VOLUME2, ISSUE3JULY25,2011
What isthe
HealthyEatingIndex?
TheHealthyEating Index(HEI)measures how well a person’s diet conforms to theU.S.Department of Agriculture’s recommendedservingsof thefivemajor food groupsas well asthetotal fat/saturated fatconsumption,sodium, and cholesterol intake.
Revisedin2005,theHEIiscomprisedof
12components:totalfruit,wholefruit
(notjuice),totalvegetables,darkgreen
and orange vegetables and legumes,
total grains, whole grains, milk (all
milk/soyproducts),meat,poultry,fish,
eggsoils(vegetableoilsandoilsinfish,
nuts,andseeds),saturatedfat,sodium,
andcaloriesfromsolidfatsandadded
sugars.
RecommendedFood Plate
Source:U.S.DepartmentofAgriculture
EarlyChildhoodPolicyFocus:
HealthyEatingandPhysicalActivity
ByDavid Murphey,BonnieMackintoshandMarciMcCoy-Roth
The importanceofgoodnutritionandexerciseiswell known,and parentshavelongworriedabout their children’sdiets andenvied theirhighenergylevels.Like somanylifestylehabits,patternsof nutritionandexercisebehaviors aretypicallyestablished in early childhood.Poordietandlackofexercisecontributeto obesity,which hasbeenassociatedwithhigher ratesofmanydiseases(e.g. diabetes andheartdisease).1Thesediseasesaccountforamajor shareof total health carecostsand threaten to reversetherecentgains inlife- expectancyintheUnitedStates.Thoughwetypicallythinkof young
childrenasnaturallygettinglotsof physicalexercise,recentstudies suggestthismaynotbethe case.Poornutrition andlackofexercise arejeopardizing ouryoung children’sabilitiestodowell inschooland to stayin goodhealth.
A numberoffactorsaffect thenutritionandexercisehabitsofyoung children,including personalchoicesbyparentsandchildren,financial constraints(suchastheavailability,accessibility,andcost of healthy options), andpublic policies. Researchonthesefactors offersinsights intowaystoencouragethedevelopmentofhealthyeatingand physicalfitnesshabitsin earlychildhoodandbeyond.
WHAT YOUNG CHILDRENEAT:
HOWGOOD (ORBAD)ARETHEIR DIETS?
AccordingtothemostrecentHealthyEatingIndex, children (ages2-5)
scored anaverageof60(of100)pointsforhealthyeating.Children’s dietswerereportedas healthiestintermsof their consumptionof totalfruits,totalgrains,and milk; theywereworstin termsof dark green andorangevegetablesandlegumes,wholegrains,and saturatedfat.2Thesefindings suggestthatchildrenneedto increase theirconsumptionofvitamin-rich foods,nutrient-densefoods (those low in fatandthat donotcontainaddedsugars)and decreasetheir
intakeofsodium,saturatedfatandhighcaloriefoods.
CHILDTRENDS:EARLY CHILDHOODHIGHLIGHTS1
IncomeEffects onFoodInsecurity
Householdincomecansignificantly
affectchildren’s diets.
Children in householdswith incomes belowthepovertyline aresix times morelikelytohave lowfoodsecurity thantheircounterpartsin
householdswithincomesat185
Impactof Insufficient Diets on YoungChildren’s
HealthandWell-Being
Insufficientdiets canjeopardizechildren’sdevelopment,threaten theirreadinessforschool,andhavelifelongeffectsonadult productivity.Adequateconsumptionofimportant nutrients(notably vitaminsA,C,D, andE,andphosphorusandmagnesium)is criticalfor normal growthanddevelopmentandlearning.3Young children who
donotgetenoughvitaminsandnutrients maybenegativelyimpacted intermsof howwell andhow muchtheycanlearn.4
Figure1.Percentageof allchildren(0to17)inUSlivingin
Food-InsecureHouseholds,SelectedYears,1995-2009
percentof povertyorhigher;and
they arefourteentimesmorelikely
to experienceverylowfoodsecurity.
