title: Changes in body mass index associated with head start participation.
abstract: OBJECTIVE
  The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI.
  
  
  METHODS
  The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19,320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity.
  
  
  RESULTS
  The total sample included 43,748 children providing 83,239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (β = -0.70 [SE: 0.05] vs -0.07 [0.08] in the Medicaid group [P < .001] and -0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups.
  
  
  CONCLUSIONS
  Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).
authors.affiliation: Centers for Human Growth and Development, and Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Human Nutrition Program, Department of Environmental Health Sciences, jlumeng@umich.edu.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lumeng
authors.affiliation: Centers for Human Growth and Development, and Department of Biostatistics, and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan;
authors.forename: Niko
authors.initials: N
authors.lastname: Kaciroti
authors.affiliation: Centers for Human Growth and Development, and.
authors.forename: Julie
authors.initials: J
authors.lastname: Sturza
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Allison M
authors.initials: AM
authors.lastname: Krusky
authors.affiliation: Centers for Human Growth and Development, and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Alison L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Centers for Human Growth and Development, and Human Nutrition Program, Department of Environmental Health Sciences, Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; and.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
authors.affiliation: Prevention Research Center, Oakland, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Lipton
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Reischl
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D002675:Child, Preschool; D018479:Early Intervention, Educational; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008824:Michigan; D011320:Primary Health Care; D012016:Reference Values; D014481:United States
keywords: child; early childhood education; obesity