II 

112TH CONGRESS 

2D SESSION S. 2119 

To establish a pilot program to address overweight/obesity among children 

from birth to age 5 in child care settings and to encourage parental 

engagement. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 16, 2012 

Mr. UDALL of Colorado (for himself, Mr. CARPER, Mr. COONS, Mr. FRANKEN, 

and Mr. UDALL of New Mexico) introduced the following bill; which was 

read twice and referred to the Committee on Health, Education, Labor, 

and Pensions 

A BILL 

To establish a pilot program to address overweight/obesity 

among children from birth to age 5 in child care settings 

and to encourage parental engagement. 

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 ‘‘Healthy Kids from 

5 Day One Act’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

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


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1 (1) Preschool years are a critical time for deter2 mining whether or not an individual will develop obe3 sity later in life. 

4 (2) The Journal of Clinical Pediatrics reports 

5 that the ‘‘tipping point’’ in obesity often occurs be6 fore 2 years of age, and sometimes as early as 3 

7 months, when the child is learning how much and 

8 what to eat. 

9 (3) Aerobic fitness and healthy eating patterns 

10 support enhanced behavioral, emotional, and aca11 demic performance in school. 

12 (4) More than 21 percent of preschool children 

13 are overweight or obese. 

14 (5) A 2009 preschool study found that 89 per15 cent of a preschooler’s day is sedentary. 

16 (6) The amount of time children spend outdoors 

17 is dwindling rapidly, as evidenced by studies showing 

18 that children enjoy half the outdoor time they did 

19 just 20 years ago. Meanwhile, children are spending 

20 nearly 8 hours per day in front of electronic media. 

21 (7) Studies indicate that children who are over22 weight at age 5 are more likely to be more over23 weight at age 9. 

24 (8) Rates of obesity are higher for African25 American, Latino, Native American, and Native 


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1 Alaskan children than the overall population of the 

2 children in the United States. 

3 (9) Children who are obese have a greater like4 lihood of being obese in adulthood and developing 

5 heart disease, diabetes, and other chronic conditions. 

6 (10) In 2005, 61 percent of children from birth 

7 through age 6 who were not yet in kindergarten 

8 (about 12,000,000 children) received some form of 

9 child care on a regular basis from persons other 

10 than their parents. 

11 (11) A 2008 survey by the National Association 

12 of Child Care Resource and Referral Agencies re13 ported that 93 percent of parents thought existing 

14 health and safety standards for child care should be 

15 improved. 

16 (12) Child care centers, family child care 

17 homes, and other early learning environments should 

18 serve as settings where children adopt healthy eating 

19 habits and have opportunities for age appropriate 

20 physical activity. 

21 (13) Age-appropriate physical activity in the 

22 outdoors, in particular, can produce immense phys23 ical, mental and emotional health benefits, including 

24 addressing childhood obesity, decreasing symptoms 

25 of attention deficit and hyperactivity disorder, imVerDate Mar 15 2010 00:46 Feb 17, 2012 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2119.IS S2119

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1 proving motor skills, stimulating brain development, 

2 increasing creativity and quality sleep, and reducing 

3 the risk of developing myopia. 

4 (14) The governmental, nonprofit, and private 

5 sectors came together to launch Let’s Move Child 

6 Care, a voluntary effort to work with child care pro7 viders to help children get off to a healthy start 

8 through healthy eating, physical activity, and screen 

9 time reduction strategies. Learning collaboratives 

10 that build upon these key elements will assist pro11 viders and parents in giving children the foundation 

12 they need for a healthy life. 

13 (b) PURPOSES.—It is the purpose of this Act to— 

14 (1) establish a 3-year pilot program in 5 States 

15 representing a diversity of rural and urban environ16 ments that will support child care collaboratives de17 signed to reduce the prevalence of overweight/obesity 

18 among children from birth to age 5 in child care set19 tings through dissemination of available tools and 

20 curricula and implementation of emerging best prac21 tices; 

22 (2) enhance the focus of child care centers and 

23 family child care homes serving the population of 

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1 formed policies and practices to improve healthy eat2 ing, physical activity, and screen time limits; and 

3 (3) upon completion of the 3-year period, termi4 nate the pilot program and disseminate the best 

5 practices and lessons learned from the pilot program 

6 through other systems, programs, or partnerships. 

