II 

116TH CONGRESS 

2D SESSION S. 4993 

To amend the Public Health Service Act to promote healthy eating and 

physical activity among children. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 9, 2020 

Mr. BOOKER introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to promote healthy 

eating and physical activity among children. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reducing Obesity in 

5 Youth Act of 2020’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) The COVID–19 pandemic has had serious 

2 impacts on the health and well-being of children and 

3 families. 

4 (2) Unemployment and poverty, likely exacer5 bated by business, school, and childcare closures, 

6 have all contributed to elevated levels of food insecu7 rity, with an estimated 14,000,000 children in the 

8 United States not getting enough to eat. 

9 (3) Millions of children receive free or reduced10 price meals through early childhood education pro11 grams, including school and early care and education 

12 programs such as childcare, Head Start, pre-kinder13 garten, and family childcare, making early childhood 

14 education an important setting for addressing food 

15 insecurity. 

16 (4) More than 30,000,000 children receive free 

17 or reduced-price meals on a daily basis, and access 

18 to both breakfast and lunch can provide some chil19 dren with more than half of their daily caloric in20 take. 

21 (5) Due to financial instability during the 

22 COVID–19 pandemic, there is an increased likeli23 hood of unhealthy weight gain among children as 

24 families shift to less costly, calorically-dense, shelf25 stable foods, rather than fresh foods. 


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1 (6) Research has shown that early childhood is 

2 an important time for developing dietary and phys3 ical activity behaviors that support health and well4 being and that may help prevent obesity. 

5 (7) Children who are exposed to healthy foods 

6 early are more likely develop eating habits that pro7 mote healthy growth that can continue throughout 

8 childhood, and healthy eating can improve a child’s 

9 learning ability, potentially lead to higher academic 

10 performance, improve mental, social, and physical 

11 well-being, and contribute to increased self-esteem. 

12 (8) Research underscores the importance of 

13 physical activity in early childhood. It is not only es14 sential for healthy weight maintenance, but also for 

15 practicing and learning fundamental gross motor 

16 skills and improving academic achievement. Further17 more, when children have the opportunity for ade18 quate physical activity, they benefit physically, psy19 chologically and socially. 

20 (9) Nearly 20 percent (1 in 5) of 2-year-olds 

21 spend more than 2 hours of a typical day watching 

22 television or videos, and the Journal of the American 

23 Medical Association Pediatrics found that each in24 cremental hour of watching television at age 2 is as25 sociated with corresponding declines in school enVerDate Sep 11 2014 03:23 Dec 16, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4993.IS S4993

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1 gagement, math achievement, and weekend physical 

2 activity, and with increases in bullying by class3 mates, consumption of soft drinks and snacks, and 

4 body mass index at age 10. 

5 (10) A study published in the New England 

6 Journal of Medicine in 2014 found that a third of 

7 children with overweight in kindergarten had obesity 

8 by eighth grade. Almost every child with severe obe9 sity remained that way, suggesting that efforts must 

10 start much earlier and focus more on the children at 

11 greatest risk. 

12 (11) A study published in the New England 

13 Journal of Medicine in 2017 estimates that over 50 

14 percent of 2-year-olds today will be obese by 35 

15 years of age. 

16 (12) A study examining the National Health 

17 and Nutrition Examination Survey published in 

18 2018 found an increase in prevalence of childhood 

19 obesity in 2015 and 2016. Childhood obesity for 

20 children between 2 and 5 years of age increased 

21 from 9 percent to 14 percent, the highest increase 

22 since 1999. 

23 (13) In 2016, about 82 percent of United 

24 States preschool-aged children were in childcare, and 

25 most of their day was spent in sedentary activities. 


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1 (14) Early care and education centers serve ap2 proximately 7,500,000 children birth through age 5 

3 years but not yet in kindergarten, making the early 

4 childhood care and education setting an important 

5 one for promoting healthful habits. 

6 (15) More than 122,000 children in 12 States 

7 have benefitted from efforts to support healthier 

8 early care and education programs. This includes 

9 the provision of training and coaching for childcare 

10 providers and technical assistance to State agencies 

11 to integrate nutrition and physical activity best prac12 tices into existing State and local systems. 

13 (b) PURPOSES.—The purposes of this Act are to— 

14 (1) establish a program that will enhance the 

15 training and knowledge of early care and education 

16 providers and influence practices, policies, and envi17 ronments in early care and education settings to 

18 support healthy eating and physical activity for chil19 dren ages birth through 5, including by addressing 

20 the growing threat of food insecurity; 

21 (2) provide support to States on ways to link 

22 early care and education programs to nutrition sup23 ports; 


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1 (3) monitor progress of healthy eating and 

2 physical activity promotion in early care and edu3 cation settings; and 

4 (4) identify emerging, and expand existing, ap5 proaches to engaging families and parents of chil6 dren ages birth to 5 in healthy eating and physical 

7 activity. 

8 SEC. 3. HEALTHY KIDS PROGRAM. 

9 Title III of the Public Health Service Act (42 U.S.C. 

10 241 et seq.) is amended by adding at the end the fol11 lowing: 

12 ‘‘PART W—HEALTHY KIDS PROGRAM 

13 ‘‘SEC. 399OO. DEFINITIONS. 

