Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America.
PLoS One. 2018 Dec 28;13(12):e0209787. doi: 10.1371/journal.pone.0209787. eCollection 2018.
The obesity rate in preschool children in the United States (US) is 13.9%, while even higher rates are associated with racial and ethnic minorities and children from low-income families. These prevalence patterns underscore the need to identify effective childhood obesity prevention programs.
A scoping review was conducted following Arksey and O'Malley's framework to provide an overview of the types, effectiveness and cost-effectiveness of obesity prevention interventions and policies in children up to 6 years old. Inclusion criteria were studies at least 6-months duration; included a weight-based outcome, conducted in the US, English publications from January 2001 to February 2018. Exclusions: studies in overweight/obese children and obesity treatments, no comparator group. Evidence was characterized across the early life course and multiple-levels of influence.
From the 2,180 records identified, 34 met the inclusion criteria. Less than half of the interventions initiated during pregnancy, infancy or preschool reported a significant improvement in a weight-based outcome. All interventions included strategies to influence individual- or interpersonal-level health behaviors, yet few removed obstacles in the healthcare system, physical/built environment, or sociocultural environment. The majority (78%) of the interventions occurred during preschool years, with 63% conducted in early childcare education settings serving low-income families. The health impact of the state-wide and national policies on children under age 6 years remains unclear. There was considerable uncertainty around estimates of the health and economic impacts of obesity prevention interventions and policies.
There is a need to intensify early childhood obesity preventive efforts during critical periods of health development in the US. Future studies should estimate the feasibility, program effectiveness, and cost of implementing multilevel obesity prevention interventions and policies. Addressing these research gaps will provide stakeholders with the scientific evidence necessary to facilitate funding and policy decisions to decrease the prevalence of early childhood obesity.
美国（US）学龄前儿童的肥胖率为 13.9%，而少数族裔和来自低收入家庭的儿童肥胖率更高。这些流行趋势凸显了识别有效儿童肥胖预防计划的必要性。
按照阿克赛和奥马利的框架进行了范围综述，以提供 6 岁以下儿童肥胖预防干预措施和政策的类型、有效性和成本效益的概述。纳入标准是持续至少 6 个月的研究；包括体重相关结果，在美国进行，2001 年 1 月至 2018 年 2 月的英文出版物。排除标准：超重/肥胖儿童和肥胖治疗的研究，无对照组。证据横跨整个生命早期课程和多层次影响。
从确定的 2180 条记录中，有 34 条符合纳入标准。在怀孕期间、婴儿期或学龄前开始的干预措施中，不到一半报告体重相关结果有显著改善。所有干预措施都包括影响个人或人际健康行为的策略，但很少有干预措施消除医疗保健系统、物理/建筑环境或社会文化环境中的障碍。大多数（78%）的干预措施发生在学龄前，其中 63%在为低收入家庭提供的早期儿童保育教育环境中进行。州和全国范围内针对 6 岁以下儿童的政策对儿童健康的影响仍不清楚。肥胖预防干预措施和政策的健康和经济影响的估计存在相当大的不确定性。
美国需要在健康发展的关键时期加强儿童期肥胖的预防工作。未来的研究应估计实施多层次肥胖预防干预措施和政策的可行性、方案有效性和成本。解决这些研究空白将为利益相关者提供必要的科学证据，以促进资金和政策决策，减少儿童早期肥胖的流行。
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