University of Wisconsin–Madison Medical College of Wisconsin

Early Childhood Obesity Prevention: Challenges and Barriers of Implementing Child and Adult Care Food

Elizabeth White, MD; Ryan Potter; Cary Rasmussen, MS; Jennifer Kleven, MD

WMJ. 2020;119(2):110-114.

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Introduction: The Child and Adult Care Food Program requirements promote healthy eating behaviors and increased physical activity in the daycare setting to help prevent childhood obesity. Some of these standards can be difficult to meet for early childhood education centers. This study examines the challenges and barriers daycare centers face when implementing these guidelines.

Methods: Focus groups consisting of participants from early childhood education centers within our community were conducted in April and May of 2018.

Results: Three focus groups were conducted, with a total of 7 childcare center directors. Eight themes that affect nutrition and physical activity curriculums at early childhood education centers arose: teacher philosophy and involvement, training/expertise of staff, parental involvement, financial constraints, children’s interests, food availability, physical environment, and regulations/guidelines. Overall, participants expressed their sense that child care facilities are undervalued. They agreed that healthy, fresh food choices are expensive, difficult to obtain due to the volume needed, and require additional training to prepare. Emphasis on gross motor development has a varied level of support from families and teachers. Challenges and barriers to providing adequate gross motor activities include limited financial support, lack of physical space, lack of teacher willingness to engage in outdoor activity, and parental resistance.

Conclusions: Financial constraints and the “undervaluing” of childcare contribute greatly to many of the challenges and barriers early childhood education centers face in meeting nutrition and physical activity standards. Findings from this study shed light on the significant role early childcare centers play in nurturing child development and the efforts these centers undertake in the interest of children.

Author Affiliations: Gundersen Health System, La Crosse, Wis (White, Potter, Rasmussen, Kleven).
Corresponding Author: Jennifer Kleven, MD, Gundersen Health System, 1900 South Ave, La Crosse, WI 54601; Phone 608.775.4492; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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