Childhood obesity prevention interventions in childcare settings: Systematic review of randomized and nonrandomized controlled trials

Objective. Childcare settings are an opportune location for early intervention programs seeking to prevent childhood obesity. This article reports on a systematic review of controlled trials of obesity prevention interventions in childcare settings. Data Source. The review was limited to English language articles published in PubMed, Web of Science, and Education Resources Information Center (ERIC) between January 2000 and April 2012. Study Inclusion and Exclusion Criteria. Inclusion criteria: childhood obesity prevention interventions in childcare settings using controlled designs that reported adiposity and behavior outcomes. Exclusion criteria: no interventions, non-childcare settings, clinical weight loss programs, non-English publications. Data Extraction. Publications were identified by key word search. Two authors reviewed eligible studies to extract study information and study results. Data Synthesis. Qualitative synthesis was conducted, including tabulation of information and a narrative summary. Results. Fifteen studies met the eligibility criteria. Seven studies reported improvements in adiposity. Six of the 13 interventions with dietary components reported improved intake or eating behaviors. Eight of the 12 interventions with physical activity components reported improved activity levels or physical fitness. Conclusion. Evidence was mixed for all outcomes. Results should be interpreted cautiously given the high variability in study designs and interventions. Further research needs long-term follow-up, multistrategy interventions that include changes in the nutrition and physical activity environment, reporting of cost data, and consideration of sustainability.