Research
Review
What Role Can Child-Care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts

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Abstract

Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.

Section snippets

Methods

Searches in PubMed and MEDLINE were completed to identify relevant, peer-reviewed research studies published between January 2000 and July 2010. Relevant articles were identified using the following key words: child care, preschool, nursery school, dietary intake, physical activity, sedentary activity, intervention, obesity, and overweight. To be included in this review, articles had to address at least one of the review objectives and describe research of relevance to preschool children (aged

State Regulations

A primary way to reach children in child-care settings is through policy and regulations. Head Start programs are subject to federal performance standards; however, child-care facilities are regulated primarily by states. Each state establishes its own set of regulations for licensed child-care facilities and sets some minimum enforcement standards to assess compliance. Most states license a number of different categories of child-care facilities, but the majority of states differentiate

Discussion

The aim of this review is to describe and evaluate research addressing opportunities and strategies for the prevention of obesity among preschool children in child-care settings. Despite widespread use of child care and an all-time high prevalence of obesity among preschool-aged children (1, 5), most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings have further identified room for improvement in

Conclusions

Early prevention is considered to be the most promising strategy for reducing obesity and the many serious health conditions that may result as a consequence of excessive weight gain during childhood (88). Eating and activity behaviors formed during the preschool years have the potential to prevent obesity in the short term and, if carried into adulthood, to set the stage for a lifetime of better health. The majority of US parents depend on child-care providers to support the development of

N. Larson is a research associate, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.

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    N. Larson is a research associate, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.

    M. Story is a professor, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.

    D. S. Ward is a professor, Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill.

    S. B. Neelon is an assistant professor, Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC.

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