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 2012, three-fourths of United States 
preschool-aged children were in child care, and most 
of their day was spent in sedentary activities. 
(14) Center-based programs serve approxi-
mately 6,980,000 children from 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) 
Early 
care 
and 
education 
learning 
collaboratives in 9 States have reached nearly 
156,000 children and improved early childhood care 
and education provider practices for nutrition and 
physical activity. 
(b) PURPOSES.—It is the purpose of this Act to— 
(1) establish a program that will influence prac-
tices, policies, and environments in early care and 
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education settings to support healthy eating, phys-
ical activity, and screen time reduction for children 
ages birth through 5 years; 
(2) enhance the training and knowledge of early 
care and education providers on strategies for pro-
moting healthy eating (including early feeding best 
practices), physical activity, and screen time reduc-
tion in early care and education settings; 
(3) monitor progress of healthy eating and 
physical activity promotion in early care and edu-
cation settings; and 
(4) identify emerging, and expand existing, ap-
proaches to engaging families and parents of chil-
dren ages birth to 5 years in healthy eating, physical 
activity, and screen time reduction. 
SEC. 3. HEALTHY KIDS PROGRAM. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART W—HEALTHY KIDS PROGRAM 
‘‘SEC. 399OO. DEFINITIONS. 
‘‘In this part: 
‘‘(1) DIRECTOR.—The term ‘Director’ means 
the Director of the Centers for Disease Control and 
Prevention. 
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‘‘(2) EARLY CARE AND EDUCATION.—The term 
‘early care and education’ means programs and ac-
tivities that serve children ages birth through 5 
years either through in-home or out-of-home set-
tings, including child care programs, Head Start 
programs, and pre-kindergarten programs. 
‘‘(3) SCREEN
TIME
REDUCTION.—The term 
‘screen time reduction’ means policies or guidelines 
designed to reduce the daily amount of time that 
children spend watching or looking at digital mon-
itors or displays, including television sets, computer 
monitors, or hand-held gaming devices. 
‘‘SEC. 399OO–1. GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, in coordination 
with the Centers for Disease Control and Prevention and 
the Administration for Children and Families shall, sub-
ject to the availability of appropriations, award 5-year 
competitive grants to eligible entities to assist in the devel-
opment of healthier early care and education environments 
to improve healthy eating and physical activity among chil-
dren ages birth through 5 years in early care and edu-
cation settings. Training provided under such grants shall 
be consistent with the best practices from existing health 
and wellness resources endorsed by the Secretary, in con-
sultation with the National Academy of Medicine, the Of-
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fice of Child Care and Office of Head Start of the Admin-
istration for Children and Families, the Division of Nutri-
tion, Physical Activity, and Obesity of the Centers for Dis-
ease Control and Prevention, the Maternal and Child 
Health Bureau of the Health Resources and Services Ad-
ministration, and the Food and Nutrition Service of the 
Department of Agriculture. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be— 
‘‘(A) a nonprofit organization with exper-
tise in early childhood health or childhood obe-
sity prevention; 
‘‘(B) an institution of higher education or 
research center that employs faculty with rel-
evant expertise; or 
‘‘(C) a consortium of entities described in 
subparagraphs (A) and (B) that submit a single 
application to carry out activities under the 
grant jointly; and 
‘‘(2) submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require. 
‘‘(c) USE OF FUNDS.— 
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‘‘(1) IDENTIFICATION OF AREAS OF OPPORTU-
NITIES AND GOALS.—An entity that receives a grant 
under this section shall, using Department of Health 
and Human Services guidance and tools (such as the 
Spectrum of Opportunities for Obesity Prevention in 
the Early Care and Education Setting developed by 
the Centers for Disease Control and Prevention), 
identify areas of opportunity and set goals and carry 
out activities to promote healthy eating, physical ac-
tivity, and screen time reduction strategies among 
children ages birth through 5 years in early care and 
education settings. 
‘‘(2) ACTIVITIES.—An entity shall use amounts 
received under a grant under this section to carry 
out each of the following activities: 
‘‘(A) Provide training, technical assistance, 
and resources to implementing partners, which 
may include States, territories, Indian Tribes or 
organizations, municipalities, and nonprofit or-
ganizations to integrate the promotion of 
healthy eating (including early feeding best 
practices), physical activity, and screen time re-
duction into existing early care and education 
State programs and initiatives to create and 
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spread sustainable change within the State or 
territory involved. 
