[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1172 Reported in Senate (RS)]






                                                       Calendar No. 417
108th CONGRESS
  1st Session
                                S. 1172

To establish grants to provide health services for improved nutrition, 
    increased physical activity, obesity prevention, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 3, 2003

   Mr. Frist (for himself, Mr. Bingaman, Mr. Dodd, Mr. DeWine, Mrs. 
    Clinton, Mr. Warner, Mrs. Murray, Mr. Lugar, Ms. Landrieu, Mr. 
 Sessions, Mr. Alexander, Mr. Stevens, Mr. Roberts, Ms. Stabenow, Mr. 
Campbell, Ms. Collins, Mr. McConnell, Mr. Fitzgerald, Mr. Cochran, Ms. 
   Mikulski, Mr. Lautenberg, Mr. Johnson, Mr. Cornyn, and Mr. Wyden) 
introduced the following bill; which was read twice and referred to the 
           Committee on Health, Education, Labor and Pensions

                           November 25, 2003

                Reported by Mr. Gregg, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
To establish grants to provide health services for improved nutrition, 
    increased physical activity, obesity prevention, and for other 
                               purposes.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Improved Nutrition and 
Physical Activity Act'' or the ``IMPACT Act''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress makes the following findings:</DELETED>
        <DELETED>    (1) An estimated 61 percent of adults and 13 
        percent of children and adolescents in the Nation are 
        overweight or obese.</DELETED>
        <DELETED>    (2) The prevalence of obesity and being overweight 
        is increasing among all age groups. There are twice the number 
        of overweight children and 3 times the number of overweight 
        adolescents as there were 29 years ago.</DELETED>
        <DELETED>    (3) An estimated 300,000 deaths a year are 
        associated with being overweight or obese.</DELETED>
        <DELETED>    (4) Obesity and being overweight are associated 
        with an increased risk for heart disease (the leading cause of 
        death), cancer (the second leading cause of death), diabetes 
        (the 6th leading cause of death), and musculoskeletal 
        disorders.</DELETED>
        <DELETED>    (5) Individuals who are obese have a 50 to 100 
        percent increased risk of premature death.</DELETED>
        <DELETED>    (6) The Healthy People 2010 goals identify obesity 
        and being overweight as one of the Nation's leading health 
        problems and include objectives of increasing the proportion of 
        adults who are at a healthy weight, reducing the proportion of 
        adults who are obese, and reducing the proportion of children 
        and adolescents who are overweight or obese.</DELETED>
        <DELETED>    (7) Another goal of Healthy People 2010 is to 
        eliminate health disparities among different segments of the 
        population. Obesity is a health problem that disproportionally 
        impacts medically underserved populations.</DELETED>
        <DELETED>    (8) The United States Surgeon General's report ``A 
        Call To Action'' lists the treatment and prevention of obesity 
        as a top national priority.</DELETED>
        <DELETED>    (9) The estimated direct and indirect annual cost 
        of obesity in the United States is $117,000,000,000 (exceeding 
        the cost of tobacco-related illnesses) and appears to be rising 
        dramatically. This cost can potentially escalate markedly as 
        obesity rates continue to rise and the medical complications of 
        obesity are emerging at even younger ages. Therefore, the total 
        disease burden will most likely increase, as well as the 
        attendant health-related costs.</DELETED>
        <DELETED>    (10) Weight control programs should promote a 
        healthy lifestyle including regular physical activity and 
        healthy eating, as consistently discussed and identified in a 
        variety of public and private consensus documents, including 
        ``A Call To Action'' and other documents prepared by the 
        Department of Health and Human Services and other 
        agencies.</DELETED>
        <DELETED>    (11) Eating preferences and habits are established 
        in childhood.</DELETED>
        <DELETED>    (12) Poor eating habits are a risk factor for the 
        development of eating disorders and obesity.</DELETED>
        <DELETED>    (13) Simply urging overweight individuals to be 
        thin has not reduced the prevalence of obesity and may result 
        in other problems including body dissatisfaction, low self-
        esteem, and eating disorders.</DELETED>
        <DELETED>    (14) Effective interventions for promoting healthy 
        eating behaviors should promote healthy lifestyle and not 
        inadvertently promote unhealthy weight management 
        techniques.</DELETED>
        <DELETED>    (15) Binge Eating is associated with obesity, 
        heart disease, gall bladder disease, and diabetes.</DELETED>
        <DELETED>    (16) Anorexia Nervosa, an eating disorder from 
        which 0.5 to 3.7 percent of American women will suffer in their 
        lifetime, is associated with serious health consequences 
        including heart failure, kidney failure, osteoporosis, and 
        death. In fact, Anorexia Nervosa has the highest mortality rate 
        of all psychiatric disorders, placing a young woman with 
        Anorexia at 18 times the risk of death of other women her 
        age.</DELETED>
        <DELETED>    (17) Anorexia Nervosa and Bulimia Nervosa usually 
        appears in adolescence.</DELETED>
        <DELETED>    (18) Bulimia Nervosa, an eating disorder from 
        which an estimated 1.1 to 4.2 percent of American women will 
        suffer in their lifetime, is associated with cardiac, 
        gastrointestinal, and dental problems, including irregular 
        heartbeats, gastric ruptures, peptic ulcers, and tooth 
        decay.</DELETED>
        <DELETED>    (19) On the 1999 Youth Risk Behavior Survey, 7.5 
        percent of high school girls reported recent use of laxatives 
        or vomiting to control their weight.</DELETED>
        <DELETED>    (20) Binge Eating Disorder is characterized by 
        frequent episodes of uncontrolled overeating, with an estimated 
        2 to 5 percent of Americans experiencing this disorder in a 6-
        month period.</DELETED>
        <DELETED>    (21) Eating disorders are commonly associated with 
        substantial psychological problems, including depression, 
        substance abuse, and suicide.</DELETED>
        <DELETED>    (22) Eating disorders of all types are more common 
        in women than men.</DELETED>

