Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Association of childcare arrangement with overweight and obesity in preschool-aged children: a narrative review of literature

International Journal of Obesity volume 41, pages 1–12 (2017)Cite this article

Subjects

Abstract

The time children spend in childcare overlaps with daily meals and opportunities to be active. Thus these environments have the opportunity to promote—or hinder—healthy weight gain among children who attend them. The purpose of this narrative review was to compile findings from studies examining childcare type and weight outcomes among preschool-age children. A literature search was conducted using PubMed, PsychInfo and ERIC. Inclusion criteria were infant- to 5-year-old children exposed to any type of childcare with a cross-sectional or longitudinal weight outcome. Among 385 studies screened, 18 were included. For comparison across studies, type of childcare was categorized as: childcare center, Head Start, nanny/babysitter, non-relative care/family childcare home and relative care. Four studies found no association with childcare type and obesity, and 10 studies reported mixed results by type of care or subpopulation analyses. Two studies found an overall positive association, and two reported an inverse association. There were differences in direction of associations and findings by type of care arrangement. For Head Start, three of eight studies demonstrated a negative relationship with obesity; none demonstrated a positive association. No other childcare type demonstrated this inverse association. Informal types of care (relative and non-relative care in a home) were positively associated with child obesity in 3 of 10 studies. This association was less commonly reported among formal childcare centers (2 of 15 studies). The majority of studies, however, reported mixed findings or no association by childcare type. Results suggested no consistent evidence for a relationship between childcare and obesity risk, except Head Start. This review exposed the need for a consistent definition of childcare type and the exploration of unmeasured confounders, such as the nutrition and physical activity environment of childcare settings, to understand how they contribute to or protect against the development of overweight/obesity among children.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. de Onis M, Blossner M, Borghi E . Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92: 1257–1264.

    Article  CAS  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311: 806–814.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Boyle MAH, David H . Community Nutrition in Action: An Entrepreneurial Approach, 6th edn . Wadsworth Cengage Learning: CA, USA, 2013.

    Google Scholar 

  4. Biro FM, Wien M . Childhood obesity and adult morbidities. Am J Clin Nutr 2010; 91: 1499S–1505SS.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dietz WH . Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998; 101 (3 Pt 2): 518–525.

    CAS  PubMed  Google Scholar 

  6. Geoffroy MC, Power C, Touchette E, Dubois L, Boivin M, Seguin JR et al. Childcare and overweight or obesity over 10 years of follow-up. J Pediatr 2013; 162: 753–8 e1.

    Article  PubMed  Google Scholar 

  7. Benjamin SE, Rifas-Shiman SL, Taveras EM, Haines J, Finkelstein J, Kleinman K et al. Early child care and adiposity at ages 1 and 3 years. Pediatrics 2009; 124: 555–562.

    Article  PubMed  Google Scholar 

  8. McGrady ME, Mitchell MJ, Theodore SN, Sersion B, Holtzapple E . Preschool participation and BMI at kindergarten entry: the case for early behavioral intervention. J Obesity 2010; 2010: 360407.

    Article  Google Scholar 

  9. McLaren L, Zarrabi M, Dutton DJ, Auld MC, Emery JC . Child care: implications for overweight/obesity in Canadian children? Chronic Dis Inj Canada 2012; 33: 1–11.

    CAS  Google Scholar 

  10. Pearce A, Li L, Abbas J, Ferguson B, Graham H, Law C et al. Is childcare associated with the risk of overweight and obesity in the early years? Findings from the UK Millennium Cohort Study. Int J Obes 2010; 34: 1160–1168.

    Article  CAS  Google Scholar 

  11. Frisvold DE, Lumeng JC . Can increasing the daily duration of head start reduce childhood obesity? J Hum Resour 2011; 46: 373–402.

    Google Scholar 

  12. Lee R, Zhai F, Han WJ, Brooks-Gunn J, Waldfogel J . Head Start and children's nutrition, weight, and health care receipt. Early Child Res Q 2013; 28: 723–733.

    Article  Google Scholar 

  13. Lumeng JC, Gannon K, Appugliese D, Cabral HJ, Zuckerman B . Preschool child care and risk of overweight in 6- to 12-year-old children. Int J Obes 2005; 29: 60–66.

    Article  CAS  Google Scholar 

  14. Lumeng JC, Kaciroti N, Sturza J, Krusky AM, Miller AL, Peterson KE et al. Changes in body mass index associated with head start participation. Pediatrics 2015; 135: e449–e456.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Capizzano J, Main R . Many Young Children Spend Long Hours in Child Care. The Urban Institute: Washington, DC, 2005.

