Creating healthy habits for Maryland preschoolers (CHAMP): a cluster-randomized controlled trial among childcare centers

Background Risks for chronic health problems are embedded in preschoolers’ dietary and physical activity habits. Childcare centers are a potential venue to establish healthy habits. We hypothesized that health-promoting center plus parent interventions would improve preschoolers’ dietary and physical activity outcomes, including body weight, over control. Methods We made local modifications to the 30-week Food Friends ® curriculum to develop a center intervention, Creating Healthy Habits Among Maryland Preschoolers (CHAMP), and a parent website (CHAMP+), aligned with the CHAMP intervention. The CHAMP intervention included a manual, web-based lessons plans, handouts, resources, and program materials implemented by CHAMP-trained staff. We evaluated effectiveness in a 3-arm cluster randomized controlled trial. Childcare centers serving low-income communities were recruited (2017–2020) from 10 counties and randomized to center (CHAMP), center plus parent (CHAMP+), or Control arms. Willingness-to-try-new-food, fruit and vegetable (FV) preference, motor competence (Test of Gross Motor Development-2), moderate-vigorous-physical-activity (MVPA, 7-day accelerometry), and anthropometry (BMI z-scores) were measured at baseline/endline (6 months post-baseline) by assessors masked to intervention status. Linear mixed models examined differences in changes among arms. Center baseline nutrition/physical activity environmental quality (Environment and Policy Assessment and Observation) was examined as moderating intervention effects. Results Fifty-six centers were randomized (CHAMP = 21, CHAMP+ = 20, Control = 20); 855 children. Centers were diverse by location, race, and income; children were mean age 48.44 (SD 7.50) months, 54% male; 26% experienced overweight/obesity. Analyses adjusted for baseline differences in child age, race, and ethnicity. The intervention improved motor competence (gross motor quotient: pooled CHAMP/CHAMP+ vs. Control 5.67 [95% CI: 0.60, 10.75]; locomotor score: pooled CHAMP/CHAMP+ vs. Control 1.74 [95% CI: 0.43, 3.05]) and reduced BMIz (pooled CHAMP/CHAMP+ vs. Control (-0.08 [95% CI: -0.15, 0.00]); with no intervention effects on willingness-to-try-new-foods, FV preference, or MVPA and no impact enhancement by the parent intervention (CHAMP+). Moderation analyses showed stronger increases in willingness-to-try-new-foods and MVPA in centers with higher quality nutrition/physical activity environments. Conclusions Childcare center interventions can improve motor competence and reduce BMIz among preschoolers. Higher quality nutrition/physical activity environment can increase the impact of interventions on children’s dietary behaviors and physical activity, contributing to healthy habits. Trial registration NCT03111264.