Obesity in Preschoolers: Behavioral Correlates and Directions for Treatment

Abstract

Nearly 14% of American preschoolers (ages 2–5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi‐component, family‐based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.

Effective Interventions in Overweight or Obese Young Children: Systematic Review and Meta-Analysis

“…23 Two systematic reviews were performed describing interventions to prevent or treat obesity in preschool-age children (2-5 years of age). 24,25 Both reviews concluded that it was advisable to address adults (e. g., parents and teachers) or families, rather than children alone, and to employ multicomponent interventions focusing on more than one strategy. 24,25 Given that a metaanalysis was not performed, the overall effectiveness of treatment programs and the characteristics of effective treatment programs for overweight or obese young children are unknown.…”

Implications of fast food restaurant concentration for preschool-aged childhood obesity

“…Yet to date surprisingly little attention has been paid to preschool aged children in the obesity prevention literature (Kuhl, Clifford, & Stark, 2012). Further, the conceptualization of the obesity epidemic has focused much more on individual choice than on environmental factors (Sturm & Cohen, 2009).…”

Strategies for Effective Eating Development—SEEDS: Design of an Obesity Prevention Program to Promote Healthy Food Preferences and Eating Self-Regulation in Children From Low-Income Families

“…36 Numerous programs have been developed, mostly in the school setting, to prevent obesity in children, some of which have had moderate success. 6,7 However, they may be of limited effectiveness for the following reasons: (1) Interventions during the school years do not address child eating patterns developed early in life; (2) interventions that do not involve parents or families limit the sustainability of behavior change; and (3) interventions that focus only on nutrition education and physical activity neglect important parental feeding behaviors that can reduce the likelihood of childhood obesity (eg, encouraging preferences for healthful foods, facilitating self-regulation of energy intake, serving appropriate childsized portions, establishing mealtime routines, and addressing food cues in the larger environment). Although researchers have begun to develop, evaluate, and disseminate family-based obesity prevention programs, 5,37,38 few comprehensive obesity prevention programs exist that focus on the role parents have in developing children's food preferences, food selection, and self-regulation of energy intake.…”

“…[5][6][7] This may be due to the age of the child because the first 5 years are important in the development of child eating behaviors 8 or owing to the lack of inclusion of parents and other family members. The current study will develop and evaluate a novel approach to obesity prevention that will incorporate the family and focus on the self-regulation of eating in young children.…”