II 

115TH CONGRESS 

2D SESSION S. 2726 

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

physical activity among children. 

IN THE SENATE OF THE UNITED STATES 

APRIL 23, 2018 

Mr. BOOKER (for himself, Mr. NELSON, Mr. COONS, and Mr. CARPER) 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 2018’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

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

9 (1) Research has shown that early childhood is 

10 an important time for developing dietary and physVerDate Sep 11 2014 03:42 Apr 26, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2726.IS S2726

lotter on DSKBCFDHB2PROD with BILLS
2 

•S 2726 IS

1 ical activity behaviors that support health and well2 being and may help prevent obesity. 

3 (2) Infants as young as 7 months have shown 

4 eating patterns that are similar to older children and 

5 adults. 

6 (3) For children under 1 year of age, promoting 

7 opportunities for movement (such as reaching, 

8 crawling, and creeping) may be the most effective 

9 way to increase physical activity and improve chil10 dren’s motor skills. 

11 (4) Children who are exposed to healthy foods 

12 early are more likely to prefer and eat healthy foods 

13 and to develop eating habits that promote healthy 

14 growth that can continue throughout childhood. 

15 (5) Healthy eating can improve a child’s learn16 ing ability and potentially lead to higher academic 

17 performance, along with his or her mental, social, 

18 and physical well-being and can contribute to in19 creased self-esteem. 

20 (6) A 2010 study indicated that daily physical 

21 activity is not only essential for healthy weight main22 tenance, but also for practicing and learning funda23 mental gross motor skills and socioemotional and 

24 cognitive skills. Furthermore, when children have the 


lotter on DSKBCFDHB2PROD with BILLS
3 

•S 2726 IS

1 opportunity for adequate physical activity, they ben2 efit physically, psychologically and socially. 

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

4 spend more than 2 hours of a typical day watching 

5 television or videos. 

6 (8) The Journal of the American Medical Asso7 ciation Pediatrics found that each incremental hour 

8 of watching television at age 2 is associated with 

9 corresponding declines in school engagement, math 

10 achievement, and weekend physical activity, and with 

11 increases in bullying by classmates, consumption of 

12 soft drinks and snacks, and BMI at age 10. 

13 (9) About 20 percent of children between 2 and 

14 5 years of age are overweight or obese. 

15 (10) A study published in the New England 

16 Journal of Medicine in 2014 found that a third of 

17 children who were overweight in kindergarten were 

18 obese by eighth grade. Almost every child who was 

19 very obese remained that way, suggesting that ef20 forts must start much earlier and focus more on the 

21 children at greatest risk. 

22 (11) A study published in the New England 

23 Journal of Medicine in 2017 estimates that over 50 

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

25 years of age. 


lotter on DSKBCFDHB2PROD with BILLS
4 

•S 2726 IS

1 (12) A study examining the National Health 

2 and Nutrition Examination Survey published in 

3 2018 found an increase in prevalence of childhood 

4 obesity in 2015 and 2016. Childhood obesity for 

5 children between 2 and 5 years of age increased 

6 from 9 percent to 14 percent, the highest increase 

7 since 1999. 

8 (13) In 2012, three-fourths of United States 

9 preschool-aged children were in child care, and most 

10 of their day was spent in sedentary activities. 

11 (14) Center-based programs serve approxi12 mately 6,980,000 children birth through age 5 years 

13 but not yet in kindergarten, making the early child14 hood care and education setting an important one 

15 for promoting healthful habits. 

16 (15) Early care and education learning 

17 collaboratives in 9 States have reached nearly 

18 156,000 children and improved early childhood care 

19 and education provider practices for nutrition and 

20 physical activity. 

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

22 (1) establish a program that will influence prac23 tices, policies, and environments in early care and 

24 education settings to support healthy eating, physVerDate Sep 11 2014 03:42 Apr 26, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2726.IS S2726

lotter on DSKBCFDHB2PROD with BILLS
5 

•S 2726 IS

1 ical activity, and screen time reduction for children 

2 ages birth through 5; 

3 (2) enhance the training and knowledge of early 

4 care and education providers on strategies for pro5 moting healthy eating (including early feeding best 

6 practices), physical activity, and screen time reduc7 tion in early care and education settings; 

8 (3) monitor progress of healthy eating and 

9 physical activity promotion in early care and edu10 cation settings; and 

11 (4) identify emerging, and expand existing, ap12 proaches to engaging families and parents of chil13 dren ages birth to 5 in healthy eating, physical activ14 ity, and screen time reduction. 

