Testimony by Julie La Barba, MD, FAAP
Senate Health and Human Services Committee
SB 818 – Updating Child Care Nutrition, Physical Activity, and Screen Time Standards
March 29, 2017
Testimony submitted on behalf of:
- Texas Pediatric Society
- Texas Medical Association
- American Heart Association
- Texas Public Health Coalition
- Partnership for a Healthy Texas
Good morning Chairman Schwertner and Committee Members,
My name is Dr. Julie La Barba and I am a pediatrician from San Antonio currently serving as the Medical Director for a culinary health education program in which I teach my patients and their families the joy of nutritious cooking. I am here today testifying on behalf of the Texas Pediatric Society, the Texas Medical Association, the American Heart Association, the Texas Public Health Coalition, and the Partnership for a Healthy Texas. Together these associations and coalitions represent more than 50 health care organizations dedicated to improving the health outcomes of our youngest Texans. As a medical professional and a mother of four, I appreciate the opportunity to testify in firm support of SB 818.
The Burden of Obesity on our Children
My role as a pediatrician is extremely rewarding because I know the preventive interventions I use in the early years can have a lasting impact on a child’s life. This is no truer than when I work with children, even as young as 2, who are already showing signs of obesity and the comorbidities that accompany it. My entire practice is centered on helping kids and their families learn healthy habits such as eating right and putting down the iPad in favor of playing outdoor games. The consequences of children not learning these healthy habits can be disastrous:
- Children who are at an unhealthy weight as preschoolers are five times more likely to be overweight or have obesity as adults 
- 60 percent of children who are overweight aged 5-10 already have one or more risk factors for heart disease and diabetes. 
- Obesity is linked with many metabolic disorders that are seen primarily in adulthood, but are now beginning to manifest in children. Examples include high blood pressure, early symptoms of hardening of the arteries, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary disorder, and disordered breathing during sleep.
- Even when these conditions do not appear in childhood, children with obesity are at increased risk for developing these medical complications during adulthood. 
Unfortunately, our state is already seeing high rates of pediatric obesity. One in four children age two to five have overweight or obesity. While this challenge is present in all Texas communities — rural, suburban, and urban — some Texas children are at a higher risk. One in seven (14.9 percent) two-to-four year-olds from low-income Texas families have obesity, a rate that exceeds the national average for this age group. 
Breaking this cycle will ultimately reduce health care costs in our state and help kids succeed in school. Being physically active and having a healthy diet before the age of five is associated with improved child development and cognitive outcomes. For example, research show that young kids that eat a healthy diet — high in lean protein and fresh fruits and vegetables — are more likely to have a higher IQ at age eight. In contrast, dietary patterns high in processed foods and added sugars are associated with lower school achievement and nonverbal reasoning. 
Healthy Environments Foster Lifetime Healthy Habits
It is my role, and that of my pediatrician primary care colleagues, to counsel our families on the best ways to keep their children safe, happy, and healthy — whether that is via mental health screenings, injury prevention anticipatory guidance, or advice on the best foods to maintain a healthy weight. I even go as far as to encourage my parents to consider healthy food and beverage options, physical activity and screen time standards and practices in selecting child care facilities that their children attend because I know that a child’s environment — where they spend most of their day — is critical to forming healthy habits.
This is why I believe Senate Bill 818 is so crucial to the health of the children I care for. All child care options available to a family throughout Texas should meet best practice standards endorsed by the American Academy of Pediatrics (AAP). I would expect nothing less for my own children, and I want to ensure my patients are guaranteed the same basic level of healthy habit-forming environments.
SB 818 updates current child care standards in three main areas:
- Nutrition – The Child and Adult Care Food Program is the premier standard for early childhood nutrition standards. The latest revision was informed by the AAP Committee on Nutrition specifically in the area of infant feeding before the age of 2. 
- Physical Activity – The Caring for our Children, 3rd Edition (CFOC) includes the most up-to-date research and best practices for promoting health and preventing childhood obesity in child care. CFOC is supported by the CDC, AAP, and American Public Health Association.
- Screen Time – Screen time standards are also being brought in line with the AAP endorsed Caring for our Children, 3rd Edition best practice to ensure children maintain healthy brain development.
Thank you for the opportunity to provide testimony in support of SB 818 to help ensure our children are growing up in the healthiest environments possible.
 Centers for Disease Control. Progress on Childhood Obesity. (Aug. 2013). Available at: http://www.cdc.gov/vitalsigns/childhoodobesity
 Barkin, MD., Shari. Division of Pediatrics at Vanderbilt University Medical Center. (Oct. 2008). Testimony to the United States Senate Committee on Health, Education, Labor & Pensions. Available at: https://www.help.senate.gov/imo/media/doc/Barkin1.pdf
 Daniels, S.R. The Consequences of Childhood Overweight and Obesity. The Future of Children, Vol. 16, No. 1, Childhood Obesity (Spring, 2006), pp. 47-67. Available at: http://www.jstor.org/stable/3556550
 Cynthia Ogden. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Journal of American Medical Association. (2014) 311(8):806-815. Available at http://jama.jamanetwork.com/article.aspx?articleid=1832542
 The State of Obesity: Obesity Among WIC Participants Ages 2-4. Project of the Trust for America’s Health and the Robert Wood Johnson Foundation (Nov. 2016). Available at http://stateofobesity.org/wic/
 Pooja Tandon, et. al. The Relationships between physical activity and diet and young children’s cognitive development: A systemic review. Preventive Medicine Reports. 3 (2016) 379-390.
 LG Smithers, et al. Dietary patterns at 6, 15 and 24 months of age are associated with IQ at 8 years of age. Eur. J. Epidemiol. 27, 7 (2012) 525–535.
 L. Feinstein, et al., Dietary patterns related to attainment in school: the importance of early eating patterns. J. Epidemiol. Community Health. 62, 8 (2008) 734–739. A. Nyaradi, et. al. Diet in the early years of life influences cognitive outcomes at 10 years: a prospective cohort study. Acta Paediatr. 102, 12 (2013) 1165–1173
 Recommendation of the Texas Early Childhood Health and Nutrition Interagency Council, a council of seven Texas agencies created by Senate Bill 395 during the 81st Legislative Session. Council members include, TWC, DSHS, TEA, DFPS, TDA, HHSC, and Texas A&M AgriLife Extension Service.
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