              <DELETED>TITLE I--TRAINING GRANTS</DELETED>

<DELETED>SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION 
              STUDENTS.</DELETED>

<DELETED>    Section 747(c)(3) of title VII of the Public Health 
Service Act (42 U.S.C. 293k(c)(3)) is amended by striking ``and victims 
of domestic violence'' and inserting ``victims of domestic violence, 
individuals (including children) who are overweight or obese (as such 
terms are defined in section 399W(j)) and at risk for related serious 
and chronic medical conditions, and individuals who suffer from eating 
disorders''.</DELETED>

<DELETED>SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH 
              PROFESSIONALS.</DELETED>

<DELETED>    Section 399Z of the Public Health Service Act (42 U.S.C. 
280h-3) is amended--</DELETED>
        <DELETED>    (1) in subsection (b), by striking ``2005'' and 
        inserting ``2007'';</DELETED>
        <DELETED>    (2) by redesignating subsection (b) as subsection 
        (c); and</DELETED>
        <DELETED>    (3) by inserting after subsection (a) the 
        following:</DELETED>
<DELETED>    ``(b) Grants.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary may award grants 
        to eligible entities to train primary care physicians and other 
        licensed or certified health professionals on how to identify, 
        treat, and prevent obesity or eating disorders and aid 
        individuals who are overweight, obese, or who suffer from 
        eating disorders.</DELETED>
        <DELETED>    ``(2) Application.--An entity that desires a grant 
        under this subsection shall submit an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including a plan for the use of funds 
        that may be awarded and an evaluation of the training that will 
        be provided.</DELETED>
        <DELETED>    ``(3) Use of funds.--An entity that receives a 
        grant under this subsection shall use the funds made available 
        through such grant to--</DELETED>
                <DELETED>    ``(A) use evidence-based findings or 
                recommendations that pertain to the prevention and 
                treatment of obesity, being overweight, and eating 
                disorders to conduct educational conferences, including 
                Internet-based courses and teleconferences, on--
                </DELETED>
                        <DELETED>    ``(i) how to treat or prevent 
                        obesity, being overweight, and eating 
                        disorders;</DELETED>
                        <DELETED>    ``(ii) the link between obesity 
                        and being overweight and related serious and 
                        chronic medical conditions;</DELETED>
                        <DELETED>    ``(iii) how to discuss varied 
                        strategies with patients from at-risk and 
                        diverse populations to promote positive 
                        behavior change and healthy lifestyles to avoid 
                        obesity, being overweight, and eating 
                        disorders;</DELETED>
                        <DELETED>    ``(iv) how to identify overweight 
                        and obese patients and those who are at risk 
                        for obesity and being overweight or suffer from 
                        eating disorders and, therefore, at risk for 
                        related serious and chronic medical conditions; 
                        and</DELETED>
                        <DELETED>    ``(v) how to conduct a 
                        comprehensive assessment of individual and 
                        familial health risk factors; and</DELETED>
                <DELETED>    ``(B) evaluate the effectiveness of the 
                training provided by such entity in increasing 
                knowledge and changing attitudes and behaviors of 
                trainees.''.</DELETED>

   <DELETED>TITLE II--COMMUNITY-BASED SOLUTIONS TO INCREASE PHYSICAL 
                ACTIVITY AND IMPROVE NUTRITION</DELETED>

<DELETED>SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE 
              NUTRITION.</DELETED>

<DELETED>    Part Q of title III of the Public Health Service Act (42 
U.S.C. 280h et seq.) is amended by striking section 399W and inserting 
the following:</DELETED>

