Research Article| Volume 51, ISSUE 8, P958-966, September 2019

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Building Blocks for Healthy Children: Evaluation of a Child Care Center–Based Obesity Prevention Pilot Among Low-Income Children



      To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.


      A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.


      A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).


      Children aged 18–71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).


      A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.

      Main Outcome Measure(s)

      Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.


      Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers.


      Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.

      Conclusions and Implications

      Curriculum-driven training and implementation support improved nutritional policies and practices and staff–child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.

      Key Words

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