7 SEC. 3. HEALTHY KIDS PROGRAM. 

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

9 241 et seq.) is amended by adding at the end the fol10 lowing: 

11 ‘‘PART W—HEALTHY KIDS PROGRAM 

12 ‘‘SEC. 399OO. DEFINITIONS. 

13 ‘‘In this part: 

14 ‘‘(1) CHILD CARE CENTER.—The term ‘child 

15 care center’ means a center licensed or otherwise au16 thorized to provide child care and services for fewer 

17 than 24 hours per day per child in a non-residential 

18 setting, unless care in excess of 24 hours is due to 

19 the nature of the parents’ work. 

20 ‘‘(2) EARLY LEARNING COUNCIL.—The term 

21 ‘early learning council’ means an early childhood as22 sembly that is established to advise governors, State 

23 legislators, or State agency administrators on how 

24 best to meet the needs of young children and their 


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1 families specifically through improvement of pro2 grams and services. 

3 ‘‘(3) FAMILY CHILD CARE HOME.—The term 

4 ‘family child care home’ means a private family 

5 home where home-based child care is provided for a 

6 portion of the day, unless care in excess of 24 hours 

7 is due to the nature of the parents’ work, and that 

8 is certified, registered, or licensed in the State in 

9 which it is located. 

10 ‘‘(4) SCREEN TIME LIMITS.—The term ‘screen 

11 time limits’ means policies or guidelines, such as 

12 those developed by the American Academy of Pediat13 rics, designed to reduce the daily amount of time 

14 that children spend watching or looking at digital 

15 monitors or displays, including television sets, com16 puter monitors, or hand-held gaming devices. 

17 ‘‘(5) STATE.—Notwithstanding section 2(f), the 

18 term ‘State’ means— 

19 ‘‘(A) each of the several States; 

20 ‘‘(B) the District of Columbia; 

21 ‘‘(C) an Indian tribe or tribal organization; 

22 ‘‘(D) the Commonwealth of Puerto Rico; 

23 and 

24 ‘‘(E) any other territory or possession of 

25 the United States. 


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1 ‘‘SEC. 399OO–1. GRANTS. 

2 ‘‘(a) IN GENERAL.— 

3 ‘‘(1) IN GENERAL.—The Secretary, in consulta4 tion with appropriate entities within the Department 

5 of Health and Human Services, shall award 3-year 

6 competitive grants to 5 eligible entities to help re7 duce and prevent obesity among the population of 

8 children from birth to age 5 in a State and to en9 courage parental engagement in child care settings 

10 outside a child’s place of residence. 

11 ‘‘(2) ELIGIBLE ENTITIES.—To be an eligible 

12 entity under paragraph (1), an entity shall be— 

13 ‘‘(A) a State health department (or other 

14 appropriate child care licensing entities within 

15 such State); or 

16 ‘‘(B) a nonprofit organization or a partner17 ship of nonprofit organizations with expertise in 

18 the healthy development of children. 

19 ‘‘(b) USE OF FUNDS.— 

20 ‘‘(1) IN GENERAL.—Grantees shall use amounts 

21 received under a grant under this subsection— 

22 ‘‘(A)(i) to establish one or more child care 

23 collaboratives consisting of the center director 

24 and staff members from multiple child care 

25 sites and family child care homes; 


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1 ‘‘(ii) in the case of a State grantee, to con2 tract with a nonprofit organization in the State 

3 with expertise in the healthy development of 

4 children to establish the collaborative or 

5 collaboratives; or 

6 ‘‘(iii) to provide funding to an entity that 

7 routinely trains child care providers to establish 

8 the collaborative or collaboratives; and 

9 ‘‘(B) to provide or contract with the orga10 nizer of the collaborative or collaboratives to 