Thoughhouseholdswithhigher incomesspend moremoneyonfood
25
2019
15
10
5
17181818
19
171717
2324
thanlowerincomehouseholds,this representsasmaller proportionof theirincome.In food-insecure households,families tend to spend lessonfoodthandofamiliesinfood- securehouseholds5suggestingthat whenresourcesaretight,families maybuylessfoodand/or less
expensivefoods.
Children whoare Hispanic,black,or living withasingleparentarealso muchmorelikelytobefood- insecurethanare children who are white or livingin married-couple families.5
1.30.70.60.80.60.70.80.60.91.51.3
0
1995 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009
FoodInsecureHouseholdsLowFoodSecurityHouseholds
13
Source:ChildTrendsDataBank
Morethan9.6millionU.S. children (ages0-6) livein“foodinsecure” households,in whichconsistentlygettingenough foodtoeatisa struggle.5Childrenwho have beenidentified as“foodinsecure”are reportedto havehigherratesof hospitalization,iron-deficiency anemia,and otherchronichealthconditions.Inveryyoungchildren
(3 yearsold), studieshaveassociatedfoodinsecuritywithhigherrates of behavioralproblems.Paradoxically,childfoodinsecurityisalso associatedwithagreaterriskforbeing overweight.Inpart,thisis becausefoodinsecuritycanresultinalower-qualitydietwith less variety,whichcancontributetobeingoverweight.The unpredictable availabilityof foodcanalsolead to overeating,especiallyamong children.6 Inaddition,therehavebeenreportsofincreased psychosocialdeficits,as well as higherratesof anxietyand
depression. Food-insecurechildrenalsoexperiencesmallergains in mathandreadingachievementbetweenkindergartenandthird grade,and (for6-11yearolds)haveahigher likelihoodofrepeatinga grade.6
CHILDTRENDS:EARLY CHILDHOODHIGHLIGHTS2
RiskFactorsforBeing
Overweight/Obese
Being overweightiswidespread among youngchildren,a conditionwhich isparticularlyprevalentamongchildren fromlower-incomefamilies.An estimated17percentofallchildren (ages 2-19 years)areoverweight, reflectinganalarmingincreaseoverthe past20years.33
Specifically,aboutonein ten infantsand toddlers is consideredoverweight (havingaBMI atorabovethe95th percentile).31Byagefive,nearlyonein four (24%)isconsideredoverweight
(BMI at orabovethe85thpercentile).32
Overweightinfants, toddlers, and preschoolersare morelikelytobecome overweightas adolescentsandadults. One studyfoundthatchildren who were overweightas preschoolersweremore thanfivetimesas likelyas their peers to beoverweightatage12.34
Incontrastto trends amongotherage- groups, theincreaseinoverweight amongtheyoungestchildren has stabilized inrecentyears.34Thesedata suggest theremaybeanimportant windowwhereinterventions can promotehealthyeatingthat mayhave lastingeffects.SeeFigure2.
WhenandWhereChildrenEatMatters
Inarecentrepresentativesample,U.S. familiesreportedthat most daily familymeals (73percent)areeatenathome,thoughexperts suggestfamiliesmayover-consumepoor-qualityor“convenience” pre-packagedfoods, whichareoftenhighinsodiumandfat.7On average,families reportedeatingoutlessthanonceaweek.8While thesereportsareencouraging,theymaynotrepresentthefullstory.