    Book  Google Scholar 

  16. Laughlin L Who’s Minding the Kids?: Child Care Arrangements, Spring 2011, US Department of Commerce, Bureau of the Census: Washington, DC, USA, 2013.

  17. Benjamin Neelon SE, Briley ME . American Dietetic A. Position of the American Dietetic Association: benchmarks for nutrition in child care. J Am Diet Assoc 2011; 111: 607–615.

    Article  PubMed  Google Scholar 

  18. Copeland KA, Khoury JC, Kalkwarf HJ . Child care center characteristics associated with preschoolers' physical activity. Am J Prev Med 2016; 50: 470–479.

    Article  PubMed  Google Scholar 

  19. Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M . Physical activity among children attending preschools. Pediatrics 2004; 114: 1258–1263.

    Article  PubMed  Google Scholar 

  20. Mamedova S, Redford J Early Childhood Program Participation, From the National Household Education Surveys Program of 2012, National Center for Education Statistics, Institute of Education Sciences, United States Department of Education: Washington, DC, USA, 2015.

  21. Waldfogel J . International policies toward parental leave and child care. Future Child 2001; 11: 98–111.

    Article  CAS  PubMed  Google Scholar 

  22. Lin SL, Leung GM, Hui LL, Lam TH, Schooling CM . Is informal child care associated with childhood obesity? Evidence from Hong Kong's ‘Children of 1997’ birth cohort. Int J Epidemiol 2011; 40: 1238–1246.

    Article  PubMed  Google Scholar 

  23. Story M, Kaphingst KM, French S . The role of child care settings in obesity prevention. Future Child 2006; 16: 143–168.

    Article  PubMed  Google Scholar 

  24. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P . Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007; 7: 16.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Belfield CR, Kelly IR . Early education and health outcomes of a 2001 U.S. birth cohort. Econ Hum Biol 2013; 11: 310–325.

    Article  PubMed  Google Scholar 

  26. Kimbro RT, Brooks-Gunn J, McLanahan S . Racial and ethnic differentials in overweight and obesity among 3-year-old children. Am J Public Health 2007; 97: 298–305.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gubbels JS, Kremers SP, Stafleu A, Dagnelie PC, de Vries NK, van Buuren S et al. Child-care use and the association with body mass index and overweight in children from 7 months to 2 years of age. Int J Obes 2010; 34: 1480–1486.

    Article  CAS  Google Scholar 

  28. Maher EJ, Li G, Carter L, Johnson DB . Preschool child care participation and obesity at the start of kindergarten. Pediatrics 2008; 122: 322–330.

    Article  PubMed  Google Scholar 

  29. Mandal B, Powell LM . Child care choices, food intake, and children's obesity status in the United States. Econ Hum Biol 2014; 14: 50–61.

    Article  PubMed  Google Scholar 

  30. O'Brien M, Nader PR, Houts RM, Bradley R, Friedman SL, Belsky J et al. The ecology of childhood overweight: a 12-year longitudinal analysis. Int J Obes 2007; 31: 1469–1478.

    Article  CAS  Google Scholar 

  31. Rapp K, Schick KH, Bode H, Weiland SK . Type of kindergarten and other potential determinants of overweight in pre-school children. Public Health Nutr 2005; 8: 642–649.

    Article  CAS  PubMed  Google Scholar 

  32. Zahir N, Heyman MB, Wojcicki JM . No association between childcare and obesity at age 4 in low-income Latino children. Pediatr Obes 2013; 8: e24–e28.

    Article  CAS  PubMed  Google Scholar 

  33. Sisson SB, Li J, Stoner JA, Lora KL, Campbell JE, Arnold SH et al. Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children. Prev Med Rep 2016; 3: 151–158.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gubbels JS, Kremers SP, Stafleu A, Dagnelie PC, de Vries NK, Thijs C . Child-care environment and dietary intake of 2- and 3-year-old children. J Hum Nutr Diet 2010; 23: 97–101.

    Article  CAS  PubMed  Google Scholar 

  35. Gubbels JS, Kremers SP, van Kann DH, Stafleu A, Candel MJ, Dagnelie PC et al. Interaction between physical environment, social environment, and child characteristics in determining physical activity at child care. Health Psychol 2011; 30: 84–90.

    Article  PubMed  Google Scholar 

  36. Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS . The childcare environment and children's physical activity. Am J Prev Med 2008; 34: 23–29.