<DELETED>``SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE 
              NUTRITION.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Director of the Centers for Disease Control and Prevention 
        and in coordination with the Administrator of the Health 
        Resources and Services Administration, the Director of the 
        Indian Health Service, the Secretary of Education, the 
        Secretary of Agriculture, the Secretary of the Interior, the 
        Director of the National Institutes of Health, the Director of 
        the Office of Women's Health, and the heads of other 
        appropriate agencies, shall award competitive grants to 
        eligible entities to plan and implement programs that promote 
        healthy eating behaviors and physical activity to prevent 
        eating disorders, obesity, being overweight, and related 
        serious and chronic medical conditions. Such grants may be 
        awarded to target at-risk populations including youth, 
        adolescent girls, racial and ethnic minorities, and the 
        underserved.</DELETED>
        <DELETED>    ``(2) Term.--The Secretary shall award grants 
        under this subsection for a period not to exceed 4 
        years.</DELETED>
<DELETED>    ``(b) Award of Grants.--An eligible entity desiring a 
grant under this section shall submit an application to the Secretary 
at such time, in such manner, and containing such information as the 
Secretary may require, including--</DELETED>
        <DELETED>    ``(1) a plan describing a comprehensive program of 
        approaches to encourage healthy eating behaviors and healthy 
        levels of physical activity;</DELETED>
        <DELETED>    ``(2) the manner in which the eligible entity will 
        coordinate with appropriate State and local authorities, 
        including--</DELETED>
                <DELETED>    ``(A) State and local educational 
                agencies;</DELETED>
                <DELETED>    ``(B) departments of health;</DELETED>
                <DELETED>    ``(C) chronic disease directors;</DELETED>
                <DELETED>    ``(D) State directors of programs under 
                section 17 of the Child Nutrition Act of 1966 (42 
                U.S.C. 1786);</DELETED>
                <DELETED>    ``(E) 5-a-day coordinators;</DELETED>
                <DELETED>    ``(F) governors' councils for physical 
                activity and good nutrition; and</DELETED>
                <DELETED>    ``(G) State and local parks and recreation 
                departments; and</DELETED>
        <DELETED>    ``(3) the manner in which the applicant will 
        evaluate the effectiveness of the program carried out under 
        this section.</DELETED>
<DELETED>    ``(c) Coordination.--In awarding grants under this 
section, the Secretary shall ensure that the proposed programs are 
coordinated in substance and format with programs currently funded 
through other Federal agencies and operating within the community 
including the Physical Education Program (PEP) of the Department of 
Education.</DELETED>
<DELETED>    ``(d) Eligible Entity.--In this section, the term 
`eligible entity' means--</DELETED>
        <DELETED>    ``(1) a city, county, tribe, territory, or 
        State;</DELETED>
        <DELETED>    ``(2) a State educational agency;</DELETED>
        <DELETED>    ``(3) a tribal educational agency;</DELETED>
        <DELETED>    ``(4) a local educational agency;</DELETED>
        <DELETED>    ``(5) a federally qualified health center (as 
        defined in section 1861(aa)(4) of the Social Security Act (42 
        U.S.C. 1395x(aa)(4));</DELETED>
        <DELETED>    ``(6) a rural health clinic;</DELETED>
        <DELETED>    ``(7) a health department;</DELETED>
        <DELETED>    ``(8) an Indian Health Service hospital or 
        clinic;</DELETED>
        <DELETED>    ``(9) an Indian tribal health facility;</DELETED>
        <DELETED>    ``(10) an urban Indian facility;</DELETED>
        <DELETED>    ``(11) any health care service provider;</DELETED>
        <DELETED>    ``(12) an accredited university or college; 
        or</DELETED>
        <DELETED>    ``(13) any other entity determined appropriate by 
        the Secretary.</DELETED>
<DELETED>    ``(e) Use of Funds.--An eligible entity that receives a 
grant under this section shall use the funds made available through the 
grant to--</DELETED>
        <DELETED>    ``(1) carry out community-based activities 
        including--</DELETED>
                <DELETED>    ``(A) planning and implementing 
                environmental changes that promote physical 
                activity;</DELETED>
                <DELETED>    ``(B) forming partnerships and activities 
                with businesses and other entities to increase physical 
                activity levels and promote healthy eating behaviors at 
                the workplace and while traveling to and from the 
                workplace;</DELETED>
                <DELETED>    ``(C) forming partnerships with entities, 
                including schools, faith-based entities, and other 
                facilities providing recreational services, to 
                establish programs that use their facilities for after 
                school and weekend community activities;</DELETED>
                <DELETED>    ``(D) establishing incentives for retail 
                food stores, farmer's markets, food coops, grocery 
                stores, and other retail food outlets that offer 
                nutritious foods to encourage such stores and outlets 
                to locate in economically depressed areas;</DELETED>
                <DELETED>    ``(E) forming partnerships with senior 
                centers and nursing homes to establish programs for 
                older people to foster physical activity and healthy 
                eating behaviors;</DELETED>
                <DELETED>    ``(F) forming partnerships with day care 
                facilities to establish programs that promote healthy 
eating behaviors and physical activity; and</DELETED>
                <DELETED>    ``(G) providing community educational 
                activities targeting good nutrition;</DELETED>
        <DELETED>    ``(2) carry out age-appropriate school-based 
        activities including--</DELETED>
                <DELETED>    ``(A) developing and testing educational 
                curricula and intervention programs designed to promote 
                healthy eating behaviors and habits in youth, which may 
                include--</DELETED>
                        <DELETED>    ``(i) after hours physical 
                        activity programs;</DELETED>
                        <DELETED>    ``(ii) increasing opportunities 
                        for students to make informed choices regarding 
                        healthy eating behaviors; and</DELETED>
                        <DELETED>    ``(iii) science-based 
