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A reduction in BMI can be caused by either better nutrition and/or more physical exercise. Physical environment is certainly important: the Frank Porter Graham (FPG) Child Development Institute included a large open space, and outside play was a part of the daily routine (11:30 am and 3:00 pm); however, this is likely to have played an important role only after the toddlers had started walking. Of course, better nutrition does not necessarily come only in the daycare center: The treated children could have enjoyed more nutritious food at home as well, both because their preferences for food might have been affected and because their parents were counseled by the pediatricians on site during the physical exams. Finally, (47) provides evidence-based on the What We Eat in America 2003-2004, combined with the National Health and Nutrition Examination Survey (NHANES) 2003-2004-that Head Start participants consume similar level of calories as non-Head Start participants during evenings and weekends but fewer calories in the morning and in the afternoon during the week.
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