By Kathryn Doyle

(Reuters Health) - A new study of Head Start pre-schoolers in Michigan found that those who were underweight or overweight at the start of the program entered kindergarten at a healthier weight than similar kids in the community.

Kids in Head Start seem to benefit socially and emotionally, and may also benefit physically, the authors write in the new study.

“I’m a pediatrician and in my experience seeing kids in clinic in a low income setting, the kids would enroll in Head Start and I was watching their weight get better,” said lead author Dr. Julie C. Lumeng of the Center for Human Growth and Development at the University of Michigan in Ann Arbor.

It is unethical to randomize children to a Head Start and a non-Head Start group, since the social and emotional benefits of the program have been proven. So the next best option was to observe kids in the program and compare them to others, Lumeng told Reuters Health by phone.

Federally funded Head Start programs can vary by community, but generally offer half- or full-day preschool to children under age five from low-income families. More than 900,000 preschool children attended the programs in 2013.

For this study the researchers had height and weight data provided by Michigan Head Start programs for 19,000 kids. They used those numbers to calculate body mass index (BMI) and characterize the children as obese, overweight, healthy or underweight.

They compared these kids to similar children in a primary care electronic health record database, including more than 5,000 covered by Medicaid and 19,000 not covered by Medicaid. The comparison kids represented the “average” pre-schoolers in the state.

White children made up the largest proportion of each group, with the second largest being Hispanic children in Head Start and black children in the Medicaid group.

Based on BMI, the Head Start group was the unhealthiest at the beginning of the study, with almost 17 percent of kids qualifying as obese. More than 12 percent of the Medicaid group and nearly seven percent of the non-Medicaid group fell into the same category.

Kids who entered Head Start obese had their BMI scores decline more over the first academic year than obese kids in either comparison group. They continued to lose weight over the first summer break, although not much more than the comparison groups.

Over a second academic year the researchers did not observe a significant change in BMI for the kids who started out obese, but at the start of kindergarten, those who had been in Head Start had lower BMIs on average than kids from either comparison group.

Similarly, kids who started off underweight gained more weight in Head Start than in the Medicaid and non-Medicaid groups, according to results in the journal Pediatrics.

As a publicly funded program, Head Start is always “on the chopping block,” but uncovering new benefits of the program may help draw new funds, Lumeng said.

“In trying to tackle childhood obesity, the interventions we try are very intensive and you hardly get any effect,” Lumeng said. “The National Institutes of Health funds a lot of research into studying obesity prevention, and in my opinion what this study suggests is that the Head Start program has lots of beneficial effects and could also be helping kids’ weight status.”

Head Start programs are holistic, so it may be hard to identify which aspect has the most influence on kids’ BMI, she noted.

Mary Cunningham Deluca, director of children services at Community Action Agency in Jackson, Michigan, believes nutrition is the most important part.

Kids in the full-day programs receive breakfast, lunch and a snack, which are subject to much more rigid nutrition standards than the school lunch program, she told Reuters Health by phone.

Deluca was on the Michigan Head Start Association 2014 board of directors and worked with Lumeng to complete the research.

“We eat family style and teach kids to serve themselves,” Deluca said. “When we hire teachers, they are required to model healthy eating, so even if they don’t like a vegetable they have to sample it.”

Kids in Head Start also have more opportunities for active play, may have better quality sleep due to a structured daily routine, and freeing up resources for their families could reduce stress in the home, all of which may influence weight status, Lumeng noted.

“I would hope that results like this could also help improve things like the school lunch program,” or other preschool programs that may be less regulated, Deluca said.


SOURCE: Pediatrics, online January 12, 2015.