Practice What You Teach: Preschool Educators’ Dietary Behaviors and BMI ^†

Abstract

The national obesity prevalence for children between 2 and 5 years old was 12.7% from 2017 to 2020. These prevalence rates are concerning because as obesity in youth increases, so do long-term health and psychosocial risks. Preschool children can spend up to 50% of their day in childcare with their educators, consuming meals and snacks together. Therefore, the role modeling of healthy eating behaviors by these educators may have an impact on children’s eating behaviors and future weight status. The purpose of this paper is to examine the relationship between Head Start educators’ self-reported dietary intake patterns and BMI. Variables included BMI and 8 items from the Starting the Conversation brief dietary assessment screener. Data were collected at educators’ respective Head Start centers in the spring of 2019. Pearson correlations were calculated to examine the relationship between educators’ self-reported dietary intake patterns and BMI. Of 66 teachers and teacher assistants who completed all items and BMI assessment, significant relationships were found between consumption of snack chips or crackers and fast food (r = 0.33, p = 0.007 and r = 0.27, p = 0.031, respectively). This study’s findings call attention to the importance of supporting healthier diets among early childhood educators.

1. Introduction

According to the Centers for Disease Control and Prevention (CDC), the national obesity prevalence for children between 2 and 5 years old was 12.7% from 2017 to 2020 [1]. Obese children are at risk for developing health and psychosocial conditions, such as hypertension, diabetes, sleep disorders, low self-esteem, anxiety, and behavioral issues [2,3,4,5]. Additionally, overweight and obese children have a greater risk of becoming overweight and obese adults, struggling with negative health outcomes [6,7]. With more than half of children aged 3 to 5 years of age enrolled in early childhood education in 2022 in the United States, preschools may offer a convenient setting for obesity prevention strategies [8].

Children in Head Start receive up to two-thirds of their nutritional needs during the school day and observe modeling of health behaviors from their teachers [9]. Previous studies have supported the effectiveness of teachers improving dietary intake among preschoolers using educational and modeling strategies [10,11]. However, half of Head Start teachers do not meet current recommendations for physical activity or fruit and vegetable consumption [12].

Head Start centers provide services for the promotion of nutrition beyond providing meals and snacks in accordance with United States Department of Agriculture (USDA) standards for Child and Adult Care Food Programs (CACFP) [9]. In these centers, teachers and support staff play an essential role in screening and assessing children for developmental delays. The staff coordinate education and child development services to encourage parental involvement in their child’s education and health and have regular parent meetings. The Head Start Program Performance Standards include requirements for physical activity, providing healthy meals and snacks, and educating families on healthy eating behaviors including the reduction in sugar-sweetened beverages [12]. The standards also encourage family-style meals to promote socialization and foster staff–child interactions. During family-style meals, teachers can model healthy eating behaviors and support positive relationships with food by giving children adequate time to eat, avoiding the use of food as a reward or punishment, and not forcing children to finish their food.

Evidence suggests that educators’ personal health behaviors and self-efficacy can influence how nutrition messages are delivered and modeled to children. In a sample of 80 Head Start teachers, 80% were classified as overweight and obese according to self-reported height and weight [13]. Additionally, 56% were not knowledgeable of current recommendations for daily fruit and vegetable intake, and 45% did not meet current physical activity guidelines of 150 min per week. Therefore, the purpose of this study was to examine the relationship between Head Start educators’ dietary intake patterns and their BMI to provide further evidence regarding the need for health promotion aimed at Head Start teachers and staff.

2. Materials and Methods

2.1. Study Design and Participants

This study was a secondary analysis of data from the Impact of a Preschool Obesity Prevention (I-POP) Intervention study, previously presented as an abstract [14]. The I-POP intervention was a cluster randomized controlled trial designed to implement a comprehensive intervention promoting healthy development of children in nine Head Start Centers in South-Central Mississippi described in detail elsewhere [15]. One of the components of the I-POP intervention was an 8-week nutrition education program for the children delivered by the Head Start teachers and teacher assistants, who are the primary participant focus of this study. The main intervention study was a collaboration between The University of Southern Mississippi, Mississippi Action for Progress, and The Mississippi State Health Department. The study was approved by the Institutional Review Boards of The University of Southern Mississippi and the Mississippi State Health Department (IRB #: CH3-17111402).

