Available, affordable, and achievable changes in parent feeding practices, child diet, and activity could normalize the BMI distribution in Head Start children

We examined the impact of parent feeding practices on the diet, activity and BMI in 4 year old Head Start (HS) children (n= 704). Child assessments: BMI, activity for 7 days by accelerometry and parent-recalled non-HS diet of 3 days. Parents nominated and grouped feeding practices into five clusters based on perceived similarity and rated the effectiveness of each practice with their child. Median child BMI z-score was 0.74. One feeding practice cluster (supervision of child consumption with contingencies) related inversely to child BMI z-score (p < 0.05). Energy-adjusted servings of sugar-sweetened beverages related positively (p< 0.05) while lean meats/eggs/beans (p< 0.05) and refined grains (p< 0.05) related negatively to child BMI z-score. Descending quartiles of sugar-sweetened beverages and increasing quartiles of lean meats/eggs/beans and refined grains were summed to create a composite diet score. Diet score and the supervision/contingency cluster of feeding practices were independent significant predictors of child BMI z-score in regression models. Total moderate activity averaged 95 minutes/day. Children spent <50% of the available HS center 60 minute play period in moderate activity. Increasing either the supervision/contingency practice cluster and child diet score from the current 50th percentile to the current 90th percentile of the HS children or increasing child moderate activity by 25 minutes to the recommended and available time would decrease the median BMI of the Head Start children from the 77th percentile to the 50th percentile without increasing the proportion of underweight children. Available, affordable, and achievable changes in parent feeding practices, child diet, and child activity as practiced by a proportion of current HS parents could normalize the BMI distribution of HS children.