# Adaptive Implementation & Costs of Obesity Prevention in Early Care and Education

> **NIH NIH P20** · ARKANSAS CHILDREN'S HOSPITAL RES INST · 2021 · $292,338

## Abstract

PROJECT SUMMARY
Few children between 2 and 5 years old in the US meet dietary guidelines.1–3 Further, 4 out of 10 children are
overweight or obese by age 5.4 Consuming a healthy diet (e.g., fiber, antioxidant-rich foods)7–9 and maintaining
a healthy weight9–11 provide significant protection against mortality and development of disease. Given that
early life patterns track into adulthood,12,13 early interventions are needed to decrease the risk of developing
obesity. Thus, early care and education (ECE) is a promising setting for obesity prevention. However,
implementation of interventions in ECE remains a challenge.
 There are two crucial gaps to optimizing obesity prevention in ECE: 1) the lack of adaptive implementation
strategies that tailor the intensity of implementation support delivery and 2) limited literature surrounding cost-
effectiveness of obesity prevention and nutrition promotion efforts in ECE. The overarching goal of this
application is to gather stakeholder perspectives on specification of an adaptive implementation
strategy and acceptable cost-effectiveness thresholds for obesity prevention in ECE.
 To this end, we will focus on the evidence-based nutrition program Together, We Inspire Smart Eating
(WISE). Compared to usual practices in ECE, WISE has demonstrated an increase in fruit and vegetable
consumption at home for children,23 improvements in carotenoid intake,24 and reductions in fast food and sugar
sweetened beverage consumption.23,25 Our prior work demonstrated that a package of 8 discrete, stakeholder-
selected implementation strategies outperformed a basic implementation approach (i.e., training and
reminders) for WISE. Given feasibility and potential prohibitive costs in the real-world, it is likely not possible to
provide all implementation strategies to all sites in the future; in addition, all strategies may not be necessary to
achieve the desired outcomes. Further, data on costs of WISE have not been examined. Future studies will
need baseline comparator data to understand the costs and cost effectiveness of WISE without implementation
strategy support to understand the relative benefit of implementation strategies such as adaptive approaches.
 Specific Aim 1. Determine key elements of an adaptive implementation strategy for WISE using
stakeholder input. Stakeholder input on critical decision points, tailoring variables and decision rules will
determine specification of an adaptive implementation strategy that can be tailored to site needs.
 Specific Aim 2. Estimate the incremental cost effectiveness of the WISE intervention compared to
usual nutrition education. We hypothesize that WISE will be cost-effective compared to usual nutrition
education when comparing each approaches’ ability to prevent BMI increases in children. Using secondary
data, we will determine the cost per unit improvement in target child outcomes (i.e., BMI, servings of
fruit/vegetables, carotenoid levels, junk food intake).

## Key facts

- **NIH application ID:** 10270955
- **Project number:** 2P20GM109096-06
- **Recipient organization:** ARKANSAS CHILDREN'S HOSPITAL RES INST
- **Principal Investigator:** Taren Swindle
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $292,338
- **Award type:** 2
- **Project period:** 2016-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10270955

## Citation

> US National Institutes of Health, RePORTER application 10270955, Adaptive Implementation & Costs of Obesity Prevention in Early Care and Education (2P20GM109096-06). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10270955. Licensed CC0.

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