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Nutrition and physical activity interventions in preschool and child care

Evidence Rating

Scientifically Supported

Health Factors

Nutrition and physical activity interventions in preschool and child care offer young children opportunities to eat healthy foods and engage in physical activity throughout the day. Nutrition interventions provide fruits, vegetables, and other healthy foods as part of snacks, meals, taste-testing, and food preparation, frequently with basic nutrition education. Physical activity interventions provide opportunities for children to increase their physical activity, typically by training teachers to incorporate physical activity into daily routines, changing the physical environment, or offering more time for physical activity. Government regulations and organizational policies can support these interventions through guidelines for healthy food consumption, physical activity, and screen time, and support for playground improvements (AAP-Early care standards 2012).

Expected Beneficial Outcomes (Rated)

  • Improved nutrition

  • Increased physical activity

Other Potential Beneficial Outcomes

  • Increased fruit & vegetable consumption

  • Improved physical fitness

  • Improved weight status

Evidence of Effectiveness

There is strong evidence that nutrition interventions in preschool and child care improve children’s diets (Mikkelsen 2014, Grantham-McGregor 2014, , Robinson 2014) and physical activity interventions increase their activity levels (, , , Robinson 2014). However, variation in the design, duration, and implementation of these interventions can result in varied effects (, Mehtala 2014) and additional evidence is needed to determine if these interventions reduce risk of overweight or obesity (, , ).

Adhering to nutrition guidelines in preschool and child care can decrease children’s fat intake and increase fruit and vegetable intake (Mikkelsen 2014, ). Implementing physical activity interventions can increase participant’s fitness and motor skills (). In some circumstances, nutrition and physical activity interventions have been shown to reduce children’s weight, body fat, or Body Mass Index (BMI) (Mikkelsen 2014, Bluford 2007, ).

Overall, interventions that increase time for physical activity, provide portable play equipment (e.g., balls and other objects), and include playground markings have been shown to increase moderate to vigorous physical activity (, Broekhuizen 2014, ). Adding portable play equipment has greater effects on physical activity than adding fixed play structures and equipment, since children tend to gather and stand still on or under fixed structures ().

Researchers recommend that child care centers provide teachers with training in how to integrate physical activity into learning to maximize effects on children’s physical activity (, , Mehtala 2014). A culturally sensitive approach is also suggested to increase the effectiveness of obesity prevention efforts such as nutrition and physical activity interventions in preschool and early child care (CDC-Cultural competence, NRC NPAA-Cultural diversity). Culturally sensitive interventions are implemented with a clear understanding of cultural values, generally with the help of bilingual and bicultural facilitators, and often include translated and literacy-appropriate materials, social support, and family-based activities (Mier 2010).

Impact on Disparities

No impact on disparities likely

Implementation Examples

The Public Health Law Center’s (PHLC) 50-state review of early childhood care and education regulations includes nutrition and physical activity standards; the on-line map is searchable by state (PHLC-Child care regulations). Terms and standards relating to nutrition, physical activity, and screen time vary widely across the country; however, very few states incorporate their standards into their statewide regulations (ALR-Frost 2015). The National Resource Center for Health and Safety in Child Care and Early Education (NRC) identifies 47 potential components for licensing standards that support healthy dietary behaviors and physical activity for young children (AAP-Early care standards 2012). CDC’s 2013 Prevention Status Reports show that no state has regulations that include more than 70% of those 47 components (CDC-NPAO PSR 2013).

Illinois adopted a resolution in 2012 calling for daily, quality physical education in preschool and early child care centers, among other child obesity prevention measures (NCSL Winterfeld-Obesity prevention 2014). In some states, nutrition and physical activity interventions focus on developing curriculum and training early childhood care and education providers through non-profit and public sector partnerships, as in Idaho (CDHD-IdahoSTARS).

Implementation Resources

WI DHS-Early care - Wisconsin Department of Health Services (DHS). Early care and education (early childhood) initiatives.

SHAPE America-PA guidelines - Society of Health and Physical Educators (SHAPE America). Physical activity guidelines.

AAP-HALF - American Academy of Pediatrics (AAP). Healthy Active Living for Families (HALF) program. Age specific content.

Eat Smart Move More NC-NAP SACC - Eat Smart, Move More North Carolina. Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC).

ChangeLab-CA childcare - ChangeLab Solutions. California childcare settings: A webinar on the child care nutrition and physical activity environments.

ChangeLab-Model childcare statute - National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). Model childcare licensing statute for obesity prevention. Oakland: ChangeLab Solutions; 2013.

Together Counts-SFTS - Together Counts. Smart from the start (SFTS).

