Peer influence on healthy eating and physical activity of preschoolers: A systematic review

Background Approximately 12% of children under the age of five living in developed countries are overweight or obese. It is suggested that preschoolers begin to modify their health-related behaviours during the preschool years as they become exposed to new environments, such as childcare centres. Since children learn by observing and imitating the behaviours of those whom they perceive as similar to themselves, peers may play an important role in promoting healthy eating behaviours and physical activity in young children. This paper systematically reviews how peers influence preschoolers’ behaviours, and how future interventions can include children in the promotion of healthier eating and increase physical activity levels in childcare centres. Methods Six international databases were searched for quantitative, peer-reviewed, English or French primary studies reporting on the correlates, predictors or effectiveness of peers as role models for healthy eating and physical activity in preschoolers. Risk of bias was independently assessed by two evaluators using the Quality Assessment Tool for Quantitative Studies. Results Thirteen articles were included in this review: six measured physical activity, and seven assessed dietary intake. The quality score was rated as weak for nine of these articles, and as moderate for the remaining four. Four of the six physical activity studies reported that children were more physically active when one or more peers were present, compared to being alone, while large peer group size was negatively associated with physical activity in two cross-sectional studies. All nutrition intervention studies reported that children’s eating behaviors may be influenced by their peers’ food choices, preferences and modeling. Conclusions There is low evidence that peers may act as role models to children’s eating and physical activity behaviours, and that the influence of peers may be mediated by the number of peers, sex, age and the perceived status of the peers. Future interventions should target peers as agents for positive eating and physical activity behaviour changes in childcare centres. Key messages Peers could act as role models for promoting healthy eating and physical activity in preschoolers Higher quality experimental studies are needed to confirm these observations

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