An Exploration of Health/Nutrition Managers Common Experiences with Measuring, Tracking, and Reporting BMI in North Carolina Head Start Programs

More than 1 million children are enrolled in Head Start (HS) programs across the United States. Possibly linked to their socioeconomic status, children enrolled in HS are at increased risk for obesity. Correctly assessing and reporting childhood Body Mass Index (BMI) in HS has the potential to reduce or prevent obesity rates, yet information related to the specific processes and policies related to BMI assessment in Head Start centers is limited. NC HS Health/Nutrition Managers, who oversee and implement assessments of children's BMI in their programs can provide initial insight in to this research gap. The purpose of this study was to examine HS Health/Nutrition Managers common experiences with measuring, tracking, and reporting the BMI of low-resource, low-income 3-5-year-old children. Researchers conducted in-depth, structured telephone interviews (n=15) with Managers across NC. Interviews were recorded using digital audio and transcribed verbatim. The phenomenology approach was used to guide the research design, data collection, and analysis. Two trained researchers coded the data and identified themes. Researchers focused on the "how" and "what" of Manager's experience with measuring, tracking, and reporting BMI in their program. Interviews continued until saturation was reached. Researchers identified four emergent themes including, (1) HS's Perceived Role in Childhood Obesity Prevention\; (2) Measuring, Tracking, and Reporting\; (3) Family Background, Education, Communication, and Engagement\; and (4) Community Partnerships. A majority of administrators felt childhood obesity prevention was one of many roles of Head Start, however many Managers reported mixed feelings towards BMI as a form of assessment for childhood overweight/obesity. Reported measuring processes varied between programs, with some Mangers reporting teachers take measurements, while others obtain data from yearly physicals. Communication methods varied including sending home newsletters and/or "BMI report cards" or communicating directly with families through meetings or telephone calls. Parents were frequently mentioned as a barrier to obesity prevention efforts, even after families were made aware of a concerning BMI. Finally, community partnerships included dietitians, physicians, and the Women's, Infants, and Children (WIC) program. Dietitians generally offered centers menu support and consultations if parents requested. Physicians rarely communicated with centers beyond providing a physical. However, WIC was referenced many times as a useful partner and resource for HS programs, including for parental support. HS is an ideal place to gather information about the health of our nation's youngest children. However, data from the current study implies the process for measuring, tracking, and reporting that data BMI may vary largely between programs which may lead to questions about the accuracy of reported data. Additional research is needed to explore accuracy of BMI child measurements obtained in HS, effectiveness of BMI training materials for staff and parents, and parental perspective of their child's BMI reports obtained from HS