Food Trust-Preschool initiative 2011 - The Food Trust. The preschool initiative: Building a healthy foundation for life. 2011.

Citations - Evidence

* Journal subscription may be required for access.

Larson 2011* - Larson N, Ward DS, Neelon SB, Story M. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts. Journal of the American Dietetic Association. 2011;111(9):1343–62.

Ward 2010* - Ward DS, Vaughn A, McWilliams C, Hales D. Interventions for increasing physical activity at child care. Medicine & Science in Sports & Exercise. 2010;42(3):526–34.

Jaime 2008* - Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Preventive Medicine. 2009;48(1):45–53.

Bluford 2007 - Bluford DA, Sherry B, Scanlon KS. Interventions to prevent or treat obesity in preschool children: A review of evaluated programs. Obesity. 2007;15(6):1356-72.

Mikkelsen 2014 - Mikkelsen MV, Husby S, Skov LR, Perez-Cueto FJ. A systematic review of types of healthy eating interventions in preschools. Nutrition Journal. 2014;13:56.

Grantham-McGregor 2014 - Grantham-McGregor SM, Fernald LCH, Kagawa RMC, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Annals of the New York Academy of Sciences. 2014;1308:11–32.

Gordon 2013* - Gordon ES, Tucker P, Burke SM, Carron AV. Effectiveness of physical activity interventions for preschoolers: A meta-analysis. Research Quarterly for Exercise and Sport. 2013;84:287-294.

Kreichauf 2012* - Kreichauf S, Wildgruber A, Krombholz H, et al. Critical narrative review to identify educational strategies promoting physical activity in preschool. Obesity Reviews. 2012;13(1):96-105.

Zhou 2014* - Zhou YE, Emerson JS, Levine RS, Kihlberg CJ, Hull PC. Childhood obesity prevention interventions in childcare settings: Systematic review of randomized and nonrandomized controlled trials. American Journal of Health Promotion. 2014;28(4):e92-103.

Mehtala 2014 - Mehtala MAK, Saakslahti AK, Inkinen ME, Poskiparta MEH. A socio-ecological approach to physical activity interventions in childcare: A systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2014;11:22.

Broekhuizen 2014 - Broekhuizen K, Scholten AM, de Vries SI. The value of (pre)school playgrounds for children's physical activity level: A systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2014;11:59.

Temple 2014* - Temple M, Robinson J. A systematic review of interventions to promote physical activity in the preschool setting. Journal for Specialists in Pediatric Nursing. 2014;19:274-284.

Robinson 2014 - Robinson LE, Webster EK, Whitt-Glover MC, Ceaser TG, Alhassan S. Effectiveness of pre-school- and school-based interventions to impact weight-related behaviours in African American children and youth: A literature review. Obesity Reviews. 2014;15(4):5-25.

CDC-Cultural competence - Centers for Disease Control and Prevention (CDC). Addressing obesity disparities: Cultural competence.

NRC NPAA-Cultural diversity - National Resource Center on Nutrition, Physical Activity & Aging (NRC NPAA). Creative solutions: Cultural diversity as part of nutrition education and counseling.

Mier 2010 - Mier N, Ory MG, Medina AA. Anatomy of culturally sensitive interventions promoting nutrition and exercise in hispanics: A critical examination of existing literature. Health Promotion Practice. 2010;11(4):541-554.

Citations - Implementation Examples

* Journal subscription may be required for access.

ALR-Frost 2015 - Frost N. Promoting physical activity in early care and education. 2015 Active Living Research (ALR) Annual Conference. 2015.

CDC-NPAO PSR 2013 - Centers for Disease Control and Prevention (CDC). Nutrition, physical activity, and obesity: Prevention status reports (PSR). 2013.

AAP-Early care standards 2012 - American Academy of Pediatrics (AAP), American Public Health Association (APHA), National Resource Center for Health and Safety in Child Care and Early Education (NRC). Preventing childhood obesity in early care and education programs: Second edition. 2012.

PHLC-Child care regulations - Public Health Law Center (PHLC). Healthy child care 50-state review.

CDHD-IdahoSTARS - University of Idaho Center on Disabilities and Human Development (CDHD), Idaho Association for the Education of Young Children (Idaho AEYC), Idaho Department of Health and Welfare (ID DHW). IdahoSTARS: Quality child care matters.

NCSL Winterfeld-Obesity prevention 2014 - Winterfeld A. State actions to reduce and prevent childhood obesity in schools and communities: Summary and analysis of trends in legislation. National Conference of State Legislators (NCSL). 2014.

Date Last Updated

Jun 9, 2015
  • Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
  • Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
  • Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
  • Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
  • Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
  • Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.