International Journal of Child Health and Nutrition, 2018, 7, 1-8 1 E-ISSN: 1929-4247/18 © 2018 Lifescience Global Evaluation of an After-School Obesity Prevention Program for Children Laura Nabors 1,* , Kristen Welker 1 , Brandon Pavilack 2 , Myia Lang 1 , Renee Hawkins 1 and Anne Bauer 1 1 University of Cincinnati, Cincinnati, Ohio, 45221, USA 2 The Ohio State University, Columbus, Ohio, 43210, USA Abstract: Dissemination of obesity prevention programs in different settings is needed. Moreover, new outreach tools to teach parents healthy eating and exercise lessons provided in these programs are important to develop. The pilot studies presented in this paper examined the implementation of the Children’s Healthy Eating and Exercise Program in two different after school programs in 2015 and 2016. Participants were elementary school-age children and their parents. Eight lessons were presented at each school. Child perceptions of healthy eating and exercise goals were examined as well as child knowledge retention and perceptions of behavior change. Parent perceptions of the program were analyzed. Results indicated that children reported improved knowledge and behaviors. Parents reported satisfaction with the program, but remained hard to reach. Children recalled key components of the healthy eating lessons at long-term follow-up assessments. In the second pilot study, children served as health coaches for teaching parents about family goals. Children believed they were successful at coaching parents, but they requested help in developing family eating and exercise goals. Improving outreach to parents and involving siblings remains a goal for future studies as does beginning to examine changes in eating and physical activity using food diaries and accelerometry. Keywords: Prevention, children, obesity, after-school program, motivational interviewing. INTRODUCTION Childhood obesity is a health problem in the United States. About 17% of children in the United States are overweight or obese [1]. Childhood overweight is related to health problems in adulthood [1-3]. Unhealthy eating, sedentary lifestyles, and less physical activity (PA), are related to overweight [4]. Children’s behaviors can be changed through knowledge about increasing levels of PA and healthy eating [4-6]. A concentration on instructional time may make it difficult to incorporate obesity prevention programs during the school day and, as such, after- school programs are an outlet for teaching children [5, 7-11]. Moreover, obesity prevention efforts need to be multi-pronged approaches to address individual and family determinants of obesity [12]. Thus, after-school programs need to pilot new ideas for providing information to parents. The current pilot studies are applications of the Children’s Healthy Eating and Exercise Program (CHEE), an after-school obesity prevention program for elementary school-age children [10, 11]. The CHEE program incorporates components from the Traffic Light Diet [13], the Coordinated Approach to Child Health Program (CATCH)[14], the Let’s Move Program *Address correspondence to this author at 2610 McMicken Circle, Teachers- Dyer Complex, 460PA, Cincinnati, Ohio, 45221-0068, USA; Tel: 513-556-5537; E-mail: laura.nabors@uc.edu (https://letsmove.obamawhitehouse.archives.gov/; accessed 2/19/2018), and MyPlate (https://www.fns. usda.gov/tn/myplate; accessed 2/19/2018). In previous studies, evaluators found that children participating in the CHEE program reported knowledge gains and behavior change [5, 10, 11, 15]. Children who participated reported eating more fruits and vegetables as well as fewer sweets [10, 11, 15]. Children’s involvement in PA also improved [11, 15]. Parents reported their children were highly satisfied with the program and that their children were trying to follow the Traffic Light Diet and exercise more at home [10, 11]. Coaches for the CHEE program use motivational interviewing (MI) to set weekly eating and PA goals with children [5, 11]. MI is a client-centered approach used to enhance intrinsic motivation through exploration and resolution of ambivalence to change [16, 17]. A component of Social Cognitive Theory [18], agency promotes participation in self-development for children [19, 20]. The incorporation of MI in the CHEE Program promotes agency in child participants. For the current projects coaches delivered the CHEE program and implemented methods for parent outreach and used surveys and interviews to assess knowledge retention at follow-up assessments. The first pilot study implemented the CHEE program with children and transmitted information to parents via telephone contacts. Children were involved as family health educators for the second pilot study. They