# Health Outcomes in Preschool: INnovations for Obesity Prevention (HOP-IN)

> **NIH NIH K01** · WASHINGTON STATE UNIVERSITY · 2021 · $131,074

## Abstract

PROJECT SUMMARY/ABSTRACT
Childhood obesity is a critical public health threat, and a major risk factor for accelerating cardiometabolic health
conditions in childhood and adulthood. In addition, obesity in childhood negatively impacts academic
achievement, which predicts lifetime health outcomes and has dramatic economic implications. Daycare settings
have been identified as a high impact target for early childhood obesity intervention. On average, 75% of
preschool-aged children in the United States spend 35 hours per week in daycare, and childcare settings have
the ability to offer children healthy meals, increase opportunities for physical activity, and promote adequate
sleep – all of which help to prevent obesity. Although preschool settings offer regular opportunities for physical
activity, most children in daycare do not meet current guidelines. In 2014, only 12% of daycare centers in
Washington State met goals for physical activity, and only 22% for outdoor time. Because children who spend
more time outdoors are more physically active than those who spend more time indoors, preschools with
outdoor- and play-based curricula may help to increase physical activity. The only published study on this topic
found that Swedish children in outdoor preschools were less likely to be overweight and slept longer than their
peers in indoor preschools. However, the study was cross-sectional, recruited a small sample, did not examine
academic achievement or cost implications, and was conducted in a country with different healthcare and
educational systems than the United States. For this K01 application, we propose a prospective observational
study that leverages a natural experiment to evaluate the impact of an outdoor preschool model on health
outcomes and academic achievement. We will partner with Tiny Trees, a preschool in Seattle, Washington, with
an entirely outdoor, play-based curriculum. We will recruit 100 children ages 3-5 who attend Tiny Trees, and 100
children from the Tiny Trees waitlist who are currently attending a traditional indoor preschool. We will collect
objective and subjective measures of physical activity, sleep, body mass index, and academic performance over
the course of the 3-year study period. We will also perform a cost-benefit analysis to evaluate the Tiny Trees
outdoor preschool model for longer-term sustainability. Our Specific Aims are to: 1) compare within-person
change in health and academic outcomes between Tiny Trees enrollees (intervention) and waitlisted children
(control), 2) estimate the short- and long-term cost-benefit of the Tiny Trees outdoor preschool model, and 3)
complete a rigorous mentored career development plan that will position the Principal Investigator to conduct
groundbreaking research in interventions to prevent childhood obesity, establish cost-benefit estimates of
interventions to inform policy, and launch a successful career as an independent investigator. This proposal
aligns with the National H...

## Key facts

- **NIH application ID:** 10218263
- **Project number:** 5K01HL145006-03
- **Recipient organization:** WASHINGTON STATE UNIVERSITY
- **Principal Investigator:** Amber Fyfe-Johnson
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $131,074
- **Award type:** 5
- **Project period:** 2019-08-20 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10218263

## Citation

> US National Institutes of Health, RePORTER application 10218263, Health Outcomes in Preschool: INnovations for Obesity Prevention (HOP-IN) (5K01HL145006-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10218263. Licensed CC0.

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