The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI.
The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19 320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity.
The total sample included 43 748 children providing 83 239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (β = –0.70 [SE: 0.05] vs –0.07 [0.08] in the Medicaid group [P < .001] and –0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups.
Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).
Comments
Re: Changes in Body Mass Index Associated With Head Start Participation
Thank-you for your interesting study on the changes in children's BMI associated with their participation in the Head Start program. The study monitored changes in children's BMI z score after two consecutive years of participation in Head Start and the summer in between. This is the first study that followed children from numerous Head Start programs and compared them against two comparison groups. Although there were a few limitations, the results suggest that participation in the Head Start program positively influences children's BMI upon the start of kindergarten. It was important that BMI z scores were obtained because these are the most effective way to measure a child's BMI as it accounts for both age and sex (1).
Childhood obesity is one of the most significant public health issues we are facing today. In addition, children from low-income households are particularly vulnerable to becoming obese (2). This highlights the importance of primary prevention programs that successfully reach these children. The evidence you have provided adds to the limited body of knowledge regarding effective prevention programs for preschool aged children from low-income families. Likewise, your study adds to the many known benefits of the Head Start program. Unfortunately, there is not a nationwide program in Canada with similar goals to those of Head Start, even though there is significant evidence to prove that these programs are beneficial. This is an evidence-based program that may potentially be suited to the Canadian population, and thus warrants research.
In closing, I have two questions; the first is whether you intend to conduct a similar study with a nationally representative sample, and the second is if you have considered doing a follow-up study with the same children to see if the healthy BMIs are maintained.
References:
1. Must, A., & Anderson, S. E. (2006). Body mass index in children and adolescents: Considerations for population-based applications. International Journal of Obesity (2005), 30(4), 590-594. doi:10.1038/sj.ijo.0803300
2. Whitaker, R. C., & Orzol, S. M. (2006). Obesity among US urban preschool children: Relationships to race, ethnicity, and socioeconomic status. Archives of Pediatrics & Adolescent Medicine, 160(6), 578-584. doi:10.1001/archpedi.160.6.578
Conflict of Interest:
None declared