How successful are healthy eating programmes in preschools, kindergartens and childcare settings?

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Listen to the English podcast here. Spanish version of this podcast here

4 page summary link for practitioners and policy makers here

Key messages

• Healthy eating programmes delivered in early childhood education and care (ECEC) settings (e.g. preschools, kindergarten, family day care) may improve child diet quality, likely increase fruit consumption, may have favourable effects on vegetable consumption, and likely have no impact on consumption of less healthy foods and sugar‐sweetened drinks. They may have favourable effects on child weight and may reduce the risk of being overweight or obese.

• We don't know if healthy eating interventions save money or cause unwanted effects because very few studies provided information about these points.

• We found little evidence from low‐ and middle‐income countries, but healthy eating programmes in high‐income countries may benefit child health. We don't know how to support educators and staff to implement these programmes in practice. We need more research about delivering programmes and about their effect in low‐income countries.

Why is it important to improve young children's diet?

Having a poor diet puts people at risk of many long‐term diseases including heart disease, type 2 diabetes and certain types of cancers. Research estimates that over 11 million deaths worldwide are caused by having an unhealthy diet. Dietary behaviours and preferences are established early in life and persist into adulthood. 

What are healthy eating programmes?

Healthy eating programmes aim to encourage children to eat a healthier diet. They may involve changes to lessons and the culture in preschools, kindergartens and day care centres (early childhood education and care (ECEC) settings), and working with children's families, teachers and healthcare staff. For example, introducing new fruits and vegetables to children, changing the menu to include healthier options or providing families with information about child healthy eating. Healthy eating programmes may establish lifelong healthy eating patterns, reduce excessive weight gain and improve overall health.

What did we want to find out?

We wanted to find out what impact healthy eating interventions have on child diet and health.  We were interested in changes to diet, weight, language and cognitive performance, social, emotional and quality of life outcomes in children aged six months to six years attending preschool, long day care, nurseries, kindergartens and family day care services. We also wanted to know the cost of interventions and whether they had any potential unwanted effects.

What did we do?

We searched for studies that compared healthy eating programmes against no action, delayed delivery of the programme, or a programme that did not aim to change child diet.

We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found 52 studies that looked at the effects of 58 healthy eating programmes in ECEC settings for children aged six months to six years. All studies were published in high and high‐middle‐income countries. The programmes were very different from each other. They:

• lasted from 4 weeks to 3 years;

• were delivered by a range of people including healthcare providers, ECEC staff, and researchers;

• used different delivery methods (telephone, face‐to‐face, online, printed materials); and

• measured results in a variety of ways (e.g. parent or staff surveys, observations of children's eating, and weighing foods before and after meals). 

Overall, the programmes aimed to:

• change the ECEC environment (e.g. staff demonstrated healthy eating to children, and provided healthier foods); 

• change the curriculum (e.g. they provided lessons about foods and healthy eating); and 

• establish partnerships (e.g. they provided educational resources to families); and

• increase children's physical activity (e.g. by structured physical activity lessons and encouraging less screen time). 

Healthy eating programmes may lead to small improvements in child diet quality, increase fruit consumption by 0.11 servings, potentially improve vegetable consumption by 0.12 servings and may have no effect on consumption of less healthy foods and sugar‐sweetened drinks. Further, we found child weight is potentially reduced by 230 g and for every 100 children, 19 would have better weight status. However, we found no evidence of impact on body mass index. The programmes may be cost‐effective and likely to have no unwanted effects, although few studies reported these points. Few studies reported on other learning, social and developmental outcomes.

What are the limitations of the evidence?

Our confidence in the evidence is low because the healthy eating programmes were conducted, delivered and assessed in different ways. Also, many of the people who received the healthy eating programmes were aware that they were being assessed and this can sometimes influence how they report their effects. For example, parents who reported their child's diet may have been more inclined to give positive answers because they felt they were doing what society expected or because they were grateful for the support and wanted to please the researchers. Also, not all studies provided information about everything we were interested in and there was often missing data when children were followed up after the study.

How up‐to‐date is the evidence? 

The evidence is up‐to‐date to February 2022.