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Childhood ObesityONE PATHNCT03817021

ONE PATH: Optimizing Nutrition Education for Parents and Teachers for Healthy Growth

A study testing ECE Provider, Parent Intervention and Child intervention in people with Childhood Obesity and Self-regulation, run by Penn State University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This proposal uses an innovative methodological framework, the multiphase optimization strategy (MOST), to design an effective and efficient responsive feeding (RF) intervention that promotes child appetite self-regulation among a high-risk sample: families with preschoolers living in rural poverty. Read more about this study

Who is it for?
Ages 2 to 6 yearsHealthy volunteers can take part
What is being tested?
ECE Provider, Parent Intervention and Child intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,461 participants
Where
1 siteUnited States
Study dates
21 Jul 2022to 7 Jul 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 6 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • children must be enrolled in a participating Head Start or Pre-K Counts center
  • children must be between 2 and 6 years old
  • parent or primary caregiver must be 18 years or older
  • parent/child English speaking
  • ECE providers must be employed in participating Head Start or Pre-K Counts center

Who cannot join

  • Parents will not be eligible to participate if their child is not eligible and/or not enrolled in the study
  • ECE providers will not be eligible if they do not teach in a participating preschool classroom

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Pennsylvania State University

    University Park, Pennsylvania, 16802

Other trials in United States

About this study

This proposal uses an innovative methodological framework, the multiphase optimization strategy (MOST), to design an effective and efficient responsive feeding (RF) intervention that promotes child appetite self-regulation among a high-risk sample: families with preschoolers living in rural poverty. The principles of MOST emphasize efficiency, allowing identification of the most efficacious intervention components (i.e., components that contribute to treatment effects) while minimizing participant burden and cost. ONE PATH will intervene on ~768 dyads recruited from 56 classrooms serving largely low-income, rural populations.

Read the detailed description

The ONE PATH: Optimizing Nutrition Education for Parents And Teachers for Healthy growth study will rigorously test the efficacy of responsive feeding (RF) and appetite regulation interventions. ONE PATH will intervene upon 3 unique targeted audiences, 1) Early Childhood Education providers (ECE), 2) preschool children, and 3) parents of the preschool children, to address childhood obesity in rural, under-served areas. ECE providers will receive online RF training and coaching. Preschool children will receive an experiential play-based curriculum delivered in the classroom focused on recognition of hunger and fullness cues and using attention control and mindfulness strategies to regulate food intake. Parents will receive RF and parenting guidance from ONE PATH educators through remote coaching. In addition to the three candidate interventions, all classrooms had the option to elect to participate in an existing evidence-based intervention (CORE intervention), the Nutrition and Physical Activity Self-Assessment of Child Care (Go NAP SACC) program. This component will not be tested as part of the optimized intervention.

Aim 1 is to identify which intervention components improve feeding practices and children's appetite regulation (primary), and BMI z-scores (secondary) over the 9-month school year. The 3 candidate intervention components include 1) RF interactive web-based training curriculum and coaching for ECE providers ("ECE provider intervention"), 2) classroom curriculum that teaches regulation strategies to preschool children ("child intervention"), and 3) responsive parenting (RP) curriculum and interactive activities for parents that provide opportunities to practice RF at home ("parent intervention"). The investigators will use the highly efficient multi-phase optimization (MOST) experimental strategy powered to detect main effects and all interactions.

Aim 2 is to improve understanding of the mechanisms by which the 3 candidate intervention components work, and determine if individuals respond differently to intervention components using the data from the experiment in Aim 1. The investigators will examine whether food security and child temperament explain the effects of the intervention on the outcomes (child appetite regulation, caregiver feeding practices, and child BMI z-score).

To investigate whether certain intervention components are more or less effective in certain subgroups, the investigators will explore moderation by child sex, race/ethnicity, and BMI categories.