2.2. Variables

Educators completed baseline data assessments that included demographic, dietary behaviors, and nutrition knowledge questionnaires. Educators’ dietary intake was assessed using items from the Starting the Conversation (STC) dietary assessment screener developed by the Center for Health Promotion and Disease Prevention [16]. The original validation of the STC was conducted with the goal of creating a practical dietary assessment for low-resource settings. Adults in primary care, including low-income and diverse populations were surveyed and STC scores were significantly correlated with reported fat intake when compared to the National Cancer Institute (NCI) fat screener [16]. The STC demonstrated acceptable sensitivity and specificity in a variety of individuals [16].

The STC screener includes 8 questions about personal dietary habits “over the past few months” from the date of completing the screener. This brief dietary screener was used to evaluate the self-reported frequency of dietary behaviors related to daily consumption of fruits, vegetables, sugar-sweetened beverages and weekly consumption of snack chips or crackers, fast food meals, and added fats, and desserts. Items are scored from 0 to 2 or 0 to 3, depending on the item, with higher scores indicating less healthy dietary behaviors. Total score typically ranges from 0 (most healthful) to 16 (least healthful). See Figure 1. In this study, the Cronbach’s alpha was 0.592 for the eight items.

Height (meters) and weight (kilograms) measurements were collected using a SECA digital scale (SECA, Hamburg, Germany) and a portable stadiometer. Body Mass Index (BMI, kg/m²) was calculated using teachers’ measured height and weight.

2.3. Statistical Analysis

Descriptive statistics for demographics were assessed. Pearson correlations were calculated to examine the relationships between participants’ reported dietary consumption, as identified by their response to the STC items, and BMI. Differences in BMI by education level were examined using a one-way ANOVA. Analyses by gender and race were not performed due to markedly unequal group sizes.

3. Results

A total of 66/75 (88%) participants (educators) completed all items including the STC dietary screener and BMI assessment. Sample characteristics for 66 Head Start teachers and teacher assistants are presented in

Table 1. Demographic Characteristics of Participants (N = 65 for Teachers and Assistants).

Characteristic	Teachers
	n	%
Gender
Female	64	98.5
Male	1	1.5
Staff Status
Teacher	29	44.6
Teacher Assistant	24	36.9
Missing	12	18.5
Ethnicity
Black or African American	61	93.8
White	2	3.1
Other	2	3
Language other than English at home
No	64	98.5
Yes	1	1.5
Marital status
Never married	18	27.7
Now married	32	49.2
Separated or divorced	11	17
Widowed	3	4.6
Missing	1	1
Education completed
Some College	6	9.2
College Degree	46	70.8
Some Graduate	3	4.6
Graduate Degree	10	15.4
Income
<$5000	3	4.6
$5000–$9999	5	7.7
$10,000–$14,999	13	20
$15,000–$19,999	12	18.5
$20,000–$24,999	7	10.8
$25,000–$29,999	1	2.3
>$30,000	9	13.8
Not disclosed	7	10
Missing	8	12.3

. The majority of teachers and teacher assistants were female (98.5%) with their race being African American (93.8%). The majority of the participants’ language was English. Almost half (49.2%) of the participants were married and more than a third (70.8%) had at least a bachelor’s degree. The mean BMI of participants was 34.9 (±8.54).

