activity, and with increases in bullying by classmates, consumption of soft drinks and snacks, and BMI at age 10. (9) About 20 percent of children between 2 and 5 years of age are overweight or obese. (10) A study published in the New England Journal of Medicine in 2014 found that a third of children who were overweight in kindergarten were obese by eighth grade. Almost every child who was very obese remained that way, suggesting that efforts must start much earlier and focus more on the children at greatest risk. (11) A study published in the New England Journal of Medicine in 2017 estimates that over 50 percent of 2-year-olds today will be obese by 35 years of age. (12) A study examining the National Health and Nutrition Examination Survey published in 2018 found an increase in prevalence of childhood obesity in 2015 and 2016. Childhood obesity for children between 2 and 5 years of age increased from 9 percent to 14 percent, the highest increase since 1999. (13) In 2012, three-fourths of United States preschool-aged children were in child care, and most of their day was spent in sedentary activities. (14) Center-based programs serve approximately 6,980,000 children from birth through age 5 years but not yet in kindergarten, making the early childhood care and education setting an important one for promoting healthful habits. (15) Early care and education learning collaboratives in 9 States have reached nearly 156,000 children and improved early childhood care and education provider practices for nutrition and physical activity. (b) Purposes It is the purpose of this Act to— (1) establish a program that will influence practices, policies, and environments in early care and education settings to support healthy eating, physical activity, and screen time reduction for children ages birth through 5 years