                        interventions with multiple components to 
                        prevent eating disorders including nutritional 
                        content, understanding and responding to hunger 
                        and satiety, positive body image development, 
                        positive self-esteem development, and learning 
                        life skills (such as stress management, 
                        communication skills, problem-solving and 
                        decisionmaking skills), as well as 
                        consideration of cultural and developmental 
                        issues, and the role of family, school, and 
                        community;</DELETED>
                <DELETED>    ``(B) providing education and training to 
                educational professionals regarding a healthy lifestyle 
                and a healthy school environment;</DELETED>
                <DELETED>    ``(C) planning and implementing a healthy 
                lifestyle curriculum or program with an emphasis on 
                healthy eating behaviors and physical activity; 
                and</DELETED>
                <DELETED>    ``(D) planning and implementing healthy 
                lifestyle classes or programs for parents or guardians, 
                with an emphasis on healthy eating behaviors and 
                physical activity;</DELETED>
        <DELETED>    ``(3) carry out activities through the local 
        health care delivery systems including--</DELETED>
                <DELETED>    ``(A) promoting healthy eating behaviors 
                and physical activity services to treat or prevent 
                eating disorders, being overweight, and 
                obesity;</DELETED>
                <DELETED>    ``(B) providing patient education and 
                counseling to increase physical activity and promote 
                healthy eating behaviors; and</DELETED>
                <DELETED>    ``(C) providing community education on 
                good nutrition and physical activity to develop a 
                better understanding of the relationship between diet, 
                physical activity, and eating disorders, obesity, or 
                being overweight; or</DELETED>
        <DELETED>    ``(4) other activities determined appropriate by 
        the Secretary.</DELETED>
<DELETED>    ``(f) Matching Funds.--In awarding grants under subsection 
(a), the Secretary may give priority to eligible entities who provide 
matching contributions. Such non-Federal contributions may be cash or 
in kind, fairly evaluated, including plant, equipment, or 
services.</DELETED>
<DELETED>    ``(g) Technical Assistance.--The Secretary may set aside 
an amount not to exceed 10 percent of the total amount appropriated for 
a fiscal year under subsection (k) to permit the Director of the 
Centers for Disease Control and Prevention to provide grantees with 
technical support in the development, implementation, and evaluation of 
programs under this section and to disseminate information about 
effective strategies and interventions in preventing and treating 
obesity and eating disorders through the promotion of healthy eating 
behaviors and physical activity.</DELETED>
<DELETED>    ``(h) Limitation on Administrative Costs.--An eligible 
entity awarded a grant under this section may not use more than 10 
percent of funds awarded under such grant for administrative 
expenses.</DELETED>
<DELETED>    ``(i) Report.--Not later than 6 years after the date of 
enactment of the Improved Nutrition and Physical Activity Act, the 
Director of the Centers for Disease Control and Prevention shall review 
the results of the grants awarded under this section and other related 
research and identify programs that have demonstrated effectiveness in 
healthy eating behaviors and physical activity in youth.</DELETED>
<DELETED>    ``(j) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) Anorexia nervosa.--The term `Anorexia 
        Nervosa' means an eating disorder characterized by self-
        starvation and excessive weight loss.</DELETED>
        <DELETED>    ``(2) Binge eating disorder.--The term `binge 
        eating disorder' means a disorder characterized by frequent 
        episodes of uncontrolled eating.</DELETED>
        <DELETED>    ``(3) Bulimia nervosa.--The term `Bulimia Nervosa' 
        means an eating disorder characterized by excessive food 
        consumption, followed by inappropriate compensatory behaviors, 
        such as self-induced vomiting, misuse of laxatives, fasting, or 
        excessive exercise.</DELETED>
        <DELETED>    ``(4) Eating disorders.--The term `eating 
        disorders' means disorders of eating, including Anorexia 
        Nervosa, Bulimia Nervosa, and binge eating disorder.</DELETED>
        <DELETED>    ``(5) Healthy eating behaviors.--The term `healthy 
        eating behaviors' means--</DELETED>
                <DELETED>    ``(A) eating in quantities adequate to 
                meet, but not in excess of, daily energy 
                needs;</DELETED>
                <DELETED>    ``(B) choosing foods to promote health and 
                prevent disease;</DELETED>
                <DELETED>    ``(C) eating comfortably in social 
                environments that promote healthy relationships with 
                family, peers, and community; and</DELETED>
                <DELETED>    ``(D) eating in a manner to acknowledge 
                internal signals of hunger and satiety.</DELETED>
        <DELETED>    ``(6) Obese.--The term `obese' means an adult with 
        a Body Mass Index (BMI) of 30 kg/
        m</DELETED>\<DELETED>2</DELETED>\ <DELETED>or 
        greater.</DELETED>
        <DELETED>    ``(7) Overweight.--The term `overweight' means an 
        adult with a Body Mass Index (BMI) of 25 to 29.9 kg/
        m</DELETED>\<DELETED>2</DELETED>\ <DELETED>and a child or 
        adolescent with a BMI at or above the 95th percentile on the 
        revised Centers for Disease Control and Prevention growth 
        charts or another appropriate childhood definition, as defined 
        by the Secretary.</DELETED>
        <DELETED>    ``(8) Youth.--The term `youth' means individuals 
        not more than 18 years old.</DELETED>
<DELETED>    ``(k) Authorization of Appropriations.--There are 
authorized to be appropriated to carry out this section, $60,000,000 
for fiscal year 2004 and such sums as may be necessary for each of 
fiscal years 2005 through 2008. Of the funds appropriated pursuant to 
this subsection, the following amounts shall be set aside for 
activities related to eating disorders:</DELETED>
        <DELETED>    ``(1) $5,000,000 for fiscal year 2004.</DELETED>
        <DELETED>    ``(2) $5,500,000 for fiscal year 2005.</DELETED>
        <DELETED>    ``(3) $6,000,000 for fiscal year 2006.</DELETED>
        <DELETED>    ``(4) $6,500,000 for fiscal year 2007.</DELETED>
        <DELETED>    ``(5) $1,000,000 for fiscal year 2008.''</DELETED>

