What Do Children Eat in the Summer? A Direct Observation of Summer Day Camps That Serve Meals

Rationale and design of Healthy Kids Beyond the Bell: a 2x2 full factorial study evaluating the impact of summer and after-school programming on children's body mass index and health behaviors

BACKGROUND

The Structured Days Hypothesis posits that structure protects children against obesogenic behaviors (e.g., physical inactivity, unhealthy dietary intake) and, ultimately, prevents the occurrence of excessive weight gain. The hours following school (i.e., 3-6 pm school days) and summer vacation are two "windows of vulnerability" when children may experience less structure. Programs that provide a healthy structured environment and may prevent BMI gain exist for both time periods (i.e., after-school programs and summer day camps). Unfortunately, these programs are cost prohibitive for children from low-income families to attend. This study will test the impact of providing vouchers to access existing, community-operated after-school and summer programs on BMI z-score, body composition, and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of children (5-12 years) from schools that primarily serve families with low income.

METHODS

The study will employ a 2x2 factorial design. Participants (N = 480) attending 4 elementary schools in one school district will be randomly assigned to a no treatment control, after-school program voucher only, summer day camp voucher only, or after-school and summer day camp vouchers. Vouchers will cover the full cost of attending a pre-existing community-based after-school or summer camp program. The primary outcome (BMI z-score) will be measured at baseline (before end of school year, ~ May), 3-month follow-up (after summer, ~ August), and 12-month follow-up (end the following school year, ~ May). Secondary outcomes include body composition (i.e., whole-body fat mass, fat free mass, and percent body fat) and obesogenic behaviors (i.e., physical activity, sedentary time, sleep, screen-time, and diet). The study will also employ a rigorous process evaluation which will consider after-school and summer camp program attendance and content. Analyses will examine differences between the four groups in BMI z-score, body composition, and obesogenic behaviors. Incremental cost effectiveness ratios will determine the cost effectiveness of the intervention.

DISCUSSION

The current study will provide critical information for researchers, practitioners, and policy makers seeking to combat the childhood obesity epidemic in children from families with low-income during the school year and summer.

TRIAL REGISTRATION

NCT05880901 . Registered 27 May 2023.

Interventions to promote healthy lifestyle behaviors in children and adolescents in summer day camps: a scoping review

BACKGROUND

Children and adolescents have suboptimal physical activity and eating habits during summer breaks. Unlike the school setting, there is little evidence on interventions to promote healthy lifestyle behaviors in Summer Day Camps (SDCs).

METHODS

The aim of this scoping review was to examine physical activity, healthy eating, and sedentary behavior interventions in the SDCs. A systematic search on four platforms (EBSCOhost, MEDLINE, EMBASE, and Web of Science) was performed in May 2021 and was updated in June 2022. Studies related to promoting healthy behaviors, physical activity, sedentary behaviors and/or healthy eating among campers aged 6 to 16 in Summer Day Camps were retained. The protocol and writing of the scoping review were done according to the guidelines of the "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR)".

RESULTS

Most interventions had a positive effect on the behavioral determinants or the behaviors themselves (i.e., physical activity, sedentary behaviors, or healthy eating). Involving counsellors and parents, setting camp goals, gardening, and education are all relevant strategies in promoting healthy lifestyle behaviors in SDCs.

CONCLUSIONS

Since only one intervention directly targeted sedentary behaviors, it should strongly be considered for inclusion in future studies. In addition, more long-term and experimental studies are needed to establish cause-and-effect relationships between healthy behavior interventions in SDCs and behaviors of children and young adolescents.

Impact of changes to the Child and Adult Care Food Program on children's dietary intake in family child care homes

OBJECTIVE

To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children's diets in family child care homes (FCCHs) serving racially/ethnically diverse children.

DESIGN

In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children's plates before and after meals matched with menus to measure children's dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers.

SETTING

FCCHs in Boston, MA, USA.

PARTICIPANTS

Three- to 5-year-old children attending FCCHs.

RESULTS

We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components.

