Obesity is a major epidemic in the United States that developed relatively rapidly with high increases in the obesity prevalence occurring throughout the 1980s and 1990s.1 Obesity now affects 12% of children 2–5 years of age in the United States.1 These children are at increased risk for a host of health problems during their childhood years (see box) and into adulthood. Obese children are more likely to become obese adults.10-11 Adult obesity is linked with many chronic diseases, including heart disease, diabetes, and some cancers.12,13 Chronic diseases account for 7 of the 10 leading causes of death in the United States and cause suffering, limitations in daily functioning, and reduced quality of life.14 The health costs associated with obesity are staggering. In 2008 dollars, these costs totaled about $147 billion.15

Health Risks of Childhood Obesity

Children who are obese are more likely to have–

  • High blood pressure and high cholesterol, which are risk factors for cardiovascular disease.2 x
  • Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.3 x
  • Breathing problems, such as sleep apnea and asthma.4,5 x
  • Joint problems and musculoskeletal discomfort.4,6 x
  • Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).3,4  
  • Increased risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood.3,7,8

The good news is, improvements in nutrition and physical activity can reduce obesity and lower the risks of many chronic diseases. Healthy eating and activity patterns established in early childhood can carry into adulthood, helping to promote health across the lifespan. The Surgeon General’s Vision for a Healthy and Fit Nation 2010 recognized the importance of early childhood environments in affecting the lives of millions of U.S. children and called for the creation of healthy child care settings.16

CDC has a long history of investing in states and communities to improve health for people of all ages. Through initiatives like the Nutrition, Physical Activity, and Obesity State Programs, Communities Putting Prevention to Work, and the Community Transformation Grants (CTG) program, CDC supports state and local efforts to reduce risk factors for obesity and other chronic diseases. Through the State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health Program17, initiated in 2013, CDC requires all states and the District of Columbia to promote physical activity in the early care and education (ECE) setting.  Many states have elected to implement nutrition standards in ECE through this grant as well.  As health promotion efforts have intensified across the nation we are starting to see significant progress in the extent to which our different environments—where we live, learn, work, and play—support and encourage everyone’s health.

This website presents a roadmap—a “Spectrum of Opportunities”—for states and communities to create healthier environments for young children in the ECE setting to prevent obesity. The information and tools provided are designed to inspire and equip you to take action to improve nutrition, breastfeeding, physical activity, and screen time practices that can help set our youngest Americans off on a path to healthy living.



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  2. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150(1)12-7.e2.
  3. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 2005;116(1):e125-44.
  4. Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet 2010;375(9727):1737-48.
  5. Sutherland ER. Obesity and asthma. Immunol Allergy Clin North Am 2008;28(3):589-602,ix.
  6. Taylor ED, Theim KR, Mirch MC, et al. Orthopedic complications of overweight in children and adolescents. Pediatrics 2006;117(6):2167-74.
  7. Dietz W. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101:518-25.
  8. Swartz MB, Puhl R. Childhood obesity: a societal problem to solve. Obesity Reviews 2003;4(1):57-71.
  9. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr 2010;91(5):1499S-505S.
  10. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. I1997;37(13):869-73.
  11. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-77.
  12. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 1998.
  13. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood overweight to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 2001;108:712-8.
  14. Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). Available from
  15. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs 2009; 28(5):w822-31.
  16. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD: DHHS, Office of the Surgeon General; 2010. Available from
  17. Department Centers for Disease Control and Prevention, State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health.