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Multidisciplinary Approach to Obesity Management: A Case Report
Published on: May 30, 2025
Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program,
Jillian Papa1, Joan Agostinelli1,2, Gertrudes Rodriguez1
1Arizona Department of Health Services, Phoenix, Arizona.
Insights
Arizona child care facilities are implementing the Empower program to combat childhood obesity. While most facilities partially implement the standards, full adoption requires more support and education, especially for breastfeeding-friendly environments.
Area of Science:
- Public Health
- Nutrition Science
- Child Development
Background:
- Childhood obesity is a significant public health issue across all age groups in the US.
- Approximately 25% of children in Arizona's WIC program are overweight or obese.
- The Empower program was created to foster healthy environments in child care settings.
Purpose of the Study:
- To evaluate the implementation level of five key standards within the Empower program.
- To assess the extent to which child care facilities adopt healthy practices promoted by the program.
Main Methods:
- A self-assessment survey was administered to 1,850 facilities between July 2013 and June 2015.
- Data analysis involved calculating the percentage of facilities reporting full or partial implementation of each standard.
- Qualitative analysis identified common themes from open-ended survey comments.
Main Results:
- All surveyed facilities reported at least partial implementation of the Empower standards.
- Full implementation of all five standards was achieved by 21.7% of facilities.
- Staff training showed the highest implementation rate (77.4% full implementation), while breastfeeding-friendly environments had the lowest (44.0% full implementation).
Conclusions:
- Arizona child care facilities demonstrate progress in adopting the Empower program's healthy environment standards.
- Enhanced education, technical assistance, and targeted support are necessary for full program implementation.
- Addressing specific areas like breastfeeding support is crucial for comprehensive success.
Introduction:
Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona's Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards.
Methods:
A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey.
Results:
All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment.
Conclusion:
Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program.
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