Parents helping parents to fight obesity in preschoolers


Program in Boston-area Head Start centers to reach thousands

August 9, 2016 — When fast food joints are on every corner and fruits and vegetables are costly at the local market, how can parents make sure their children eat a healthy diet?

How can low-income parents ensure their children get enough exercise when they don’t have a safe place to play outdoors?

What’s the best way to limit a child’s screen time when trying to do so causes stress and conflict?

These questions, and many more focused on healthy eating and healthy behaviors, will be tackled in parent-to-parent discussions as part of a new obesity prevention program currently in the planning stages at Head Start programs in three Massachusetts cities. Researchers at Harvard T.H. Chan School of Public Health are collaborating with Head Start parents and staffers in Boston, Cambridge, and Somerville to develop the program. The goal is to engage parents and staff as co-leaders in an effort to help parents in low-income communities build the kinds of self-advocacy and life skills they need to promote better nutrition, increased physical activity, and healthier sleep behaviors in their children.

The Communities for Healthy Living (CHL) program—which will reach up to 4,000 children over three years—is led by Kirsten Davison, Donald and Sue Pritzker Associate Professor of Nutrition at Harvard T.H. Chan School of Public Health. She and her colleagues hope that if the program is successful it can be replicated in Head Start programs nationwide. “We’re very focused on taking what research says people should do, and finding effective ways to move the science into people’s everyday lives,” Davison said.

Unemployment, mental health, housing affect obesity

Davison said the new project is different from other family-based obesity prevention projects “because it addresses many things going on in the lives of low-income families that could prevent them from using any nutrition education we might offer them. This program definitely promotes good nutrition and physical activity, but it also links parents with resources to help with other life challenges, such as housing insecurity, unemployment, or mental health issues in their families.”

Head Start is a federal program that promotes school readiness of children under age 5 from low-income families through education, health, social, and other services. About 950,000 children nationwide participate in Head Start programs each year.

The five-year CHL project is funded by a $3 million grant from the National Institutes of Health. It’s an intervention with a curriculum focused on empowering parents. It’s also a research study that will examine whether the intervention is successful.

The project follows up on a small pilot study of five Head Start centers in upstate New York, co-led by Davison and Janine Jurkowski from the University at Albany-SUNY. With parents as part of the team developing health-promoting efforts at the centers, obesity rates among preschoolers were reduced. The new effort will follow the same approach as the pilot study, but on a much broader scale in Boston, Cambridge, and Somerville, where, as of 2013, about 43% of the children in Head Start programs were overweight and 21% were obese.

Rollout of the program will begin in September 2017 after an 18-month planning phase.

A different approach

A key component of the program will be information sessions led by parents for other parents. Topics will include life skills to promote family health, such as effective communication (with health professionals, for example), health literacy (such as being able to identify key healthy habits), and the ability to identify and advocate for resources that support health in the family (such as farmers’ markets or weight management programs).

From left: Harvard Chan School’s Kirsten Davison; Sonia Carter of ABCD Head Start; and Adrienne Vigilante of CAAS Head Start

The Harvard Chan School team partnered with local organizations that run Boston-area Head Start programs—Action for Boston Community Development (ABCD) and the Community Action Agency of Somerville (CAAS)—to create two community advisory boards, including researchers, Head Start staff, and parents. The groups have been meeting monthly since January to plan aspects of the CHL program. “The idea is that we work with Head Start parents to find out what’s important to them, what they value, what resources we have to draw on—and we will develop the program around what they tell us,” Davison explained.

Parents and Head Start staff are enthusiastic about the program.

Dorchester parent Njiba Mbuyi said a discussion at a recent meeting about what parents serve for dessert at home was an “eye-opener.” She admitted that she hadn’t really thought about it before. “At Head Start they only serve fruit for dessert,” Mbuyi said. “It dawned on me after that discussion that I should be doing the same thing at home.”

Adrienne Vigilante, assistant to the director of programs/Head Start director at CAAS, said that including parents in the planning process “creates a buy-in that is immeasurable.” She appreciates the CHL program’s focus on identifying barriers families face in maintaining healthy nutrition and healthy behaviors and in providing practical ways to get around those barriers.

“Parents have a tremendous load of different concerns for their families, like where they live, safety, or mental or physical disabilities among their children,” said Sonia Carter, nutrition coordinator at ABCD Head Start. “I believe that this program will provide skills to help them better manage some of the issues that prevent them from living a healthy life.”

Turning research into reality

In tandem with the rollout of the program in the fall of 2017, Davison and her colleagues—including co-investigators Jurkowski, Sebastien Haneuse at Harvard Chan School, and Elsie Taveras at Harvard Chan School and Massachusetts General Hospital for Children—will conduct a randomized controlled trial to test the program’s effectiveness. Half of the 16 Head Start centers involved in the project will use the obesity-related interventions and half will maintain their existing health programming, without obesity-related programs. The researchers will compare outcomes between the two groups, looking at body mass index, diet, physical activity, screen time, sleep, and behavioral factors among the children, and by surveying parents.

The researchers hope that the program will lead to reduced obesity, healthier behaviors among children and families, and greater empowerment among parents in the intervention group. If these improvements come to pass, Davison hopes the program can be scaled up to Head Starts throughout the U.S.

“There have been many hands and minds involved in designing the Communities in Healthy Living program, from Head Start parents and staff to community members to students to research faculty,” said Davison. “While this participatory approach is time intensive, the potential payoff is an effective program—one that could be seamlessly integrated into Head Start centers across the country—that could make a real difference in the health of millions of low-income families.”

Karen Feldscher

— photo of young boy eating canteloupe: CDC/Amanda Mills

— photo of Davison, Carter, and Vigilante: Sarah Sholes