Table 3.

Content, delivery and outcomes in school/childcare‐based interventions

Reference	Study aims	Content	Delivery	Child obesity measures	Diet and PA outcomes
Bellows et al. (2013)	To test the efficacy of a Food Friends: Get Moving' With Mighty Moves programme. To determine whether children participating in the intervention improved their gross motor skill performance, physical activity levels and weight status	Diet and PA Intervention: 15–20 min/day of exercise, 4 days/week (72 lessons in total). 12‐week Food Friends nutrition programme, including Food Friends character to introduce children to new foods. Each class received an activity binder, music CD, activity mats, flashcards, puppets, scarves, balls, beanbags, ropes and parents' materials. Home connection materials were sent home throughout the programme, including educational handouts and a copy of the Mighty Moves music CD Control: 12‐week Food Friends nutrition programme Duration: 18‐week intervention	Classroom teachers to school children.	No intervention effect was found for weight status	No intervention effect was found for physical activity levels
Fitzgibbon et al. (2011) (postintervention) Kong et al. (2016) (1‐year follow‐up)	To assess whether a modified Hip‐Hop to Health Jr. intervention could be integrated into the everyday preschool curriculum and delivered by classroom teachers. The primary aim was to compare BMI and BMI z‐ score changes between treatment groups	Diet and PA Intervention: Hip‐Hop to Health Jr. intervention consisted of interactive lessons each week with the aim of increasing PA and promoting healthy eating behaviours. Activities and themes included portion sizes, heart healthy exercises, Instead of TV, I could…, healthy snacks, colourful “Pyramid Puppets” representing food groups and cooking and food tasting sessions. Parental involvement included weekly newsletters that matched in‐class curriculum, Hip Hop to Health Physical Activity CDs used in the classroom to take home, and nutrition homework where if completed, parents would receive $5, for example, information on the calcium content of different types of milk and differences in fat content. Control: teacher‐delivered general health intervention control group. Duration: 14‐weeks	School teachers to children in a classroom twice a week for 20 min. Parents were provided with the option of attending twice weekly 30‐minute aerobic classes.	No significant outcomes	Greater level of moderate to vigorous PA (p = 0.03) in the intervention group postintervention. At 1‐year follow‐up, between groups a significant difference in HEI total score (p = 0.02). Significant differences in total fruit (p = 0.003), whole fruit (p = 0.02), SoFAAS (p = 0.02) and whole grains (p = 0.02).
Hodgkinson et al. (2019)	To prevent excess weight gain in preschool children within a childcare setting	Diet, PA and Policy Intervention: Training of early years classroom teachers to implement healthy eating and drinking policies, such as healthy meals/snacks served, food growing and active play. The Healthy Heroes curriculum pack from the educational health promotion resource Be Active Eat Healthy was used. Activities included the use of colourful characters doing healthy activities, for example, ‘going to the park’, puppets, songs and Change4Life materials Control: Usual activity Duration: 6 months	Early Years Centres staff during one to one and group sessions with parent–infants' dyads	Significant reduction in BMI z‐score: 0.49; 95% CI: 0.17–0.80, p = 0.002.	No significant outcomes in dietary behaviours. Changes in physical activity were not reported
Kim et al. (2019)	To assess the effectiveness of a NASA‐established nutrition‐themed Mission X: Train Like an Astronaut programme to improve the dietary behaviours and nutritional status of South Korean preschool children	Diet only Intervention: A nutrition‐themed curriculum intervention using an astronaut as a role model. Topics included a balance of food groups, high calcium foods, healthy versus unhealthy snacks and food. Control: usual activity Duration: 10 weeks	Weekly intervention delivered by a dietitian to school children and class teachers taught using the provided lesson plans and materials	No significant outcomes	A difference in total NQ score (p < 0.05) at 10‐week follow‐up, with a greater increase in the intervention group
Lumeng et al. (2017)	To determine the effect of an intervention to improve emotional and behavioural self‐regulation in combination with an obesity‐prevention programme on the prevalence of obesity and obesity‐related behaviours in preschoolers	Diet and PA Intervention POPS: based on social cognitive theory, POPS was developed to provide developmentally and culturally appropriate, evidence‐based and coordinated obesity‐prevention messages to preschoolers and their parents. Behavioural goals included increased frequency and variety of fruit and vegetable intake, reduced sugar‐sweetened beverage consumption, reduced screen time, cooking healthy meals at home, eating family meals, and eating healthy foods when eating out. IYS: programme that emphasises positive behavioural management techniques and enhances self‐regulation in young, low‐income children. It consisted of 60 lessons followed by smaller group activities that addressed self‐regulation skills, problem‐solving strategies and prosocial behaviour. The parent component consisted of lessons delivered by using video vignettes in 14 group sessions or 10 home visits that were reinforced with homework and follow‐up phone calls. Control: HS: education programme targeting evidence‐based obesity‐prevention behaviours embedded in Head Start Duration: 6–8 months	Both the parent and child components were delivered by a master's‐level nutrition educator (POPS) or master's‐level mental health specialist (IYS)	No effect on the prevalence of obesity	Sugar‐sweetened beverage intake (HS + POPS + IYS resulted in a greater decline than HS; p = 0.005).