Results from the one-way ANOVA revealed no significant difference in BMI across education categories. More than half of participants who completed the STC screener (n = 41, 54.7%) reported eating fast food meals or snacks 1–3 times a week and 40% (n = 30) reported eating snack chips or crackers 1–3 times a week. In addition, almost half of respondents indicated eating less than 2 servings of fruit each day (n = 32, 42.7%) and a third of them reported eating only 3–4 servings of vegetables daily (n = 25, 33.3%). As shown in

Table 2. Correlation of Body Mass Index (BMI) and Starting the Conversation (STC) Items (n = 66).

Measure
	1	2	3	4	5	6	7	8	9
1. Fast food	-	0.13	0.18	0.22	−0.13	0.37 **	0.31 *	0.21	0.27 *
2. Fruit	0.13	-	0.40 **	−0.05	−0.18	−0.00	0.02	−0.03	0.05
3. Vegetables	0.18	0.40 **	-	−0.09	0.10	0.08	0.19	0.00	0.11
4. Soda/Sweet tea	0.22	−0.05	0.09	-	0.02	0.48 **	0.38 **	0.33 **	0.24
5. Beans, chicken, fish	−0.13	−0.18	0.10	0.02	-	−0.02	0.02	0.07	0.18
6. Snack chips or Crackers	0.37 **	−0.00	0.08	0.48 **	−0.02	-	0.44 **	0.29 **	0.33 **
7. Desserts and sweets	0.31 *	0.02	0.19	0.38 **	0.02	0.44 **	-	0.33 **	0.22
8. Margarine, butter, meat fat	0.21	−0.03	0.00	0.33 **	0.07	0.29 *	0.33 *	-	−0.09
9. BMI	0.27 *	0.05	0.11	0.24	0.18	0.33 **	0.22	−0.09	-

Note: Equal variances not assumed. ** p < 0.01, * p < 0.05, two-tailed.

, participants’ BMI demonstrated significant, though weak, positive correlation with Question 1 (fast food consumption; r = 0.27, p = 0.031) and a significant, moderate association with Question 6 (snack chips or crackers; r = 0.33, p = 0.007). No significant associations were observed between BMI and the intake of fruits, vegetables, legumes, desserts, added fats, or sugar-sweetened beverages. A composite dietary score was created by summing the eight variables from the screener. Correlational analysis of this total score and BMI indicated a significant and moderate positive relationship (r = 0.31, p = 0.011).

4. Discussion

The purpose of this study was to examine the relationship between Head Start educators’ self-reported intake patterns related to sugar-sweetened beverages, fast foods, snack chips and crackers, and desserts and BMI. Findings indicated Head Start educators who reported more frequently consuming fast food and snack chips or crackers tended to have higher BMIs, which is consistent with previous research linking fast food intake in adults with higher BMI, weight gain, and poorer weight control [17,18]. Snack behaviors show a similar trend where frequent consumption of chips, sweets, or other high-calorie snacks can diminish overall diet quality and contribute to excess calorie intake [19]. The total score for the STC screener was moderately and significantly associated with BMI suggesting that as BMI increased, STC score increased, reflecting higher intakes of fast food, snack chips or crackers, added fat, desserts, and sugar sweetened beverages. Taken together, these findings may support the significant associations observed in our study where educators with more frequent fast-food meals or snacking are likely to consume extra calories that contribute to higher BMI. Given that convenience is a primary reason many adults choose fast food [20], Head Start educators juggling busy schedules might rely on quick, energy-dense options, inadvertently impacting their weight.

