A version of this article also appeared at Time.
Debbie Ellis remembers the instant potatoes, chocolate pudding and classic Southern fried foods once served at the child care centers she owns in Greenwood, Miss. Watching kids eat was a joy—even though spending $800 a month on groceries for meals that could hardly be called nutritious was not.
These days, Ellis has a caterer preparing meals with fruits, vegetables, whole grains and plenty of low-fat milk and 100 percent juice, all approved by the U.S. Department of Agriculture. Children are healthier and the quality of care has greatly improved, and the new diets save her hundreds of dollars a month—while guaranteeing healthier food in a state with the nation’s highest rate of childhood obesity.
“We don’t have that [joy] now,” Ellis joked, “but we do have good quality.”
When the USDA passed new nutrition requirements for school lunches in January, more U.S. students gained access to healthier foods—like it or not. The food served in public schools represents an important statement “about how seriously we take learning,’’ said Colorado State Sen. Michael Johnston, D-Denver, who wrote a book about his experiencing teaching in the impoverished Mississippi Delta.
“It impacts student achievement, and yes, it impacts how engaged students’ minds are in the afternoon,” said Johnston, who has worked to bring more nutritious foods to Colorado schools. Serving healthy foods is even more critical for the youngest learners in high poverty areas like Mississippi—which has the highest rate of child poverty in the U.S.— Johnston said.
In places like Greenwood, efforts are underway to help kids form better eating habits before they even reach elementary school, while the new diets at Debbie Ellis’s day care centers are a result of the federally funded Child and Adult Care Food Program (CACFP), which reimburses centers for the cost of serving children a more nutritious diet.
Ellis enrolled her two centers six years ago and has not looked back. Yet despite obvious health and financial benefits, less than half of child care centers across the United States participate in the 44-year-old federal program. The USDA has acknowledged the systems surrounding the program can place an undue burden on child care centers. In 2007, a federally-commissioned group of experts attempted to simplify some of the more cumbersome requirements by recommending changes to the program. Some of the recommendations were put in place three years later by the Healthy, Hunger-Free Kids Act.
But experts say the program is still a logistical challenge, involving extensive travel for training and detailed documentation to claim reimbursement. Some say this has scared child care centers away.
“It is extraordinarily difficult for a small rural center in an underdeveloped area without much administrative capacity,” said Warren Yoder, executive director of the Public Policy Center of Mississippi.
Although participation rates in Mississippi have increased 93 percent since 1996—the year welfare reform created eligibility guidelines for the program—it’s far less than advocates had hoped. In 2011, only about 38 percent of Mississippi’s 1,800 child care centers participated, even though nearly all were eligible, according to Lenora Phillips, who directs the program for the Mississippi Office of Healthy Schools.
Nationally, participation rates have only increased 59 percent over the same period.
Even more discouraging are participation rates for family day care homes—largely unlicensed programs that do not have to comply with child care center regulations—which have plummeted in Mississippi and across the country. In a 2003 memo, the USDA attributed this to complicated changes in the program. Since 1996, the year these changes were implemented, the number of family day care homes enrolled in the food program has dropped nearly 60 percent.
A scattered but growing network of Mississippi nonprofits has been leading the efforts in the state to bolster participation, by convincing centers of the federal food program’s value and supporting them through administrative tasks.
The need to improve nutrition is urgent in Mississippi, where more than two-thirds of adults could be obese by 2030 if current trends continue, according to a recent report by Trust for America’s Health and the Robert Wood Johnson Foundation.
Obese children may face long-term health problems and are at higher risk of social, psychological and academic problems. Obesity has been linked to lower math scores, for example. Last spring, retired generals complained that far too many of the Mississippi’s students aren’t fit to serve in the military; the state leads the nation in the percentage of overweight 18- to 24-year-olds.
A report released in early September suggests that recent school-based efforts to combat childhood obesity in the state have been relatively successful. In 2006, Mississippi established nutritional standards for food sold in school vending machines. A year later, a state law was passed requiring public schools to provide more physical activity time. Since then, obesity has decreased 13 percent for school-aged children.
Child care centers are in a unique position to combat the problem since obesity usually begins between the ages of 5 and 6, according to the American Academy of Child and Adolescent Psychiatry. That’s why it’s essential to introduce children to a healthy diet as early as possible, says Geraldine Henchy, director of nutrition policy at the Food Research and Action Center in Washington, D.C.
“They’re in child care the majority of working days, and that’s where they’re really going to get nutrition and learn good eating habits,” Henchy said.
A complex program
In Leland, a town where 67 percent of children under five live in poverty, Deloris McWright works to boost enrollment in the federal program. McWright has helped eight centers in the Mississippi Delta—the poorest part of the state—make it through the application process; seven more are on a waiting list for her support.
McWright says that it is easy to explain the benefits to financially-strapped child care providers, who get reimbursed for grocery or food preparation costs through the program. But a lot of questions arise during the enrollment process. Directors must attend two days of training, usually held in Jackson, more than 100 miles away from many Delta towns. Then comes a trial period, monitored by the state. Afterwards, providers must submit daily attendance records, meal logs, and grocery receipts to get reimbursed.
Youngsters are placed in six different age groups, and each age group requires different types and amounts of food. Even just serving a smoothie can be a complicated process. A four-page memo released in July details what needs to be in the drink to qualify for reimbursement. Reimbursement rates also differ by meal and a child’s family income.
And the program only covers food if the child shows up to eat it. If a youngster does not attend on any given day, providers must swallow the costs. And if child care centers make a mistake, such as giving a child the wrong food, they will owe money.
“Your thought is, I don’t want to deal with another agency and red tape,” said Donna Nicholson, owner of Kids Konnection in Richland, Miss. The child care center has been open for 16 years, and enrolled in the food program in April. Nicholson says that the paperwork involves a lot of math, and she is nervous about making mistakes that would prevent them from being reimbursed.
But Lenora Phillips from the state’s Office of Healthy Schools says the program doesn’t require much more from centers than the paperwork already required to gain a license.
“I don’t agree that it’s difficult,” she said. “I agree that the first time you do it, it takes more time.”
Centers that don’t participate in the federal program have been known to serve more affordable, but unhealthy meals of hot dogs, chicken nuggets, potato chips and fruit punch. In Mississippi, centers are required to submit menus to the state Department of Health whether or not they participate, but nutrition advocates say no one monitors them.
“These are small centers with very limited resources, just frightfully limited resources,” said Yoder, of the public policy center. “They’re feeding children a very inadequate diet.”
Yoder said many parents end up leaving their children in centers with few resources and poor instruction—as well as unhealthy meals—because they have no other choice.
Thousands of low-income families in the state cannot even access quality child care, much less ensure their children eat nutritious food. Only 35 percent of working families who qualify for federally subsidized child care are being served, said Carol Burnett, director of the Mississippi Low Income Child Care Initiative.
And in a state where the median income is about $24,000—and even lower for single parents—there is no guarantee of quality at all centers.
Many centers cannot think about joining the USDA food program because they struggle to pass basic safety inspections, said Yoder. “I think we’ve probably gotten as far as we can go,” Yoder said. “And now, we’ve got to look for another model to make [participation] happen.”
McWright thinks better communication about the financial and nutritional advantages of participating would encourage other centers to enroll. She still owns her own center, and spends time every morning making sure all is running smoothly, even though it’s not easy.
“It is a passion for me because I know how hard it was for me when I started,” she said.
Annie Gilberston of the Southern Education Desk, a consortium of public media stations reporting on education issues in the south, contributed to this story.
This story also ran on Time.com as part of an exclusive collaboration. Reproduction is not permitted.