D.C. needs to create regulations for day care centers that will require kids to get more exercise, according to a new study that points to climbing childhood obesity rates. But the report from Altarum Institute, a nonprofit health care consultancy, also acknowledged that limited space and equipment prevent day cares from doing much more than they are -- and plenty say they are doing enough already.

Mercedes Maddox, director of Kids' Corner Day Center in Northwest, said all her students -- right down to the infants in quad-strollers -- play outside at least twice a day. While the older children kick around balls or play tag, "the toddlers love to chase each other or be chased after." Even when it's cold outside, she said, they play indoor kickball, or Maddox and her teachers create mazes for the kids to navigate.

But despite these high-energy activities D.C. has the highest childhood obesity rate in the country, according to the Centers for Disease Control and Prevention,

Matt Longjohn, co-director of Altarum's Childhood Obesity Prevention Mission Project, pointed out that about one in four D.C. preschool children is obese or overweight. His report cites the District's current day care licensure rules, which require two hours of outdoor activity each day for full-day programs or 30 minutes for part-time programs, as too broad because "activity" can include sedentary pursuits like arts and crafts.

"Making changes to promote physical activity in child care centers will not be a silver bullet to addressing the obesity crisis, but it's an important strategy that should be pursued," the report said.

Vivian Gabor, the report's lead author, acknowledged that limited indoor and outdoor space, play equipment, and access to public parks curtails a day care's ability to provide extensive exercise opportunities: "It won't be a simple fix in the District."

Longjohn and Gabor recommend that policymakers expand physical activity training for child care staff and build more playgrounds with portable play equipment, as well as partner with the Department of Parks and Recreation,the public school system and other community organizations to increase access to safe play space.

Colleen McCarthy, director of private Northwest day care Huckleberry Cheesecake, said that when her students can't get to the park, they play on an indoor trampoline and balance beam.

"Every once in a while we wish we could do a bit more, but for the most part, they seem to get amount of gross motor activities," she said.