ToyBox – a European multi-country study to develop an obesity prevention programme specifically for pre-school children

ToyBox is an EU-funded study (2010-2014) to develop and test an innovative and evidence-based obesity prevention programme for children aged 4-6 years. It aims to expand our knowledge and understanding of the behaviours and their determinants leading to early childhood obesity. Taking into consideration the cultural, legislative and infrastructural diversities in the participating countries, an intervention will be developed to promote healthy food, fun and active play in preschool settings throughout Europe.

Why age 4-6?
Early childhood is a critical period for addressing obesity prevention since behaviours, psychological traits and physiological processes are largely developed or formed at this young age. The development and adoption of the desired behaviours will help to ensure optimum growth during childhood and increase the likelihood of long-term health in adulthood.

What will ToyBox-study do?
The overall goal of ToyBox-study is to promote healthy lifestyles in early childhood in order to prevent obesity. It also aims to guide the scientific community, health and education professionals and policy makers in potentially expanding such initiatives throughout Europe. ToyBox-study will:

  • Identify key behaviours and their determinants related to early childhood obesity; evaluate existing behavioural models and educational strategies that best support behavioural change in this age group; assess environments, policies and legislation affecting the implementation of preschool-based health promotion activities;
  • Develop a preschool-based, family-involved intervention to influence obesity-related behaviours in 4-6 year olds, adjusting for cultural, legislative and infrastructural diversities in the participating countries;
  • Implement the intervention program in 6 European countries, assess its process, impact and outcomes and estimate its cost-effectiveness;
  • Disseminate the results and make recommendations for European public health policy.

Study partners
ToyBox comprises a multidisciplinary team of 15 partners across the EU: a variety of experts will be involved in this project such as public health experts, epidemiologists, nutritionists, physical activity experts, pedagogists, psychologists, behavioural scientists, pediatricians, early childhood psychologists and health economists. The consortium consists of 11 universities, 1 research institute, 2 advocacy groups, and an SME representing all regions of Europe, and all of them have ample experience in conducting and coordinating multi-centre international research as well as understanding dissemination activities to all relevant stakeholders.

Brief guide of intervention 
ToyBox is a kindergarten-based, family-involved intervention, which targets key behaviours related to early childhood obesity i.e. drinking, eating and snacking, physical activity and sedentary behaviour and their determinants, in preschool children from six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).
The ToyBox-intervention was implemented from October 2012 to April 2013 in the latter European countries and had duration of 24 weeks. It focused on four levels:

  • Setting environmental changes in the classroom (Level 1)
  • Children implementing the actual behaviour (water consumption, healthy snacking, physical activity and interruption of sedentary time) in the kindergarten (Level 2)
  • Teachers implementing fun classroom activities (e.g. stories, experiments, games etc) with the active participation of the whole class (Level 3)
  • Actively involving parents to apply environmental changes and implement these lifestyle behaviours together with their children at home (Level 4).

The ToyBox-intervention material included a kangaroo hand-puppet, a Teachers’ General Guide and four Classroom Activities Guides, one for each of the targeted behaviours, which were used in the kindergarten. To involve parents in the intervention, nine newsletters, eight tip-cards and four posters, were included and were handed to the parents throughout the year. In addition, three training sessions for teachers were conducted throughout the year to train the teachers on how to implement the intervention.

More than 300 kindergartens and 7000 children with their parents and their teachers were recruited. The process, impact, outcome and cost-effectiveness of the ToyBox-intervention were assessed via questionnaires and measurements of children’s anthropometric characteristics (height, weight, waist circumference) and physical activity levels (pedometers).