Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Twenty-three percent of 2–5 years-old in the United States (US) are estimated to be overweight (BMI≥85th percentile) or obese (BMI≥95th percentile).1 Although rates have decreased over the past decade, these changes have not been experienced equally, and disparities persist for preschoolers from low-income and minority backgrounds.1,2 Excess weight gain in early childhood remains a significant public health concern given immediate physical and psychosocial health consequences (e.g., high blood pressure, run/walk difficulties, peer stigmatization, lower health-related quality of life),3–6 its persistence into adolescence and adulthood,7–9 and the implications for morbidity and mortality in adulthood even when controlling for adult weight status.10 Early intervention (before age 6) is important because the incidence of new onset obesity is greater during kindergarten than any other time in childhood,11 because children overweight at kindergarten are 4 times more likely to become obese later in childhood,11 and because prevention efforts have unclear benefits for preschoolers who already overweight and obese.12–14 A recent comprehensive review of the preschool obesity intervention literature by Foster and colleagues15 concluded multidisciplinary, intensive behavioral programs appear most promising for achieving the goal of obesity reduction in children <6 years-old. The purpose of this paper is to move beyond examining efficacy to explore the current state of the preschool obesity treatment literature by critically evaluating the sociodemographic characteristics of who preschool obesity interventions are reaching (i.e., who is enrolling), which lifestyle behaviors and behavior change strategies are most efficient and effective for yielding improvements in preschooler weight status, and how to best evaluate program effectiveness. Integrated into this discussion is a call to focus on early stage intervention development to address critical gaps in each domain and to concentrate efforts on developing programs for families from low-income and minority backgrounds. The same criteria for intervention inclusion as Foster and colleagues15 were applied for this review: 1) enrolled children ages 0–6 years-old (or tailoring to preschoolers if sample included older children), 2) included measure of weight status, 3) only included children with BMI≥85th percentile. We identified one additional publication16 than Foster and colleagues, bringing the total number of studies included to seven.