Obesity Prevention in Head Start
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 3/15/2019 |
| Start Date: | August 24, 2018 |
| End Date: | January 18, 2019 |
Obesity Prevention in Low-Income Preschoolers: Testing the Impact of an Alternative Meal Service Approach in Head Start
Family style dining is a widely-advocated approach by which to feed children in early
education settings. While family-style dining is hypothesized to allow children to attend to
their hunger and satiety and consume only the amount of food they need to meet their energy
needs, children's ability to self-regulate eating in this setting is dependent on a number of
factors including early life experiences, the feeding strategies caregivers use during meals,
and the eating environment. The goal of this study is to develop and implement a novel
curriculum for childcare providers, Mealtime Matters, that addresses the factors that
interfere with children's self-regulation of eating and offers caregivers strategies to
reduce exposures that promote over-eating in the early education environment. Mealtime
Matters will be pilot tested through a randomized controlled trial design with 7 Head Start
classrooms, enrolling approximately 72 low-income preschool-aged children. Intervention
feasibility and acceptability will be examined, as well as changes in caregiver/child
mealtime interactions and children's dietary intake during meals at Head Start. Study results
will inform the development of a fully-scaled efficacy trial.
education settings. While family-style dining is hypothesized to allow children to attend to
their hunger and satiety and consume only the amount of food they need to meet their energy
needs, children's ability to self-regulate eating in this setting is dependent on a number of
factors including early life experiences, the feeding strategies caregivers use during meals,
and the eating environment. The goal of this study is to develop and implement a novel
curriculum for childcare providers, Mealtime Matters, that addresses the factors that
interfere with children's self-regulation of eating and offers caregivers strategies to
reduce exposures that promote over-eating in the early education environment. Mealtime
Matters will be pilot tested through a randomized controlled trial design with 7 Head Start
classrooms, enrolling approximately 72 low-income preschool-aged children. Intervention
feasibility and acceptability will be examined, as well as changes in caregiver/child
mealtime interactions and children's dietary intake during meals at Head Start. Study results
will inform the development of a fully-scaled efficacy trial.
Obesity disproportionately affects low-income children. Already by age 5, 20% of low-income
children in the US are obese, a prevalence three times higher than among high-income
children. Obesity that emerges by this young age is persistent and contributes to sustained
obesity and obesity-related chronic disease in adulthood. Identifying effective approaches to
prevent obesity among young, low-income children is a national priority.
Family-style dining, in which children serve themselves food and drinks from communal dishes,
is advocated as a strategy to prevent childhood obesity. It is theorized that family-style
dining allows children to attend to their hunger and satiety, and consume only the amount of
food they need to meet their energy needs. The alternative, where adults direct children's
intake, is theorized to interfere with children's ability to self-regulate their eating and
cause excess weight gain. Based on this theoretical model, the USDA's Child and Adult Care
Food Program (CACFP), which provides meals to 4.2 million low-income children annually, and
Head Start, the federally-funded preschool program that serves 42% of all preschool-aged
children in poverty nationally, strongly encourage family-style dining.
Contrary to current beliefs however, the investigators posit that many low-income children
are not able to self-regulate their eating and overeat when allowed to self-serve, leading to
excess weight gain. Thus, family-style dining may increase, rather than decrease, obesity
among low-income children. Basic behavioral and epidemiologic research suggests that chronic
stress, which many low-income children experience, contributes to obesity-promoting appetite
characteristics among children. Laboratory-based experiments have demonstrated that appetite
characteristics such as these lead to excessive consumption when children are allowed to
self-serve. Among low-income preschoolers, one-third to one-half of children consume calories
in excess of Institute of Medicine recommendations during family-style meals. This excessive
energy intake is driven by intake of meat and grains, while intake of nutrient-dense, lower
calorie fruits and vegetables is far below recommendations. Children's excessive and
unbalanced eating during family-style dining is often noted by teachers, who are uncertain
how limit these behaviors.
Changing environmental supports for eating may be particularly important for modifying the
dietary intake of young children who, unlike adolescents and adults, do not yet have the
cognitive capacity to inhibit intake of highly palatable foods in favor of selecting food
based on healthfulness. Therefore, the objective of this Collaborative Research pilot study
is to conduct T2 translational research among low-income preschool children by developing an
easily-implemented curriculum to support family-style dining in Head Start called Mealtime
Matters, where teachers receive focused training on preschooler nutrition, appropriate
portion sizes for preschool children, responsive feeding strategies, and improvements to the
classroom environment that promote children's self-regulation of eating. The feasibility and
potential impact of Mealtime Matters will be examined with 72 children from up to 7 Head
Start classrooms in Adrian, Michigan. The investigators hypothesize that Mealtime Matters
will be feasible and acceptable to teachers. Further, by reducing prompts to over-consume and
empowering teachers to direct children to serve appropriate portion sizes while using
responsive feeding approaches, the investigators will: 1. Increase the proportion of children
consuming within an acceptable range of the recommended kilocalories (kcal) during meals at
Head Start and 2. Increase the servings of fruits and vegetables children consume during
meals at Head Start. Sustained engagement in these dietary behaviors can prevent excessive
weight gain and obesity.
