Overweight and obesity often begin in early childhood and can have lasting negative effects on health and quality of life. One in eight low-income preschoolers in the U.S. is obese, according to the Centers for Disease Control and Prevention (CDC). Children are five times more likely to be obese as adults if they’re overweight between the ages of three and five years. More than 10.5 million licensed child care slots across the nation are filled primarily by young children,1 including many of the most vulnerable and at- risk children who receive federally subsidized child care.2

In September 2021, the National Resource Center for Health & Safety in Child Care & Early Education (NRC) released its annual report, Achieving a State of Health Weight, highlighting how well states’ licensing regulations for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes align with national obesity prevention recommendations for young children.

Key Findings from the Report include:

• 7 states (Arizona, Arkansas, Delaware, Georgia, Mississippi, North Dakota, and Pennsylvania) adopted early care and education (ECE) licensing regulations that impact healthy eating behaviors and physical activity opportunities in 2020.
• Most of these changes impacted obesity prevention best practices in Large and Small Family Child Care Homes.
• 81% of the revised licensing regulations increased support for obesity prevention best practices.
• Georgia now requires licensed Small Family Child Care homes to follow nutrition guidance in the U.S. Child and Adult Care Food Program (CACFP).
• Washington leads the nation in ECE regulations that support obesity prevention best practices, followed by Tennessee and Delaware.
• Mississippi made regulatory changes that support age-appropriate physical activity practices for infants and toddlers attending licensed child care programs.

Since 1995, the National Resource Center for Health and Safety in Child Care and Early Education (NRC) at the University of Colorado Anschutz College of Nursing has maintained and continues to develop national health and safety standards for early care and education settings and conducted this annual ASHW assessment of new and revised child care regulations across the nation. This 2020 Report determines how state regulations support obesity prevention in licensed ECE programs, highlights state successes, and identifies opportunities for ECE regulations to improve support of obesity prevention in young children. This study is supported by the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, in the National Center for Chronic Disease Prevention and Health Promotion (subcontract #UCDCN-02-4574, awarded by CDC prime contractor McKing Consulting Corporation).