15 SEC. 3. HEALTHY KIDS PROGRAM. 

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

17 241 et seq.) is amended by adding at the end the fol18 lowing: 

19 ‘‘PART W—HEALTHY KIDS PROGRAM 

20 ‘‘SEC. 399OO. DEFINITIONS. 

21 ‘‘In this part: 

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

23 the Director of the Centers for Disease Control and 

24 Prevention. 


lotter on DSKBCFDHB2PROD with BILLS
6 

•S 2726 IS

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

2 ‘early care and education’ means programs and ac3 tivities that serve children ages birth through 5 

4 years either through in-home or out-of-home set5 tings, including child care programs, Head Start 

6 programs, and pre-kindergarten programs. 

7 ‘‘(3) SCREEN TIME REDUCTION.—The term 

8 ‘screen time reduction’ means policies or guidelines 

9 designed to reduce the daily amount of time that 

10 children spend watching or looking at digital mon11 itors or displays, including television sets, computer 

12 monitors, or hand-held gaming devices. 

13 ‘‘SEC. 399OO–1. GRANTS. 

14 ‘‘(a) IN GENERAL.—The Secretary, in coordination 

15 with the Centers for Disease Control and Prevention and 

16 the Administration for Children and Families shall, sub17 ject to the availability of appropriations, award 5-year 

18 competitive grants to eligible entities to assist in the devel19 opment of healthier early care and education environments 

20 to improve healthy eating and physical activity among chil21 dren ages birth through 5 years in early care and edu22 cation settings. Training provided under such grants shall 

23 be consistent with the best practices from existing health 

24 and wellness resources endorsed by the Secretary, in con25 sultation with the National Academy of Medicine, the OfVerDate Sep 11 2014 03:42 Apr 26, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2726.IS S2726

lotter on DSKBCFDHB2PROD with BILLS
7 

•S 2726 IS

1 fice of Child Care and Office of Head Start of the Admin2 istration for Children and Families, the Division of Nutri3 tion, Physical Activity, and Obesity of the Centers for Dis4 ease Control and Prevention, the Maternal and Child 

5 Health Bureau of the Health Resources and Services Ad6 ministration, and the Food and Nutrition Service of the 

7 Department of Agriculture. 

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

9 under subsection (a), an entity shall— 

10 ‘‘(1) be— 

11 ‘‘(A) a nonprofit organization with exper12 tise in early childhood health and obesity pre13 vention; 

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

15 research center that employs faculty with rel16 evant expertise; or 

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

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

19 application to carry out activities under the 

20 grant jointly; and 

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

22 such time, in such manner, and containing such in23 formation as the Director may require. 

24 ‘‘(c) USE OF FUNDS.— 


lotter on DSKBCFDHB2PROD with BILLS
8 

•S 2726 IS

1 ‘‘(1) IDENTIFICATION OF AREAS OF OPPORTU2 NITIES AND GOALS.—An entity that receives a grant 

3 under this section shall, using Department of Health 

4 and Human Services guidance and tools (such as the 

5 Spectrum of Opportunities for Obesity Prevention in 

6 the Early Care and Education Setting developed by 

7 the Centers for Disease Control and Prevention), 

8 identify areas of opportunity and set goals and carry 

9 out activities to promote healthy eating, physical ac10 tivity, and screen time reduction strategies among 

11 children ages birth through 5 years in early care and 

12 education settings. 

13 ‘‘(2) ACTIVITIES.—An entity shall use amounts 

14 received under a grant under this section to carry 

15 out each of the following activities: 

16 ‘‘(A) Provide training, technical assistance, 

17 and resources to implementing partners, which 

18 may include States, territories, Indian tribes, 

19 municipalities, and nonprofit organizations to 

20 integrate the promotion of healthy eating (in21 cluding early feeding best practices), physical 

22 activity, and screen time reduction into existing 

23 early care and education State programs and 

24 initiatives to create and spread sustainable 

25 change within the State or territory involved. 


lotter on DSKBCFDHB2PROD with BILLS
9 

•S 2726 IS

1 ‘‘(B) Work directly with implementing 

2 partners to create sustainable programs to train 

3 early care and education providers through 

4 train-the-trainer models, learning collaboratives, 

5 or other approaches approved by the Secretary. 

