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Nutrition and physical activity interventions in preschool and child care

Evidence Rating

Scientifically Supported

Health Factors

Nutrition interventions include guidelines or policies governing the food children eat in preschool or child care. Physical activity programs directly guide children to increase their physical activity, whereas policy changes include devoting more time to physical activity, increasing activity in daily curricula, playground improvements, physical activity requirements, or restrictions on screen time.

Expected Beneficial Outcomes

  • Increased physical activity

  • Improved nutrition

  • Increased fruit & vegetable consumption

  • Improved physical fitness

Evidence of Effectiveness

There is strong evidence that nutrition interventions in preschool and child care improve children’s diets () and that physical activity interventions improve their activity levels (, ).  

Adhering to nutrition guidelines in preschool and child care can decrease children’s fat intake and increase fruit and vegetable intake (), while implementing physical activity interventions can increase participant’s fitness and motor skills (). Physical activity interventions have been shown to reduce participating children’s weight or body fat in some circumstances (Bluford 2007). However, there is insufficient evidence to determine if nutrition () or physical activity interventions reduce children’s risk of overweight ().

Policy and environmental interventions can also make preschool and child care  more conducive to physical activity. Researchers recommend that centers train teachers in integrating physical activity into learning in order to most effectively increase children’s physical activity ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Most preschoolers do not reach recommended physical activity levels in child care; the center a child attends accounts for roughly half of the variation in his or her physical activity overall. Head Start centers are required to meet federal nutrition standards, but most states lack strong nutrition or physical activity requirements for child care centers. Tennessee, Delaware, Georgia, and Indiana require the most of child care centers while Idaho, Washington, and Nebraska do not regulate physical activity or nutrition standards in preschools ().

Implementation Resources

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

NASPE-PA guidelines - National Association for Sport and Physical Education (NASPE). National guidelines for physical activity.

AAP-Guidelines - American Academy of Pediatrics (AAP). 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.

Citations - Evidence

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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.

Citations - Implementation Examples

* 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.

Date Last Updated

May 22, 2014
  • 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.

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