In this national survey, we found that Head Start programs reported using a multilevel approach to childhood obesity prevention, which included activities directed at staff, parents, and community partners. They offered workshops to parents about preparing and shopping for healthy foods, trained new staff on children's feeding and gross motor activity, provided activities for staff to improve their own eating and activity habits, and established partnerships with community organizations to help prevent childhood obesity. These activities can reach the salient adults in children's lives and establish positive and consistent social norms for children regarding diet and physical activity. The importance of reaching these adults is reflected in the fact that many Head Start program directors considered obesity to be a substantial problem for both parents and staff.
Many childhood obesity prevention efforts have taken place in schools, where children spend a great deal of time and where the environments related to both diet and physical activity can be altered (17
). However, children consume most of their calories outside the school setting (18
). Furthermore, seasonal patterns of weight gain in young children suggest that the nonschool environment may be more influential than the school environment (20
). A more effective approach may be to reach children in the multiple contexts in which they spend their time, not only in school but also at home and in their neighborhoods. Few examples of such multilevel approaches to childhood obesity prevention have been evaluated (2
), and their activities were centered in schools but did not specifically involve preschools or child care settings.
A major challenge in this school-centered approach is that the primary focus in elementary and secondary schools is on academic achievement. Additionally, these schools are not inherently oriented to an ecological model of child development, nor do they include children younger than 5 years in whom health habits are already being established. Applying a multilevel approach to obesity prevention in Head Start, however, has many advantages because Head Start reaches children at younger ages, integrates children's health, nutrition, and gross motor development, and requires involvement of staff, parents, and community partners. Additionally, the Program Performance Standards require that former or current Head Start parents be given preference for Head Start staff positions for which they are qualified (10
). The fact that more than one-fourth of staff are former or current Head Start parents (21
) means that efforts to reach parents about obesity prevention will also reach some future staff. In addition, Head Start could frame some of its messages about obesity prevention in a similar way for parents and staff.
Since its inception, Head Start has focused on children's health, recognizing the relationship between health and children's ability to learn (22
). These efforts have involved staff, parents, and community partners. For example, in its recent initiatives to improve children's oral health, Head Start programs received grant support to build connections with dentists and dental hygienists in the community and to increase education of parents (23
). Head Start has also applied an ecological approach to address children's mental health, using interventions that include both parent and staff training (24
As with oral and mental health, effective and sustainable models for obesity prevention will likely require involvement of staff, parents, and community partners. A promising example of obesity prevention efforts in Head Start is the I Am Moving, I Am Learning initiative, a program enhancement designed to encourage children's moderate to vigorous physical activity, adult-guided movement activities, and healthy eating behaviors (26
). Of the 50 programs participating in the early implementation of I Am Moving, I Am Learning, more than half offered activities for staff about their own diet and physical activity behaviors, nearly all provided activities for parents, and more than half formed a partnership with at least 1 community organization to prevent obesity (27
Despite the high response rate to the SHAPES survey, which attempted to reach all Head Start programs, this study had several limitations. We did not validate program reports of their activities by conducting on-site interviews of staff, parents, or community partners. This was not an evaluation in which we tried to assess details about the implementation (content and intensity), reach (number of adults who participated), and effectiveness of the reported activities (28
). In addition, the survey required programs to respond to questions on the basis of the average or typical Head Start center in their program. Programs with large between-center variability might have been more likely to misclassify their program's activities.
Considering that young children can benefit in many ways from links between the school, home, and community (29
) and that there is growing interest in obesity prevention efforts in early childhood education settings (4
), more information is needed on how early childhood programs are implementing such links in their obesity prevention efforts. The philosophical and administrative foundation for a multilevel approach to obesity prevention is already in place in Head Start. We now have national data on the types of staff training, parent outreach activities, and community partnerships used in Head Start to encourage children's healthy eating and gross motor activity. Future research is needed to explore the content and effectiveness of these strategies.