<DELETED>SEC. 202. NATIONAL CENTER FOR HEALTH STATISTICS.</DELETED>

<DELETED>    Section 306 of the Public Health Service Act (42 U.S.C. 
242k) is amended by striking subsection (n) and inserting the 
following:</DELETED>
<DELETED>    ``(n)(1) The Secretary, acting through the Center, may 
provide for the--</DELETED>
        <DELETED>    ``(A) collection of data for determining the 
        fitness levels and energy expenditure of children and youth; 
        and</DELETED>
        <DELETED>    ``(B) analysis of data collected as part of the 
        National Health and Nutrition Examination Survey and other data 
        sources.</DELETED>
<DELETED>    ``(2) In carrying out paragraph (1), the Secretary, acting 
through the Center, may make grants to States, public entities, and 
nonprofit entities.</DELETED>
<DELETED>    ``(3) The Secretary, acting through the Center, may 
provide technical assistance, standards, and methodologies to grantees 
supported by this subsection in order to maximize the data quality and 
comparability with other studies.''.</DELETED>

<DELETED>SEC. 203. STUDY OF THE FOOD SUPPLEMENT AND NUTRITION PROGRAMS 
              OF THE DEPARTMENT OF AGRICULTURE.</DELETED>

<DELETED>    (a) In General.--The Secretary of Agriculture shall 
request that the Institute of Medicine conduct, or contract with 
another entity to conduct, a study on the food and nutrition assistance 
programs run by the Department of Agriculture.</DELETED>
<DELETED>    (b) Content.--Such study shall--</DELETED>
        <DELETED>    (1) investigate whether the nutrition programs and 
        nutrition recommendations are based on the latest scientific 
        evidence;</DELETED>
        <DELETED>    (2) investigate whether the food assistance 
        programs contribute to either preventing or enhancing obesity 
        and being overweight in children, adolescents, and 
        adults;</DELETED>
        <DELETED>    (3) investigate whether the food assistance 
        programs can be improved or altered to contribute to the 
        prevention of obesity and becoming overweight; and</DELETED>
        <DELETED>    (4) identify obstacles that prevent or hinder the 
        programs from achieving their objectives.</DELETED>
<DELETED>    (c) Report.--Not later than 2 years after the date of 
enactment of this Act, the Secretary of Agriculture shall submit to the 
appropriate committees of Congress a report containing the results of 
the Institute of Medicine study authorized under this 
section.</DELETED>
<DELETED>    (d) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $750,000 for fiscal years 
2003 and 2004.</DELETED>

<DELETED>SEC. 204. HEALTH DISPARITIES REPORT.</DELETED>

<DELETED>    Not later than 18 months after the date of enactment of 
this Act, and annually thereafter, the Director of the Agency for 
Healthcare Research and Quality shall review all research that results 
from the activities outlined in this Act and determine if particular 
information may be important to the report on health disparities 
required by section 903(c)(3) of the Public Health Service Act (42 
U.S.C. 299a-1(c)(3)).</DELETED>

<DELETED>SEC. 205. PREVENTIVE HEALTH SERVICES BLOCK GRANT.</DELETED>

<DELETED>    Section 1904(a)(1) of the Public Health Service Act (42 
U.S.C. 300w-3(a)(1)) is amended by adding at the end the 
following:</DELETED>
        <DELETED>    ``(H) Activities and community education programs 
        designed to address and prevent overweight, obesity, and eating 
        disorders through effective programs to promote healthy eating, 
        and exercise habits and behaviors.''.</DELETED>

<DELETED>SEC. 206. REPORT ON OBESITY RESEARCH.</DELETED>

<DELETED>    (a) In General.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to the Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce of the House of 
Representatives a report on research conducted on causes and health 
implications of obesity and being overweight.</DELETED>
<DELETED>    (b) Content.--The report described in subsection (a) shall 
contain--</DELETED>
        <DELETED>    (1) descriptions on the status of relevant, 
        current, ongoing research being conducted in the Department of 
        Health and Human Services including research at the National 
        Institutes of Health, the Centers for Disease Control and 
        Prevention, the Agency for Healthcare Research and Quality, the 
        Health Resources and Services Administration, and other offices 
        and agencies;</DELETED>
        <DELETED>    (2) information about what these studies have 
        shown regarding the causes of, prevention of, and treatment of, 
        overweight and obesity; and</DELETED>
        <DELETED>    (3) recommendations on further research that is 
        needed, including research among diverse populations, the 
        department's plan for conducting such research, and how current 
        knowledge can be disseminated.</DELETED>

<DELETED>SEC. 207. REPORT ON A NATIONAL CAMPAIGN TO CHANGE CHILDREN'S 
              HEALTH BEHAVIORS AND REDUCE OBESITY.</DELETED>