CONCLUSION

Young children's dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.

The potential of a year-round school calendar for maintaining children's weight status and fitness: Preliminary outcomes from a natural experiment

Purpose

To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention compared to a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss via a natural experiment.

Methods

Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured in children (5-12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 ± 2.4 years, 53.1% male, 68.9% African American) from 1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- and sex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular Endurance Run laps completed) were assessed for summer 2017 (May-August 2017), school year 2017/2018 (August 2017-May 2018), and summer 2018 (May-August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixed effects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondary regression analyses estimated differences in change within and between groups during each time period, separately.

Results

Year-round students gained less BMI (difference in ∆ = -0.44, 95% confidence interval (CI): -0.67 to -0.03) and less CRF (difference in ∆ = -1.92, 95%CI: -3.56 to -0.28) than students attending a traditional school overall. Compared with traditional students, during both summers, year-round students gained less BMI (summer 2017 difference in ∆ = -0.15, 95%CI: -0.21 to -0.08; summer 2018 difference in ∆ = -0.16, 95%CI: -0.24 to -0.07) and zBMI (summer 2017 difference in ∆ = -0.032, 95%CI: -0.050 to -0.010; summer 2018 difference in ∆ = -0.033, 95%CI: -0.056 to -0.009), and increased CRF (summer 2017 difference in ∆ = 0.40, 95%CI: 0.02-0.85; summer 2018 difference in ∆ = 0.23, 95%CI: -0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI and zBMI and increasing CRF compared with year-round students (difference in BMI ∆ = 0.05, 95%CI: 0.03-0.07; difference in zBMI ∆ = 0.012, 95%CI: 0.005-0.019; difference in Progressive Aerobic Cardiovascular Endurance Run laps ∆ = -0.43, 95%CI: -0.58 to -0.28).

Conclusion

The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit to children's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight and CRF gain/loss were consistent with the structured days hypothesis.

Foods served at faith community events for children - Is there room for improvements in this unexplored child nutrition site?

OBJECTIVE

To describe food and beverage provisions by Faith Communities from one denomination in association with events for children.

DESIGN, SAMPLE AND MEASURES

Foods and beverages provided at 32 child-focused activities were documented using direct observation methodology and analyzed for contribution to food groups and per serving energy, fat, saturated fat, sugar, and sodium contents.

RESULTS

Main dishes were mostly (71%) convenience/casserole-type foods, and averaged 962 mg sodium and 436 kcal, with 36% of energy from fat and 14% as saturated fat. Cheese was the main source of dairy products. Grain-based side dishes, provided at 29% of meals, included white rice, pasta, and bread. Non-starchy vegetables were provided at three (29%) meals. Fruits were served at six events. Desserts, served at 75% of events, contained 41% of energy from fat, with 17% as saturated fat, and 22 g of added sugar. Snack chips, provided at 31% of events, contributed 165 kcal mostly from fat and 243 mg of sodium. Sugar-sweetened beverages, served at 71% of events, contributed 28 g of added sugar.

CONCLUSIONS

This pilot investigation identified areas for improvements in the nutritional quality of foods/beverages served at faith community child-focused events and aligns with expanding public health efforts to improve child nutrition beyond traditional settings.

Use of the School Setting During the Summer Holidays: Mixed-Methods Evaluation of Food and Fun Clubs in Wales

OBJECTIVE

School summer holiday clubs in deprived areas of Wales were evaluated to examine opportunities for healthy eating and physical activity and explore delivery processes.

METHODS

Ten Food and Fun clubs participated in 2016. Quantitative data (child and parent surveys; N = 196, N = 84) assessed the opportunity to provide children with breakfast and lunch. A sub-sample of children wore an accelerometer (N = 41) to evaluate the opportunity for achieving 1-hour of moderate to vigorous activity (MVPA) at club. Features of successful club delivery were identified through; focus groups (child and parent; N = 74, N = 69) and interviews (staff/volunteer; N = 32).