A recentUSDA studyshowedthat,onaverage,one-thirdof children’s calorieintakeis“away-from-home”food.Foodfromfast-foodand otherrestaurantshasbeenassociatedwithincreased caloricintake andlowerdietquality,while consumption ofsweetenedbeverages (e.g., non-dietsoda,fruitjuice)accountsforabout35percentof the caloriesassociated with“away-from-home”food.9
Skipping mealsandsnackingcanalsoresultinweightgainand nutritionaldeficiencies.Morethan onein eightchildrenreportrarely or nevereatingbreakfast,andone infourskipdinner atleastsome of thetime.10Skipping meals(especially breakfast)hasseriousnegative effectsonlearning,particularlyif childrenarealreadynutritionally at risk.11Snackingisassociated withnutrient-poorcalories,becausethe snackfoods childrenreporteatingtend to offerlittlein the wayof vitamins,minerals,and protein,andarerelativelyhighinsugar and fat.Inanationallyrepresentative,randomsample,childrenreported that theyfrequentlysnack while doing otheractivities(e.g., while doinghomework,watchingtelevision),which maycontributetoa greateramountofcaloriesconsumed.Aboutone-fourthofchildren reportedeatingwhile watchingTV,and about25percent of the childrenreportedtheytypically snackafterdinner.12
CHILDTRENDS:EARLY CHILDHOODHIGHLIGHTS3
WhatWorks?
Research-BasedApproachesto PromotingEatingand Physical Activity
Research has shown thatprograms that successfullypromotehealthylifestyles emphasizeteachingchildrenhowto incorporateexerciseinto their daily routinesandmakingphysical activity fun. Bestresultswerefoundwhen programswereimplementedformore than6 months.35
Programsthatfocusononly oneaspect (nutrition, physical activity,orweight loss)tendtobemoresuccessful than
2007-2008
2003-2006
1999-2002
1988-1994
1976-1980
Figure2.PercentofOverweightChildrenAges2-19 byAge,SelectedYears1976-2008
10.2
12.4
10.3
0510152025
Percentage
Ages12-19
Ages6-11
Ages2-5
thosethatsimultaneouslyfocusonall threeoutcomecategories,suggesting that eachoutcomeneeds tobetargeted inahighlyspecified manner ratherthan a “onesizefitsall”approach.36
Both family- andschool-based settings canbeeffectivefor impactingchild nutrition, physical activity,andweight loss. Youngchildrenoften respondto modelingfromthosearoundthemand behavioralprompts(e.g. tellingachild that “drinkingmilkwillmakeyou strong”).37
Since manychildren’smeals are prepared byothers,someeffective strategies includeimprovingschool breakfastandlunch menus,to incorporate morefresh fruitand vegetables,as wellaseducatingfamilies aboutwaystoincorporate healthier eatingintofamilyroutines.38
Source:ChildTrendsDataBank13
Physical ActivityandScreen Time:
Are youngchildren gettingenough exercise?
The wideavailabilityandvarietyof passiveentertainmentmedia (television,video games,computers,etc.)mayalso benegatively affectingthelevelofchildren’sphysicalactivity.TheAmerican AcademyofPediatrics(AAP)recommendsthatscreen-mediawith veryyoungchildren (youngerthan2years)shouldbe avoided.14For childrenages2 yearsandolder,theAAPrecommendswatchingno morethan1-2hoursof“quality programming”per day,15 and that children shouldnothavetelevisionsintheir bedrooms.16Despite theserecommendations,arecentOregonstudyof2-year-oldsfound that nearlyone infive(20percent)spentmorethan twohoursofa typical daywatchingtelevisionorvideos,andoneinsix (18percent) hada televisionin theirbedroom,which hasbeen associated with increasedmedia use.17 Accordingtoastratifiedrandomizedstudy, eachincrementalhour ofwatchingtelevision atagetwowas associatedwith correspondingdeclinesinschoolengagement,math achievement,and weekendphysicalactivity,andwith increasesin bullyingbyclassmates,consumptionofsoftdrinksandsnacks,and BMIatage 10.18
