News: CJ Exclusives

Childhood Obesity Task Force Looks Into Home Visits

Recommendations from state panel expected this month

The North Carolina Institute of Medicine’s Task Force on Early Childhood Obesity Prevention, which has spent the last two years brainstorming new policy ideas to decrease obesity in children, soon may go beyond school cafeterias and private child care facilities and take its programs right through parents’ front doors.

The task force’s official recommendations are scheduled for release in mid-September. The previous set of recommendations published in 2009 by a related task force – the North Carolina Task Force on Preventing Childhood Obesity – focused on measures like removing sodas from school vending machines, banning most non-cafeteria foods on campuses, and cutting the fat out of milk in preschools and child care centers.

The new task force – created by the North Carolina Institute of Medicine at the behest of the Blue Cross Blue Shield of North Carolina Foundation, and staffed by many of the same government officials and health professionals as the earlier state task force — has taken the mission further, as minutes from its meetings indicate.

At a June 2012 task force meeting, one presentation recommended sending “family support workers” to visit “at-risk” families in their homes weekly from the time a woman becomes pregnant until her child is 5 years old, to teach them how to eat.

The government employees would be responsible for educating and counseling parents about smoking, breast-feeding, supplemental feeding, nutrition, physical activity, sleep, and “screen time.” A slide in the presentation titled “Intervention” talks about how the family support workers would be responsible for “monitoring” the children’s growth, encouraging exercise and collaborating with medical and other care providers.

These efforts are contemplated because previous aggressive government intervention have failed. Poor children in North Carolina are just as fat as they were five years ago, says a report released Aug. 9 by the federal Centers For Disease Control and Prevention.

This lack of success has not deterred public-health officials, however, who are considering more aggressive measures, including in-person visits by social workers to the homes of “at-risk” children.

Not just North Carolina

And it’s not just a North Carolina problem. The CDC studied 12 million low-income preschoolers across 40 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands between 2008 and 2011 to determine the impact of state and local obesity prevention programs. The results are less than stellar.

Twenty-one states and territories, including North Carolina, saw no improvement in their rates of early childhood obesity over the four-year period. Nineteen states saw only slight improvement (less than a percentage point), and three states saw increased rates of obesity. Ten states were not studied.

The state and federal governments have been trying to reduce childhood obesity in North Carolina for years. Their most recent efforts include changing the foods available through the federal Women, Infants and Children program to include more low-fat options (2009); cutting the availability of whole-fat milk, flavored milk, and juice from — and requiring more exercise in — public and private child care centers (2010); and passing a resolution to reduce sodium in North Carolinians’ diets and attempting to eliminate “competitive” foods — those competing with meals provided by the federal school lunch program — from schools (2011).

In 2012, a Carolina Journal report that a Hoke County school employee swapped a 4-year-old’s homemade turkey sandwich for cafeteria chicken nuggets revealed that state regulations required all lunches served in both public and private preschools and child care centers in North Carolina to meet U.S Department of Agriculture nutritional guidelines, even lunches brought from home.

Obamacare provision

The idea of having government employees perform in-home evaluations of “at-risk” children and families is not merely limited to state-run school nutrition programs.

As part of the “Maternal, Infant, and Early Childhood Home Visiting Program” of the federal Affordable Care Act, aka Obamacare, the U.S. Department of Health and Human Services has been providing grants to state HHS agencies that send social workers to homes of children on Medicaid under certain circumstances: if the mother is younger than 21; a member of the household uses tobacco; one of the parents is or has been a member of the military; or at least one child in the household has low student achievement, developmental delays, or other disabilities.

According to, attorney Kent Masterson Brown, who was a lead attorney for the plaintiffs in one of the federal lawsuits challenging the federal health care law, said that the home visitation provision could be extended to include any family, not just those on Medicaid.

Durham pilot program

Another presentation at the June 2012 task force meeting discussed a home-visit pilot program called Healthy Families Durham — funded by the county, state, and federal governments. The program involves 11 “family support workers” visiting 170 “at-risk” families weekly or biweekly, depending on the family’s stability, and offering “guidance” about nutrition, as well as keeping an eye out for abuse and neglect.

The workers are responsible for helping parents with recognizing “hunger cues and ways to know their children are full,” weaning children from the bottle or breast, and making “appropriate transitions to healthy solid foods … starting with finger foods.”

They also “help parents navigate challenges with picky eaters and overeating with individualized counseling and support” and distribute free fruit and vegetables during their visits.

Supporters of the interventions say the programs aren’t failing; they’ll just take a long time to produce results.

Kimberly Alexander-Bratcher, director of NCIOM’s childhood obesity task force, told the News and Observer the results of the CDC study are “really exciting.”

Measuring success

“Even states that showed a leveling and not a decrease — that’s actually a marker of success, because what we’ve seen pretty much over the past 20 to 30 years is an annual rise in obesity rates,” she said. “I wouldn’t necessarily say let’s celebrate — but things are moving in the right direction for our state.”

“Even just stopping the increase represents a significant advance,” said Kelly Brownell, dean of Duke University’s Sanford School of Public Policy.

Brownell attributes the country’s small advances against obesity to “aggressive” steps taken by the federal and state governments and suggests more action will need to be taken to make a real dent in the numbers.

But the expanding role of government worries advocates for parental autonomy and limited government.

Not everyone agrees that the USDA’s dietary guidelines – which are at the core of all of the above-mentioned programs — are the solution to childhood obesity. The Weston A. Price Foundation — a nonprofit dedicated to “restoring nutrient-dense foods to the American diet” – has been a long-time critic of the guidelines, arguing that they actually cause obesity.

“Current USDA dietary guidelines are based on the flawed notion that cholesterol and saturated fat are unhealthy,” writes Sally Fallon, the foundation’s president. “They are unrealistic, unworkable, unscientific, and impractical; they have resulted in widespread nutrient deficiencies and contributed to a proliferation of obesity and degenerative disease, including problems with growth, behavior and learning in children.”

In her critique, Fallon says several recent studies show “the restriction of natural animal fats actually leads to more obesity in both children and adults, while the refined carbohydrates, polyunsaturated and trans fats that frequently replace natural saturated fats contribute to weight gain and chronic disease.”

While the debate over the ideal diet continues, the question of whether parents or the government will decide what kids are allowed to eat remains.

Sara Burrows is a contributor to Carolina Journal.