Being tested
ECE Provider, Parent Intervention, Child intervention
Keywords
Responsive parenting, Early Childhood Education, Appetite Regulation
Medical subject headings
Pediatric Obesity, Self-Control

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ECE ProviderBehavioural

    Also called Responsive feeding for early childhood educators, ECE

    Provide online training for Head Start educators

  • Parent InterventionBehavioural

    Also called RF, Parent Responsive Feeding

    Coach parents remotely to educate them on responsive feeding and parenting

  • Child interventionBehavioural

    Also called Appetite regulation, Child regulation

    Through classrooms lessons cover 3 topics: 1) self-regulation, 2) hunger and fullness, and 3) mindfulness in eating and attention control practices

Study groups in NCT03817021
Study groupRoleWhat they receive
All Factors OnExperimentalECE Provider intervention will be turned on Parent intervention will be turned on Child intervention will be turned on
Receives: Behavioral: ECE Provider; Behavioral: Parent Intervention; Behavioral: Child intervention
ECE on/Parent onExperimentalECE Provider intervention will be turned on Parent intervention will be turned on Child intervention will be turned off
Receives: Behavioral: ECE Provider; Behavioral: Parent Intervention
ECE on/Child onExperimentalECE Provider intervention will be turned on Parent intervention will be turned off Child intervention will be turned on
Receives: Behavioral: ECE Provider; Behavioral: Child intervention
ECE onExperimentalECE Provider intervention will be turned on Parent intervention will be turned off Child intervention will be turned off
Receives: Behavioral: ECE Provider
Parent on/Child onExperimentalECE Provider intervention turned off Parent intervention turned on Child intervention turned on
Receives: Behavioral: Parent Intervention; Behavioral: Child intervention
Parent onExperimentalECE Provider intervention turned off Parent intervention turned on Child intervention turned off
Receives: Behavioral: Parent Intervention
Child onExperimentalECE Provider intervention turned off Parent intervention turned off Child intervention turned on
Receives: Behavioral: Child intervention
All Factors OffNo interventionECE Provider intervention turned off Parent intervention turned off Child intervention turned off

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Child Appetite Regulation

    Difference in mean COMPX score at post-intervention between intervention and control conditions:

    Child appetite regulation skills will be assessed using the gold standard caloric compensation score (COMPX). On 2 occasions, children will be served a smoothie ~20 minutes prior to lunch - on 1 occasion, they will receive a low-calorie smoothie, and on the other a high-calorie smoothie (order will be randomized by classroom). Children will then be served an ad-libitum lunch (same foods on both occasions), and intake will be determined by pre- and post-weighing of food. The difference in intake between the two conditions reflects the child's ability to compensate for the higher calorie preload, a measure of appetite regulation. Caloric compensation score (COMPX) will be calculated as a percentage score. A COMPX of 100% reflects perfect caloric compensation. A COMPX higher than 100% indicates overcompensation, whereas a COMPX lower than 100% indicates under-compensation.

    Measured: Post intervention (~9 months)

  2. Parent feeding practices

    Differences in baseline-post change in parent feeding practice scores between intervention and control conditions

    Parent feeding practices will be assessed using the Structure and Control in Parent Feeding (SCPF) questionnaire, a 34-item measure that assesses positive, structure based feeding practices (i.e., limit-setting, consistent routines) and controlling feeding practices (i.e., restriction, pressure to eat). Items are scored on a 5-point likert scale (0 = never- 4 = always), with higher scores indicating higher frequency of engagement in a specific feeding behavior.

    Measured: Baseline and post intervention (~9 months)

  3. Parent feeding practices

    Differences in baseline-post change in parent feeding practice scores between intervention and control conditions. Parent feeding practices will be assessed using the Feeding to Manage Child Behavior questionnaire (FMCBQ), a 9-item measure that assesses parents' use of food to soothe and food as reward. Items are scored on a 5-point Likert scale (0 = never- 4 = always), with higher scores indicating higher frequency of engagement in food to soothe or as reward.

    Measured: Baseline and post intervention (~9 months)

  4. Early childhood educator (ECE) feeding practices

    Difference in percentage of educators engaging in specific feeding practices between intervention and control conditions at post-study.

    Early childhood educators feeding practices will be assessed using the Mealtime Observation in Childcare Checklist (MOCC). This measure will capture whether educators engage in specific feeding styles and practices during meal time. Some of the behaviors observed will include: whether educators pressured children to eat their food, praised children for trying a certain food or finishing their food, or if they provided food- or non-food related rewards to children for eating food. Additionally, we will observe how educators handled food refusal and if they supported children's self-regulation. For each item on the check list, observers indicate if they did or did not observe the behavior.