Amongyoungchildren (birth throughsix yearsold), two-thirdslivein homeswherethe televisionisonatleasthalfof thetime,andone- thirdwheretheTVis on “always”or“mostof thetime.”Children in thesesettingsaremorelikelyto watchTVeverydayandtowatchfor
CHILDTRENDS:EARLY CHILDHOODHIGHLIGHTS4
longertimeperiodsthanotherchildren.Theyarealsolesslikelyto readeveryday(59vs. 68percent),and whentheydoreadorareread to, itisforashorteramountoftimethanfor childreninnon-heavy-
TVhouseholds.19Thoughparentsreportedtheyweremorelikelyto
engageinphysicalactivitieswiththeir childrenthanin yearspast, theyalsoreportedan increasein thetimetheyspenttogetherin sedentaryactivities(e.g.watchingTV,playing video games)during that sametime period.20Inanotherstudy,parentsreportedthat children (ages0-6years)spendaboutthesameamountof timeusing screenmediaastheyspendplayingoutside(abouttwohoursper
day).Thesefindingsareparticularlyconcerningsince this mediauseis nearlythreetimestheamountof timethatfamiliesreportreadingto theirchildren(about39minutes).21
Although neithertelevision norcomputersarecategorically “bad” for children,theirheavyusecan beassociatedwithdisruptionsin important familyroutines,suchaseatingmealstogetherandgetting adequatesleep atnight. A recentlarge,nationallyrepresentative studyfoundthatyoung children whosefamilies reportedlimiting “screen time,”regularlyeatingdinnertogether,andensuringtheir children gotadequatesleep weresignificantlyless likelytobe
obese.22Eachof thesehousehold routineswasassociated witha
significantlylowerprevalenceofpreschool obesity,suggestingthere maybeeffectivewaystosupport families intheireffortsto adopt healthylifestyles.
“Screen time”alsoexposesyoungchildrentopowerfuladvertising messagesthattendto encouragean unhealthydiet. Whileyoung children’s exposuretoadvertisements forsugary foods, suchascandy andsweeteneddrinks, has declined inrecentyears,theirexposureto fast-foodadvertisinghasincreased.23Someofthismarketingis targeteddirectlyto preschoolers,usingcharactersfamiliartothem fromtelevisionprogramming,whichmayinfluencethe food choices
ofyoungchildren.Arandomized study ofethnicallydiverse3-to4- year-oldsshowedthat children weremorelikelytopreferthetasteof snacksandmorelikelytochoosesnackswhenalicensedcharacter appearedon thepackage.Thiswasparticularlythe casefornutrient- poorsnacks (e.g., gummyfruitsnacks),whichmaynegatively
influence children’seating habits and may leadchildren toconsume
moreof thesefoodswith lownutritional value.24
ABOUTTHEEARLY CHILDHOODHIGHLIGHTS SERIES…
TheEarlyChildhoodHighlights seriesisintendedtoprovidea snapshotofthelatestresearchon earlychildhoodreleasedbyChild Trendsandotherleading researchersworkingonyoung children’sissues.ChildTrendsisa nationalnonprofit,nonpartisan researchcenterthatstudies childrenatall stagesof development.Ourmissionisto improveoutcomes
forchildrenbyprovidingresearch,
data,andanalysistothepeople andinstitutionswhosedecisions andactionsaffectchildren, includingprogramproviders,the policycommunity,researchers andeducators,andthemedia.
Eachbriefsummarizesa particular areaofresearchbasedonlonger academicpaper(s).Moredetailed informationandadditional resourcesareavailablefromChild Trends.
© Copyright2011 Child Trends
ChildTrendsisanonprofit,nonpartisan researchcenter.
4301ConnecticutAvenue,NW,Suite 350, Washington,DC 20008
Tel (202)572-6000Fax (202)362-8420
Pub.#2011-20
CONCLUSIONS
Accumulatingdatasuggestthereisa criticalneed toaddressthe
issuesofnutrition,exercise,andobesityamongyoung children. Researchalsoidentifiessomeeffectivestrategiesandprogramsthat improvenutritionandexerciseoutcomesforyoung children.Through a betterunderstandingoftheexistingresourcesandservicegaps, policiescanimprove accesstohealthy,affordable food,and encouragemorephysicalactivityforyoungchildren.
