Given the high levels of obesity in young children, number of children in out-of-home care, and data suggesting a link between early care and education (ECE) participation and overweight/obesity, obesity prevention in ECE settings is critical. This systematic review covered obesity prevention interventions in center-based ECE settings published between 2010 and 2015. The goal was to identify promising intervention characteristics associated with successful behavioral and anthropometric outcomes. The review used a quality assessment tool for the studies identified, and a coding strategy was developed to assess intervention strength based on the hypothesis that more intensive interventions should yield better outcomes. The review found that 72 percent of the studies with a dietary intake measure demonstrated at least one significant impact. For studies that measured change in physical activity, fitness, or motor skills, 77 percent demonstrated at least one significant impact. Ten of the 24 studies with an anthropometric measure demonstrated at least one successful intervention effect. Relationships between intervention strength and behavioral outcomes demonstrated negative relationships for all behavioral outcomes. The review provides tentative evidence that multi-component, multi-level ECE interventions with parental engagement are most likely to be effective with anthropometric outcomes.