Context With 25% of pre-school age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been done since the last systematic review. Objective To systematically review the literature on treatment interventions for overweight or obesity in pre-school age children. Data Sources Medline (1948–July 2014), the Cochrane Central Registry (1991–July 2014), CINAHL (1990–July2014) and PAS abstracts (2000–2014). Study Selection Inclusion criteria were children age 0–6 in the study and adiposity as an outcome. Exclusions were having normal weight children in the trial and not having a comparison group. Data Extraction Data were extracted independently by two authors using a template. Results The initial search yielded 1,981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of six randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multi-disciplinary approach over six months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at six months. One study used education on a dairy-rich diet and showed a possible effect on adiposity. Limitations The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included. Conclusions Multi-disciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in pre-school children.

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Objective: Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices.Methods: In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight.Results: Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups.Conclusions: We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.

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