Family- and Program-Level Approaches to Understanding and Addressing Obesity Among Preschool-Aged Children Attending Head Start

Abstract

Childhood obesity now affects 13.7% of children 2 – 5 years old in the United States, putting them at increased risk for obesity and adverse health outcomes at later ages. Children in low-income families and racial/ethnic minorities are disproportionately impacted, making this issue also a matter of social justice. Head Start is a promising avenue for promoting healthy weight among these populations of young children. Head Start is a federally funded public preschool program that serves nearly three quarters of a million children in low-income families each year. Health promotion is already a core component of Head Start. This dissertation focuses on better understanding how to build upon current practices to further support healthy weight in early childhood among the communities Head Start serves. All work in this dissertation is based upon data from the Communities for Healthy Living (CHL) early childhood obesity prevention trial taking place in Head Start programs in the Greater Boston Area. Through CHL, de-identified Head Start administrative records were shared with the study team. Chapter 1 uses enrollment data from these administrative records to characterize the population currently reached by Head Start while also identifying opportunities to expand this reach among eligible children not enrolled in Head Start. Chapter 2 uses height and weight measurements from these administrative records to identify when children enrolled in Head Start tend to gain excess weight most rapidly, which can inform Head Start-based programs and policies for obesity prevention. Chapter 3 explores a novel implementation model for an obesity prevention program in Head Start. As part of CHL, a parent program focused on improving key child weight-related behaviors (i.e., nutrition, physical activity, screen time, and sleep) is co-led by a Head Start parent and a Head Start staff member. Interviews with these staff and parent facilitators are analyzed to explore the acceptability and appropriateness of this facilitation model, which are two key implementation outcomes for ultimately creating a sustainable and scalable program. Collectively, this work contributes to understanding the reach, timing, and implementation of early childhood obesity prevention efforts based in Head Start.