in a five-year effort to develop, assets/files/TFAH-2014-ObesityReport-Fnl10.9.pdf. implement, and evaluate an intervention that leverages early Obesity Prevention Source. “Early Child Care Obesity life systems and community resources, and addresses individ- Prevention Recommendations: Complete List.” Accessed ual and family socio-contextual factors to improve outcomes October 2014. http://www.hsph.harvard.edu/obesity- among vulnerable family units in the “First 1000 Days” – prevention-source/obesity-prevention/early-child-care/ from conception through 24 months of age. The overall goal early-child-care-obesity-prevention-recommendation- of the First 1000 Days study is to reduce obesity risk and complete-list/. related racial/ethnic and socioeconomic disparities among vulnerable families, prevent excess weight gain among moth- Ogden, Cynthia L., Margaret D. Carroll, Brian K. Kit, and ers, promote healthful growth among their offspring, and Katherine M. Flegal. “Prevalence of Childhood and Adult improve obesogenic behaviors in the family unit. It will bring Obesity in the United States, 2011-2012.” The Journal of the together obstetric/gynecologic and pediatric medical practi- American Medical Association 311, no. 8 (2014): 806-814. tioners with the Women, Infants, and Children federal grant doi:10.1001/jama.2014.732 program and community health programs (specifically mater- Taveras, Elsie, Masschusetts General Hospital, email message to nal, infant, and early childhood home visiting programs) in a the author, 2014. collective effort to improve health and behavioral outcomes for both the mothers and their children. A strong network of community and public health partners, as well as clinical and public health practitioners from three Views from the Field is offered by GIH as a forum different Massachusetts communities with a high burden of for health grantmakers to share insights and experiences. If you are interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.