11 provide— 

12 ‘‘(i) technical assistance, including on13 site assistance when appropriate, to the 

14 child care providers participating in the 

15 collaborative; 

16 ‘‘(ii) a compilation of best practices, 

17 strategies, and lessons learned from the 

18 collaborative, to be reported annually to 

19 the Secretary; and 

20 ‘‘(iii) a plan to ensure that the col21 laborative will be sustainable, without addi22 tional Federal funding, upon the conclu23 sion of the 3-year pilot program. 

24 ‘‘(2) COLLABORATIVES.—Each collaborative es25 tablished under clause (i), (ii), or (iii) of paragraph 


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1 (1)(A) shall share best practices, strategies, and 

2 techniques for successfully implementing evidence3 based or data-informed policies and practices relat4 ing to healthy eating, physical activity, parental en5 gagement, and other topics, such as breastfeeding, 

6 relating to the healthy development of children, 

7 using available curricula, tools, and other interven8 tions. 

9 ‘‘(3) CONTENT OF PLAN.—The plan described 

10 under paragraph (1)(B)(iii) may include the incorpo11 ration of the best practices, strategies, and tech12 niques described in paragraph (2) into the training 

13 and professional development for child care providers 

14 in the State or other approaches determined appro15 priate by the State and the Secretary. 

16 ‘‘(c) COLLABORATIVE TRAINING REQUIREMENTS.— 

17 ‘‘(1) IN GENERAL.—Collaboratives shall incor18 porate no less than 5 and no more than 10 daylong, 

19 interactive training sessions each year and ongoing 

20 technical assistance to the child care providers par21 ticipating in the collaborative that include— 

22 ‘‘(A) the provision and discussion of infor23 mation concerning implementation by the child 

24 care providers of age-appropriate healthy eating 

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1 able tools and culturally competent curricula for 

2 population of children from birth to age 5 in 

3 the State involved, which at a minimum shall 

4 include— 

5 ‘‘(i) a handbook that includes rec6 ommendations, guidelines, and best prac7 tices for child care centers and family child 

8 care homes relating to healthy eating, 

9 physical activity, and screen time reduc10 tion; 

11 ‘‘(ii) information about the availability 

12 of and services provided by child care 

13 health consultants; and 

14 ‘‘(iii) health and wellness resources 

15 available through the Child Care Bureau, 

16 the Maternal and Child Health Bureau, 

17 Let’s Move Child Care, and the Food and 

18 Nutrition Service of the Department of 

19 Agriculture; 

20 ‘‘(B) the identification, improvement upon, 

21 and expansion of nutrition and physical activity 

22 best practices targeted to the population of chil23 dren from birth to age 5 in the State involved 

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1 porating parental education and other parental 

2 engagement; 

3 ‘‘(C) the identification of strategies and 

4 techniques for overcoming barriers to healthy 

5 eating, physical activity, and parental engage6 ment; and 

7 ‘‘(D) the provision of instruction and dis8 cussion of techniques used to appropriately 

9 model, direct, and encourage child care staff be10 havior to apply the best practices and strategies 

11 identified under subparagraphs (B) and (C). 

12 ‘‘(d) PRACTICE, CURRICULA, AND POLICY

13 CHANGES.—A grantee shall ensure that the participants 

14 involved in the collaborative, on an ongoing basis— 

15 ‘‘(1) implement policy changes that promote 

16 healthy eating, physical activity, and appropriate 

17 screen time limits among the population of children 

18 from birth to age 5; 

19 ‘‘(2) utilize a culturally competent healthy eat20 ing and physical activity curriculum focusing on 

21 such population of children from birth to age 5; 

22 ‘‘(3) implement programs, activities, and proce23 dures for incorporating parental education and en24 gagement of parents in programs; and 


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1 ‘‘(4) implement innovative ways to remove bar2 riers that exist to providing opportunities for healthy 

3 eating and physical activity. 

