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Early Care and Education (ECE)

Why is this setting important?

  • With more than 1 in 5 U.S. children ages 2 – 5 years already overweight or obese, prevention efforts must target our youngest children. 1, 2
  • Most young children spend time in care outside of their home, making the ECE setting one of the best places to reach young children with obesity prevention efforts. The use of ECE facilities – including child care centers, day care homes, Head Start programs, preschool and pre-kindergarten programs – has become the norm in the U.S. 3
    • More than 60% of children under 6 years of age are in a non-parental care arrangement on a weekly basis.
    • More than 11 million children under age 6 spend an average of 30 hours in non-parental care, with children of working mothers spending almost 40 hours a week in such care. 4
  • Improving the ECE environment of child care and early education facilities may directly impact what children consume and how active they are, as well as help them develop a foundation of healthy habits for life.
  • ECE is identified as a priority setting for obesity prevention in the “Surgeon General’s Vision for a Healthy and Fit Nation [PDF-840KB].

What is CDC’s framework for obesity prevention in the ECE setting?

CDC’s framework for obesity prevention, in the ECE setting is known as the Spectrum of Opportunities [PDF-287KB]. The Spectrum identifies ways that states, and to some extent communities, can support child care and early education facilities to achieve recommended standards and best practices for obesity prevention. Each opportunity represents a unique avenue that states or communities have worked successfully to change the ECE environment to improve nutrition, breastfeeding support, physical activity, and reduce screen time in ECE facilities.

What are the standards and best practices for obesity prevention targeting the ECE setting?

How does CDC help states and communities address obesity prevention in the ECE setting?

CDC provides funding, training, and technical assistance to a variety of state and community agencies and other organizations to carryout obesity prevention efforts targeting this setting. Key activities include:

  • State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (1305)
    This 5-year cooperative agreement funds all 50 states and the District of Columbia for chronic disease prevention efforts. All grant recipients are required to promote physical activity in the ECE setting and many are also implementing nutrition standards in this setting.
  • Early Childcare and Education Obesity Prevention Program
    This cooperative agreement with Nemours  Children’s Health System (Nemours)  supports partnerships with state public health and ECE leaders to: 1) make state-wide improvements in their early care and education system by  incorporating obesity prevention strategies; and 2) to support a targeted group  of ECE providers to make facility-wide improvements using a learning  collaboratives intervention. These activities help providers support  breastfeeding, healthy eating and physical activity for children in their ECE facilities. Since FY12, we have reached ECE  systems and programs in 10 states – Alabama, Arizona, California,  Florida, Indiana, Kansas, Kentucky, Missouri, New Jersey, and Virginia.
  • Childhood Obesity Research Demonstration Project (CORD)
    This 4-year cooperative agreement research demonstration project provides funding to 3 grantees to determine better ways to improve children’s nutrition and physical activity behaviors in the places where they live, learn, and play through a multilevel, multi-sector approach. CORD targets children aged 2–12 years covered by the Children’s Health Insurance Program. CORD project grantees are working with 60 ECEs located in Texas, California, and Massachusetts to provide training, technical assistance, and support to CORD intervention ECE centers.
  • Early Care and Education Research and Evaluation Working Group [PDF-278KB]
    The Early Care and Education working group focuses on improving the health of young children through improved research and practice in out-of-home care settings. The working group is a collaborative effort of the Robert Wood Johnson Foundation’s Healthy Eating Research (HER) and Active Living Research (ALR) programs and the CDC’s Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) and Physical Activity Policy Research Network (PAPRN).
  • Monthly Obesity Prevention in ECE Networking Call and News blast: This national networking group brings together early care and education professionals from a variety of settings (health departments, universities, non-profits, etc.) to share expertise and resources around improved nutrition, physical activity, and obesity prevention in the ECE setting. To join this networking group and to receive monthly ECE news blasts, please email Information on accessing archived recordings of calls is available here.

How does CDC support national obesity prevention initiatives targeting the ECE setting?

Photo: Children eating while adults supervise
  • CDC co-leads the Healthy Kids, Healthy Future National Steering Committee: a public-private partnership dedicated to advancing research, policies, and practices that promote obesity prevention in the ECE setting.
  • CDC collaborates with the National Farm to School Network Farm to Preschool Subcommittee to promote best practices, research and evaluation in farm to preschool programs. Farm to Preschool program activities include purchasing local food for snacks or meals, garden-based education, cooking demonstrations, classroom visits from farmers and more. These activities help to shape early taste preferences and create healthy eating habits to last a lifetime. Resources are available at the Farm to Preschool Website.

Key Resources and Publications

In this area, you will find key resources and publications that may help you and your organization make positive changes to early care and education.


  1. Ogden CL, Carroll MD, Kit BK, Flegal KM.
    Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806-814.
  2. Cunningham SA, Kramer MR, Narayan KM. Incidence of Childhood Obesity in the United States, N Engl J Med 2014;370(5) 403-411.
  3. Early Childhood Program Participation Survey of the National Household Education Surveys Program (ECPP-NHES:2005) National Center for Education Statistics Web site. Available from Accessed 2014 Jan 2.
  4. Early Childhood Program Participation Survey of the National Household Education Surveys Program (ECPP-NHES:2005). National Center for Education Statistics Web site. Accessed January 2, 2014.