6 ‘‘(C) Enter into a contract with a non7 profit organization or other entity with relevant 

8 expertise that is approved by the Secretary, to 

9 evaluate the programs carried out under the 

10 grant, including baseline, process, and outcome 

11 measurements. 

12 ‘‘(3) DISSEMINATION OF BEST PRACTICES.— 

13 Upon the conclusion of programs and activities car14 ried out under the grants under this section, the 

15 Secretary shall disseminate to all appropriate agen16 cies within the Department of Health and Human 

17 Services evidence, best practices, and lessons derived 

18 from the experiences of grantees with respect to re19 ducing and preventing obesity and overweight among 

20 children ages birth through 5 years in the early care 

21 and education settings. Such agencies shall encour22 age the adoption of such best practices. 

23 ‘‘(d) PREFERENCE.— 


lotter on DSKBCFDHB2PROD with BILLS
10 

•S 2726 IS

1 ‘‘(1) GRANTEES.—In awarding grants under 

2 this section, the Secretary shall give preference to el3 igible entities that demonstrate— 

4 ‘‘(A) a history of working with early care 

5 and education providers and States in obesity 

6 prevention in the early care and education set7 ting; 

8 ‘‘(B) a history of, and capacity to, leverage 

9 private dollars to amplify obesity prevention ef10 forts in early care and education settings; 

11 ‘‘(C) a history of working successfully with 

12 an evaluator to determine program effective13 ness; 

14 ‘‘(D) a history of, and capacity to, collabo15 rate with the health sector on obesity preven16 tion initiatives; 

17 ‘‘(E) a history of, and capacity to, spread 

18 and sustain health initiatives; and 

19 ‘‘(F) the ability to conduct at least 3 pilot 

20 programs to test innovative or evidence-in21 formed approaches to engage families, including 

22 families of children ages birth to 5 years, or to 

23 pursue other innovative approaches in the pro24 motion of healthy eating and physical activity. 


lotter on DSKBCFDHB2PROD with BILLS
11 

•S 2726 IS

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

2 States, territories, Indian tribes, municipalities, or 

3 nonprofit organizations under a grant under this 

4 section, a grantee shall ensure that such partners— 

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

6 ethnically, socioeconomically, and geographically 

7 diverse; 

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

9 settings; 

10 ‘‘(C) have a varied level of existing infra11 structure, capacity, and other programmatic 

12 initiatives to address obesity prevention in early 

13 care and education systems; and 

14 ‘‘(D) possess expertise in early care and 

15 education or children’s health and the ability to 

16 implement evidence-informed interventions to 

17 promote healthy eating, physical activity, and 

18 screen time reduction strategies in early care 

19 and education settings for children ages birth 

20 through 5 years, including strategies targeted 

21 to addressing the needs of children ages birth 

22 through 2 years and strategies to engage par23 ents in healthy eating and physical activity pro24 motion. 


lotter on DSKBCFDHB2PROD with BILLS
12 

•S 2726 IS

1 ‘‘(e) TRACKING STATE PROGRESS.—The Secretary 

2 shall use amounts appropriated under subsection (g)(2) to 

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

4 of higher education, nonprofit organizations, or other enti5 ties with relevant monitoring and surveillance expertise 

6 that are approved by the Secretary, to track State 

7 progress in obesity prevention policies and practices of 

8 early care and education programs through a sentinel set 

9 of States. 

10 ‘‘(f) REPORT TO CONGRESS.—Not later than 12 

11 months after the completion of the programs and activities 

12 funded under grants awarded under this section, the Sec13 retary shall submit to Congress a report concerning an 

14 evaluation of the results of such programs and activities 

15 and sentinel surveillance, including recommendations on 

16 how lessons learned from such programs can be incor17 porated into future guidance documents developed and 

18 provided by the Secretary or Director and other Federal 

19 agencies as appropriate. 

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

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

22 ‘‘(1) $4,000,000 for each of fiscal years 2019 

23 through 2023; and 

24 ‘‘(2) $1,700,000 for fiscal year 2019, to be 

25 used to track State progress in obesity prevention 


lotter on DSKBCFDHB2PROD with BILLS
13 

•S 2726 IS

1 policies and practices of early care and education 

2 programs in a sentinel set of States as provided for 

3 in subsection (e).’’. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS