Background
The most recent National Health and Nutrition Examination Survey (NHANES) reported that 16.9 percent of children ages 2-19 are obese and 31.7 percent are overweight or obese. According to CDC, the obesity rate for children ages 2 to 5 has more than doubled (from 5 to 10.4 percent) since 1980. A recent report by Trust for America’s Health (2010) listed Georgia as having the second-highest population of overweight and obese children in the U.S.

The number of child care (CC) facilities in the United States jumped from less than 25,000 in 1977 to 40,000 in 1987 and then to more than 117,000 in 2007, keeping pace with rising rates of employment among mothers of young children. Based on results of the National Education Survey conducted by the US Department of Education and the Survey of Income conducted by the US Census Bureau, as of 2006, it is estimated that 12 million, or 61%, of the 19 million US children 5 years of age and younger are in some form of child care on a regular basis. There are a total of 740,000 children ages 0-5 years in Georgia. A recent study by Georgia State University and the University of Georgia estimated that the early care and education industry in Georgia serves more than 380,000 children (51%) each year.

By spending much of their day in child-care, pre-school children consume a majority of their daily intake in child care. Previous studies have shown that children in child-care do not meet dietary intake recommendations. Therefore, nutrition in child-care is in need of improvement. To achieve goals for healthy children today and healthy adults tomorrow, it is essential that health professionals work in partnership with child care providers to ensure that meals and snacks consumed in child care settings meet children’s nutrition needs and provide them with excellent opportunities to learn healthful dietary and physical activity patterns. Story et al. have noted that child care centers offer “untapped opportunities” for implementing obesity-preventing initiatives because the infrastructure needed to incorporate more nutrition and physical activity programs for children and parents already exists in child care centers.

Objectives
The goal of this project is to improve children’s lifelong eating and physical activity habits by training caregivers on the importance of nutrition and physical activity to help reverse the trend of overweight and obesity among Georgia’s children. The objectives of the project are to:

1. Introduce child care providers to the concept of a wellness policy and the benefits of creating and adopting a wellness policy for their child care center;
2. Help child care providers develop a relevant wellness policy and a practical plan for implementing the policy in their child care centers;
3. Support child care centers through training, technical assistance, and funding through mini-grants to implement their wellness policy;
4. Evaluate the impact of a wellness policy on children and staff in a child care environment.
Researchers provided program evaluation services to Georgia Department of Early Care and Learning through instrument development, data collection, data entry and analysis and results dissemination.


Methods
Twenty-four (24) child care centers in southwest Georgia were recruited to participate in a pilot program aimed at improving nutrition and PA practices through caregivers’ training and policy changes over a one-year period. The program focused on implementing wellness policies. Center directors and staff attended two training sessions and received monthly in-person, phone, and e-mail support/technical assistance. The environments and policies across centers were assessed at baseline and at one year using the Environmental and Policy Assessment and Observation (EPAO) instrument.

Results
Baseline EPAO scores revealed low levels of nutrition training for staff across centers and low levels of active play for children. At one year, following program implementation, analysis found statistically significant improvements for numerous EPAO components and overall nutrition and physical activity scores. Specifically, post-score improvements were observed for total nutrition score (p < .001) and total physical activity score (p < .001). Specific areas of improvement for nutrition scores included nutrition environment (p < .001), nutrition training and education (p < .001), and nutrition policy (p < .05). Areas of greatest improvement for physical activity scores included, active play (p < .05), sedentary environment (p < .05), portable environment (p < .05), staff behavior (p < .05), and physical activity training and education (p < .001).

Conclusions
Findings suggest that increased engagement and training/education for staff in combination with modest amounts of technical assistance and support have potential to positively impact nutrition and physical activity policies, environments and behaviors in child care centers.

Support/Funding
Support for this project was provided by the US Department of Agriculture through a Team Nutrition grant to the Georgia Department of Early Care and Learning (GaDECAL). Subcontract for evaluation provided to researchers by to GaDECAL.