Little Autumn Stepp selected a slice of raw carrot from the serving bowl on the table and, after a few moments scrutiny, dunked it in the pool of ketchup on her lunch tray and took a tentative nibble. Pleased with the taste, she dunked and nibbled until the bright orange, crinkle-cut slice was gone.

The three-year-old was one of about a dozen children eating lunch at Carbon County Head Start's Lehighton program on recent day. The carrot slices were among a served family-style meal that also included apple sauce and low-fat milk.The tempting foods offered the children reflect a growing trend toward healthier - lower-fat, lower sugar, higher fiber - meals served at Head Start programs. The nutrition and exercise standards in place at most Head Start programs in the United States surpasses standards set by the federal government, according to a recent study funded by the Robert Wood Johnson Foundation through two national programs, Healthy Eating Research and Active Living Research.Done by researchers from Temple University and the Mathematica Policy Research, the "Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES)" was recently published in the Archives of Pediatrics and Adolescent Medicine. The Robert Wood Johnson Foundation released the results on Dec. 7.The study reviewed responses from the directors of 1,583 Head Start programs - 87 percent of the programs nationwide - which serve almost 829,000 children. Head Start is the largest federally-funded early-childhood education program in the United States. It serves low-income children from ages 3-5.The researchers found that most Head Start programs have initiated healthier diet and exercise policies even without prodding from the federal government."This is the first time anyone has looked at practices and environments related to healthy eating and physical activity in Head Start. The study sheds light on what they're doing right and areas where they can improve access to healthy foods and increase opportunities for physical activity for children early in life," said Robert Whitaker, lead author of the study and professor of Public Health and Pediatrics at Temple University.The changes in Head Start meals, according to the study, were prompted by concerns about the rising incidence of childhood obesity.The study found that 70 percent of Head Start programs served skim or 1 percent milk, and 75 percent reported encouraging at least 30 minutes a day of physical activity. The federal government sets no standards for either."Head Start has traditionally been a leader in the field of early childhood education, and this is another example of how they are out in front. Yet they should evaluate their current standards for healthy eating and physical activity so that all programs are encouraged to implement current best practices for obesity prevention," Whitaker said.In Pennsylvania, the prevalence of obesity in children aged 2-4 years rose from 10.7 percent in 1998 to 11.5 percent in 2008, according to the U.S. Centers for Disease Control in Atlanta, Georgia."Children who are obese in their preschool years are more likely to be obese in adolescence and adulthood and to develop diabetes, hypertension, hyperlipidemia, asthma, and sleep apnea," the CDC report says.That rings true for MaryAnn Sakusky, Health Disabilities Services Coordinator for Pathstone Child and Family Development Services, which administers the Carbon County Head Start program.She has seen an increase in the numbers of overweight or obese children entering the program."When I first started here (about four years ago) we had approximately 8-10 kids who were considered obese by the BMI standards. Today, there are approximately between 18-20 kids. It has gone up quite a bit," she said. "I just feel something needs to be done with the healthier meals and more exercise in the program."The Carbon County program started changing its menus about three years ago, Sakusky said. "We tried to become more health conscious with the food because of the problem of childhood obesity."The program is reimbursed for food purchases by the Child And Adult Care Food Program. CACFP guidelines are "a little bit more stringent than the U.S. Department of Agriculture regulations," she said. "They do include healthier lunches, such as 1 percent milk, and instead of having pudding for dessert, you need to have a fruit. For breakfast, you need to have a half-cup of fruit and for lunch you must have a cup of vegetables and a cup of fruit" per meal.Marie Garritano, who cooks the meals for the Carbon County program, said it sometimes takes extra effort to get children to try foods they haven't tasted before. Parents working one or more jobs for not much money sometimes rely on fast food restaurants."A lot of the foods are new to them, and at first they are a little apprehensive about trying them, so we take different approaches," she said. "Then they usually try them and they like them."That's where the crinkle-cut carrot slices little Autumn enjoyed, with her non-traditional dip choice of ketchup, come in."Prior to that, we were getting baby carrots. Being that they are crinkle-cut now, they look more like (potato) chips," Garritano said. "So, a lot them are more familiar with the junk food than with the good food, and once they tried the crinkle-cut carrots with low-fat dip, they really liked them."Garritano, who has a background in school nutrition and has had state Department of Education and USDA training, said the children check out the food as they enter the building each morning."They want to know what's for lunch and when will it be ready," she said. "Spaghetti and (low-fat) meatballs are a favorite. And believe it or not, they like salad."Preparing food that is both healthy and kid-friendly can be a challenge. "We don't fry anything here. we don't use a lot of fast food. a lot of our food is made from scratch, and we use as much fresh and frozen food as possible as opposed to canned foods," she said.Sakusky said the early introduction of healthy eating will put children on the right path for adulthood."I think there will be a turn-about from the junk food eating to more nutritious foods," she said. Sakusky has had parents tell her their tykes have taken them to task over what they're eating. "They tell their parents, oh, that's not healthy for you. You need to eat this instead," she said. "So they are learning. It's going to take time, but they are learning."Autumn's mother, Amanda Jennings, likes the changes."Sometimes she's picky, but she's eating a lot more fruit now. She used to eat pretty much only corn and mashed potatoes," Jennings said. Autumn's favorite vegetable is still corn, and her favorite fruit is bananas."I like it," Jennings said the of Head Start's nutrition program. "I think it's good for the kids. It's healthy for them. They don't always eat like that at home. At Head Start, they see other kids eating them and so they're more likely to try them."