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OBJECTIVE: We examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico. METHODS: CHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared. RESULTS: At baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores. CONCLUSIONS: Obesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2years to achieve.

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BACKGROUND: The Child Health Initiative for Lifelong Eating and Exercise is a multicomponent obesity-prevention intervention, which was evaluated among Head Start (HS) centers in American Indian and predominantly Hispanic communities in rural New Mexico. This study examines the intervention's foodservice outcomes: fruits, vegetables, whole grains, discretionary fats, added sugars, and fat from milk served in meals and snacks. METHODS: Sixteen HS centers were randomized to intervention/comparison groups, following stratification by ethnicity and preintervention median body mass index of enrolled children. The foodservice component included quarterly trainings for foodservice staff about food purchasing and preparation. Foods served were evaluated before and after the 2-year intervention, in the fall 2008 and spring 2010. RESULTS: The intervention significantly decreased fat provided through milk and had no significant effect on fruit, vegetables and whole-grain servings, discretionary fats, and added sugar served in HS meals and snacks. When effect modification by site ethnicity was examined, the effect on fat provided through milk was only found in American Indian sites. CONCLUSIONS: Foodservice interventions can reduce the amount of fat provided through milk served in HS. More research is needed regarding the implementation of foodservice interventions to improve the composition of foods served in early education settings.

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Associations between food insecurity and overweight/obesity, feeding behaviors, and public food assistance utilization have been explored to a greater extent among adults and adolescents than among young children. This cross-sectional study examines a subset of pre-intervention implementation data (n = 347) among families participating in the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study conducted in rural New Mexico among predominantly Hispanic and American Indian Head Start centers. No significant relationships emerged between food insecurity and child overweight/obesity, certain feeding behaviors, or public food assistance utilization. Additional research is necessary to understand relationships between food insecurity and child overweight/obesity status, use of public assistance benefits, and certain feeding behaviors among rural preschool-aged children in predominantly Hispanic and American Indian communities.

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BACKGROUND: Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described. METHODS: CHILE uses a socioecological approach to improve dietary intake and increase physical activity. The intervention includes: a classroom curriculum; teacher and food service training; family engagement; grocery store participation; and health care provider support. RESULTS: Lessons learned from CHILE include the need to consider availability of recommended foods; the necessity of multiple training sessions for teachers and food service; the need to tailor the family events to local needs; consideration of the profit needs of grocery stores; and sensitivity to the time constraints of health care providers. CONCLUSIONS: HS can play an important role in preventing obesity in children. CHILE is an example of a feasible intervention that addresses nutrition and physical activity for preschool children that can be incorporated into HS curricula and aligns with HS national performance standards.

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