My weight-their weight: eHealth intervention for managing obesity in child care settings

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ABSTRACT Child care centers ─ and their providers ─ are critical partners in public health efforts to address today’s obesity epidemic. Diet and physical activity (PA) habits are formed early, influencing immediate and long-term obesity risk, and both centers and providers play key roles in forming children’s weight-related habits. Yet, the standard paradigm of child care-based obesity prevention initiatives primarily target only center directors to change organizational-level policies and practices; failing to recognize the needs of the child care providers. These providers suffer disproportionally high prevalence of obesity and research has shown that providers’ own poor eating and PA behaviors reduce their confidence and ability to model and promote healthy lifestyle behaviors to the children in their care. However, information regarding the effectiveness of improving provider health behaviors or whether such improvements elicit meaningful change in the child care environment and the children in their care is limited. Leveraging our team’s expertise with implementing evidence-based behavior change and weight loss interventions, the proposed study will integrate an evidence-based weight management intervention for child care providers into Go NAPSACC’s existing childhood obesity prevention program (Go NAPSACC+). Go NAPSACC+ program will be assessed using a clustered randomized controlled trial to evaluate if improving child care providers’ health behaviors elicit meaningful change in dietary and PA behaviors in 2-5-year-old children in their care and the child care environment. We will recruit 84 centers, including 168 providers, and 672 2–5-year-old children to participate in the evaluation. Centers will be randomly assigned to 1) standard “Go NAPSACC” or 2) “Go NAPSACC+” (with a provider weight management component). Outcome measures will assess impact on dietary intake and PA behaviors of 2-5-year-old children at 6 months (primary aim) and 12 months. Secondarily we will compare the impact of the intervention on centers’ implementation of healthy weight practices and the effect on provider-level weight, diet quality and/or PA at 6 and 12-months. Extensive process analysis, guided by the RE-AIM framework, will document the fidelity of the interventions, challenges and barriers to effective implementation, and use of program specified activities. If successful, findings will provide a highly implementable, scalable, and sustainable strategy that would enhance the standard paradigm of early childhood obesity prevention initiatives.