title: Lifestyle Interventions in Preschool Children: A Meta-analysis of Effectiveness.
abstract: BACKGROUND
  With healthy behaviors becoming established in the preschool years, intervening with preschool children to assist them in establishing a healthy lifestyle and maintaining a long-term healthy weight is critical. To optimize future intervention designs, this meta-analysis aimed to estimate the effects of lifestyle interventions on BMI among preschool children and explore potential intervention moderators.
  
  
  METHODS
  In October 2015, a search of PubMed, CINAHL, EMBASE, PsycINFO, ERIC, and Cochrane library databases yielded 52 eligible articles with 42 randomized intervention-control comparisons (31 prevention and 11 treatment). In 2016, weighted standardized mean differences for BMI were calculated using random-effects models to estimate effect sizes.
  
  
  RESULTS
  The effect sizes were -0.19 (95% CI=-0.28, -0.09) and -0.28 (95% CI=-0.48, -0.09) kg/m2for prevention and treatment interventions, with sustained effect sizes of -0.21 (95% CI=-0.35, -0.08) and -0.23 (95% CI=-0.43, -0.04) kg/m2, respectively. Child mean age, percentage Hispanic, and parental intervention sessions were common significant moderators. School-based or prevention interventions with active parental involvement did not yield better outcomes. Interventions targeting parents with parenting skill training and behavioral change strategies, and children with general health and nutrition education, resulted in greater effects.
  
  
  CONCLUSIONS
  Although publication bias limits the validity of the study findings, the meta-analysis results highlight the promising intervention approaches of parenting skill training and behavioral change strategies to target parents. However, for children, general health and nutrition education should be employed.
authors.affiliation: Michigan State University College of Nursing, East Lansing, Michigan. Electronic address: jiying.ling@hc.msu.edu.
authors.forename: Jiying
authors.initials: J
authors.lastname: Ling
authors.affiliation: Michigan State University College of Nursing, East Lansing, Michigan.
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Robbins
authors.affiliation: Michigan State University Department of Kinesiology, East Lansing, Michigan.
authors.forename: Fujun
authors.initials: F
authors.lastname: Wen
authors.affiliation: University of Cincinnati Department of Pediatrics, Cincinnati, Ohio.
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
mesh_terms: D032763:Behavior Control / Q000379:methods*; D015992:Body Mass Index; D002675:Child, Preschool; D006266:Health Education; D000070497:Healthy Lifestyle; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010290:Parents / Q000193:education; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012574:Schools; D016896:Treatment Outcome