Wednesday, June 30, 2010

Sweet tea for toddlers?

Rep. Maggie Jeffus has come in for some criticism over at Joe Guarino's blog. Joe criticizes her for H1726, a bill that would require modest standards for the types of foods that licensed day care centers could provide children and that would lead to the development of physical activity standards for day care centers.

Among the specific requirements, the bill would require the NC Child Care Commission to
...adopt rules for child care facilities to ensure that all children receive nutritious food and beverages according to their developmental needs. The Commission shall consult with the Division of Child Development of the Department of Health and Human Services to develop nutrition standards to provide for requirements appropriate for children of different ages. In developing nutrition standards, the Commission shall consider the following recommendations:
  1. Limiting or prohibiting the serving of sweetened beverages, other than 100% fruit juice, to children of any age.
  2. Limiting or prohibiting the serving of whole milk to children two years of age or older or flavored milk to children of any age.
  3. Limiting or prohibiting the serving of more than six ounces of juice per day to children of any age.
  4. Limiting or prohibiting the serving of juice from a bottle.
  5. Creating an exception from the rules for parents of children who have medical needs, special diets, or food allergies.
Joe criticizes the bill as "ridiculous."

The language in the bill closely follows a recommendation that was made by the the "ridiculous" NC General Assembly Task Force on Childhood Obesity. The Task Force, in turn, relied on "ridiculous" model regulations that were proposed by researchers at UNC and other experts.

The Task Force was responding to high and growing rates of obesity in North Carolina. Indeed, the Robert Wood Johnson Foundation has just released a study that shows that North Carolina ranks 10th in rates of adult obesity and 11th in rates of childhood obesity. However, these figures must also be "ridiculous."

There is also evidence that North Carolina day care centers do a poor job of feeding their charges. A research team from UNC examined the foods and beverages that preschoolers in NC day care centers were served and consumed (Ball et al., J. Am. Dietetic Assoc., 2008). The team found that, on average, preschoolers consumed less than 13% of the recommended amounts of whole grain foods and around 7% of the recommended amounts of dark vegetables. Preschoolers did get adequate amounts of milk, but most of that milk was whole milk--only 11% was low- or non-fat.

They concluded
Our data suggest that children are not consuming recommended amounts of whole grains, fruits, or vegetables while attending full-time child care. Instead, children are consuming excessive amounts of added sugars from sweet snacks and condiments, and saturated fat from whole milk and high-fat or fried meats.
It would be nice if we could rely on market pressures to contribute to better nutrition standards at day care centers. The laissez faire argument goes something as follows:
  • parents know what's best for their children and will value care providers who meet their children's nutritional needs;
  • day care providers, in turn, will be forced to compete for the hard-earned dollars of those parents; the day care centers will have to provide good meals or risk going out of business.
However, the trends in obesity and the evidence that child care centers do a poor job of feeding children undercut this argument.

While parents may know what's best for their children in a general sense, they may not know everything that goes on in a day care center. There is asymmetric information in the sense that day care centers know more about the quality of care provided than the parents. Day care centers are especially problematic because their clients--infants, toddlers, and preschoolers--have limited or no ability to report what happens to them.

A related problem is that the consequences of poor nutritional practices are not immediately apparent. A single serving of soda or whole milk typically doesn't lead to noticeable, immediate problems (unless the child is diabetic or lactose intolerant). People have considerable trouble appropriately accounting for consequences that are uncertain or that occur far off in the future.

Even if parents and care providers take these direct consequences into account, they are unlikely to take other externality effects into account, such as the amounts that society is likely to contribute to mitigating health problems or that obesity may have on society.

The costs of complying with this legislation are minimal. Sugar-free drinks, including water, can be substituted for sugary drinks. Low-fat milk can be substituted for whole milk. There's virtually no cost difference.

At the same time, there's scope for some real benefits from reduced obesity and its co-morbidities.

Rep. Jeffus and the 66 other representatives who supported this legislation (including 5 Republicans) are offering a modest, common-sense, and well-considered approach to improve children's nutrition and reduce obesity.