StateandLocalPolicyImplications
Nutritionassistanceprogramsare importantresourcesfor low- incomehouseholds.Thethreelargestfederalfoodandnutrition assistanceprograms—theSupplementalNutrition AssistanceProgram(SNAP,formerlyknownas foodstamps),theNationalSchoolLunch Program,and theSpecialSupplementalNutritionProgramfor
Women,Infants,andChildren(WIC)—areadministeredbyeachstate. A recentanalysis ofhouseholdsthatparticipatedintheseprograms (generally,thosewithannualincomesbelow185percentof the povertyline),revealedthat55percentof SNAPrecipients,52percent freeor reducedmealrecipients,and49percentofWICrecipients werestilldescribed as“foodinsecure”at times.Thesefindings suggestthattheremaybe critical, yetvarying,timeperiodsduring which families needadditionalassistanceinsecuringadequate
food.25A morerecentanalysisofsimilarlow-incomefamilies found
thattheprevalenceof foodinsecuritydecreasedduringthesame timeperiod thatparticipationin SNAPincreased.Typical food expendituresby theselow-incomefamiliesalsoincreased,suggesting that appropriate,increasedfundingofthesesupplementalresources can helpfamiliesmeettheirfoodneeds.26Statesmayoptto set eligibilityrequirementsabovefederalminimums,simplifyenrollment andadministration,andincreaseoutreachefforts.
State-levelpoliciesonhousingandfood assistancedirectlyaffect foodinsecurity.Ananalysisofstate-to-statevariationin food securitydeterminedthatonly abouthalfof thevariabilitycould be explainedbydemographiccharacteristicsof households;the remaindercouldbeattributedtostate-levelpolicies,programs,and economic climate.27Specifically, statescanimplementprogramsthat addressthebroaderchallengesfamiliesfacethatthreatentheir
economic and foodsecurity,suchasincreasingthesupply of affordablehousingfor low-incomehouseholds,andpromotingthe useofgovernmentaland communityfoodassistanceprogramsto reducetheprevalenceof foodinsecurity.
Improveaccesstohealthierfoods instateand federallyfundedfood programs.Nutritionalstandardsfor therangeofsuchfoodprograms (e.g. WIC,SNAP)shouldbe alignedwithexistingUSDA requirements topromotehealthiereating. Temporaryrevisionsweremadeto WIC toprovideparticipantswithincreasedmonthlyallocationsto purchaseessential,yetmore costlyfresh fruitsandvegetables, thoughfinaldeterminationisanticipatedin2011.28TheChild and AdultCareFoodProgram(CACFP) servesinfants, preschoolchildren, andchildrenyoungerthan12yearsinchildcaresettings(aswell as olderat-riskchildreninafterschoolprogramsandadultsin adult day
carecenters).Afterarecentevaluation,theNationalAcademyof Sciencesrecommendedincreasingthevarietyof fruitsandvegetables and the proportionofwholegrains,whiledecreasingthe amountof fats,added sugars,andsodiumfor all children(ages1 yearandolder) receivingreimbursablemeals.Additionalrecommendationsincluded prohibitingfoods such assoftdrinks,fruitdrinks,andcandyinthese programs.29Anotheranalysis ofstates’regulationsgoverningchild
carecentersandfamily daycarehomesshowsmanystateshave alreadyadopted rulestopromotehealthiereatingamong preschoolers.Forexample,13stateshavepolicies prohibitingor limitingservingfoodsoflownutritionalvalue;nine stipulatethat childrenolderthanagetwoshouldbe servedreduced-fatmilk.30
Improveneighborhoodaccesstohealthierfoodchoicesandsafe, affordableoptionsfor physicalexercise. Communitygrocerystores should, but oftenfailto,offeravarietyofaffordable freshproduce andotherchoicesforhealthiereating.Inarecentstudy,low-income Latinomothersreportedtheyoften shopatlocal“mini-markets”due to childcareandtransportationconstraints,eventhoughthislimited theamountandvarietyof foods theycouldpurchase.Inthesame study,safetyconcerns(e.g.violence,drug sales)andinclement
weatherwerecitedasbarriersto regularlyexercising outdoors.31
Improvingneighborhoodsafetyandinstalling sidewalks,parks,and indoorrecreationcentersencouragesfamilieswith young childrento get regularexerciseas partofahealthylifestyle.32
AbouttheAuthorsandAcknowledgments
DavidMurpheyisaseniorresearchscientist,Child Trends; Bonnie Macintoshisaconsultant,andMarciMcCoy-RothisSeniorDirectorof PublicPolicyandCommunications, ChildTrends. Thisbriefwas developedwithcontributionsfromHope Cooper,PaulaDaneri,and MeganFletcherof ChildTrends.