‘‘(B) Work directly with implementing 
partners to create sustainable programs to train 
early care and education providers through 
train-the-trainer models, learning collaboratives, 
or other approaches approved by the Secretary. 
‘‘(C) Enter into a contract with a non-
profit organization or other entity with relevant 
expertise that is approved by the Secretary, to 
evaluate the programs carried out under the 
grant, including baseline, process, and outcome 
measurements. 
‘‘(3) DISSEMINATION
OF
BEST
PRACTICES.— 
Not later than 12 months after the date on which 
the programs and activities carried out under the 
grants under this section conclude, the Secretary 
shall disseminate to all appropriate agencies within 
the Department of Health and Human Services evi-
dence, best practices, and lessons derived from the 
experiences of grantees with respect to reducing and 
preventing obesity and overweight among children 
ages birth through 5 years in the early care and 
education settings. Such agencies shall encourage 
the adoption of such best practices. 
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‘‘(d) PREFERENCE.— 
‘‘(1) GRANTEES.—In awarding grants under 
this section, the Secretary shall give preference to el-
igible entities that demonstrate— 
‘‘(A) a history of working with early care 
and education providers and States in obesity 
prevention in the early care and education set-
tings; 
‘‘(B) a history of, and capacity to, leverage 
funding to amplify obesity prevention efforts in 
early care and education settings; 
‘‘(C) a history of working successfully with 
an evaluator to determine program effective-
ness; 
‘‘(D) a history of, and capacity to, collabo-
rate with the health sector on obesity preven-
tion initiatives; 
‘‘(E) a history of, and capacity to, spread 
and sustain health initiatives; and 
‘‘(F) the ability to conduct at least 3 pilot 
programs to test innovative or evidence-in-
formed approaches to engage families, including 
families of children ages birth to 5 years, or to 
pursue other innovative approaches in the pro-
motion of healthy eating and physical activity. 
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‘‘(2) IMPLEMENTING PARTNERS.—In selecting 
States, territories, Indian Tribes or organizations, 
municipalities, or nonprofit organizations under a 
grant under this section, a grantee shall ensure that 
such partners— 
‘‘(A) serve populations that are racially, 
ethnically, socioeconomically, and geographically 
diverse; 
‘‘(B) represent a mix of rural and urban 
settings; 
‘‘(C) have a varied level of existing infra-
structure, capacity, and other programmatic 
initiatives to address obesity prevention in early 
care and education systems; and 
‘‘(D) possess expertise in early care and 
education or children’s health and the ability to 
implement evidence-informed interventions to 
promote healthy eating, physical activity, and 
screen time reduction strategies in early care 
and education settings for children ages birth 
through 5 years, including strategies targeted 
to addressing the needs of children ages birth 
through 2 years and strategies to engage par-
ents in healthy eating and physical activity pro-
motion. 
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‘‘(e) TRACKING STATE PROGRESS.—The Secretary 
shall use amounts appropriated under subsection (g)(2) to 
enter into contracts with, or award grants to, institutions 
of higher education, nonprofit organizations, or other enti-
ties with relevant monitoring and surveillance expertise 
that are approved by the Secretary, to track State 
progress in obesity prevention policies and practices of 
early care and education programs through a sentinel set 
of States. 
‘‘(f) REPORT
TO CONGRESS.—Not later than 12 
months after the completion of the programs and activities 
funded under grants awarded under this section, the Sec-
retary shall submit to Congress a report concerning an 
evaluation of the results of such programs and activities 
and sentinel surveillance, including recommendations on 
how lessons learned from such programs can be incor-
porated into future guidance documents developed and 
provided by the Secretary or Director and other Federal 
agencies as appropriate. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $4,000,000 for each of fiscal years 2019 
through 2023; and 
‘‘(2) $1,700,000 for fiscal year 2019, to be 
used to track State progress in obesity prevention 
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policies and practices of early care and education 
programs in a sentinel set of States as provided for 
in subsection (e).’’. 
Æ 
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