    Measured: Post intervention (~9 months)

  5. Parent feeding practices

    Differences in baseline-post change in parent feeding practice scores between intervention and control conditions

    Parent feeding practices will be assessed using the Caregiver's Feeding Styles Questionnaire (CFSQ), a 19-item measure which classifies caregivers into 1 of 4 feeding styles (authoritarian, authoritative, indulgent and uninvolved). Items are scored on a 5-point scale (1=never-5=always), with higher scores indicating higher frequency of engagement in a specific feeding style.

    Measured: Baseline and post intervention (~9 months)

Secondary outcomes (6)
  1. BMI z-scores

    Difference in change in BMI z-scores from baseline to post between intervention and control conditions

    Children's weights and heights will be obtained at baseline and the end of the study using standard procedures. BMI will be calculated and values will be standardized to z-scores and percentiles according to Centers for Disease Control (CDC) standards and adjusted for child's sex and age.

    Measured: Baseline and post intervention (~9 months)

  2. Child Appetite Regulation and Satiety Responsiveness

    Differences in change from baseline-post intervention in calories consumed in the Eating in the Absence of Hunger (EAH) task between intervention and control conditions.

    The EAH procedure measures children's snack food consumption when not hungry. Children will be presented with a variety of snack foods shortly after being fed a full meal. The snacks will be weighed prior to and following the procedure to calculate intake. This will be evaluated at baseline and post intervention.

    Measured: Baseline and post intervention (~9 months)

  3. Child Appetite Regulation and Satiety Responsiveness

    Differences in change in appetitive traits (parent-rated) from baseline-post, and mean appetitive traits at post-intervention (ECE provider-rated) between intervention and control conditions.

    Child appetitive traits will be assessed using the Children's Eating Behavior Questionnaire, which will be completed by parents at baseline and post intervention and by ECE providers post intervention only. This measure assesses children's eating style using a 5-point scale (1 = never - 5 = always).

    Measured: Baseline and post intervention (~9 months)

  4. Classroom/school food environment

    Differences in percent of classrooms exhibiting specified characteristics of food environment at post-intervention between intervention and control conditions.

    The ECE environment, including food and beverages served, physical environment, teacher engagement, and feeding practices will be assessed observationally at baseline (subset) and the conclusion of the project (all classrooms) using the validated MOCC. We hope to observe more teacher engagement, positive environment, and feeding practices in the classrooms post-intervention.

    Measured: Post intervention (~9 months)

  5. Waist Circumference

    Differences in mean waist circumference at post-intervention between intervention and control conditions. Waist circumference values will be standardized to z-scores and percentiles according to sex- and age-specific guidelines. Waist circumference will be obtained using standardized procedures at baseline and post-intervention.

    Measured: Baseline and post intervention (~9 months)

  6. Weight Status

    Differences in percentage of overweight and obesity status (compared to not having overweight or obesity) at post-intervention between intervention and control conditions.

    BMI percentiles according to Centers for Disease Control (CDC) standards and adjusted for child's sex and age will be calculated and use to determine prevalence of overweight (≥ 85th percentile) and obesity (< 95th percentile).

    Measured: Post intervention (~9 months)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Jan 2019
  2. Study start21 Jul 2022
  3. Primary completion7 Jul 2025
  4. Study completion7 Jul 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Factorial
Model description
Using Multiphase Optimization (MOST) Strategy, we will examine 3 treatment factors and their interactions to determine a 'best' or optimum approach to education of the Early Childhood Environment (ECE), child and family.
Masking
None (open label)
Enrolment
1,461 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03817021
Sponsor's protocol ID
1R01DK120754-01
Acronym
ONE PATH
Status last verified
Jan 2025
First submitted
18 Jan 2019
Last updated
15 Oct 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Deidentified participant data will be available to researchers on request after the conclusion of the study.

Questions about this trial

What is this clinical trial studying?

A study testing ECE Provider, Parent Intervention and Child intervention in people with Childhood Obesity and Self-regulation, run by Penn State University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Child Appetite Regulation (time frame: Post intervention (~9 months)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Oct 2025.

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