In contrast, this study did not find significant relationships between educators’ BMI and their self-reported intake of fruits, vegetables, lean protein, added fat, or sugar-sweetened beverages or desserts. This lack of association is somewhat surprising, as ample research has linked sugar-sweetened beverage (SSB) consumption to weight gain in adults and children [21]. Several potential explanations could account for the null findings in our sample. First, self-report bias may obscure true dietary effects. Research shows that individuals often under-report caloric intake, and the degree of underreporting tends to increase with BMI [22]. In other words, overweight individuals may systematically under-estimate or under-report their intake of unhealthy items like sugary drinks and desserts, due to social desirability or recall biases. This could potentially attenuate any statistical link with BMI. It may also be possible that many individuals have already reduced their consumption of sugary drinks or switched to diet beverages, especially if they are weight-conscious or following wellness guidance. In summary, while sugar-sweetened drinks and sweets are known contributors to obesity risk in the general population, this study’s null results for these items could potentially reflect measurement limitations and adaptive behaviors among this educator group. The low reliability of the instrument could also be problematic for assessing relationships in this group. Likewise, a more robust instrument to assess diet, rather than screen dietary behaviors, may be warranted. Future studies using objective dietary assessments or biomarkers would be valuable to clarify these relationships.

These dietary and BMI patterns have important implications for the health and well-being of Head Start educators, and for the preschool children observing them. Early childhood educators play a critical role in modeling eating behaviors to young children, who are at a formative age for developing lifelong dietary habits [23]. In Head Start programs, it is common to have family-style meals where staff sit with children at the table; during these meals, children learn about food by watching adults’ attitudes and choices. Head Start educators play a crucial role as pivotal agents in the fight against obesity within preschool environments. They are responsible for enforcing nutrition policies in the classroom and can either facilitate or hinder a healthy food environment.

Prior studies have shown that personal beliefs and behaviors impact educators’ classroom practices. For example, educators’ feeding styles influence how much and what foods children consume [23]. If an educator is not concerned about obesity or has unhealthy habits, they may be less likely to encourage children to try vegetables or drink water, inadvertently creating a more obesogenic classroom climate. National data and regional studies have found high rates of overweight and obesity among early childhood educators [24]. Teachers are a vital part of the early strategies for preventing obesity, serving as educators but as role models of a healthy lifestyle.

Additional research is essential to enhance our comprehension of the dietary behaviors of Head Start teachers and their implications for both educator and child outcomes. One important direction is to use objective measures to validate self-reported consumption of beverages and snacks. Ultimately, research must explore the broader impacts of health programs for educators on child health outcomes. If educator practices shape children’s eating habits and classroom health, demonstrating improvements in both educator BMI and children’s diet quality and obesity rates is vital for public health efforts and funding advocacy for nutrition education. Likewise, such evidence would build the case for integrating educator wellness into early childhood health initiatives.

At a policy level, there is a clear rationale to integrate staff wellness into Head Start and other early childhood education programs. One recommendation is for Head Start program standards and funding guidelines to explicitly include objectives for staff health behaviors. Policymakers should also consider allocating resources for pilot programs that provide healthy food subsidies or cafeteria services for teachers in early childcare centers, recognizing that many Head Start educators are from low-income backgrounds themselves, as seen in our results where 85% of teachers had an income ≤ $29,999 or did not report their income, and may struggle with food affordability.

5. Conclusions

In conclusion, this study highlights the importance of supporting healthier diets among early childhood educators. Head Start educators play a central role in shaping children’s eating habits, and promoting better nutrition and weight management among staff benefits both educator wellness and childhood obesity prevention. Initiatives that encourage healthy choices can strengthen teachers as positive nutrition role models, creating a healthier environment for children. These findings align with public health recommendations advocating for educator-focused interventions [25] and underscore the value of incorporating staff health into comprehensive early childhood obesity prevention policies.

To guide future efforts in promoting health behaviors, programs could integrate structured wellness initiatives directly into the work environment, such as brief on-site nutrition education, wellness incentives integrated with health plans, and low-cost or no-co-pay nutrition counseling from registered dietitians. Center directors and administrators may consider adopting wellness policies that include structured movement breaks required for staff and children, enhancement or promotion of resources for stress management like employee assistance programs (EAP), and partnerships with worksite wellness clinics to help staff manage regular primary care visits for health maintenance and improvement. Implementing these types of practical, feasible supports may enhance teacher engagement and longevity, contribute to sustainable behavior change, and strengthen the overall impact of early childhood health promotion strategies.