WATCH Program Background

MOP Updating and Version Control

The MOP is a dynamic document that will be updated throughout the program implementation of WATCH to reflect any protocol or consent amendments, as well as the refinement of program procedures. As sections/chapters are revised, the MOP version information and date on the cover page and Table of Contents will be updated.

As the public health intervention progresses, WATCH Program Coordinator will be responsible for documenting any recommended and approved changes to the MOP. The Program Coordinator will incorporate all the approved changes and will update the MOP periodically. When the revisions are final, the MOP will be posted to the WATCH folders within SPTHB and made available to all program personnel. All staff will be notified that the MOP has been updated and is available in the WATCH folders. The author of an updated MOP chapter will ensure that all necessary changes are captured and that the document or chapters reflect the latest version.

If paper copies of the MOP are maintained in the WATCH Program Documents binder, the program coordinator will print and store the updated materials in the binder. Outdated materials will be removed from the binder and filed in another location clearly marked “obsolete.”

WATCH Program Background

Early Prevention of Obesity is Essential for Improving Lifelong Health. Overweight children in kindergarten are 4 times more likely to be obese at age 14, with the poorest children at greatest risk.1 While the national prevalence of overweight in preschool-age children is 23%,2 the prevalence among American Indian (AI) preschool children is 38-48%.3, 4 The prevalence of obesity alone – not including overweight – in AI children is nearly 21%.5 Primary prevention of obesity is necessary to improve quality of life,6 especially in environments where young children spend substantial time such as early care and education (ECE). This is particularly true in Oklahoma where AI populations, obesity, and associated health disparities are prevalent. Oklahoma AI Children Have Higher Prevalence of Obesity and Related Behaviors. Healthy lifestyle habits, such as regular physical activity,7-9 limited screen time,10, 11 and nutritious diet12 early in life will prevent weight gain and chronic disease. Our previous research in 7-to-13 year old AI children demonstrate they are consuming more calories/day from sugary beverages (309-38213, 14 vs. 17815 kcal); eating fewer fruits and vegetables (1.913, 14 vs. 3.416 servings/day); spending more time with screens (7.213, 14 vs. 2.2-3.717, 18 hours/day); and fewer participate in sufficient levels of physical activity (32%13 vs. 70%19). National Institutes of Health (NIH)

children’s health initiative, We Can!™ , 20 and The National Academy of Medicine’s (NAM) Early Childhood Prevention Policies21 include obesity prevention behaviors. Health Care Providers Have Multiple Barriers to Effective Obesity Prevention. Many pediatric health care providers lack the time and knowledge to effectively discuss patients’ weight status and health habits during well-child checks,22 which last about 15-20 minutes.23 In preschool years, visits are only once yearly24 and providers either avoid or de-prioritize obesity prevention due to limited time and competing parental concerns.25-28 Childhood obesity prevention in primary care has demonstrated modest effects on improving health outcomes and behaviors.29, 30 Effective strategies have included clinician training,31, 32 motivational interviewing,33, 34 multistakeholder community initiatives,31, 35-40 and family engagement.29 Our current work across Oklahoma indicates that some AI parents feel more comfortable at Women, Infants, and Children (WIC) clinics41 and distrust health care providers.42

ECE is an Untapped Venue for Community-Based Programs to Prevent Obesity in AI

Communities. Young children have 120 times greater exposure to the ECE environment and teachers than their health care provider.23, 43 ECE environments are important settings for obesity prevention.21, 44 Recognizing the inherent barriers health care providers face, the NIH,20 American Academy of Pediatrics,45 the World Health Organization (WHO),46 and the NAM47, 48 have encouraged expanding the delivery of health information to other sectors capable of providing health information, such as ECE.47, 48 Furthermore, ECEs have room for improving the quality of their environment for promoting healthy lifestyle behaviors. Children are not eating adequate amounts of whole grains, fruits, vegetables, and nutrients49-57 or accumulating sufficient physical activity while at ECE.58-63 Our previous research demonstrates the importance of the nutritional and physical activity environment and teacher practices in ECE settings in general64-68 and in tribal ECE settings.4, 61 However, few Programs have leveraged the important role of tribal ECE teachers for childhood obesity prevention. ECE Programs grounded in behavior change theory and implemented at multiple ecological levels have reduced obesity and improved prevention behaviors.67, 69, 70 While several ECE-focused Programs integrated parent components, none, to date, have included health care providers.69 Interventions to reduce obesity and promote prevention behaviors in AI children have had mixed efficacy.39, 71-93 The majority of intervention studies have included elementary and older children, two included infants and toddlers,39, 86 none have included young children aged 2-to-5 years or utilized the ECE environment. Lessons learned from interventions conducted to date include the necessity of environmental changes that support behavioral modification,39, 93 community integration,81, 88, 92, and use of health workers.39 The limited effectiveness of interventions focused on 3rd through 5th graders87, 90, 94 suggest that approaches focused on younger children may yield better outcomes. While another intervention75 included younger grade school children, it did not include community stakeholders. Further, parent outreach,