A symposium in Raleigh last week highlighted the ways child-care centers could contribute to reducing kids’ weight.

By Rose Hoban

You wouldn’t think a furniture company in rural North Carolina would be perched on the cutting edge of childhood-obesity prevention. But that’s what’s happening at the Mitchell Gold + Bob Williams factory in Alexander County, nestled in the foothills of the Appalachians.

About 65 youngsters from 0 to 12 years old come to the child-care center for employee’s kids every day, and that center has completely changed the way it handles diet and exercise since factory owner Mitchell Gold had some heart trouble a few years ago.

Changes at Lulu's Child Enrichment Center included adding more fruits, vegetables and high fiber breads and snacks to the menu, which director Kim Draughn said the kids eat readily.
Changes at Lulu’s Child Enrichment Center included adding more fruits, vegetables, salad and high-fiber breads and snacks to the menu, which director Kim Draughn said the kids eat readily. Photo courtesy MG+BW

“He looked at the kids in the day care and said, ‘I don’t want them to have these issues when they are older,'” said Kim Draughn, head of Lulu’s Child Enrichment Center at the factory. “So he challenged us to come up with some healthy menus.”

Eventually, Draughn also got help improving the outdoor learning environment – otherwise known as the playground – to get kids moving more. She said she’s been seeing results: everything from parents telling her their kids insist on broccoli at home to the kids asking for more active play time at the center.

Draughn was in Raleigh last week to share her successes at a meeting that brought together people from across the state to trade ideas about reducing childhood obesity.

Department of Health and Human Services Sec. Aldona Wos told the gathering that obesity in North Carolina accounts for more than $17 billion in health care costs and lost productivity. Almost one in three children will be overweight or obese by the time they’re 5 years old. North Carolina ranks as the nation’s 15th-most obese state.

“These costs affect the entire health care industry, whether it is paid for by Medicaid or the private sector,” Wos said. “So it is imperative that all of us are invested in having healthier citizens and healthier children.”

“I can tell you that the insurance companies in the state recognize that having a healthy population is critical for lower costs on health insurance,” said Mark Dessauer from the Blue Cross and Blue Shield of North Carolina Foundation. “The science is saying that … the best place to get most bang for the buck is early childhood.”

“If [as a society] we’re going to pay for dialysis, why shouldn’t we pay for healthier food in their early lives?” Dessauer asked.

Multiple barriers

Kim Draughn will tell you that while change isn’t easy, the kids she cares for were very receptive to the new cuisine.

Changes on the outdoor learning environment (playground) included low-cost additions, such as hay bales, logs and a gravel path.
Changes on the outdoor learning environment (playground) included low-cost additions, such as hay bales, logs and a gravel path. Image courtesy MG+BW

“[O]n Friday we were serving regular pasta and white bread, and on Monday we were eating whole-grain bread and whole-grain pastas and turkey instead of ground beef,” she said. “The children never even noticed a difference; they never even blinked.”

Parents tell her that now their kids drive healthier choices for the rest of the family.

“One mom came back and said after you started doing whole-wheat pasta, that’s the only kind of spaghetti my son will eat now, so I have to buy it for the rest of us,” she said.

The biggest hurdle, said Draughn, has been the teachers. She estimates that of her 14-person staff, only five or six are really on board with the changes; the rest are just going along.

That doesn’t surprise Henrietta Zalkind, head of the Down East Partnership for Children, based in Rocky Mount. Her organization is the information and best practices resource for child-care centers in Halifax, Warren, Wilson and Nash counties.

She said even the federal guidelines for healthy eating, such as recommendations on the [USDA] What’s on My Plate website, still allow room for “terrible stuff” to be fed to children at day care centers.

Zalkind said the concept is to get early adopters to “create these model centers that are following these best practices and move people along and work with the staff to gradually change how they are interacting with the kids.”

It’s important to get parents involved with making the changes, she said, otherwise you’ll get resistance at home.

“If you don’t engage families, you can even feed kids great things at the child-care center, but if they go to McDonald’s on the way home, you’ve blown the whole thing,” Zalkind said.

Jumping hurdles

Draughn said her center now has a reputation for being the best in Alexander County, something she attributes to the vision of the company’s owners.

“I have parents who come to work for the company because of the day care,” she said. The Mitchell Gold + Bob Williams factory employs 700 people, more than 4 percent of Alexander County’s workers. Alexander County has a lower unemployment rate than the counties surrounding it.

Kids at Lulu's Child Enrichment Center find plenty of entertainment climbing on hay bales.
Kids at Lulu’s Child Enrichment Center find plenty of entertainment climbing on hay bales. Image courtesy MG+BW

The draws include changes in play areas, said Jennifer McDougall of Shape NC, an initiative created by the North Carolina Partnerships for Children and the state Smart Start network, with $3 million from the Blue Cross and Blue Shield of North Carolina Foundation.

MacDougall said consultants from Shape NC have gone into 19 demonstration child-care centers, like Draughn’s, and worked with them to do what they could. Teachers are given a self-assessment that allows them to see what they can improve. Then they map out how the kids play, measure how much active and sedentary time they have and get teachers and parents to think about how to help kids move more.

The changes in the demonstration sites range from adjusting menus to updating play areas to make them more interactive and … well … play-able.

“They redesign playgrounds with natural elements,” MacDougall said. The idea is to create hills, paths, stepping stones, places where kids want to jump and run and roll around.

“You create a tiny little hill and the kids run up and roll down the hill. Oh my gosh, they’re having a great time. A lot of it seems simplistic and silly but it’s amazing,” MacDougall said.

“If you got in your car and went to most child-care centers in North Carolina, most are doing the best they can,” she said. “They have the plastic equipment they got at Walmart, there’s sandboxes, and there’s no shade.”

MacDougall said the goal is to make changes affordable and to give centers a different way of doing business.

The business argument

Draughn said the people running the four other commercial child-care centers in Alexander County have taken notice of what her center has done. Most were able to take concepts and apply what they could with the funds they had. “I would say we have influenced all of them, including some of the home-based child-care centers.”

She said it’s “like the old shampoo commercial, I told two friends, and they told two friends, and so on.”

One of the changes at Lulu's Child Enrichment Center includes a path where kids can run and ride bikes. There's a field near the factory where they can play games such as kickball, according to Kim Draughn, director of the center.
Changes at Lulu’s Child Enrichment Center included creating a path where kids can run and ride bikes. There’s a field near the factory where they can play games such as kickball, according to Kim Draughn, director of the center. Image courtesy MG+BW

Dessauer from the BCBSNC Foundation said the worst thing his organization could do is hire someone from outside “with a master’s degree to go in and tell them what to eat.”

“That smacks of elitism, and you get into the culture wars,” he said.

Zalkind argued that making child-care centers healthier places is good business, allowing centers that adopt healthy practices to set themselves apart from the competition.

“You create a culture that builds the supply of those available centers and little by little you get people to adopt those changes,” she said. “And then you can charge more for it; you can stay full because people want it.”

Dessauer suggested that perhaps child-care centers could adopt a voluntary rating system for healthfulness.

“We pioneered the 5-star rating method for assessing child-care services,” he said, noting that most of the about 5,000 child-care centers in the state have evolved to become 3-, 4- and 5-star-rated centers.

“We can do a 5-apples program,” he said. “If you can say you are going to get a healthy start here, only healthy food, less screen time and an environment that allows for active play, that’s 5 apples.”

Dessauer said that the ratings could become a market force, the way quality has.

“Other centers will look around at the competition and say, ‘They have five apples; we need to do that,'” he said.

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