Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006
Head Start, a federal preschool program serving infants and children up to age five, includes a varied mix of programs—education, health, nutrition, social services, and parental involvement—that presents a unique opportunity to combat childhood obesity. Created in 1965, Head Start was designed to help break the cycle of poverty by providing preschool children of low-income families with a comprehensive program to meet their educational, emotional, social, health, and nutritional needs.76 In 2003, 19,200 Head Start sites throughout the country reached more than 900,000 children. The program is racially diverse, and most children are three (34 percent) or four (53 percent) years old.77 Although Head Start has touched millions of children's lives, it reaches only about 40 percent of those who are eligible.78
One objective of Head Start is to ensure that all children are linked to an ongoing source of health care.79 The emphasis on continuous primary care means that children's height and weight are monitored and that parents receive guidance on nutrition and physical activity. Head Start maintains a Child Health Record for each child and requires a health screening within forty-five days of enrollment.80 Although each child's height and weight are measured and BMI calculated as part of a routine health examination, it is not clear how these data are used on an individual basis or what information is given to the parents. Nor is it clear whether the BMI data collected are analyzed at a state or national level or used for surveillance or monitoring.
Head Start is also a vital source of nutrition for low-income children. Its federal performance standards require that its meals and snacks provide at least one-third of the daily nutritional needs of children in a part-day center-based setting and one-half to two-third of the needs of children in a full-day program.81 Head Start sites participate in the CACFP program and must have a registered dietitian review and evaluate their menus. Performance standards also require that parent education activities include “opportunities to assist individual families with food preparation and nutritional skills.”82
Head Start's federal regulations also require that settings provide opportunities for outdoor and indoor active play, adequate indoor and outdoor space, equipment for active play, and opportunities to develop gross and fine motor skills. The regulations do not specify the amount, frequency, and type of physical activity. No standards or rules govern television use.
Overall, evaluations of Head Start show many benefits for children, families, and communities, though little research has focused on obesity prevention.83 The only published study to date is Hip-Hop to Health Jr., described above.84 Because of its multiple components and because it serves low-income, multiethnic children who are at high risk of overweight, Head Start could well be used to strengthen and expand obesity-prevention efforts. The program has national reach and could significantly improve healthful eating and physical-activity patterns of young children. Interventions and policy changes could focus on ensuring that meals and snacks adhere to the Dietary Guidelines, that physical activity is increased, and that parents are actively involved. BMI screening results could be provided to parents and health providers and could be used for surveillance on state and national levels.