An educational intervention to prevent overweight in pre-school years - a cluster randomised trial with a focus on disadvantaged families

Oct 3, 2026

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Early prevention is assessed as a strategy to reduce childhood obesity, focusing on pre-school settings as high-value intervention venues. A pragmatic cluster randomised trial evaluated an educational approach aimed at preventing overweight and obesity in pre-school children, combining staff training and centre-level policy evaluation with a 6-month participant activity pack delivered by early years staff. Primary outcome was BMI z-score change from ages 2 to 4 years; parents reported secondary outcomes at baseline and follow-up.

LanguageEnglish

CategoryResearch & Report

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Pages13

Reading Time33 min

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Abstract

Background

Methods

Results

Conclusions

Introduction

Hodgkinson et al. BMC Public Health (2019) 19:1430 [https://doi.org/10.1186/s12889-019-7595-2](https://doi.org/10.1186/s12889-019-7595-2) RESEARCH ARTICLE Open Access An educational intervention to prevent overweight in pre-school years: a cluster randomised trial with a focus on disadvantaged families Alison Hodgkinson 1, Janice Abbott 1*, Margaret A. Hurley2, Nicola Lowe3 and Pamela Qualter4 Abstract Background: Early prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children. Methods: A pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years’ Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child) . At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over 2 years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up. Results: Five pairs of Early Years’ Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families) . At the cluster level, improvement in Centre policies and practices was similar for both groups (p = 0 . 830) . At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p = 0 . 002; change difference 0 .49; 95% CI 0 . 17 to 0 . 80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p = 0 . 582) were similar in both groups. Conclusions: The Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years’ staff can implement the Healthy Heroes programme. Trial registration: ISRCTN22620137 Registered 21st December 2016 . Keywords: Obesity, Early years’ centres, Healthy heroes, Cluster randomised trial, Cluster randomized trial, Parenting * Correspondence: [jabbott@uclan.ac.uk](jabbott@uclan.ac.uk) 1School of Psychology, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK Full list of author information is available at the end of the article © The Author(s) . 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4 .0 International License ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated. Introduction The rising incidence of obesity and in particular childhood obesity is a major public health concern worldwide [1, 2]. In 2016, 11% of 2 to 4-year olds, more than 20% of 4 to 5-year olds and one-third of 11-year olds were overweight or obese in England [3, 4]. Childhood obesity is not only associated with a greater chance of premature death and disability in adulthood [

FAQs

What is the main goal of the educational intervention in this trial?

To prevent overweight and obesity in pre-school children through an educational approach delivered in early years settings.

How were the interventions delivered at the centre and participant levels?

Centre-level staff training used the “Be Active, Eat Healthy” educational resource and assessed policies for healthy eating and physical activity, while participant-level delivery used the “Healthy Heroes Activity Pack” over 6 months by centre staff.

What were the key findings on child BMI z-score?

The intervention group reduced mean BMI z-score between ages 2 and 4 years, while the control group showed increasing BMI z-score; parent-reported outcomes and parent BMI were similar between groups.

Oct 3, 2026

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