<DELETED>    Section 399Y of the Public Health Service Act (42 U.S.C. 
280h-2) is amended--</DELETED>
        <DELETED>    (1) by redesignating subsection (b) as subsection 
        (c); and</DELETED>
        <DELETED>    (2) by inserting after subsection (a) the 
        following:</DELETED>
<DELETED>    ``(b) Report.--The Secretary shall evaluate the 
effectiveness of the campaign described in subsection (a) in changing 
children's behaviors and reducing obesity and shall report such results 
to the Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improved Nutrition and Physical 
Activity Act'' or the ``IMPACT Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) An estimated 61 percent of adults and 13 percent of 
        children and adolescents in the Nation are overweight or obese.
            (2) The prevalence of obesity and being overweight is 
        increasing among all age groups. There are twice the number of 
        overweight children and 3 times the number of overweight 
        adolescents as there were 29 years ago.
            (3) An estimated 300,000 deaths a year are associated with 
        being overweight or obese.
            (4) Obesity and being overweight are associated with an 
        increased risk for heart disease (the leading cause of death), 
        cancer (the second leading cause of death), diabetes (the 6th 
        leading cause of death), and musculoskeletal disorders.
            (5) Individuals who are obese have a 50 to 100 percent 
        increased risk of premature death.
            (6) The Healthy People 2010 goals identify obesity and 
        being overweight as one of the Nation's leading health problems 
        and include objectives of increasing the proportion of adults 
        who are at a healthy weight, reducing the proportion of adults 
        who are obese, and reducing the proportion of children and 
        adolescents who are overweight or obese.
            (7) Another goal of Healthy People 2010 is to eliminate 
        health disparities among different segments of the population. 
        Obesity is a health problem that disproportionally impacts 
        medically underserved populations.
            (8) The United States Surgeon General's report ``A Call To 
        Action'' lists the treatment and prevention of obesity as a top 
        national priority.
            (9) The estimated direct and indirect annual cost of 
        obesity in the United States is $117,000,000,000 (exceeding the 
        cost of tobacco-related illnesses) and appears to be rising 
        dramatically. This cost can potentially escalate markedly as 
        obesity rates continue to rise and the medical complications of 
        obesity are emerging at even younger ages. Therefore, the total 
        disease burden will most likely increase, as well as the 
        attendant health-related costs.
            (10) Weight control programs should promote a healthy 
        lifestyle including regular physical activity and healthy 
        eating, as consistently discussed and identified in a variety 
        of public and private consensus documents, including ``A Call 
        To Action'' and other documents prepared by the Department of 
        Health and Human Services and other agencies.
            (11) Eating preferences and habits are established in 
        childhood.
            (12) Poor eating habits are a risk factor for the 
        development of eating disorders and obesity.
            (13) Simply urging overweight individuals to be thin has 
        not reduced the prevalence of obesity and may result in other 
        problems including body dissatisfaction, low self-esteem, and 
        eating disorders.
            (14) Effective interventions for promoting healthy eating 
        behaviors should promote healthy lifestyle and not 
        inadvertently promote unhealthy weight management techniques.
            (15) Binge Eating is associated with obesity, heart 
        disease, gall bladder disease, and diabetes.
            (16) Anorexia Nervosa, an eating disorder from which 0.5 to 
        3.7 percent of American women will suffer in their lifetime, is 
        associated with serious health consequences including heart 
        failure, kidney failure, osteoporosis, and death. In fact, 
        Anorexia Nervosa has the highest mortality rate of all 
        psychiatric disorders, placing a young woman with Anorexia 
        Nervosa at 18 times the risk of death of other women her age.
            (17) Anorexia Nervosa and Bulimia Nervosa usually appears 
        in adolescence.
            (18) Bulimia Nervosa, an eating disorder from which an 
        estimated 1.1 to 4.2 percent of American women will suffer in 
        their lifetime, is associated with cardiac, gastrointestinal, 
        and dental problems, including irregular heartbeats, gastric 
        ruptures, peptic ulcers, and tooth decay.
            (19) On the 1999 Youth Risk Behavior Survey, 7.5 percent of 
        high school girls reported recent use of laxatives or vomiting 
        to control their weight.
            (20) Binge Eating Disorder is characterized by frequent 
        episodes of uncontrolled overeating, with an estimated 2 to 5 
        percent of Americans experiencing this disorder in a 6-month 
        period.
            (21) Eating disorders are commonly associated with 
        substantial psychological problems, including depression, 
        substance abuse, and suicide.
            (22) Eating disorders of all types are more common in women 
        than men.

                        TITLE I--TRAINING GRANTS

SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION STUDENTS.

    Section 747(c)(3) of title VII of the Public Health Service Act (42 
U.S.C. 293k(c)(3)) is amended by striking ``and victims of domestic 
violence'' and inserting ``victims of domestic violence, individuals 
(including children) who are overweight or obese (as such terms are 
defined in section 399W(j)) and at risk for related serious and chronic 
medical conditions, and individuals who suffer from eating disorders''.

SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSIONALS.

    Section 399Z of the Public Health Service Act (42 U.S.C. 280h-3) is 
amended--
            (1) in subsection (b), by striking ``2005'' and inserting 
        ``2007'';
            (2) by redesignating subsection (b) as subsection (c); and
            (3) by inserting after subsection (a) the following:
    ``(b) Grants.--
            ``(1) In general.--The Secretary may award grants to 
        eligible entities to train primary care physicians and other 
        licensed or certified health professionals on how to identify, 
        treat, and prevent obesity or eating disorders and aid 
        individuals who are overweight, obese, or who suffer from 
        eating disorders.
            ``(2) Application.--An entity that desires a grant under 
        this subsection shall submit an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require, including a plan for the use of funds that may be 
        awarded and an evaluation of the training that will be 
        provided.
            ``(3) Use of funds.--An entity that receives a grant under 
        this subsection shall use the funds made available through such 
        grant to--
                    ``(A) use evidence-based findings or 
                recommendations that pertain to the prevention and 
                treatment of obesity, being overweight, and eating 
                disorders to conduct educational conferences, including 
                Internet-based courses and teleconferences, on--
                            ``(i) how to treat or prevent obesity, 
                        being overweight, and eating disorders;
                            ``(ii) the link between obesity and being 
                        overweight and related serious and chronic 
                        medical conditions;
                            ``(iii) how to discuss varied strategies 
                        with patients from at-risk and diverse 
                        populations to promote positive behavior change 
                        and healthy lifestyles to avoid obesity, being 
                        overweight, and eating disorders;
                            ``(iv) how to identify overweight and obese 
                        patients and those who are at risk for obesity 
                        and being overweight or suffer from eating 
                        disorders and, therefore, at risk for related 
                        serious and chronic medical conditions;
                            ``(v) how to conduct a comprehensive 
                        assessment of individual and familial health 
                        risk factors; and
                    ``(B) evaluate the effectiveness of the training 
                provided by such entity in increasing knowledge and 
                changing attitudes and behaviors of trainees.''.

