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

The paper does not state the total number of children analyzed, only the number of child care centers. Food intake came from parent reports, not observed intake. Teacher delivery fidelity was collected inconsistently, so differences between phases may partly reflect how well the program was delivered. Phase 1 and phase 2 were separate trials with different centers, so the comparison of university delivery and train-the-trainer delivery is confounded by time and participant demographics. The two phases had different caregiver demographics, and the paper notes this may have influenced results. Children with diagnosed disabilities with an Individual Education Plan, failure to thrive, or who brought their own meals were excluded, so findings may not apply to those groups. The intervention included multiple components, so the effect of any single component cannot be separated. Children were grouped by center, and the study did not randomize children individually.

The authors declared no conflict of interest. The article lists support from NIH and U.S. government non-PHS funding.

Do not conclude that the program prevents obesity because some eating habits improved. Body mass index percentile did not decrease in phase 1 and increased by 0.16 points in phase 2. The intervention included policy changes, child lesson plans, teacher role modeling, and parent workshops, so no single component can be credited.