Family-focused programs remain important, but they cannot prevent childhood obesity on their own. They need to be embedded within routine services and reinforced by coordinated action across communities, sectors and policy.

Early childhood is a critical period for establishing eating, movement and sleep behaviours that may support healthy growth and development and promote lifelong health.

However, the TOPCHILD study, the largest international analysis of early childhood obesity prevention trials to date, found that parent-focused interventions had no effect on children’s weight relative to their height, age and sex (zBMI), and only limited effects on health behaviours during the first two years of life.

Parents and caregivers influence children’s health, but their choices are also shaped by service access, food affordability, working conditions, neighbourhood environments, cultural expectations and government policy. The findings therefore reinforce the need to combine family support with broader service, community and policy action.

We recommend four priorities to strengthen downstream support for families.

1. Build health promotion capacity across routine early childhood services

Early childhood education and care, general practice, and child and family health services have regular contact with most young children and families. These settings provide repeated opportunities to identify concerns early, offer consistent evidence-based advice, and connect families with further support.

Their capacity to promote healthy eating, movement and sleep could be strengthened by embedding role-specific training, practical tools and resources into guidelines and routine service systems, such as child health records, preschool health checks and electronic medical records. Training should also support staff to have practical, culturally responsive and non-judgemental conversations with families.

This would make health promotion more consistent, accessible and sustainable across the services families already use.

2. Co-design support with priority communities and trusted organisations

A ‘one size fits all’ approach will not meet the needs of all families. Advice may be inaccessible, culturally inappropriate or unrealistic for families experiencing financial stress, food insecurity, insecure housing, limited English proficiency or competing health and social priorities.

Programs should be co-designed or adapted with families and trusted organisations, while also considering what is feasible within existing service delivery systems. This helps ensure that support is culturally responsive, accessible and practical to deliver at scale.

3. Improve how intervention impact is understood and measured

Research and evaluation should examine not only whether an intervention works, but how it works, for whom and under what conditions. Although TOPCHILD found no overall effect on children’s zBMI, outcomes varied across individual programs, suggesting that intervention design, delivery and context may influence effectiveness.

Evaluations should therefore identify the program components, reach, engagement, implementation quality and local conditions associated with better outcomes. This would help determine which approaches should be refined, scaled up or discontinued.

They should also use consistent measures of eating, physical activity, sedentary behaviour and sleep alongside BMI, and consider broader outcomes such as child wellbeing and school readiness. This would provide a fuller picture of program impact.

4. Scale effective programs as part of coordinated systems approach

Evidence of program effectiveness alone is not enough. More evidence is needed on the implementation strategies that support uptake, reach, consistent delivery and long-term sustainability.

This includes testing approaches such as workforce training, leadership support, funding models, service integration and partnerships. Evaluations should also consider feasibility, cost, equity, adaptation across settings and the resources required for sustained delivery. Programs could be implemented and evaluated alongside structural actions, such as improving access to services, healthy food and safe places for play, to understand their combined effects.

This evidence would support more informed decisions about how programs are implemented, scaled and integrated with broader system change.

The way forward

Family-focused programs remain an important part of early childhood health promotion, but they are not sufficient on their own.

Rather than abandoning these programs, the priority is to strengthen support for families by embedding it within routine services, designing it with diverse communities, improving how impact is measured, and combining it with sustained policy and environmental action.

A whole-of-child, whole-of-family and whole-of-system approach is needed to create the conditions in which all children can grow and thrive.

Read more here: https://doi.org/10.3389/fpubh.2026.1801182