Unintended Consequences: The potential effect of childcare-based obesity prevention interventions on the home

Background: Numerous policy and environmental change interventions have recently been designed and tested to assess their potential effect on childhood obesity. Several recent reports have suggested that school- and childcare-based interventions have the potential to impact both nutrition and physical activity levels in children. Most of the research on these interventions has not considered behavior outside of these target environments as outcomes, however, despite studies showing that the majority of consumption and physical activity occurs outside of these environments. Methods: A multi-stage search strategy was used to identify papers for review. Intervention studies were eligible for the review if they involved primary prevention of obesity among children age 5 and younger conducted in the preschool or childcare environment. Eligible papers were coded by the author for 1) whether and how authors addressed consumption and/or activity outside the childcare setting; 2) how the authors measured behavior outside the childcare setting, if applicable; and 3) findings about behavior outside the childcare setting, if applicable. Results: Twelve papers describing 10 different interventions were ultimately included in the review. All 10 interventions were traditional primary prevention interventions involving a combination of nutrition education and/or physical activity. The literature reviewed showed that most evaluations are not considering behavior outside the targeted setting as primary outcomes.

Conclusions: The potential effect on behavior away from the primary setting should be considered in future research evaluating the effect of childcare-based environmental change interventions.