Natale et al. (2014)	Aims included: (1) increase healthy eating habits and PA behaviours of 2–5‐year‐old children at the centre and at home, and (2) determine the feasibility and efficacy of the intervention in ethnically diverse child care centres to address health disparities	Diet, PA and Policy Intervention: Healthy Inside–Healthy Outside intervention involved introducing physical activity and snack policy, for example, creating school menu changes to reduce saturated fat content and having <60 min twice a week of screen time and >60 min of PA/day Homework and resources were sent to parents covering themes, such as how to introduce new foods, increase fruit and veg intake and PA, reduce screen time and modelling healthy eating behaviours.	Teacher component: Teachers and staff were trained on the role and rationale of the HI‐HO programme and were provided lessons to use with the children. Parent component: Monthly group parent educational dinners delivered by dietitians. A nutritionist worked with each child care centre to modify menus to make them compliant with the policies	No significant outcomes	No outcomes reported.
		Control: a visit from an injury prevention education mobile.
		Duration: 6 months
Natale et al., 2017	To evaluate HC2, a theoretically based, multifaceted obesity prevention intervention, targeting low‐income, multiethnic children. To assess whether the combination of two healthy role models; teachers and parents as nutritional gatekeepers would be more effective in maintaining BMI percentile and improving diet quality	Diet, PA and Policy Intervention: The Healthy Caregivers–Healthy Children intervention involved sessions in the first year delivered 6 monthly, and in Years 2 and 3, four booster sessions. The intervention involved environmental changes in line with policies outlined in the AAP Caring for Our Children, 3rd edition, for example, providing water as the main beverage, daily fruit and/or vegetables, physical activity >60 min per day, and screen time <30 min per week. These were used to design lesson plans for the school curriculum and during joint parent‐teacher group sessions, for example, education surrounding healthy food choices, snacks, budgeting, use of food stamps and food labels.	Sessions for children were delivered by trained teachers at the day care centre and the programme staff delivered the joint parent‐teacher group sessions	Significant effect on child BMI percentile: β = −1.95, SE = 0.97, p = 0.04	No significant outcomes in dietary behaviours. Differences in physical activity were not reported
		Control: an attention control injury prevention curriculum delivered by “Safety Sam,” a character who provided parents and teachers with home, car and child seat safety information
		Duration: 2/3 years
Salazar et al. (2014)	To assess the outcomes of a lifestyle intervention for 4–5‐year‐old children attending daycare centres, with the aim of increasing moderate to vigorous PA, reducing energy‐dense foods and body fat	Diet and PA Intervention: Education training delivered to teachers to implement in daycare centres based on Educative Guidelines in Nutrition and Physical Activity resources. Nutritionists and PA teachers provided weekly support. Families attended group sessions once to twice a month and were provided with educational leaflets. Topics included growth, nutrition and daily PA requirements for preschoolers, reducing energy‐dense foods, monitoring regular eating patterns and limiting screen time <1 h/day Control: usual activity Duration: not specified	Teachers received weekly training from nutritionists and PE teachers to deliver nutrition, PA and health promotion education to children and parents during “Healthy Days” group sessions	Significant difference for children with obesity and healthy weight in the IG compared with CG for: (1) fat‐mass index (obesity: −0.3 kg/m2 IG vs. +0.2 kg/m2 CG) (healthy: −0.1 kg/m2 IG vs. +0.1 kg/m2 CG p < 0.01) (2) Fat‐free mass index (obesity: +1.4 kg/m2 IG vs. +0. kg/m2 CG) (healthy: +1.0 kg/m2 IG vs. +0.5 kg/m2 CG p < 0.01) (3). Triceps and subscapular (obesity: −3.2 IG vs. +3.3 CG) (healthy: 1.0 IG vs. +2.0 CG p < 0.01) and (4). (4) Percentage body fat (obesity: −1.5% IG vs. +1.3% CG) (healthy: −0.7% IG vs. +1.0% CG p < 0.01)	Increase in time spent doing vigorous PA, a reduction in moderate PA, fat and energy intake (all p < 0.05). Behavioural changes were not compared between treatment groups.
