Children are more likely to be obese if they grow up in low-income families, the U.S. Centers for Disease Control and Prevention (CDC) reports.  And when parents work long hours at low-wage jobs, that can contribute to childhood obesity as well, according to health experts, because time-squeezed parents struggle to provide home-cooked meals and family activities.

Colleen Shaddox explores how teens in New Britain learn how to make healthy food choices.

The CDC defines obesity as “having excess body fat,” and says it is affected by genetic, behavioral and environmental factors.

In Connecticut, 15.8 percent of children aged 2 to 4 in low-income homes are obese, according to the State of Obesity, a September 2016 report by Trust for America’s Health and the Robert Wood Johnson Foundation. That figure has remained constant since 2007, according to the report. Of 10- to 17-year-olds, 15 percent are obese, the report said.

Fair Haven Community Health Center (FHCHC) Nurse Practitioner Elizabeth Magenheimer said that more than 60 percent of the families she serves do not eat meals together because of work and other obligations, which contributes to bad eating habits and a lack of what she calls “meal culture,” a time for family conversation and introducing children to healthy cooking and eating.

Understanding the reality of life for low-income families is key to helping their kids get to a healthy weight, said Melissa Santos, a pediatric psychologist at the Connecticut Children’s Medical Center and assistant professor at the University of Connecticut School of Medicine. “We all know what we’re supposed to do, but a lot of things get in the way,” she said.

Helping these families eat healthier is a process, according to Santos, because their lives are already overwhelming. “We always start small because we never want to overwhelm families in terms of making changes,” she said.

At Children’s Medical Center, Patricia Esposito, clinical nutrition manager, shows working parents how to pull together easy meals for busy days. She steers them to items like pre-washed salad greens and pre-cooked chicken—and stresses that though these may be among the pricier items in the grocery store, they end up being cheaper than fast food.

But that solution isn’t perfect, she said, because it requires easy access to a grocery store—something low-income families often don’t have.

Such families often live in “food deserts,” described by the U.S. Department of Agriculture as mostly urban areas—such as some neighborhoods in Hartford, New Haven and Bridgeport—where access to healthy food is limited or non-existent due to a lack of grocery stories, farmers markets, and other providers of healthy food. Consumers in these areas instead depend on “quickie marts,” which offer processed, sugar- and fat-laden foods, according to the USDA.

But even if there is access to vegetables and healthier food options, children living in poverty often don’t get the chance to try them. “If you’re not sure your kid’s going to eat it, you’re not going to put some expensive vegetable in front of your kid. For a low-income parent, that’s a huge deal,” said Marlene Schwartz, director of the UConn Rudd Center for Food Policy. The center’s mission is to promote solutions to childhood obesity through research and policy.

Food preferences are formed in early childhood. But kids can learn to accept more foods, like fruits and vegetables, through repeated exposure—exactly the process Schwartz said poor parents can’t afford.

Photo Provided By CCMC.

Melissa Santos, a pediatric psychologist at Connecticut Children’s Medical Center, works with families on ways to make healthy food choices.

In New Britain, a community grassroots project, called PhotoVoice, is teaching young teens about healthy lifestyles, including making good food choices and incorporating exercise daily. For one project, teens fanned out in their neighborhoods and took streetscape photos full of fast food restaurants, convenience stores and torn-up sidewalks.

They compiled a report, which they presented to the city council, asking for access to more public pools. The council said no, but did set up a water play area for kids in one of the city’s parks.

Dayjah Green, 19, an assistant PhotoVoice teacher who participated as a student in the program two years ago, said, “A lot of these kids will tell me that they eat more fast food than they eat a home-cooked meal.”

Dr. Dara Richards, chief medical officer at Southwest Community Health Center in Bridgeport, said that parents who aren’t coming home to make dinner aren’t taking their children outside to exercise either.

“The families cannot go outside because they are working. It has created a perfect storm for a culture of inactivity,” said Magenheimer, the nurse practitioner at Fair Haven Community Health Center.

Low-income parents frequently are unfairly blamed when their children are obese, Magenheimer said. “The number of slackers I have met in my 40 years at Fair Haven Community Health Center is so small as to be absurd,” she said.

Richards said obesity and nutritional counseling can be discussed during primary care visits, which insurance covers. “The more we get to know them, they share more,” she said.