RESULTS

Opportunities for healthy eating were delivered with high fidelity: 86% of children reported breakfast consumption and 75% eating a healthy lunch. On club days, children reported consuming fewer sugary snacks (66%), fewer sugary drinks (81%), and more fruits and vegetables (67%). About 71% of children achieved the recommended MVPA at club, with children engaging in more MVPA (+17 minutes/day, p < .01) on average compared to non-club days. Successful delivery processes were: use of school facilities and staff; flexible partnership-working; and whole family involvement.

CONCLUSIONS

Schools appear to provide a suitable setting for the delivery of healthy eating and physical activity opportunities during school summer holidays.

Project SWEAT (Summer Weight and Environmental Assessment Trial): study protocol of an observational study using a multistate, prospective design that examines the weight gain trajectory among a racially and ethnically diverse convenience sample of economically disadvantaged school-age children

INTRODUCTION

Racial/ethnic minority school-age children are at risk for unhealthy weight gain during the summer, and there is a dearth of information regarding the underlying behavioural and environmental factors. The study objective is to provide an in-depth examination of dietary and physical activity behaviours and food, physical activity, and social environments of African American and Hispanic school-age children during the summer.

METHODS AND ANALYSIS

An observational study will be conducted using a multistate (Ohio and Indiana, USA) prospective design examining the weight gain trajectory among a racially/ethnically diverse convenience sample of economically disadvantaged school-age children. In addition, a subset of these children will be evaluated to learn their daily health behaviours and food, physical activity, and social environments during the summer. Comparisons will be made between children who routinely attend programming and those who do not, both in the larger sample and subset. Determinants of programme participation and factors that may enhance the beneficial effects of programme participation will also be identified. Data collection at the Indiana site is planned for summer 2018.

ETHICS AND DISSEMINATION

This study is approved by The Ohio State University Behavioral and Social Sciences Institutional Review Board. Results from this study will be disseminated in publications for practitioners, scientists and stakeholders.

TRIAL REGISTRATION NUMBER

NCT03010644; Pre-results.

The State of the Summer: a Review of Child Summer Weight Gain and Efforts to Prevent It

PURPOSE OF REVIEW

Accumulating evidence shows that children in the USA gain weight more rapidly during the summer, when school is not in session. This narrative review spanning 2007 to 2017 summarizes efforts to characterize the problem, identify key determinants, and intervene to prevent excess summer weight gain.

RECENT FINDINGS

Summer weight gain remains a concern for elementary-age youth. Few studies have examined its determinants, but unfavorable summertime shifts in diet, physical activity, sedentary time, screen media use, and sleep have been reported. Increased structure is thought to protect against summer weight gain. Interventions to support physical activity and nutrition during the summer show promise, though large-scale impact on weight outcomes remains to be seen. Supporting health behaviors during the summer remains a priority for obesity prevention researchers, practitioners, and policymakers. Strategies to expand access to structured programs and reach beyond such programs to improve behaviors at home are of particular importance.

Summer Weight Gain and Fitness Loss: Causes and Potential Solutions

Over the past 3 decades, public health professionals have worked to stem the rising childhood obesity epidemic. Despite the field's best efforts, no progress has been made in reducing child obesity. One reason for this failure may be that obesity prevention and treatment efforts have predominately been delivered during the 9-month school year. However, recent evidence suggests that the summer, not the school year, is when unhealthy changes in body composition (ie, accelerated increases in percent body fat) and fitness losses occur. This unhealthy change in body composition and fitness loss during the summer could be explained by the "Structured Days Hypothesis," which posits that children engage in a greater number of unhealthy obesogenic behaviors on unstructured days when compared with structured days. Furthermore, the summer may be contributing to a widening "health gap" between children from low-income and middle- to upper-income families. During summer, fewer opportunities exist for children from low-income households to access healthy structured programs that do not require fees for participation. Moving forward, public health professionals should prioritize efforts to mitigate unhealthy changes in body composition and fitness loss during the summer by identifying ways to provide access to structured programming during this timeframe for children from low-income households.