14 ‘‘In this part: 

15 ‘‘(1) DIRECTOR.—The term ‘Director’ means 

16 the Director of the Centers for Disease Control and 

17 Prevention. 

18 ‘‘(2) EARLY CARE AND EDUCATION.—The term 

19 ‘early care and education’ means programs and ac20 tivities that serve children ages birth through 5 

21 years either through in-home or out-of-home set22 tings, including childcare programs, Head Start pro23 grams, family childcare, and pre-kindergarten pro24 grams. 


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1 ‘‘SEC. 399OO–1. GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary, acting through 

3 the Director of the Centers for Disease Control and Pre4 vention and in coordination with the Assistant Secretary 

5 for the Administration for Children and Families, shall 

6 award 5-year competitive grants to eligible entities to im7 prove healthy eating and physical activity among children 

8 ages birth through 5 years in early care and education 

9 settings. 

10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

11 under subsection (a), an entity shall— 

12 ‘‘(1) be— 

13 ‘‘(A) a nonprofit organization with exper14 tise in early childhood health and childhood obe15 sity prevention; 

16 ‘‘(B) an institution of higher education or 

17 research center that employs faculty with rel18 evant expertise and has expertise in training 

19 early care and education providers; or 

20 ‘‘(C) a consortium of entities described in 

21 subparagraphs (A) and (B) that submit a single 

22 application to carry out activities under the 

23 grant jointly; and 

24 ‘‘(2) submit to the Director an application at 

25 such time, in such manner, and containing such in26 formation as the Director may require. 


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1 ‘‘(c) USE OF FUNDS.— 

2 ‘‘(1) IN GENERAL.—An entity shall use 

3 amounts received under a grant under this section to 

4 work directly with implementing partners, which 

5 may include States, territories, Indian Tribes, mu6 nicipalities, and nonprofit organizations, to— 

7 ‘‘(A) create sustainable programs to train 

8 early care and education providers through di9 rect coaching and peer-learning, access to qual10 ity technical assistance, and professional devel11 opment opportunities that are focused on 

12 healthy eating, physical activity, and addressing 

13 food insecurity; 

14 ‘‘(B) build State capacity through training, 

15 technical assistance, and resources to integrate 

16 the promotion of healthy eating and physical 

17 activity into existing early care and education 

18 programs, systems, and initiatives, including 

19 helping to link early care and education pro20 grams with existing resources for nutrition sup21 ports; and 

22 ‘‘(C) test innovative or evidence-informed 

23 approaches to engage families of children ages 

24 birth to 5 years served in early care and edu25 cation programs participating in this grant. 


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1 ‘‘(2) IMPLEMENTING PARTNERS.—In selecting 

2 States, territories, Indian tribes, municipalities, or 

3 nonprofit organizations to be implementing partners 

4 under a grant under this section, a grantee shall en5 sure that such partners— 

6 ‘‘(A) serve populations that are racially, 

7 ethnically, socioeconomically, and geographically 

8 diverse; and 

9 ‘‘(B) represent a mix of rural and urban 

10 settings. 

11 ‘‘(3) NATIONAL INDEPENDENT EVALUATOR.— 

12 From the amounts appropriated to carry out this 

13 section, and prior to awarding any grants under 

14 paragraph (1), the Director shall enter into a con15 tract with an external entity to create a single, uni16 form process to— 

17 ‘‘(A) ensure that entities that receive 

18 grants under paragraph (1) comply with the re19 quirements of this section; and 

20 ‘‘(B) evaluate the outcomes of the grant 

21 activities carried out by each participating enti22 ty. 

23 ‘‘(d) TRACKING STATE PROGRESS.—The Director 

24 may use amounts appropriated under subsection (f)(2) to 

25 enter into contracts with, or award grants to, institutions 


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1 of higher education, nonprofit organizations, or other enti2 ties with relevant monitoring and surveillance expertise, 

3 for purposes of— 

4 ‘‘(1) tracking State progress in obesity preven5 tion policies and practices of early care and edu6 cation programs in States where grantees are 

7 present; and 

8 ‘‘(2) measuring changes in food security within 

9 exposed groups. 

10 ‘‘(e) REPORT.—Not later than 1 year after the com11 pletion of the programs and activities funded under grants 

12 awarded under this section, the Secretary shall submit to 

13 Congress, and all appropriate agencies, a report con14 cerning an evaluation of the results of such programs, ac15 tivities, and surveillance, including best practices, and les16 sons derived from the experiences of grantees with respect 

17 to reducing and preventing food insecurity and obesity and 

18 overweight among children ages birth through 5 years in 

19 the early care and education settings. 

20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section— 

22 ‘‘(1) $4,500,000 for each of fiscal years 2022 

23 through 2026; and 

24 ‘‘(2) $1,700,000 for fiscal year 2022, to be 

25 used to track State progress in obesity prevention 


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1 policies and practices of early care and education 

2 programs in a sentinel set of States as provided for 

3 in subsection (d).’’. 

Æ 


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