self-esteem. (8) Research underscores the importance of physical activity in early childhood. It is not only essential for healthy weight maintenance, but also for practicing and learning fundamental gross motor skills and improving academic achievement. Furthermore, when children have the opportunity for adequate physical activity, they benefit physically, psychologically and socially. (9) Nearly 20 percent (1 in 5) of 2-year-olds spend more than 2 hours of a typical day watching television or videos, and the Journal of the American Medical Association Pediatrics found that each incremental hour of watching television at age 2 is associated with corresponding declines in school engagement, math achievement, and weekend physical activity, and with increases in bullying by classmates, consumption of soft drinks and snacks, and body mass index at age 10. (10) A study published in the New England Journal of Medicine in 2014 found that a third of children overweight in kindergarten had obesity by the eighth grade. Almost every child with severe obesity 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 2016, about 82 percent of United States preschool-aged children were in childcare, and most of their day was spent in sedentary activities. (14) Early care and education centers serve approximately 7,500,000 children 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) More than 122,000