Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index

Abbey Alkon,Eric Savage,Viet Nguyen,Linda Shipman,Yi Pan,Sara E Benjamin Neelon,Roberta Rose,Angela A Crowley,Jonathan B Kotch,Nina Forestieri,Sherika Hill

doi:10.1186/1471-2458-14-215

Abstract

BackgroundTo address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI).MethodsA seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center’s written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children’s nutritional intake, physical activity, and height and weight pre- and post-intervention.ResultsHierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers’ and parents’ knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children’s zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points.ConclusionsThe NAP SACC intervention, as delivered by trained child health professionals such as child care health consultants, increases provider knowledge, improves center policies, and lowers BMI for children in child care centers. More health professionals specifically trained in a nutrition and physical activity intervention in child care are needed to help reverse the obesity epidemic.Trial registrationNational Clinical Trials Number NCT01921842

Highlights

To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI)
Interventions to address the obesity epidemic can reach the majority of young children if they are delivered through child care programs, where over 60% of preschool-age children in the United States (U.S.) spend an average of 30 hours per week [4,5,6]
Model results in tabular format may be seen in Additional file 1. This decrease may be explained in part by the observation that, there was an increase in healthy weight in both intervention and control centers, there was a net shift in the distribution of children from the obese to the overweight category in intervention centers, whereas the shift in the control centers appears to have gone in the opposite direction, from overweight to obese (Table 3). This randomized control trial showed that a seven-month nutrition and physical activity intervention provided by nurse Child care health consultant (CCHC) significantly increased provider and parent knowledge, improved the number and quality of the nutrition and physical activity written policies, and decreased mean children’s zBMI in the intervention centers compared to matched control centers

Summary

Introduction

To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI). Compared to children with healthy weights, children who are overweight or obese at three to five years of age are five times more likely to be overweight or obese in adolescence [2] and are at greater risk of chronic health problems later in life [3]. Interventions to address the obesity epidemic can reach the majority of young children if they are delivered through child care programs, where over 60% of preschool-age children in the United States (U.S.) spend an average of 30 hours per week [4,5,6]. A study of meals served to 117 two to five year olds in 20 child care centers found that children did not consume the recommended amounts of whole grains, fruits, or vegetables and exceeded recommended amounts of saturated fats and sugar [11]

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