ENDNOTESk
1Levi,J., Vinter,S., St. Laurent,R.,Segal,L. M. (2010).FasinFat:How Obesity
ThreatensAmerica'sFuture2010.Washington, DC: Trust for America‘sHealth
andRobertWoodJohnson Foundation.Retrievedfrom
2FungweT., GuentherP.,JuanW.Y.,Hiza, H.A., Lino, M. (2009).The Qualityof Children’s
Dietsin2003-04as MeasuredbytheHealthyEatingIndex-2005.NutritionInsight43,Center
for NutritionPolicyandPromotion2009.
3AmericanDieteticAssociation.(2010).State of familynutritionandphysical activity:Arewe making progress?Retrievedfrom
4AmericanDieteticAssociation.(2010).Op. cit.
5Nord,M.,Coleman-Jensen,A.,Andrews,M.,andCarlson,S. (2010).Householdfoodsecurity intheUnitedStates,2009.(ERR-108).Washington,DC: U. S. Departmentof Agriculture,
EconomicResearchService.Retrievedfrom
6ChildTrendsDataBank. (2009).Foodinsecurity.Retrievedfrom:
7AmericanDieteticAssociation.(2010).Keyfindings:2010Family Nutrition andPhysical
ActivitySurvey.Retrievedfrom
8AmericanDieteticAssociation.(2010). Op. Cit.
9Mancino,L., Todd, J., Guthrie,J.,& Biing-HwanLin, B-H.(2010).How FoodAway FromHome
AffectsChildren’s Diet Quality. (ERR-104).Washingotn,DC: U.S. Deptartmentof Agriculture,
EconomicResearchService.Retrievedfrom:
10AmericanDieteticAssociation.(2010). Op. cit.
11NationalAnti-HungerOrganizations.(2009).Roadmap toendchildhood hunger in America by2015.Retrievedfrom
12AmericanDieteticAssociation.(2010). Op.cit.
13ChildTrendsDataBank. (2010).Overweightchildrenand youth. Retrievedfrom:
14 AmericanAcademyof PediatricsCommitteeonPublicEducation. (1999).Media
Education. Pediatrics,104,341-343.
15AmericanAcademyof Pediatrics.(2010). Policystatement—Mediaeducation.Pediatrics,
126(5),1012-1017.
16AmericanAcademyof Pediatrics.(2010). Policystatement—Children,Adolescents, Obesity,andtheMedia.Pediatrics,126(5),1012-1017.Accessed:
17TelevisionandVideo ViewingTimeAmongChildrenAged2Years(2010).Morbidityand
MortalityWeeklyReport(MMWR)AccessedonJuly15,2011at:
18Pagani,L. S., Fitzpatrick,C., Barnett,T. A.,& Dubow,E. (2010).Prospectiveassociations betweenearlychildhoodtelevisionexposureandacademic,psychosocial,and physicalwell-
beingbymiddlechildhood. Archivesof AdolescentPediatricMedicine,164(5),425-431.
19Rideout,V. J., Vandewater,E. A.,& Wartella,E. A.(2003). Zerotosix: Electronicmediain thelivesof infants, toddlersandpreschoolers.(3378).MenloPark,CA:Kaiser Family
Foundation. Retrievedfrom
20AmericanDieteticAssociation.(2010). Opcit.