Obese children with weight problems at FHCHC get referred to Bright Bodies, a Yale program that provides nutritional education for parents and children as well an activity program with exercise physiologists. They are also encouraged to exercise outside the program.

Green said that it is critical that children in low-income areas have more access to opportunities for safe exercise: “People complain about us not being healthy or not getting enough exercise,” she said. “If you give us something to do … we’ll be exercising.”

While there are programs throughout the state to work with obese children and families, the underlying economics that contribute to the problem are not improving. Private sector jobs in low-wage industries have risen by 20 percent, while the share of private sector jobs in high-wage industries have decreased by 13 percent, according to a September report by Connecticut Voices for Children. That means more low quality jobs, where parents need to work long hours to pay the bills. The child poverty rate has held steady at 14.5 percent overall, though in New Haven and New London it tops 20 percent.

“I think that the obesity epidemic can’t be solved from the food perspective,” Magenheimer said. “It has to be solved from a much more broader society perspective.”

A new policy brief by the Child Health and Development Institute says the best way to fight numbers like these is to “require action in a child’s earliest years — from birth to 2.” The numbers also indicate that 25 percent of all white kindergartners are overweight or obese also.

“The numbers are staggering, and the health implications are so big,” said Judith Meyers, president and CEO of the Farmington-based CHDI, whose brief is based, in part, on research by UConn’s Rudd Center for Food Policy & Obesity.

“Connecticut’s rates [of childhood obesity] are among the highest in the country,” she said.

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One of every three kindergartners is overweight or obese, a CHDI study reports.

Other recent studies show that the state is among the bottom in terms of enacting effective policies on preventing childhood obesity.

Meyers noted that according to pediatricians, once children as young as 2 start developing fat cells, it’s very hard to turn that around as the children grow, which is why prevention is key.

Being overweight or obese during childhood often leads to obesity during adulthood, says CHDI, and this can cause a host of serious illnesses, including heart disease, Type 2 diabetes and asthma. Despite high-profile efforts, such as Michelle Obama’s Let’s Move obesity remains a major public health issue, costing taxpayers hundreds of millions of dollars a year.

Two efforts to confront this epidemic are underway in Connecticut, including a legislative bill, voted out of the Committee on Children, that would impose dietary restrictions and minimum physical activity requirements on child care centers, preschools and elementary schools. Connecticut currently has recommendations in these areas, not mandates.

The second step is today’s release by the CHDI of five recommendations aimed at preventing childhood obesity:

• Increase support of breast-feeding in hospitals, day care centers and group child-care homes, including to stop the practice of providing infant formula in hospital gift bags to new mothers;

• Require day care centers to serve only breast milk or infant formula to children under 11 months, and to serve breast milk, unflavored whole milk, water and no more than 4 ounces of 100% fruit juice a day to children 12 months to 2 years old;

• Help child-care centers follow federal nutrition guidelines;

• Provide infants and toddlers with minimum times to be physically active every day; and,

• “Protect” all younger children from “screen time,” including to never permit a baby or toddler “to passively watch a television, computer, mobile phone, or other screen that older children in the same room are watching.”

Public health policy consultant Roberta Friedman, who researched and wrote the Rudd Center report, said she studied what states across the country have done to help reduce childhood obesity. None, she said, have acted on the five recommendations CHDI is proposing. Were Connecticut to do so, it would be a leader in the field.

Several of CHDI’s recommendations dovetail with the bill’s requirements.

Perhaps the most important part of the proposed legislation is requiring physical activity among young schoolchildren, said Rep. Diana Urban, D-North Stonington, co-chairwoman of the Committee on Children.

“I was stunned to learn that 39 elementary schools don’t have recess,” she said.

Childhood obesity has emerged as one of the most serious and widespread health threats in the United States. Nationally, 17 percent of children ages 2 to 19 (about 1 in 6) are overweight or obese, according to the Centers for Disease Control and Prevention.

The obesity problem is particularly acute among Hispanic children. In Connecticut, for example, 16.7 percent of Hispanic children ages 2 to 5 participating in the Women, Infants and Children (WIC) program were overweight and 18 percent were obese, compared to non-Hispanic black children (13.6 percent overweight, 14.2 percent obese) or non-Hispanic white children (14.5 percent overweight, 13.5 percent obese), according to 2011 data.