The specific aims of this trial are:
Aim 1: Examine the effect of Mealtime Matters on children's dietary intake during meals at
Head Start.
Aim 2: Examine the effect of Mealtime Matters on teacher/child mealtime interactions at Head
Start.
Aim 3: Determine the feasibility and acceptability of Mealtime Matters among Head Start
teachers.
children in the US are obese, a prevalence three times higher than among high-income
children. Obesity that emerges by this young age is persistent and contributes to sustained
obesity and obesity-related chronic disease in adulthood. Identifying effective approaches to
prevent obesity among young, low-income children is a national priority.
Family-style dining, in which children serve themselves food and drinks from communal dishes,
is advocated as a strategy to prevent childhood obesity. It is theorized that family-style
dining allows children to attend to their hunger and satiety, and consume only the amount of
food they need to meet their energy needs. The alternative, where adults direct children's
intake, is theorized to interfere with children's ability to self-regulate their eating and
cause excess weight gain. Based on this theoretical model, the USDA's Child and Adult Care
Food Program (CACFP), which provides meals to 4.2 million low-income children annually, and
Head Start, the federally-funded preschool program that serves 42% of all preschool-aged
children in poverty nationally, strongly encourage family-style dining.
Contrary to current beliefs however, the investigators posit that many low-income children
are not able to self-regulate their eating and overeat when allowed to self-serve, leading to
excess weight gain. Thus, family-style dining may increase, rather than decrease, obesity
among low-income children. Basic behavioral and epidemiologic research suggests that chronic
stress, which many low-income children experience, contributes to obesity-promoting appetite
characteristics among children. Laboratory-based experiments have demonstrated that appetite
characteristics such as these lead to excessive consumption when children are allowed to
self-serve. Among low-income preschoolers, one-third to one-half of children consume calories
in excess of Institute of Medicine recommendations during family-style meals. This excessive
energy intake is driven by intake of meat and grains, while intake of nutrient-dense, lower
calorie fruits and vegetables is far below recommendations. Children's excessive and
unbalanced eating during family-style dining is often noted by teachers, who are uncertain
how limit these behaviors.
Changing environmental supports for eating may be particularly important for modifying the
dietary intake of young children who, unlike adolescents and adults, do not yet have the
cognitive capacity to inhibit intake of highly palatable foods in favor of selecting food
based on healthfulness. Therefore, the objective of this Collaborative Research pilot study
is to conduct T2 translational research among low-income preschool children by developing an
easily-implemented curriculum to support family-style dining in Head Start called Mealtime
Matters, where teachers receive focused training on preschooler nutrition, appropriate
portion sizes for preschool children, responsive feeding strategies, and improvements to the
classroom environment that promote children's self-regulation of eating. The feasibility and
potential impact of Mealtime Matters will be examined with 72 children from up to 7 Head
Start classrooms in Adrian, Michigan. The investigators hypothesize that Mealtime Matters
will be feasible and acceptable to teachers. Further, by reducing prompts to over-consume and
empowering teachers to direct children to serve appropriate portion sizes while using
responsive feeding approaches, the investigators will: 1. Increase the proportion of children
consuming within an acceptable range of the recommended kilocalories (kcal) during meals at
Head Start and 2. Increase the servings of fruits and vegetables children consume during
meals at Head Start. Sustained engagement in these dietary behaviors can prevent excessive
weight gain and obesity.
The specific aims of this trial are:
Aim 1: Examine the effect of Mealtime Matters on children's dietary intake during meals at
Head Start.
Aim 2: Examine the effect of Mealtime Matters on teacher/child mealtime interactions at Head
Start.
Aim 3: Determine the feasibility and acceptability of Mealtime Matters among Head Start
teachers.
TEACHERS
Inclusion Criteria:
- employed as teachers in the Adrian Public School's Head Start Program
Exclusion Criteria:
- N/A
CHILDREN
Inclusion Criteria:
- enrolled in the Adrian Public School's Head Start Program
- the specific age range for children selected of 3-4 years by September 1 of the given
academic year is based on the age of eligibility for Head Start enrollment
- the custodial and legal guardian is able to provide valid consent
Exclusion Criteria:
- child has serious medical problems
- the child is a foster child
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