 TITLE II--COMMUNITY-BASED SOLUTIONS TO INCREASE PHYSICAL ACTIVITY AND 
                           IMPROVE NUTRITION

SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h et seq.) is amended by striking section 399W and inserting the 
following:

``SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE 
              NUTRITION.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention and 
        in coordination with the Administrator of the Health Resources 
        and Services Administration, the Director of the Indian Health 
        Service, the Secretary of Education, the Secretary of 
        Agriculture, the Secretary of the Interior, the Director of the 
        National Institutes of Health, the Director of the Office of 
        Women's Health, and the heads of other appropriate agencies, 
        shall award competitive grants to eligible entities to plan and 
        implement programs that promote healthy eating behaviors and 
        physical activity to prevent eating disorders, obesity, being 
        overweight, and related serious and chronic medical conditions. 
        Such grants may be awarded to target at-risk populations 
        including youth, adolescent girls, health disparity populations 
        (as defined in section 485E(d)), and the underserved.
            ``(2) Term.--The Secretary shall award grants under this 
        subsection for a period not to exceed 4 years.
    ``(b) Award of Grants.--An eligible entity desiring a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require, including--
            ``(1) a plan describing a comprehensive program of 
        approaches to encourage healthy eating behaviors and healthy 
        levels of physical activity;
            ``(2) the manner in which the eligible entity will 
        coordinate with appropriate State and local authorities, 
        including--
                    ``(A) State and local educational agencies;
                    ``(B) departments of health;
                    ``(C) chronic disease directors;
                    ``(D) State directors of programs under section 17 
                of the Child Nutrition Act of 1966 (42 U.S.C. 1786);
                    ``(E) 5-a-day coordinators;
                    ``(F) Governors' councils for physical activity and 
                good nutrition;
                    ``(G) State and local parks and recreation 
                departments; and
                    ``(H) State and local departments of transportation 
                and city planning; and
            ``(3) the manner in which the applicant will evaluate the 
        effectiveness of the program carried out under this section.
    ``(c) Coordination.--In awarding grants under this section, the 
Secretary shall ensure that the proposed programs are coordinated in 
substance and format with programs currently funded through other 
Federal agencies and operating within the community including the 
Physical Education Program (PEP) of the Department of Education.
    ``(d) Eligible Entity.--In this section, the term `eligible entity' 
means--
            ``(1) a city, county, tribe, territory, or State;
            ``(2) a State educational agency;
            ``(3) a tribal educational agency;
            ``(4) a local educational agency;
            ``(5) a federally qualified health center (as defined in 
        section 1861(aa)(4) of the Social Security Act (42 U.S.C. 
        1395x(aa)(4));
            ``(6) a rural health clinic;
            ``(7) a health department;
            ``(8) an Indian Health Service hospital or clinic;
            ``(9) an Indian tribal health facility;
            ``(10) an urban Indian facility;
            ``(11) any health provider;
            ``(12) an accredited university or college;
            ``(13) a community-based organization;
            ``(14) a local city planning agency; or
            ``(15) any other entity determined appropriate by the 
        Secretary.
    ``(e) Use of Funds.--An eligible entity that receives a grant under 
this section shall use the funds made available through the grant to--
            ``(1) carry out community-based activities including--
                    ``(A) city planning, transportation initiatives, 
                and environmental changes that help promote physical 
                activity, such as increasing the use of walking or 
                bicycling as a mode of transportation;
                    ``(B) forming partnerships and activities with 
                businesses and other entities to increase physical 
                activity levels and promote healthy eating behaviors at 
                the workplace and while traveling to and from the 
                workplace;
                    ``(C) forming partnerships with entities, including 
                schools, faith-based entities, and other facilities 
                providing recreational services, to establish programs 
                that use their facilities for after school and weekend 
                community activities;
                    ``(D) establishing incentives for retail food 
                stores, farmer's markets, food co-ops, grocery stores, 
                and other retail food outlets that offer nutritious 
                foods to encourage such stores and outlets to locate in 
                economically depressed areas;
                    ``(E) forming partnerships with senior centers and 
                nursing homes to establish programs for older people to 
                foster physical activity and healthy eating behaviors;
                    ``(F) forming partnerships with daycare facilities 
                to establish programs that promote healthy eating 
                behaviors and physical activity; and
                    ``(G) providing community educational activities 
                targeting good nutrition;
            ``(2) carry out age-appropriate school-based activities 
        including--
                    ``(A) developing and testing educational curricula 
                and intervention programs designed to promote healthy 
                eating behaviors and habits in youth, which may 
                include--
                            ``(i) after hours physical activity 
                        programs;
                            ``(ii) increasing opportunities for 
                        students to make informed choices regarding 
                        healthy eating behaviors; and
                            ``(iii) science-based interventions with 