21Rideout,V. J., Vandewater,E. A.,& Wartella,E. A.(2003). Opcit.
22Anderson,S. E. &Whitaker,R.C. (2010). Householdroutinesand obesityinU.S. preschool children.Pediatrics,125(3),420-428.
23Powell,L. M., Szczypka,G.,& Chaloupka, F. J.(2010). Trendsin exposuretotelevisionfood advertisementsamongchildrenandadolescents intheUnitedStates.Archivesof Adolescent
& PediatricMedicine,164(9),794-802.
24Roberto,C. A.,Baik,J.,Harris,J. L., & Brownell,K.D. (2010). Influenceof licensed
charactersonchildren’stasteand snack preferences.Pediatrics,126(1),89-93.
19Nord,M.,Coleman-Jensen,A., Andrews,M.,& Carlson, S. (2010). Op. Cit.
25Nord,M.,Coleman-Jensen,A., Andrews,M.,& Carlson, S.(2010).Opcit.
26Nord,M.,& Prell,M.(2011).Foodsecurityimprovedfollowing the2009ARRAincreasein
SNAPbenefits.(ERR-116).Washington,DC:U.S. Departmentof Agriculture,Economic
ResearchService.Retrievedfrom:
27Bartfeld,J., Dunifon, R., Nord,M.,& Carlson, S.(2006).Whatfactorsaccountfor state-to- statedifferencesin foodsecurity?(EconomicInformationBulletin20).Washington,DC:Food
andNutrition Services,U.S. Departmentof Agriculture.
28USDA FoodNutritionService.(2011).WIC Food Packages.Retrievedfrom:
29Instituteof Medicine.(2011).Child andAdultCareFood Program:Aligning Dietary
Guidancefor All. Washington,DC: TheNational AcademiesPress. Retrievedfrom:
30Levi,J., Vinter,S., St. Laurent,R.,Segal,L. M. (2010). Opcit. P.34.
31Lindsay, A.C., Sussner,K.M.,Greaney,M.L.,& Peterson,K.E. (2009).Influenceof social contexton eating,physicalactivity,and sedentarybehaviorsof Latina mothersandtheir
preschool-agechildren.Health EducationBehavior,36(1),81-96.
32WhiteHouseTask ForceonChildhoodObesity.(2010). Solving theproblemof childhood obesity within ageneration.Retrievedfrom
010_FullReport.pdf
30Ogden,C. L., Carroll,M. D.,Flegal,K.M. (2008). Highbodymassindexforageamong
U.S. childrenandadolescents,2003-2006.Journal of theAmericanMedicalAssociation,
299(20),2401-2405.
31NationalCenterforHealthStatistics.(2007).Prevalenceof overweight,infants andchildren
lessthan 2 yearsof age:UnitedStates,2003-2004.Atlanta,GA:Centersfor DiseaseControl andPrevention.Retrievedfrom
32Ogden,C. L., Carroll,M. D.,Flegal,K.M.(2008). Op. Cit.
33ChildTrendsDataBank. (2010).Overweightchildrenand youth.Retrievedfrom
34Nader, P. R., O’Brien, M., Houts, R.,Bradley, R.,Belsky, J.,Crosnoe, R.,Friedman, S.,Mei, Z.,
andSusman, E. J.(2006). Identifyingriskforobesityin earlychildhoodPediatrics,118(3), e594-e601.
35Hadley, A.M.,Hair, E.C. & Dreisbach,D. (2010).Whatworksfor thepreventionand
treatmentof obesity amongchildren: Lessons fromexperimentalevaluationsof programs
andinterventions.Washington,DC:ChildTrends. Retrievedfrom
36Hadley, A.M.,Hair, E.C.,Dreisbach,D.(2010). Opcit.
37U.S. Departmentof Agriculture.(2008).Maximizingthemessage:Helping moms andkids
makehealthierfoodchoices.(FNS-409). Retrievedfrom:
38Hadley, A.M.,Hair, E.C.,Dreisbach,D. (2010). Opcit.