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Gesunde Kitas – starke Kinder

Evidence level:
Best PracticePromising PracticeEmergent Practice
Evidence of Effectiveness:
Enduring Impact:
Review criteria and process

Policy category

Supporting Parenting and Assisting with Childcare, Facilitating Positive Transitions to Adulthood

Recommendation Pillars

Enhance family support and the quality of alternative care settings, Put in place mechanisms that promote children’s participation in decision making that affect their lives

Countries that have implemented practice


Age Groups

Young Children (age 0 to 5)

Target Groups

Parents, Children

Years in Operation

2008  - still operating

Type of Organization Implementing Practice

Other Private Organization

Practice Overview

The gesunde KITAs – starke Kinder, or Healthy Nursery Centers - Strong Children program’s goal is to fight the childhood obesity epidemic in Germany by prevention, particularly among pre-school children. In order to do so, the program teaches children a mix of balanced nutrition, movement, and relaxation, and also fosters an ongoing health dialogue with parents. As opposed to previous anti-obesity programs, Healthy Nurseries puts a strong emphasis on ex-ante prevention and teaching of a healthy way of living, by connecting and integrating the four project components outlined above. After an initial introductory phase of 12-15 months, the components become part of the center’s daily routine. Final implementation is at the discretion of the program staff at a particular site.


While this project was conducted as a pilot only, the positive results were documented across four regions in Germany. However, none of these regions have conducted evaluations that meet the EPIC evaluation criteria. The project components are very well documented and implementation has been conducted carefully, under the supervision of program designers, but the effects of the program have not been evaluated for regions outside the study population at this point.

Evidence of Effectiveness

The program gesunde KITAs – starke Kinder, or Healthy Nursery Centers - Strong Children was first carried-out as a 1.5 year pilot project in 2008-09 across four regions in Germany among a set of nursery centers receiving the program as well as “control” nursery centers which did not receive the program. Program effects were measured using expert responses to questionnaires about nutrition, movement, and relaxation planning and equipment, as well as interactions between parents and administrators on these topics. Responses were given on a 0-4 scale, where four was specified as the best and 0 as the worst outcome. Subsequently, one-tailed t-tests were performed to check for effects that were statistically significantly greater than zero.


Treatment Group

Control Group

Outcomes improved (statistically significant at the 5% level)

Overall nutrition (all scores out of 4)



Nutrition planning and equipment



Interaction between program admins and parents on the topic of nutrition



Overall movement (all scores out of 4)



Movement planning and equipment



Interaction between program Admins and parents on the topic of movement



Overall relaxation (all scores out of 4)



Relaxation planning and equipment



Issues to consider

It is important to note that nursery centers were invited to implement the program on a voluntary basis. After selection of program sites, the control sites were chosen by program administrators to match the treatment groups as closely as possible. Along with the lack of a follow-up, this self-selection of program sites puts severe limits on the ability to generalize study results to a larger population outside the one studied.

Other private organization

Plattform Ernährung und Bewegung e.V. (PEB – Platform for Nutrition and Physical Activity

Evaluation Details

The program was carried out as a pilot project in pre-schools across four regions in Germany in 2008-2009 and ran for 1.5 years at the point of evaluation. Within the regions Bielefeld, Mülheim an der Ruhr, Augsburg and Munich, as well as Halle an der Saale, 46 institutions were selected to participate in the program. As a control group, evaluators looked at 23 comparable institutions that volunteered to take part in the study but chose not to implement the treatment. These control institutions were distributed proportionally across program regions and showed no differences from the treatment groups at baseline, although the baseline characteristics were not specified in great detail. Additionally, evaluation results and program effects were compared to 30 other pre-school projects across the country, that aim to reduce the problem of obesity through at least one of the program components: nutrition, movement, relaxation and parental dialogue.

The study consisted of questionnaires given to a number of program stakeholders, asking questions pertaining to the effect of the program on key outcomes. Experts were asked to rate outcomes in both treatment and control groups on a 0-4 scale, where 4 was the highest and 0 the lowest possible degree to which the objectives were satisfied. In the questionnaires, respondents were asked to give their opinion on both the effects of the program and its implementation.

Additionally, program components were adjusted to the specific pilot centers through an ongoing interaction between program coordinators and pedagogical expert and employees in the pilot nursery centers. This constant adjustment and improvement loop resulted in a better adaptability to regional factors and may provide useful insights for the project’s scalability going forward. Both internal and external experts were asked to rate the key outcomes nutrition, movement and relaxation on a 0-4 scale in both treatment and control institutions. Internal experts in this case are the employees of the nursery centers in question; for this reason, their answers were excluded from the analysis since an upward bias could not be ruled-out conclusively. External experts form their opinions through a five hour visit at one of the locations. Moreover, each program component was divided into three sub-areas: overall effect, planning and equipment, as well as interactions between program areas, and responses were then compared between treatment and control institutions. Lastly, the interactions between the core project elements were measured, asking experts to list the number of meaningful interactions between two or more program components.

Enduring Impact

No follow-up has been conducted for this program. The evaluation was done at a single point in time, without any pre-post design.

Additional information

"KiCo – Kita-Coaches IN FORM" is a follow-up project of “Gesunde Kita ∙ starke Kinder” (2007-2009). Within this new project the approved approach of supporting day-care centres (i.e. “Kitas”) by so called Kita-Coaches is going to be developed further: Multipliers such as nutritionists are going to be qualified in compact workshops so that they can work as Kita-Coaches afterwards. Since the participants of the workshops are not meant to be freelancers but for example employees of municipalities or federal states, they should be able to work as Kita-Coaches not only for the duration of the project but for a longer period. The idea behind the approach of training Kita-Coaches in three federal states is to work more sustainable and to reach more day-care centers both in the short- and long-term.

Available Resources

Program page includes program materials, contact information, evaluation results and study site overview:


Refere Lasson, Andrea, Christine Ulbrich, and Wolfgang Tietze. "Evaluierung des Pilotprojektes gesunde kitas - starke kinder." (2009), available at

Contact Information


Mirko Eichner


Program Contact  gesunde kitas – starke kinder


Plattform Ernaehrung und Bewegung (PEB)