title: Interventions to prevent and manage overweight or obesity in preschool children: A systematic review.
abstract: OBJECTIVE
  The preschool period is a pivotal time for lifestyle interventions to begin the establishment of long-term physical activity and healthy eating habits. This systematic review sought to (a) examine the effects of prevention and management interventions on overweight/obesity among children aged 2-5 years, and (b) explore factors that may influence intervention effects.
  
  
  METHODS
  A systematic review of randomized controlled studies was conducted.
  
  
  METHODS
  Six databases, including PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library, were searched for relevant studies.
  
  
  METHODS
  Data were extracted and checked by two reviewers. Each study was appraised based on 4 quality indicators adapted from the Cochrane Handbook for Systematic Reviews of Interventions. A narrative summary technique was used to describe the review findings.
  
  
  RESULTS
  Thirty-seven articles describing 32 randomized controlled trials and 29 unique interventions were retained. Eight of 23 prevention and 4 of 6 management interventions resulted in significant weight loss, with 3 prevention and 5 management interventions showing sustained effects over 6 to 24 months. Of the 12 efficacious interventions, 10 included physical activity and nutrition components, 9 actively involved parents, and only 4 were theory-based. Interactive education was the most common strategy used for parents in prevention interventions, compared to behavioral therapy techniques in management interventions. For children, interactive education and hands-on experiences involving physical activity and healthy eating were equally used.
  
  
  CONCLUSIONS
  Management interventions showed greater effects in weight loss compared to prevention interventions. Future prevention interventions in preschool children should target both parents and children, and focus on physical activity and nutrition through interactive education and hands-on experiences, although intervention effects were less than optimal. Management interventions should focus on parents as the "agents of change" for physical activity and nutrition while integrating behavioral therapy techniques and interactive education.
authors.affiliation: Michigan State University College of Nursing, 1355 Bogue St., Room C241, East Lansing, MI 48824, United States. Electronic address: jiying.ling@hc.msu.edu.
authors.forename: Jiying
authors.initials: J
authors.lastname: Ling
authors.affiliation: Michigan State University College of Nursing, 1355 Bogue St., Room C245, East Lansing, MI 48824, United States. Electronic address: robbin76@msu.edu.
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Robbins
authors.affiliation: Michigan State University Department of Kinesiology, 308 W. Circle Drive, East Lansing, MI 48823, United States. Electronic address: wenfujun@msu.edu.
authors.forename: Fujun
authors.initials: F
authors.lastname: Wen
mesh_terms: D002675:Child, Preschool; D004435:Eating; D006801:Humans; D009043:Motor Activity; D009765:Obesity / Q000517:prevention & control*; D050177:Overweight / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
keywords: Early intervention; Eating; Motor activity; Pediatric obesity; Systematic review