Fair Play a Tavola: a school-based framework integrating nutrition education and anthropometric screening for early identification of excess weight in preschool children

Background Preschool age is a critical yet underexplored period for the early emergence of dietary behaviours and excess weight. Children aged 3–5 years are largely excluded from national nutrition surveillance systems, limiting the timely identification of excess weight and related behavioural patterns. Fair Play a Tavola was conceived to integrate nutrition education with anthropometric screening in preschool settings, providing an early epidemiological overview of lifestyle behaviours and excess weight in preschool children. Methods A multicenter cross-sectional observational study was conducted between October 2023 and February 2025 in 57 preschools in Lazio, Italy. Approximately 5,000 children aged 3–5 years participated in play-based, multisensory-nutrition-education activities, while anthropometric and questionnaire-based analyses were conducted in a subsample with complete data. Anthropometric measurements and a multilingual parent-reported questionnaire assessed growth parameters, dietary habits, physical activity, screen time, sleep, and family characteristics. BMI categories were defined according to WHO 2006–2007 standards. Results The final analytical sample included 1,542 children (48% female; mean age 4.4 ± 0.9 years), of whom 38% showed excess weight (17% at risk of overweight, 14% overweight, 7% obesity). Waist circumference increased progressively across BMI categories ( p < 0.0001), and higher BMI was associated with higher birth weight and higher parental BMI. Parents frequently underestimated their child's weight status, particularly in overweight categories. Physical activity levels were generally low across the cohort, while children with obesity reported higher video game use. Dietary differences across BMI groups were limited but significant for selected food categories, including fish, eggs, processed meats, and fast food. Across the entire population, adherence to national dietary recommendations ( CREA 2018 ) for fruits, vegetables, cereals, and yogurt was consistently low. Conclusions Differences in anthropometric measures and selected parent-reported behaviors were observed across BMI-defined categories. In this cross-sectional study, anthropometric screening conducted within preschool settings allowed the descriptive characterization of excess weight and related behavioural patterns at an early developmental stage. Given the partial participation rates and the absence of longitudinal follow-up, findings should be interpreted descriptively. Further longitudinal and intervention-based studies are required to determine long-term impact and preventive effectiveness.