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Issue Brief 59 - Ensuring Children Grow Up at a Healthy Weight: Supporting Emerging Research & Prevention Efforts in CT

December 5, 2017

Ensuring Children Grow Up at a Healthy Weight:

Supporting Emerging Research and Prevention Efforts in Connecticut

Investing in policies and best practices to prevent and reduce childhood obesity is vital to help children in Connecticut grow up at a healthy weight. Funders, health providers, and researchers in Connecticut have intensified efforts to prevent obesity in infants and toddlers because once childhood obesity sets in, it can be difficult to reverse.

Research and Best Practice Approaches Can Help Target Limited Obesity Prevention Resources

Preventing obesity is not easy. The field is still developing and testing new strategies to see if they yield outcomes, particularly for low-income and minority populations disproportionately affected by childhood obesity. In 2014 CHDI released an IMPACT titled Preventing Childhood Obesity: Maternal/Child Life Course Approach. The report identified opportunities for intervening in infant and early child nutrition, feeding practices, and physical activity. Shortly after, a coalition of experts convened to discuss effective prevention strategies and identified opportunities, research gaps, and challenges for Connecticut in the areas of policy, data, evidence-based interventions, and health messaging. The coalition’s work informed funding from the Children’s Fund of Connecticut (CHDI’s parent organization) for four projects to advance promising obesity prevention strategies for children ages birth to 2. What follows is a summary of results from these four projects and next steps to continue this important work.

1. Policy: Advancing Best Practices for Obesity Prevention in Child Care Settings:

   The UConn Rudd Center for Food Policy and Obesity conducted a review of relevant policies, regulations, and legislation to inform an agenda for early childhood obesity prevention. The resulting policy brief presented recommendations for policy changes focused on child care sites, which serve more than 15,000 infants and toddlers in Connecticut. The Rudd Center’s analysis concluded with the following recommendations: a) Increase support for breastfeeding in early care and education settings; b) Serve only healthy beverages in child care centers; c) Help child care sites follow best practices for nutrition; d) Increase physical activity time for infants and toddlers; and e) limit screen time for infants and toddlers in all child care settings. CHDI and other early childhood obesity experts are working with the Connecticut Office of Early Childhood to explore changes in child care licensing regulations to promote best practices in obesity prevention.

2. Data: Harnessing Early Childhood Data to Inform Obesity Prevention Strategies:   

   To explore the establishment of a childhood obesity surveillance database, the UCONN Health Program in Public Health and Health Policy linked birth records from the Connecticut Department of Public Health (DPH) with electronic health records from Community Health Center Inc. using software called PATH. The goal was to obtain an integrated, longitudinal database containing child weight, height, and information about the child’s mother (including demographic information and prenatal characteristics). A longitudinal database makes it possible to identify population level estimates of risk for the development of childhood obesity and measure the effects of targeted interventions over time. The work yielded a dataset of de-identified information on 3,133 children. Analyses identified critical trajectories of weight gain in infants and toddlers, as well as factors that increase the risk of being overweight at age five.

3. Evidence-Based Interventions: Disseminating a National Breastfeeding Intervention in Connecticut:

   Breastfeeding support is one strategy for promoting healthy weight in young children. Achieving the Baby-Friendly hospital designation is a way for hospitals to support breastfeeding. To achieve this designation, a maternity hospital must implement the Ten Steps to Successful Breastfeeding in the US and meet other standards as outlined by the Baby-Friendly USA accrediting body. The barriers to obtaining this designation include: financial limitations, reporting requirements, training, community level support, and hospital staff commitment. Only eight hospitals in Connecticut had achieved the Baby-Friendly designation prior to the Children’s Fund of Connecticut’s support. The grant to the Connecticut Breast Feeding Coalition (CBC) helped two additional hospitals, Day Kimball and Yale New Haven Hospital, achieve the Baby-Friendly designation. In addition CBC’s work brought Backus and Windham Hospital closer to achieving their designation, and other hospitals in Connecticut are now using the evidence-based 10 Steps to Successful Breastfeeding practice.

4. Health Messaging: Developing Consistent and Effective Messaging for Parents to Prevent Obesity:

   CHDI awarded funding to the University of Connecticut’s Department of Nutritional Sciences to develop and test effective obesity prevention messages for children birth to 24 months and disseminate these messages to providers working with young children. The researchers collected and analyzed educational materials related to early childhood obesity prevention from a variety of providers (WIC, pediatric practices, health clinics, community nutrition education programs and other sources). Based on interviews with English-speaking and Spanish speaking parents the research team developed a core set of messages to promote healthy nutrition and age appropriate feeding practices, including strategies for introducing foods and handling picky eaters. Interviews with early education, healthcare, and community-based providers about these messages revealed the conflicting nature of current messaging and supported the need to have consistent messaging across settings that serve young children. Messages developed as a result of this project will be included in a training module for pediatric providers to be delivered through CHDI’s Educating Practices in the Community (EPIC) program.

Lessons Learned Can Inform Future Obesity Prevention Efforts in Connecticut

Each of these obesity prevention projects helps address existing gaps in obesity prevention by identifying innovative solutions. In the area of policy, Connecticut can enact changes in legislation or licensing requirements for early care and education settings that promote obesity prevention. The success of the data project illustrates future opportunities to embed early childhood obesity data collection into statewide data systems. The obesity prevention messaging will be used to train pediatric health providers so they can help parents ensure a healthy start for their babies. 

Building from the results of these projects and informed by new research linking responsive feeding to healthy weight, CHDI awarded a second round of grants in October 2017 with funding from the Children’s Fund of Connecticut, the Connecticut Health Foundation, and Newman’s Own Foundation. The four new projects will test the effectiveness of innovations across several early childhood settings with a focus on improving early feeding practices in diverse socio-economic, racial, and ethnic groups. The solutions identified and tested by our partners will offer Connecticut policymakers, providers and others new opportunities to ensure children grow up at a healthy weight.

For more information visit www.chdi.org, or contact Abby Alter at aalter@uchc.edu or (860) 679-8788. This Issue Brief was prepared by Abby Alter and Lisa Honigfeld.

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