Efficacy of Center-based Childcare to Mitigate Unhealthy Weight Gain in Preschoolers from Low-income Households During the Summer

Studies show that preschool-age children are especially vulnerable to accelerated weight gain during the summer, with those from low-income households (≤185% poverty level or Medicaid eligible - the target population for this study) exhibiting the greatest risk of unhealthy weight gain. Despite numerous interventions designed to prevent OWOB, none target preschoolers during summer. For families from low-income households, attending center-based childcare is associated with a lower risk of developing OWOB by 1st grade compared to attending home-based care. We believe center-based childcare lowers the risk of OWOB through daily rules/routines that promote healthy behaviors. For families from low-income households, publicly funded center-based childcares (e.g., needs-based pre-K, Head Start) typically operate on an academic/school 9-month calendar (Aug-May). During summer, fewer than 30% of preschoolers attend center-based childcare. For many preschoolers from lower-income households, summer may serve as an extended period away from formal center-based childcare, because the out-of-pocket expense may prohibit attendance. This may promote unhealthy behaviors and excessive weight gain. In the majority of US states, publicly funded center-based childcare during the academic/school year for families from underserved populations is free; however, center-based childcare during the summer is an out-of-pocket expense for many of these families. Despite parents’ desire for childcare during the summer, a major reason children from low-income households do not attend center-based care during summer is cost. This creates unequal access to resources and likely exacerbates health disparities for families from low-income households. Using a structural intervention approach, our study will test the impact of providing free center-based childcare in the summer. For this R01, we will rigorously test the impact of providing free center-based childcare during the summer on weight status (i.e., BMI z-score/BIA - primary outcome) and health behaviors (physical activity, diet, sleep and screentime - secondary outcomes) of preschoolers from low-income households (≤185% of poverty level or Medicaid eligible). We will also evaluate the impact of the intervention on parental well-being and employment. Using a pragmatic randomized design, we will randomize 300 preschoolers from low-income households to either free center-based childcare during the summer or a comparison/control group. The Specific Aims are: Evaluate changes in A) preschoolers’ weight status (primary), B) preschoolers’ health behaviors (secondary) and C) parental well-being and paid employment (tertiary) between intervention and control groups; Examine changes in A) preschoolers’ health behaviors and B) parental well-being as potential mediators of changes in preschoolers’ weight status between the intervention and control groups; and Evaluate the incremental cost effectiveness of the intervention in terms of additional cost per weight status reduced and compare this to published childhood obesity cost effectiveness prevention/treatment interventions. Project Number: 1R01HD116435-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: MICHAEL BEETS | Institution: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA, COLUMBIA, SC | Award Amount: $609,354 | Activity Code: R01 | Study Section: Lifestyle Change and Behavioral Health Study Section[LCBH] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11643501A1