NAP SACC program educates care providers and parents; improves children's health, study finds

April 7, 2014

Dr. Jonathan Kotch

Dr. Jonathan Kotch

Educating parents and child-care providers about nutrition and physical activity can reap benefits for obese preschoolers, according to a study conducted by a research team that included Jonathan B. Kotch, MD, MPH, research professor of maternal and child health at UNC’s Gillings School of Global Public Health. 

The article was published online March 1 in BMC Public Health.

During a seven-month period in 2009 and 2010, researchers conducted a randomized control trial in 17 licensed child-care centers serving low-income families in California, Connecticut and North Carolina. The study involved 137 child-care providers and 552 racially and ethnically diverse families.

Child-care health consultants facilitated five hour-long workshops for child-care providers designed by the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). The sessions covered childhood obesity, healthy eating and physical activity for young children, personal health and wellness, and working with families to promote healthy behaviors.

Seven centers also received a parenting workshop on raising healthy children. Providers and parents completed pre- and post-workshop knowledge surveys. Nutritional intake, physical activity, and height and weight pre- and post-intervention were measured for randomly selected children. Child-care health consultants continued to provide onsite, email and telephone consultations with child-care centers in the intervention group for the seven months of the clinical trial.

Results showed significant increases in providers’ and parents’ knowledge of nutrition and physical activity among those who participated in the NAP SACC workshops. The centers where the workshops were offered also improved the number and quality of their written policies for nutrition and physical activity.

The study also revealed changes in the children’s body-mass index. Researchers noted a net shift in the distribution of children from the obese to the overweight category in centers that received the NAP SACC classes, whereas the shift went in the opposite direction in the centers that didn’t receive the intervention. In those control centers, more children moved from the overweight category into the obese group.

The positive results suggest that more health professionals specifically trained in nutrition and physical activity in child care might help reverse the childhood obesity epidemic.

Kotch, whose research in early-childhood interventions has received national acclaim, founded the National Training Institute for Child Care Health Consultants. His co-authors for this article include Nina Forestieri, Yi Pan, PhD, and Eric Savage of UNC’s Frank Porter Graham Child Development Institute; Viet Nguyen, MD, and Linda Shipman in UNC’s Gillings School’s Department of Maternal and Child Health; Sherika Hill, PhD, then a Gillings School doctoral student; and Sara E. Benjamin Neelon, PhD, a 2006 Gillings School alumna who is now an associate professor of community and family medicine and global health at Duke University.   

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or