Legal and policy approaches can be important tools for achieving healthier communities. The report, The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States, provides evidence-based information and identifies priority areas that can help communities achieve Healthy People objectives.
This Bright Spot describes how the state of Georgia is improving nutrition and fitness in child care centers.
Challenge: Bringing healthy foods into early care education programs
About 75% of U.S. children under age 6 attend an early care education program (ECE), so policies to improve nutrition environments in ECEs have the potential to impact the health of hundreds of thousands of children, including those who experience the greatest health disparities. A healthy diet—which includes plenty of fruits and vegetables—is associated with less overweight and obesity, and fewer serious chronic diseases like diabetes and high blood pressure.1 Unfortunately, 9 in 10 children ages 2 to 18 do not regularly eat the recommended amount of vegetables, and 6 in 10 do not eat enough fruit.2
In the state of Georgia, more than 1 in 3 children meet the criteria for overweight or obesity.3 With Georgia’s Student Health and Physical Education (SHAPE) Act, enacted in 2009, the state is trying to change that. Building on the momentum of SHAPE’s enactment, the Governor’s office led additional statewide initiatives to help children and their families eat healthier. One of the initiatives focused specifically on Georgia’s ECEs.
Strategy: Nutrition and fitness standards for ECEs
This initiative grew out of a collaboration between the Georgia Department of Public Health, the Department of Early Care and Learning (DECAL), and HealthMPowers, Inc. Together, they created Growing Fit, a training curriculum and toolkit to help ECEs create, implement, and improve on their wellness policies and practices, particularly around physical activity and nutrition.
Growing Fit teaches child care providers to evaluate—and, in some cases, write—wellness policies; to identify areas to improve physical activity and nutrition practices in their centers; and to collaborate to make those improvements. When a center meets or exceeds DECAL’s Quality Rating and Improvement System standards—which provide quality ratings to licensed child care providers based on how closely they meet certain standards of care—it gets recognition, a marketing boost, and additional classroom resources from state agencies.
Christi Kay, president of HealthMPowers, explains that the toolkit focuses on more than just meeting the minimum licensing standards for physical activity and nutrition. Georgia Fit encourages ECEs to develop wellness policies that do more than simply meet the standards—for example, centers may teach children simple food preparation skills in addition to serving food that meets dietary guidelines. “It’s a tool for continuous improvement,” she says.
The Growing Fit program is continuously improving, too. When it started, Kay says, few ECEs in Georgia already had wellness policies in place. Those that didn’t struggled with drafting their own. So Growing Fit began offering technical assistance to help centers draft policies and to understand why the policies are important. One approach that really resonated with centers, she explains, was stressing that wellness policies are a commitment to the parents as well as to the children, because it shows what centers are doing to create a healthy environment.
Growing Fit has also been working on expanding the assessment portion of the toolkit, which centers use to evaluate how their wellness policies and practices align with the Quality Rated standards. For this, they’re partnering with organizations and individuals who have experience working holistically with ECEs around healthy eating and physical activity, including academic institutions, child advocacy groups, and a pediatric hospital. Kay says that in addition to subject matter expertise, these partners help Growing Fit strike a balance between an assessment that’s useful but also simple to administer.
Impact: Better nutrition education
In the 5 years since the inception of Growing Fit, Kay is proud to report that 302 early childhood environments in the state have adopted the toolkit and over 1,270 staff have been trained. This means over 39,318 children are benefiting from policies that give them more physical activity and healthier food during the day.
The Learning Station in Ellenwood, Georgia, is one ECE that used the toolkit to transform their wellness practices. The transition took several years, but eventually, nutritious treats replaced sugary snacks. Today, the children drink water instead of juice, and Fridays are New Taste Days when they can sample spinach dip, taste different varieties of apples, or try kiwi for the first time.
Dr. Sharona Fountain, Director of the Learning Station, says, “Without this program we wouldn’t have the knowledge to improve nutritional habits and physical activity for our children. We’ve been fortunate to receive additional funding for training as well.”
Dr. Fountain is excited to report that the teachers in her center are modeling healthy eating habits for the children, too. The children are also influencing their families’ nutrition by asking for fruits and vegetables at the grocery store.
Lesson learned: Change takes time
Changes like these don’t happen overnight. Even after new policies are put in place—in ECEs, but also at the state level—communities need to get everyone invested in the changes.
In Ellenwood, Kay says, the whole community—students, parents, teachers, and administrators—worked together to enact the new policies. “[Dr. Fountain] brought the parent population along so they began to see… that they were creating a healthier environment for their children,” she explains.
Now in its fifth year, Growing Fit continues to grow. There are now 11 partners involved in the program. More centers are achieving the Quality Rated standard, and parent surveys help to track the influence of the program on home eating habits. Kay hopes that soon they’ll have access to aggregate data from all the centers, which will help DECAL continue their work of ensuring safe and healthy early child care environments for Georgia’s children. “It’s a very holistic approach,” she says.
Healthy eating is just one part of raising healthy children. But thanks to the push from the SHAPE Act, Growing Fit is helping ECEs create healthier environments where children eat more nutritious foods. And that’s real progress.
About the Law and Health Policy Project
The goal of the Healthy People Law and Health Policy project was to highlight how evidence-based legal and policy interventions and strategies can facilitate progress toward Healthy People 2020 targets by improving community health and well-being. In addition to reports and webinars, the project included "Bright Spots," or success stories, that highlighted successful policy interventions that led to improved health outcomes. The project was a collaboration between the HHS Office of Disease Prevention and Health Promotion (ODPHP), the Centers for Disease Control and Prevention (CDC), the CDC Foundation, and the Robert Wood Johnson Foundation.
1 Crawford P, Dunning L, Kappagoda M, O’Connor JC. The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States. Rockville (MD). Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP); 2018 Sept 13. Supported by the Centers for Disease Control and Prevention, ODPHP, and the CDC Foundation through a grant from the Robert Wood Johnson Foundation. Available from: https://www.healthypeople.gov/sites/default/files/LawHealthPolicy_Report_2018.10.pdf
2 Kim S, Moore L, Galuska D, Wright AP, Harris D, Grummer-Strawn L, et al. Vital Signs: Fruit and Vegetable Intake Among Children-United States, 2003-2010. MMWR. Morbidity and mortality weekly report. 2014 Aug 8. 63(31):671-676. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25102415
Related Healthy People 2030 objectives: