Strategies for Change: Using the Spectrum of Opportunities

The Spectrum of Opportunities illustrates ways states and communities can support ECE facilities to achieve best practices for childhood obesity prevention.


Each opportunity represents a unique avenue to improve nutrition, increase physical activity, support breastfeeding, and reduce screen time. Not all opportunities need to be pursued in each state to achieve impact; however, it is likely that multiple opportunities pursued as part of a coordinated approach will be most effective at achieving desired goals. A number of factors should be considered to help determine which opportunities are viable options to pursue at a specific point in time.

Licensing and Administrative Regulations

Within Licensing and Administrative Regulations, there are several ways to promote healthy nutrition and physical activity. Often times, the first strategy that comes to mind is strengthening licensing standards. While this may be a viable strategy in your state or community, there are several sub-options to take into consideration that extend beyond licensing standards.

Licensing and Administrative Regulations sub-options include:

  1. Improve licensing standards for obesity prevention
  2. Include obesity prevention content in licensing-approved trainings
  3. Provide incentives for providers to exceed licensing standards
  4. Enhance content in licensing commentary/support materials
  5. Use licensing monitors as a technical assistant touch-point
  6. Collect and use data from licensing monitors
  7. Support enhanced local standards (if not pre-empted by the state)

For more details on sub-options, see the Quick Start Action Guide 2.0 .

State Example: How Massachusetts Changed ECE Physical Activity Regulations

Additional Resources:

» Achieving A State of Healthy Weight: National assessment of 47 healthy weight practices present in child care regulations in all 50 states and D.C.

» Early Care and Education Licensing: A tool from the CDC to support obesity prevention efforts

» Foundational Quality Standards for Early Learning Settings: This resource shows the progression of licensing and quality standards in Washington state since 2015

» Interactive Child Care Licensing Map: Public Health Law Center’s map of child care licensing and healthy eating, active play, and screen time

» The Long and Winding Road to Improving Health and Environment: Describes changes since 2015 in the rules for Utah home and center-based licensees

» National Database of Child Care Licensing Regulations: A tool for finding and searching state and territory licensing regulations and agency contacts

» Revising State Licensing Requirements—Readiness for Change: This document poses questions for states and territories to consider as they assess opportunities to revise state licensing

Child Care Food Program (CACFP)

CACFP sub-options:

  1. Increase CACFP participation and retention rates
  2. Promote enhanced standards within CACFP
  3. Support a specific obesity prevention facility-level intervention
  4. Include full obesity prevention content in CACFP trainings
  5. Build technical assistance competencies for obesity prevention
  6. Partner with Sponsoring Organizations to incorporate obesity prevention into their work
  7. Address barriers to full utilization of federal CACFP funds

For more details on sub-options, see the Quick Start Action Guide 2.0

State Examples:

» How West Virginia Successfully Uses CACFP

» Successful CACFP Expansion Campaign in Virginia

Additional Resources

» Child and Adult Care Food Program: On USDA’s website for CACFP, find general information about CACFP, contact information for state agencies, tips for managing CACFP, resources and tools, and more.
» CACFP Training Tools: Colorful and engaging materials can be used to empower CACFP providers and operators with knowledge, skills, and expertise to implement the updated CACFP meal patterns.
» CACFP Resource Library: There are several free resources to support the implementation of CACFP meal patterns that are specifically tailored for ECE settings.
» National CACFP Sponsors Association: A national platform for the CACFP community. Find resources, information about regulations and advocacy, news, events, and conferences.
» Local Food for Little Eaters: A Purchasing Toolbox for CACFP
» USDA Nutrition and Wellness Tips for Young Children: Provider Handbook for CACFP
» Steps to Plan Obesity Prevention Efforts Using CACFP

Quality Rating & Improvement System (QRIS)

QRIS Sub-options:

  1. Include obesity prevention standards
  2. Require/support assessments of policies and practices
  3. Require/support action planning
  4. Strengthen expertise of QRIS coaches/TA providers
  5. Offer incentives to support implementing obesity prevention strategies
  6. Update training and education requirements

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: How Wisconsin Uses the YoungStar Rating System

Additional Resources

» State Quality Rating and Improvement Systems, Strategies to Support Achievement of Healthy Eating and Physical Activity Practices in Early Care and Education Settings: This review examines the implementation supports states offer to providers through QRIS initiatives to promote healthy eating, physical activity, and nutrition best practices.
» Crosswalk of Obesity Prevention Standards in States’ Licensing Regulations and QRIS: States, communities, and other ECE stakeholders can use this resource to identify obesity prevention standards in states’ licensing and QRIS.
» Supporting Obesity Prevention in Statewide Quality Rating and Improvement Systems — A Review of State Standards: This review examines the presence of ‘high-impact’ obesity prevention standards present in states’ QRIS.
» State Efforts to Address Obesity Prevention in Child Care QRIS