Obese children are at increased risk for a host of mental and physical health problems, from depression to heart disease, and they face shorter life expectancies. Public-health experts have long sought ways to address the issue through schools and health care providers and the federal Let’s Move! program to promote more healthful lifestyles among young people.

Child care providers offer “an important opportunity to address childhood obesity” since many children spend more time in child care than other settings, except home, the study notes.

iStock Photo.

Family-based day care centers can help develop good eating habits by offering healthy snacks, such as fruit.

Kim Gans, a professor in the department of Human Development and Family Studies at the University of Connecticut, and colleagues from Brown University, the Rhode Island Department of Health, and the University of Rhode Island, ran four focus groups with a total of 30 family child care providers (referred to in the study as FCCPs), asking them about policies regarding meals, snacks, and physical activity they maintain in their home-based day care centers. All of the FCCPs were female Hispanics.

Among the study’s chief findings is that the family child care providers “really consider themselves to be part of the family” of each of the children they care for, Gans notes.

That finding comports with research results published in the Journal of Nutrition Education and Behavior in 2013 that looked at the home child care setting’s role in shaping young children’s eating and physical activity habits. Dr. Marjorie S. Rosenthal of the Yale School of Medicine, Department of Pediatrics, and colleagues interviewed 17 Connecticut FCCPs of various ethnic and racial backgrounds about the challenges and opportunities they faced in fostering environments that encourage children to engage in healthful eating and activities.

The research revealed three core strategies FCCPs use to improve children’s diets and levels of physical activity. The strategies included working directly with the children to improve behaviors in the day care setting; engaging and educating parents about state and federal nutrition and activity standards that need to be met; and taking advantage of the leverage provided by licensing, training, community-based services, and other programs to effect change without ruffling parents’ feathers.

Gans says that while the UConn study looked only at FCCPs in Rhode Island, its findings—from the ways cultural mores shape food choices to the need to accommodate parents’ approaches to diet and activity—likely translate to Connecticut, where home child care demographics and settings are similar to those in the neighboring state.

Indeed, Jessica Sager, co-founder and executive director of the New Haven-based nonprofit organization All My Kin, which trains and supports community child care providers throughout Connecticut, says the study’s findings “resonate with what we see in our work,” particularly in “the commitment that the family-based child care providers have to promoting good nutrition and physical activity among the children they care for. They see themselves as playing a central role in that.

“They understand that the practices they establish around physical activity and eating are clearly going to shape children’s experience in life,” Sager says.

Gans says her study adds to the body of evidence that FCCPs who come from cultures in which historically children don’t get enough food tend to overfeed children. “So even if kids are not hungry, we found in this study that providers would encourage eating, even spoon-feeding” children, Gans says.

Despite the tendency toward over-feeding, which also may be linked to cultural perceptions that heavier children are healthier than thinner ones, Gans says, “Overall I think the meals providers offer are pretty healthy, featuring rice and beans, vegetables and fruit, not the chicken nuggets and hot dogs” that are more commonly served by non-Hispanic FCCPs.

Sager notes that about two-thirds of the providers working with All Our Kin are Hispanic, adding that there is “great diversity” within that umbrella term. That diversity makes her hesitant to paint with a broad brush, as a Peruvian provider and a Mexican provider may hew to different dietary and physical-activity traditions.

The study unearthed some conflict between FCCPs and parents, Gans notes, though not “across the board.” In some instances, providers reported that parents send their children to day care with tablets, Nintendos, and other hand-held electronics, implicitly undermining guidelines regarding “screen time.” FCCPs further noted that some parents request their children not play outside when it’s cold—which they defined as 50 degrees or lower. Gans adds that the research found that “sometimes parents didn’t have time to prepare breakfast, and the child arrives at day care with doughnuts,” undermining nutrition standards.

The research’s findings will inform efforts to devise interventions that capitalize on the key role FCCPs can play in reducing childhood obesity, limiting kids’ screen time, and improving children’s access to appropriate (and age-appropriate) physical activity and to nutritionally sound foods.

“We need to create policies to promote better nutrition and physical activity in child care homes and better communicate those policies with parents,” Gans says. “We can teach providers to serve as role models, to encourage children to eat appropriately without forcing them.”