Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study

Abstract

BackgroundNearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity.Methods/designThe Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction.DiscussionThe Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children.Trial registration numberClinicaltrials.gov Identifier: NCT01398358

Validation of the Children's Eating Behaviour Questionnaire in a low-income preschool-aged sample in the United States

“…Head Start is a free, federally-funded preschool program for low-income children. The first study examined stress and eating in low-income preschoolers (“Appetite, Behavior, and Cortisol [ABC]” Cohort; see Lumeng et al, 2014 for more details) and the second was an intervention study, with the CEBQ administered pre- and post-intervention (“Growing Healthy” cohort, see Miller et al, 2012 for a detailed description). The first administration of the CEBQ and corresponding BMI were used in the analyses for all participants.…”

Providers perspectives on self-regulation impact their use of responsive feeding practices in child care

“…Existing obesity prevention educational curricula (e.g., the Preschool Obesity Prevention Series) (Miller et al, 2012) seek to enhance children's behavioral regulation skills, but educational materials focused on enhancing children's regulatory skills specific to the childcare context are lacking. CACFP participation has been associated with improved nutritional quality of foods and beverages served in childcare centers (Ritchie et al, 2012) and among low-income children, has been shown to moderately increase consumption of milk and vegetables (Korenman, Abner, Kaestner, & Gordon, 2012).…”

The role of emotion regulation in childhood obesity: implications for prevention and treatment

“…In the field of childhood obesity prevention focusing on ER, to our knowledge there is only one pilot study and two ongoing studies (147)(148)(149) . A school-based pilot intervention translated specific components of a violence and substance abuse programme into a lifestyle intervention.…”

“…Another school-based intervention study is currently being carried out in toddlers, combining a traditional obesity prevention programme with a programme to enhance self-regulation. The study teaches children tools for behavioural self-regulation and includes a parental intervention (148) .…”