An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program

Ruby A. Natale, Folefac Atem, Sitara Weerakoon, Cynthia Lebron, M. Sunil Mathew, Krystal Sardinas, Catherina Chang, Karla P. Shelnutt, Rachel Spector, Fiorella Altare, Sarah E. Messiah

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011-2014) and 2 (2015-2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2). METHODS: Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families. RESULTS: The mean rate of weekly fruit consumption significantly increased (β = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (β = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (β = -0.36, p < 0.001), fast (β = -0.16, p = 0.001), and other unhealthy food (β = -0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (β = -0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases. CONCLUSION: A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.

Original languageEnglish (US)
Pages (from-to)135-145
Number of pages11
JournalJournal of developmental and behavioral pediatrics : JDBP
Issue number2
StatePublished - Feb 1 2021

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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