» QRIS Compendium: A catalog and comparison of quality initiatives like quality rating and improvement systems
» Steps to Use QRIS in Planning Efforts to Prevent Childhood Obesity

ECE Funding Streams

ECE Funding Streams’ (Subsidy, Pre-K, Head Start) sub-options:

  1. Require obesity prevention requirements in CCDF provider eligibility standards (Subsidy)
  2. Require obesity prevention training in preservice training on obesity prevention (Subsidy)
  3. Require obesity prevention content in annual clock-hour training (Subsidy)
  4. Require parent education and engagement on obesity prevention topics through CCDF (Subsidy)
  5. Promote enhanced standards within state funded programs (Pre-K and Head Start)

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: How Delaware Joined Forces and Found Funding

Additional Resources:

» Child Care and Development Fund Plans
» Steps to Research Funding Opportunities for Childhood Obesity Prevention Strategies

Pre-Service and Professional Development Systems

Pre-Service and Professional Development Systems’ sub-options:

  1. Ensure availability of on-demand obesity prevention trainings are available and approved for CEUs
  2. Require that state’s ECE certification/degree programs include obesity prevention content, standards, and implementation guidance
  3. Ensure optional training in obesity prevention is available within ECE certification/degree programs for those providers interested in going beyond minimum requirements
  4. Ensure that state-approved trainers are qualified to train on current obesity prevention standards and best practices for achieving them

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: How Nevada Provided More Wellness Training for ECE Providers

Additional Resource: Steps to Prevent Obesity by Starting With Child Care and Early Education Provider Training

Statewide Technical Assistance Networks

Statewide Technical Assistance Networks’ sub-options:

  1. Standardize expertise among existing TA network providers and ensure they remain current on obesity prevention standards and best practices for meeting them
  2. Assess and address the need for additional TA providers in the state

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: Minnesota’s Technical Assistance Encourages Providers to Adopt Healthy Policies

Additional Resource: Steps to Use Technical Assistance to Prevent Childhood Obesity in ECE

Statewide Recognition and Intervention Programs

Statewide Recognition and Intervention Programs’ sub-options:

  1. Maintain an ongoing, statewide recognition program that includes obesity prevention requirements
  2. Promote a specific obesity prevention intervention statewide
  3. Make intervention participation incentives available statewide

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: How North Carolina Uses NAP SACC as an Intervention

State Designation and Recognition Programs: 

The CDC’s 2016 Early Care and Education State Indicator Report highlights state level data and information about policy and system supports for obesity prevention in Early Care and Education (ECE) settings. The report applies CDC’s Spectrum of Opportunities and a set of indicators to determine to what extent states are incorporating obesity prevention into broader state systems. Among the “Emerging Opportunities and Process Indicators” is an indicator for states with a recognition or designation process for ECE providers, such as Healthy Child Care Center or Breastfeeding Friendly Child Care. As noted by the report, these programs are typically voluntary and require ECE providers to meet predetermined criteria on a particular topic(s) to receive recognition or designation¹. The CDC report indicated there are 24 states with a recognition program for ECE providers.

Nemours took a closer look at programs in these 24 states:

» Healthy Eating and Physical Activity Recognition Programs

» Breastfeeding Recognition Programs

Additional Resources:

» SNAP-Ed Toolkit: Use this toolkit to find evidence-based interventions to promote healthy nutrition and physical activity

Nutrition and Physical Activity Curricula:

» Color Me Healthy
» Eat Well, Play Hard in Child Care
» Grow It, Try It, Like It
» I Am Moving, I Am Learning

Other toolkits and resources for statewide interventions:

» Nutrition and Physical Activity Self Assessment for Child Care (Go NAP SACC)

» Intervention Strategies: Obesity Prevention Targeting the ECE Setting

» Steps to Use ECE Interventions for Obesity Prevention

Statewide Access Initiatives

Statewide Access Initiatives’ (Farm2ECE) sub-options:

  1. Organize stakeholders statewide to develop access initiatives
  2. Launch or strengthen statewide Farm to ECE initiative
  3. Develop guidance, tools, and incentives for central kitchens
  4. Strengthen fresh food procurement and distribution chains

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: Oregon’s Farm to Preschool Initiative

Additional Resources:

» Farm to Preschool
» Growing Farm to Preschool Toolkit
» Steps to Research Healthy Environments for ECE

Early Learning Standards

Early Learning Standards’ (ELS) sub-options:

  1. Include standards for obesity prevention content areas
  2. Create guidance materials for meeting ELS using obesity prevention strategies

For more details on sub-options, see the Quick Start Action Guide 2.0

State Example: Delaware’s Early Learning Foundations (ELFs)

Additional Resource: Steps to Use Early Learning Standards as Part of a Childhood Obesity Prevention Strategy