State Childcare Licensing as a Tool to Support Obesity Prevention

Across the country early care and education (ECE) programs, such as childcare centers, large family care homes, and small family care homes, must follow certain regulations to be licensed providers and legally operate.

State-mandated licensing requirements help ensure that health and safety rules are followed by all ECE programs. Licensing regulations can also encourage widespread adoption of science-based practices that promote healthy eating and physical activity. States typically update their licensing regulations about every 3 to 5 years.

By embedding science-based obesity prevention standards into ECE policies and practices, states can equitably invest in a healthier future for their youngest children.

The National Picture

In the last decade, many states have adopted licensing requirements that go beyond traditional health and safety rules to include health-promoting standards, such as infant brain development, emotional well-being, healthy eating, and physical activity.

States have consistently included more obesity prevention standards in ECE regulations over time. From 2010 to 2018, the proportion of high-impact obesity prevention standards fully included in licensing regulations for centers doubled, from about 13% in 2010 to 29% in 2018, when the number of regulations rose to 47.

A Healthy Start: National Trends in Child Care Regulations and Uptake of Obesity Prevention Standards (2010–2018)

Take Action in Your State

Review CDC’s resources to help strengthen childcare policies and practices that support healthy growth through good nutrition, healthy eating behaviors, and physical activity early in life.

Review your state’s 2020 State Licensing Scorecard. Use your state’s licensing scorecards to understand areas for improvement in childcare centers and to help mobilize partners to adopt high-impact obesity prevention policies in licensed ECE programs. The scorecards assess how well a state’s licensing regulations support each of the 47 high-impact obesity prevention standards in child care centers over time and will be updated again in 2023.

See how well your state’s licensing regulations compare to the national average in 6 obesity prevention licensing subdomains:

1. Breastfeeding Support
2. Infant Feeding Practices
3. Nutrition Standards
4. Healthy Mealtime Practices
5. Physical Activity
6. Screen Time Limits

Each year, the National Center for Health & Safety in Early Care & Education releases a report that illustrates how well state licensing regulations support obesity prevention standards. View your state’s 2021 Center-based Child Care Profile [PDF-3.63MB], Large Family Childcare Profile, [PDF-3.30MB], and Small Family Childcare Profile. [PDF-3.63MB].

Finally, see CDC’s Spectrum of Opportunities [PDF-665KB] for more information on how your state’s ECE system can embed recommended standards and support implementation for obesity prevention at both the state and local level.

State Story

In 2021, 12 states revised ECE licensing regulations related to nutrition, physical activity, screen time, or breastfeeding support, according to data from the National Center for Health & Safety in Early Care & Education. Texas made significant progress in 2021, going from a state obesity prevention summary score of 61%¹ in 2020 to 81%². The state now leads the nation in licensing regulations that support high-impact obesity prevention standards. Read more about their story:

With funding from CDC’s State Physical Activity and Nutrition (SPAN) Program, the Texas Department of State Health Services (DSHS) Obesity Prevention Program (OPP) convened early childhood experts from around the state to adopt and implement a standard set of best practices in early care and education settings (ECE).

As a result of these efforts, Texas DSHS OPP was well-positioned to assist and support ECE programs in meeting the new licensing standards established with the passing of Texas Senate Bill 952 in 2019. Senate Bill 952 required that all Texas ECE facilities meet revised minimum standards for breastfeeding support, infant feeding, nutrition, physical activity, and screen time.

These minimum standards align with the science-based High Impact Obesity Prevention Standards for ECEs in Caring for Our Children and USDA’s Child and Adult Care Food Program. Texas DSHS OPP and other state partners supported ECE facilities through several strategies, such as statewide access to an evidence-based intervention to improve healthy policies and practices in ECE settings called Go NAPSACC. As a result of Texas Senate Bill 952 and Texas DSHS OPP’s implementation support, about 14,250 ECE programs and more than 1.1 million children will benefit from these changes. To learn more about the improvements and specific language used in licensing guidance see the next section:

Texas’ Guidance and Support for ECE Providers

This guidance outlines the minimum standards for physical activity, nutrition, and screen time:

• Display of March 2021 Changes for 744: Physical Activity, Nutrition, and Screen Time [PDF-339KB]
• Changes in 747 New Requirements for Tummy Time Supervision in Child-Care Homes [PDF-59.9KB]

To help ECE programs implement licensing regulations, Texas launched a statewide recognition program along with online professional development training and a quality seal for outdoor learning environments:

• Recognition Program: Texas Healthy Building Blocks
• Online Training: Physical Activity Training
• Quality Seal: Outdoor Learning Environments (OLE! Texas)