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

摘要 儿童保育中心及其提供者是解决当今肥胖问题的公共卫生努力的重要合作伙伴 疫情饮食和体力活动（PA）习惯形成早，影响即时和长期肥胖 风险，中心和提供者在形成儿童与体重有关的习惯方面发挥着关键作用。然而，标准 儿童保健为基础的肥胖预防举措的范例主要是针对中心主任改变 组织层面的政策和做法;未能认识到儿童保育提供者的需求。这些 供应商遭受肥胖的高患病率，研究表明，供应商自己的穷人 饮食和PA行为降低了他们的信心和能力，以示范和促进健康的生活方式行为， 孩子们在他们的照顾。然而，关于改善提供者健康的有效性的信息 行为或这种改善是否会引起儿童保育环境和儿童的有意义的变化 他们的照顾是有限的。利用我们团队的专业知识，实施基于证据的行为改变， 减肥干预，拟议的研究将整合一个基于证据的体重管理干预 为儿童保育提供者加入Go NAPSACC现有的儿童肥胖预防计划（Go NAPSACC+）。 Go NAPSACC+计划将使用一项随机分组对照试验进行评估，以评估是否改善 儿童保健提供者的健康行为引起2-5岁儿童的饮食和PA行为发生有意义的变化 儿童在他们的照顾和儿童保育环境。我们将招募84个中心，包括168个提供者，672个 2-5岁的孩子参加评价。中心将被随机分配到1）标准“Go NAPSACC”或2）“Go NAPSACC+”（使用提供者体重管理组件）。结局指标将 评估6个月（主要目的）和12个月时对2-5岁儿童饮食摄入和PA行为的影响 个月其次，我们将比较干预对中心实施健康体重的影响 实践以及对6个月和12个月时提供者水平体重、饮食质量和/或PA的影响。广泛进程 在RE-AIM框架的指导下，分析将记录干预措施、挑战和障碍的真实性 有效实施和使用计划规定的活动。如果成功，调查结果将提供一个高度 可实施、可扩展和可持续的战略，以加强幼儿教育的标准模式 肥胖预防措施。

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.