Relationship between teacher fidelity to an early childhood obesity prevention program and the Child care center nutrition and physical activity environment

•The child care center is an optimal setting for obesity prevention.•Yet, little attention has been paid to teacher fidelity to obesity prevention programs.•Measuring teacher fidelity may provide guidance for further improvements to sustainability.•Teacher fidelity was correlated with the nutrition but not the physical environment.•Childcare center teachers may require continued support for obesity prevention. Child care centers (CCC) can be strategic settings to establish healthy lifestyle behaviors through obesity prevention programs. Fidelity to the implementation of such programs is a vital evaluation component, but is often not measured. This study assessed CCC teacher fidelity to the implementation of “Healthy Caregivers, Healthy Children (HC2)”, a CCC-based obesity prevention intervention. CCCs serving low-resource, ethnically diverse families with ≥ 50 children ages 2-to-5 years old that were randomized to the HC2 intervention and that had teacher fidelity data collected (n = 9 CCC) were included in this analysis. The Environment and Policy Assessment and Observation (EPAO) tool assessed the CCC nutrition and physical activity (PA) environment at the beginning/end of the school year. Fidelity assessments were conducted in CCCs randomized to HC2 in Spring 2016 (n = 33 teachers) and 2017 (n = 39 teachers) by a trained observer. The relationship between teacher fidelity and EPAO was assessed via mixed models. For every-one unit rise in teacher fidelity, EPAO nutrition increased 0.055 points (p =.006). No significant relationship was shown between teacher fidelity and EPAO PA score (p =.14). Teacher fidelity to obesity prevention program implementation may support a healthy CCC obesity prevention and nutrition environment but might require continued support for all components.