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Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study

Alison L Miller12*, Mildred A Horodynski3, Holly E Brophy Herb4, Karen E Peterson12, Dawn Contreras45, Niko Kaciroti1, Julie Staples-Watson1 and Julie C Lumeng16

Author affiliations

1 Center for Human Growth and Development, University of Michigan, Ann Arbor, USA

2 School of Public Health, University of Michigan, Ann Arbor, USA

3 College of Nursing, Michigan State University, Ann Arbor, USA

4 Department of Human Development and Family Studies, Michigan State University, Ann Arbor, USA

5 Health and Nutrition Institute, Michigan State University, Ann Arbor, USA

6 Department of Pediatrics, University of Michigan, Ann Arbor, USA

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Citation and License

BMC Public Health 2012, 12:1040  doi:10.1186/1471-2458-12-1040

Published: 30 November 2012



Nearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity.


The Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction.


The Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children.

Trial registration number Identifier: NCT01398358

Obesity prevention; Low-income children; Preschoolers; Head start; Incredible years series; Self-regulation; Intervention study