Motor Competence and Attainment of Global Physical Activity Guidelines among a Statewide Sample of Preschoolers

Global physical activity guidelines for preschoolers include 60 min of moderate-to-vigorous physical activity (MVPA) daily. This study, based on the developmental model of motor skill competence, examines how motor competence relates to preschoolers’ likelihood of meeting global guidelines using ankle accelerometry. We measured physical activity using 24-h ankle-placement accelerometry (Actical) for at least two consecutive days (87% with six-seven days), motor competence using the Test of Gross Motor Development-2 (TGMD-2), and BMI-for-age z-scores (BMIz) using anthropometry and age- and sex-specific CDC norms. Caregivers provided demographic characteristics of children’s age, sex, and race. We used multivariable logistic regression to examine how motor competence, BMIz weight status, and demographic characteristics related to meeting global physical activity guidelines. The sample included 588 preschoolers, age 3–5 years; 55% male; 60% white; and 28% overweight/obese; 75% attained the recommended 60 min of MVPA per day. The odds of meeting MVPA guidelines were associated with higher gross motor quotient, higher object control scores, sex (male), age (older), and race (white), but not with BMIz weight status. Findings support the use of 24-h ankle accelerometry among preschoolers and are consistent with the developmental model of motor competence applied to preschoolers, whereby object control competence relates positively to attaining global physical activity guidelines.

Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices

Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25 kg/m2 = overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha = 0.65; higher score = more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI = 30.5 ± 7.1; aged 41.1 ± 11.8 years). Means and standard deviations were calculated for HEI (52.2 ± 12.2) and nutrition-related classroom practices sum score (25.4 ± 5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE = 0.05; p < 0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.

Overweight/Obesity Among Preschoolers Is Associated with Caregiver Overweight/Obesity, Not with Neophobia

Objectives

Overweight/obesity (OO) among preschoolers is a major public health issue that has been linked to many factors. Food neophobia is an important factor in children's diet but has inconsistent associations with obesity. Intersectionality affects the outcome of any childhood events. This study examines: 1) direct association of FN and preschooler OO, 2) whether FN moderates or mediates the caregiver OO-preschooler OO association, and 3) intersectionality of sex and race and preschooler OO.

Methods

Baseline data were gathered from 52 childcare centers participating in a randomized controlled trial to promote healthy dietary habits. The sample included 500 preschoolers and caregivers. Children were weighed and measured; we calculated body mass index percentile (BMIp) and categorized them as OO vs. healthy based on CDC criteria. Caregivers reported their weight, family demographics, and completed the 2-item Household Food Security Scale and the Child Food Neophobia Scale. Logistic Mixed Models (LMM) were used with childcare centers as random effects, adjusting for child age, sex, race, and sociodemographic. Model 1 examined the association between FN and OO. Model 2 added the caregiver OO*FN interaction, and Model 3 examined FN as a mediator in the caregiver OO-preschooler OO association. Model 4 tested the sex*race interaction with preschooler OO.

Results

Children's mean age was 48 months (SD = 7.5), 55% boys, and 25.4% OO. Caregiver mean age was 36 years (SD = 5.7), 90% women, 67% educated at bachelor's or higher, 84% employed full-time, 13% food insecure, and 58% OO. In multivariable LMM, compared to normal weight, overweight and obese caregivers were 2.6 (95% CI: 1.6–4.3) and 3.9 (95% CI: 2.1–7.3) times, respectively, more likely to have OO child. FN was not associated with preschoolers’ OO directly or through moderation or mediation. The intersectionality of child race and sex was significant (P = 0.01) in predicting child obesity. Non-White girls had the highest mean BMIp, 69.3.

Conclusions

OO among preschoolers and caregivers was related. FN was not associated with preschooler OO either directly or indirectly. Research into the mechanisms linking caregiver and preschooler OO is needed. The elevated BMIp among non-white preschool girls calls for research focused on this population.

Funding Sources

National Institute Diabetes and Digestive and Kidney Diseases.

CHAMP: A cluster randomized-control trial to prevent obesity in child care centers

Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.