4 All activities described in this subsection shall be evidence5 based and data-informed and be consistent with the cur6 riculum presented through training activities described in 

7 subsection (c). 

8 ‘‘SEC. 399OO–2. GRANTS FOR THE EVALUATION OF PILOT 

9 PROGRAMS. 

10 ‘‘The Secretary shall award competitive grants to 

11 Prevention Research Centers, universities, or other appro12 priate entities to evaluate the programs carried out with 

13 grants under section 399OO–1, including baseline, proc14 ess, and outcome measurements. 

15 ‘‘SEC. 399OO–3. COORDINATION. 

16 ‘‘(a) INTERAGENCY COORDINATION.—To the extent 

17 practicable, the Secretary shall coordinate activities con18 ducted under this part with activities undertaken by the 

19 National Prevention, Health Promotion and Public Health 

20 Council established under section 4001 of the Patient Pro21 tection and Affordable Care Act. 

22 ‘‘(b) PILOT COORDINATION.—The Secretary shall 

23 designate an entity (directly or through contract) to pro24 vide technical assistance to States and pilot centers in the 

25 coordination of activities as described in subsection (a). 


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1 ‘‘SEC. 399OO–4. TECHNICAL ASSISTANCE, EVALUATION, AND 

2 REPORTING. 

3 ‘‘(a) TECHNICAL ASSISTANCE AND INFORMATION.— 

4 The Secretary shall— 

5 ‘‘(1) provide technical assistance to grantees 

6 and other entities providing training under a grant 

7 under section 399OO–1; and 

8 ‘‘(2) disseminate to grantees information con9 cerning evidence-based or data-informed approaches, 

10 including dissemination of available tools, curricula, 

11 and available or emerging best practices that can be 

12 expanded or improved upon through the pilot pro13 gram conducted under section 399OO–1. 

14 ‘‘(b) EVALUATION REQUIREMENTS.—With respect to 

15 evaluations conducted under section 399OO–2, the Sec16 retary shall ensure that— 

17 ‘‘(1) evaluation metrics are consistent across all 

18 programs funded under this part; 

19 ‘‘(2) interim outcomes are measured by the 

20 number of centers that adopt policies to increase 

21 healthy eating and physical activity and reduce 

22 screen time; 

23 ‘‘(3) interim outcomes are measured, to the ex24 tent practicable, by changes in foods served, oppor25 tunities for physical activity, and screen time in the 


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1 child care participants in the collaboratives estab2 lished under section 399OO–1; and 

3 ‘‘(4) upon completion of the pilot program 

4 under section 399OO–1, the evaluation shall include 

5 an identification of policies, best practices, and 

6 strategies to improve healthy eating, physical activ7 ity, screen time limits, and parental engagement 

8 that could be replicated in other child care settings. 

9 ‘‘(c) DISSEMINATION OF INFORMATION.—Upon the 

10 conclusion of the pilot program under section 399OO–1, 

11 the Secretary shall disseminate to all appropriate agencies 

12 within the Department of Health and Human Services evi13 dence, strategies, best practices, and lessons learned from 

14 grantees. Such agencies shall encourage the utilization of 

15 best practices through Federal programs and other appro16 priate methods. 

17 ‘‘(d) REPORT TO CONGRESS.—Not later than 180 

18 days after the completion of the pilot program under sec19 tion 399OO–1, the Secretary shall submit to Congress a 

20 report concerning the evaluation of the pilot program, in21 cluding recommendations as to how lessons learned from 

22 such programs can be incorporated into future guidance 

23 documents developed and provided by the Secretary and 

24 other Federal agencies, as well as Federal programs, as 

25 appropriate. 


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1 ‘‘SEC. 399OO–5. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There is authorized to be appropriated to carry out 

3 this part, $1,500,000 for each of fiscal years 2012, 2013, 

4 and 2014.’’. 

Æ 


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