Taking baby fat off the menu in L.A.

As preschoolers pack on the pounds, a push is on to train day-care workers in better nutrition.

Say bye-bye to those tater tots and juice drinks, baby. Day care workers all over Los Angeles County are about to get an education on how kids ought to eat.

Thanks to a recent initiative to release of hundreds of millions of dollars in funds for early childhood development programs, the Los Angeles County Department of Public Health got the go-ahead this week on a sweeping plan to school babysitters and childcare facilities in preventing childhood obesity.

The $6 million project initially will offer workshops, coaching and follow-up assistance to about 8,000 providers on age-appropriate nutrition, portion control and exercise. However, the service, underwritten by First 5 LA, is expected to eventually expand to all of the 20,000 or so licensed and exempt caretakers operating in the county, from big Head Start programs to family day care homes to neighborhood sitters.

The outreach is considered critical because obese children have a higher likelihood of obesity in adulthood, and childhood obesity is strongly associated with grave and costly health risks such as type 2 diabetes and, over time, heart disease.

More than 16% of preschoolers between the ages of 2 and 5 are overweight in the U.S., and more than 14% are obese, according to the Centers for Disease Control. This is especially true among low-income children; in Los Angeles County, the obesity rate among 3- and 4-year-olds in the federally funded Women, Infants and Children nutrition program is more than 20%.

Those rates tend to worsen as children get older. In California, 38% of fifth- seventh- and ninth- graders were obese or overweight in 2010; in Los Angeles County, that figure stood at about 42%.

More than 350,000 infants, toddlers and pre-schoolers here spend at least part of their day in child care, where the meals they get “leave a lot to be desired,” says Dr. Robert Gilchick, DPH medical director of child and adolescent health programs and policy.

New measures would put healthier lunches on the day care menu.

A 2008 study sponsored in part by First 5 LA found that nutrition in Los Angeles County childcare centers was generally too light on lean meat, fresh fruit and vegetables and whole-grain carbohydrates. “There were a lot of fried fish sticks and Tater Tots, and a lot of the portions were much too large for children 3 and 4 years old,” Gilchick says.

Water, in particular, was rarely on the menu. Nearly half the sites regularly served fatty meats such as fried chicken and hot dogs; four offered fried potatoes and at least one was dishing up Doritos.

And lest parents feel smug, meals were even less nutritious when children brought their own lunches.

“One child brought [four] packaged foods—chips, Cheez-Its, candy and cookies—in addition to fried potatoes, an English muffin, 20 ounces of 100% fruit juice, string cheese and yogurt,” the report found; another child’s brown bag featured a McDonald’s McGriddles sandwich with sausage and flavored milk.

Recent state legislation has begun to improve the picture. A new state law, for instance, establishes guidelines that will discourage sweetened milk, sugary “juice” drinks, sodas and other caloric junk drinks in day care facilities.  Another bill, AB 1872, would mandate more milk, fruit and vegetables in the meals served in day care homes, which now are not legally obligated to follow any nutritional standards.

But a little county intervention will go a long way, says Gilchick.

In fact, he says, a pilot project conducted in about 120 South Los Angeles day care centers has already paid off. “Just a 4-hour training course actually made a difference in average nutrition scores.”

Under the new program, DPH will disburse $4.5 million for training and workshops through the Child Care Resource Center and Child Care Alliance, a consortium of 11 childcare service agencies. The rest of the $6 million will remain with the department for follow-up and oversight. “We expect to have the curricula ready for trainers by year-end,” says Gilchick. The workshops should begin in 2013.

The day care project is among many being funded under an aggressive plan to turn some of the hundreds of millions of dollars on reserve at First 5 LA in to much-needed services for children. Dedicated to programs for children age 5 and younger, the money comes from a special 1998 tobacco tax.

Last year, the surplus became a source of controversy after the governor attempted to divert unused First 5 money to help ease the state’s budget problems—an unsuccessful gambit that focused attention on First 5 LA and led to an independent audit. The audit found no malfeasance, but accused the agency of sitting on some $800 million and led to the resignation of its chief executive, Evelyn Martinez.

First 5 LA’s new spending strategy will fund programs ranging from parenting therapy to health insurance outreach to dental and vision care for small children. But it is not without critics. Some of the new and expanded programs will be carried out or overseen by the county, and an original plan, already approved by the First 5 LA Commission, would have fast-tracked several years’ worth of money into a special account to be drawn down by the departments involved as the programs develop. Some $29.1 million would have been added to the account to continue longstanding programs already being supported with First 5 LA funds, and another $58.2 million would have provided long-term funding for new projects.

The account was intended to speed services by eliminating the need to return to First 5 every year for ongoing funding, a step that had contributed to the agency’s slowness in disbursing money. But it required four votes for approval, and was blocked on Tuesday when Supervisor Mark Ridley-Thomas abstained and Supervisor Gloria Molina voted against it.

“Shame on you,” said Molina, who had been an advocate of Martinez, and who charged that the county, like the state, was merely trying to loot the First 5 surplus. “They’re just trying to make up stuff . . . to rip off the money.”

But Supervisor Zev Yaroslavsky noted that the agreements with county agencies dated back years to when Molina herself was chairing the First 5 LA Commission. “Somebody has to stand up when you castigate an entire group of bureaucrats as rip-off artists,” said Yaroslavsky. “It’s not fair.”

As a compromise, the Board approved only the multi-year contracts between First 5 LA and the county’s public health and mental health departments, which will launch the new and expanded programs but still require First 5 to renew the funding annually. The contracts, which required only three votes and passed over Molina’s no vote and Ridley-Thomas’ abstention, will pay for parent-child therapy, substance abuse treatment for at-risk parents and caregivers, outreach for the county’s Healthy Kids health insurance program and the initiative to reduce childhood obesity.

Posted 8/2/12