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IntroductionHead Start is a federally funded early childhood education program that serves just over 900,000 US children, many of whom are at risk for obesity, are living in food insecure households, or both. The objective of this study was to describe Head Start practices related to assessing body mass index (BMI), addressing food insecurity, and determining portion sizes at meals.MethodsA survey was mailed in 2008 to all eligible Head Start programs (N = 1,810) as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start. We describe program directors\ue2\u20ac\u2122 responses to questions about BMI, food insecurity, and portion sizes.ResultsThe response rate was 87% (N = 1,583). Nearly all programs (99.5%) reported obtaining height and weight data, 78% of programs calculated BMI for all children, and 50% of programs discussed height and weight measurements with all families. In 14% of programs, directors reported that staff often or very often saw children who did not seem to be getting enough to eat at home; 55% saw this sometimes, 26% rarely, and 5% never. Fifty-four percent of programs addressed perceived food insecurity by giving extra food to children and families. In 39% of programs, staff primarily decided what portion sizes children received at meals, and in 55% the children primarily decided on their own portions.ConclusionHead Start programs should consider moving resources from assessing BMI to assessing household food security and providing training and technical assistance to help staff manage children\ue2\u20ac\u2122s portion sizes