    Article  PubMed  Google Scholar 

  37. Lyn R, Maalouf J, Evers S, Davis J, Griffin M . Nutrition and physical activity in child care centers: the impact of a wellness policy initiative on environment and policy assessment and observation outcomes, 2011. Prev Chronic Dis 2013; 10: E83.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Vanderloo LM, Tucker P, Johnson AM, van Zandvoort MM, Burke SM, Irwin JD . The influence of centre-based childcare on preschoolers' physical activity levels: a cross-sectional study. Int J Envir Res Pub Health 2014; 11: 1794–1802.

    Article  Google Scholar 

  39. Dowda M, Brown WH, McIver KL, Pfeiffer KA, O'Neill JR, Addy CL et al. Policies and characteristics of the preschool environment and physical activity of young children. Pediatrics 2009; 123: e261–e266.

    Article  PubMed  Google Scholar 

  40. Erinosho TO, Ball SC, Hanson PP, Vaughn AE, Ward DS . Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005. J Acad Nutr Diet 2013; 113: 1084–1089.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Benjamin Neelon SE, Vaughn A, Ball SC, McWilliams C, Ward DS . Nutrition practices and mealtime environments of North Carolina child care centers. Child Obes 2012; 8: 216–223.

    Article  PubMed  Google Scholar 

  42. Kharofa RY, Kalkwarf HJ, Khoury JC, Copeland KA . Are mealtime best practice guidelines for child care centers associated with energy, vegetable, and fruit intake? Child Obes 2016; 12: 52–58.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gubbels JS, Van Kann DHH, Jansen MWJ . Play equipment, physical activity opportunities, and children's activity levels at childcare. J Environ Public Health 2012; 2012: 326520.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cardon G, Van Cauwenberghe E, Labarque V, Haerens L, De Bourdeaudhuij I . The contribution of preschool playground factors in explaining children's physical activity during recess. Int J Behav Nutr Phys Act 2008; 5: 11.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Whitaker RC, Gooze RA, Hughes CC, Finkelstein DM . A national survey of obesity prevention practices in Head Start. Arch Pediatr Adolesc Med 2009; 163: 1144–1150.

    PubMed  Google Scholar 

  46. Gunter KB, Rice KR, Ward DS, Trost SG . Factors associated with physical activity in children attending family child care homes. Prev Med 2012; 54: 131–133.

    Article  PubMed  Google Scholar 

  47. Kaphingst KM, Story M . Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States. Prev Chronic Dis 2009; 6: A11.

    PubMed  Google Scholar 

  48. Tandon PS, Zhou C, Christakis DA . The frequency of outdoor play for preschool age children cared for at home-based child care settings. Acad Pediatr 2012; 12: 475–480.

    Article  PubMed  Google Scholar 

  49. Davison K, Jurkowski J, Li K, Kranz S, Lawson H . A childhood obesity intervention developed by families for families: results from a pilot study. Int J Behav Nutr Phys Act 2013; 10: 3.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Boles RE, Burdell A, Johnson SL, Gavin WJ, Davies PL, Bellows LL . Home food and activity assessment. Development and validation of an instrument for diverse families of young children. Appetite 2014; 80: 23–27.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Head Start Program Performance Standards and Other Regulations: Administration for Children and Families Web site. (cited 3 March 2016). Available at http://eclkc.ohs.acf.hhs.gov/hslc/standards/hspps.

Download references

Acknowledgements

We thank the Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine. KS was supported by the College of Allied Health, Department of Nutritional Sciences at the University of Oklahoma Health Sciences Center.

Author contributions

KAC was responsible for study inception and design, literature search, literature extraction, generation of tables and writing assistance; KS was responsible for the literature search, literature and data organization, literature synthesis, generation of tables and writing of the manuscript; SBS was responsible for article synthesis, generation of tables, literature preparation, review and writing assistance; KL was responsible for reviewing, providing critical content input and editorial assistance; SC was responsible for reviewing, providing critical content input and editorial assistance. All authors were involved in writing the paper and approved the submitted and published versions.

Author information

Authors and Affiliations

  1. Department of Nutritional Sciences, Behavioral Nutrition and Physical Activity Laboratory, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    K Swyden, S B Sisson & K Lora

  2. Center for Public Health and Health Policy, University of Connecticut Health, Farmington, CT, USA

    K Lora

  3. Early Childhood Education Institute, University of Oklahoma, Tulsa, OK, USA

    S Castle

  4. Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    K A Copeland

Authors
  1. K Swyden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S B Sisson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Lora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Castle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K A Copeland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S B Sisson.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swyden, K., Sisson, S., Lora, K. et al. Association of childcare arrangement with overweight and obesity in preschool-aged children: a narrative review of literature. Int J Obes 41, 1–12 (2017). https://doi.org/10.1038/ijo.2016.198

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2016.198

This article is cited by

Search

Advanced search

Quick links