Huge red strawberries were the star of the show for the three- and four-year-olds eating their weekly vegetarian lunch at Sunshine Center Head Start in Commerce City on a recent Tuesday. The children, who also had whole grain rolls, one-percent milk, and baked potatoes with grated cheese and sour cream, asked for seconds, thirds and fourths of the berries.
Watching the children eating fruit like candy, it was momentarily hard to believe that excess weight can be a pressing issues for these preschoolers. But about 18 percent of the 545 low-income children here and at other Head Start locations run by Adams County, are overweight or obese.
It’s a problem that staff members like Health and Nutrition Supervisor Andrea Pruett are working hard to address. Although she says the process is just beginning, a number of changes have already taken place this year.
Meatless meals, ranging from roasted red pepper hummus to black bean and sweet potato chili, are now offered once a week. More money has been allocated for fresh fruits and vegetables, lessening the program’s reliance on canned products.
In addition, items like white flour biscuits, juice and bacon have been eliminated in favor of foods with less fat and sugar and more whole grains. After an unpopular skim milk trial, one-percent milk replaced two-percent milk.
Aside from menu changes, Adams County Head Start administrators are taking steps to incorporate more physical activity into the school day, educate staff and parents about healthy habits and involve them in conversations about new initiatives. Next year, Pruett hopes to offer parent cooking classes, increase the number of vegetarian meals and buy new kitchen equipment.
The goal is to reduce the rates of overweight and obesity by 10 percentage points by 2015. If all goes well, that means about 46 fewer Head Start children will fall into those categories two years from now.
A statewide push
Pruett and her colleagues are not alone in their efforts to tackle the complicated problem of overweight and obese kids. In fact, many Head Start programs face even tougher odds than Adams County. In Colorado Springs, 23 percent of 1,034 students enrolled in Head Start through the Community Partnership for Child Development are overweight or obese.
“That number, that’s alarming,” said Chief Operating Officer Linda Meredith.
But it’s also the norm for low-income preschoolers across Colorado. In 2010, 23.2 percent of the state’s poor children, ages two to five, were overweight or obese, according to the Pediatric Nutrition Surveillance System run by the Centers for Disease Control and Prevention. That number fell slightly from a high of 24.7 percent in 2005. All told, there are 41 Head Start programs enrolling 10,400 children in Colorado.
Obesity among the early childhood set has been on the radar of Head Start leaders in Colorado and nationally for about a decade, said Andreas Molarius, executive director of the Colorado Head Start Association. But it was really after the Head Start Act was reauthorized in late 2007 with new language about obesity that many program directors began to take a more aggressive and comprehensive approach to the problem.
Now, efforts to address obesity are often woven throughout entire Head Start programs, and touch children through curriculum, on-site meals and body mass index monitoring. In addition, parent outreach may include referrals to dieticians or other specialized staff, cooking and health classes at Head Start centers and in-home health education by Head Start staff.
Molarius said a handful of programs, including the Community Partnership for Child Development, Boulder County Head Start and Clayton Early Learning in Denver, are particular stand-outs when it comes to tackling obesity. For example, she said that the Boulder Head Start matches master gardeners with Head Start families to help them start and sustain their own home vegetable gardens.
“It’s definitely innovative and food security is just a huge issue for our families,” she said.
Despite these kinds of efforts, Head Start leaders face a raft of challenges when it comes to reducing obesity and overweight rates. Societal factors like the availability of cheap processed food, the ease of entertaining kids with television, and the difficulty of outdoor play for low-income children living in apartments or unsafe neighborhoods are part the problem.
Plus, Head Start programs housed in elementary schools may rely on school district menus, which vary widely in their emphasis on whole foods and scratch cooking. Some Head Start centers have high staff turn-over, lack access to specialists like dieticians or scrap to find funding for nutrition and movement programming or intensive parent outreach.
Other programs struggle to get buy-in from parents or staff members, some of whom may struggle with weight problems themselves. Pruett said while about 60 percent of the staff at Adams County Head Start support the recent changes, some don’t.
“It’s been a little scary for a lot of my staff,” said Pruett.
Some don’t want to give up indulgences like donuts and soda that were once acceptable in the classroom. In other cases, new menu items like hummus are unappealing to teachers, who eat family style with their students.
Boosting healthy habits
One of the key offensives in the obesity fight is getting kids and families to like, and ultimately choose healthy foods over salty, sugary and high-fat fare. That’s one reason that many Head Start centers use the Food Friends program developed by Colorado State University’s Department of Food Science and Human Nutrition.
In addition to a physical activity component called “Mighty Moves,” the program introduces preschoolers to a variety of new foods, from daikon radishes to gouda cheese.
Terri Hulsey, director of health and nutrition at the Community Partnership for Child Development, said, “They end up having a tasting party at the end and they’ll eat everything.”
A second widely-used program, which focuses more on physical activity, is called “I Am Moving, I Am Learning.” Developed by Head Start in 2005, the program aims to increase the number of minutes of moderate to vigorous exercise that children get each day.
Amber Arens, health/nutrition specialist at the Colorado Early Education Network in Weld County, said the curriculum ensures that her program’s full-day Head Start kids children get an hour of exercise during the school day and that half-day children get 30 minutes. One-third of the program’s 562 children are overweight or obese.
For parents, Cooking Matters classes are a popular offering at many Head Start centers. The Community Partnership for Child Development offers these cooking classes featuring healthy meals made by the chef from the local food bank. At the end of each class, parents are given a bag of groceries containing everything they need to recreate the meal.
“They’re crazy for it,” said Meredith, adding that more parents show up than there are slots available.
Encountering resistance
Not surprisingly, weight can be a touchy subject, especially since perceptions about what constitutes a healthy weight don’t always jibe with clinical findings. It was a lesson Meredith learned the hard way last fall when program staff sent out letters to scores of parents informing them that their children were obese or on track to becoming obese according to body mass index measurements.
“Parents were livid,” she said. “We had a lot of families calling and saying, ‘How dare you?’”
Despite the push by some staff not to sugar-coat what they saw as an urgent health message, Meredith said future iterations were massaged so they didn’t upset parents so much.
Arens knows the feeling.
“Once you say ‘obese’ sometimes families shut down,” she said.
Lynne Clifft, a Head Start teacher at the Sunshine Center, said she tries to keep things positive when parents come to her for advice about dealing with overweight children. She focuses on physical activity because telling people what to eat makes her uncomfortable.
“That’s mostly my thing with them, if they can get outside and play,” Clifft said. “I don’t like to go the food route.”
Cultural norms can also impact the weight discussion.
Pruett said some Hispanic parents feel that having a chubby child is a good thing, demonstrating that they are well fed. Hulsey has noticed similar attitudes among some parents in her program, and one outcome has been a shifting focus from addressing a child’s weight problem to living a healthy lifestyle.
“You won’t get to everybody,” she said. “We just kind of plug along.”