Stookey et al. (2017)	To determine if the integration of HAP resources into routine public health nursing services significantly increased the number of nutrition and physical activity best practices adopted by childcare centres and improved changes in child obesity measures	Diet, PA and Policy Intervention: CCHP + HAP intervention involving healthy lifestyle promotion training and resources provided to childcare providers to implement the best nutrition and physical activity practices over one year; 16 h of voluntary training, which included menu planning, healthy lifestyle resources provided to parents and age‐appropriate physical activity. The intervention incorporated themes of self‐assessment and practice improvement for centres	CCHP public health nurses or health workers delivered the HAP resources to childcare centre staff in group sessions. Staff members from each childcare provider implemented changes within their centre to parent–infant dyads	Significant reduction in BMI percentile: mean (SE): −2.6 (0.9), p = 0.003 and BMI z‐score: mean (SE): −0.08 (0.03), p = 0.007	Behavioural outcomes were not reported
		Control: usual activity
		Duration: 1 year
Verbestel et al. (2014)	To evaluate the effects of a 1‐year family‐based healthy lifestyle intervention delivered through day‐care centres on children's BMI z‐scores and parental reported physical activity and diet‐related behaviours	Diet and PA Intervention: (1) practical tips relating to target health behaviour topics presented on a poster discussed every 2 months e.g. consumption of sweets, savoury snacks, fruit and vegetables, increasing PA and decreasing screen‐time, drinking milk and water, and (2) a tailored feedback form for parents to report their child's current health‐related behaviours and compare it with current recommendations. Control: control group Duration: 12‐months	Guidelines and tips were presented on a poster, and tailored feedback on activity and diet behaviours were developed by the researchers	At the 12‐month follow‐up, significant reduction in BMI z‐score in the intervention group (1.33–0.38): By time 0.93, p < 0.001 and time‐by‐condition –0.5, p < 0.05	No significant changes in health behaviours post‐ intervention. Significant effects by time were found in both groups: increases in soft drinks (p < 0.01), water (p < 0.01), sweet (p < 0.01) and savoury snacks (p < 0.01), and decreases in fruit (p < 0.01) and vegetable intake (p < .01) over 1 year. No differences in PA.
Walton et al. (2015)	To assess the effectiveness of a family‐based obesity prevention intervention that combined strategies to improve pre‐schoolers' nutrition and physical activity behaviours with an existing, empirically tested general parenting programme.	Diet and PA Intervention: Parents and Tots Together intervention involved weekly 2‐h group sessions. Activities included interactive children's programmes, learning ignore/distract strategies to reduce sugar‐sweetened drinks intake, group discussions and homework, for example, family physical activity, establishing routines, including sleep and identifying hunger/satiety cues	Weekly sessions delivered by trained group facilitators to both parents and infants in a group format	No significant outcomes	No significant outcomes.
		Control: Supervising for Home Safety sessions
		Duration: 9 weeks

Abbreviations: AAP, American Academy of Pediatrics; BMI, body mass index; CCHP, Child Care Health Program; CCHP+HAP, Child Care Health Program Plus Healthy Apple Program; CG, control group; HAP, Healthy Apple Program; HC2, Healthy Caregivers–Healthy Children; HEI, Healthy Eating Index; HS, Head Start; IG, intervention group; IYS, Incredible Years Series; NASA, The National Aeronautics and Space Administration; NQ, nutrition quotient; PA, physical activity; POPS, Preventing Obesity in Preschoolers Series; SoFAAS, calories from solid fat, alcohol and added sugar; SE, standard errors.