                        multiple components to prevent eating disorders 
                        including nutritional content, understanding 
                        and responding to hunger and satiety, positive 
                        body image development, positive self-esteem 
                        development, and learning life skills (such as 
                        stress management, communication skills, 
                        problem-solving and decisionmaking skills), as 
                        well as consideration of cultural and 
                        developmental issues, and the role of family, 
                        school, and community;
                    ``(B) providing education and training to 
                educational professionals regarding a healthy lifestyle 
                and a healthy school environment;
                    ``(C) planning and implementing a healthy lifestyle 
                curriculum or program with an emphasis on healthy 
                eating behaviors and physical activity; and
                    ``(D) planning and implementing healthy lifestyle 
                classes or programs for parents or guardians, with an 
                emphasis on healthy eating behaviors and physical 
                activity;
            ``(3) carry out activities through the local health care 
        delivery systems including--
                    ``(A) promoting healthy eating behaviors and 
                physical activity services to treat or prevent eating 
                disorders, being overweight, and obesity;
                    ``(B) providing patient education and counseling to 
                increase physical activity and promote healthy eating 
                behaviors; and
                    ``(C) providing community education on good 
                nutrition and physical activity to develop a better 
                understanding of the relationship between diet, 
                physical activity, and eating disorders, obesity, or 
                being overweight; or
            ``(4) other activities determined appropriate by the 
        Secretary.
    ``(f) Matching Funds.--In awarding grants under subsection (a), the 
Secretary may give priority to eligible entities who provide matching 
contributions. Such non-Federal contributions may be cash or in kind, 
fairly evaluated, including plant, equipment, or services.
    ``(g) Technical Assistance.--The Secretary may set aside an amount 
not to exceed 10 percent of the total amount appropriated for a fiscal 
year under subsection (k) to permit the Director of the Centers for 
Disease Control and Prevention to provide grantees with technical 
support in the development, implementation, and evaluation of programs 
under this section and to disseminate information about effective 
strategies and interventions in preventing and treating obesity and 
eating disorders through the promotion of healthy eating behaviors and 
physical activity.
    ``(h) Limitation on Administrative Costs.--An eligible entity 
awarded a grant under this section may not use more than 10 percent of 
funds awarded under such grant for administrative expenses.
    ``(i) Report.--Not later than 6 years after the date of enactment 
of the Improved Nutrition and Physical Activity Act, the Director of 
the Centers for Disease Control and Prevention shall review the results 
of the grants awarded under this section and other related research and 
identify programs that have demonstrated effectiveness in healthy 
eating behaviors and physical activity in youth.
    ``(j) Definitions.--In this section:
            ``(1) Anorexia nervosa.--The term `Anorexia Nervosa' means 
        an eating disorder characterized by self-starvation and 
        excessive weight loss.
            ``(2) Binge eating disorder.--The term `binge eating 
        disorder' means a disorder characterized by frequent episodes 
        of uncontrolled eating.
            ``(3) Bulimia nervosa.--The term `Bulimia Nervosa' means an 
        eating disorder characterized by excessive food consumption, 
        followed by inappropriate compensatory behaviors, such as self-
        induced vomiting, misuse of laxatives, fasting, or excessive 
        exercise.
            ``(4) Eating disorders.--The term `eating disorders' means 
        disorders of eating, including Anorexia Nervosa, Bulimia 
        Nervosa, and binge eating disorder.
            ``(5) Healthy eating behaviors.--The term `healthy eating 
        behaviors' means--
                    ``(A) eating in quantities adequate to meet, but 
                not in excess of, daily energy needs;
                    ``(B) choosing foods to promote health and prevent 
                disease;
                    ``(C) eating comfortably in social environments 
                that promote healthy relationships with family, peers, 
                and community; and
                    ``(D) eating in a manner to acknowledge internal 
                signals of hunger and satiety.
            ``(6) Obese.--The term `obese' means an adult with a Body 
        Mass Index (BMI) of 30 kg/m2 or greater.
            ``(7) Overweight.--The term `overweight' means an adult 
        with a Body Mass Index (BMI) of 25 to 29.9 kg/m2 and a child or 
        adolescent with a BMI at or above the 95th percentile on the 
        revised Centers for Disease Control and Prevention growth 
        charts or another appropriate childhood definition, as defined 
        by the Secretary.
            ``(8) Youth.--The term `youth' means individuals not more 
        than 18 years old.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $60,000,000 for fiscal year 
2004 and such sums as may be necessary for each of fiscal years 2005 
through 2008. Of the funds appropriated pursuant to this subsection, 
the following amounts shall be set aside for activities related to 
eating disorders:
            ``(1) $5,000,000 for fiscal year 2004.
            ``(2) $5,500,000 for fiscal year 2005.
            ``(3) $6,000,000 for fiscal year 2006.
            ``(4) $6,500,000 for fiscal year 2007.
            ``(5) $1,000,000 for fiscal year 2008.''.

SEC. 202. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306 of the Public Health Service Act (42 U.S.C. 242k) is 
amended--
            (1) in subsection (m)(4)(B), by striking ``subsection (n)'' 
        each place it appears and inserting ``subsection (o)'';
            (2) by redesignating subsection (n) as subsection (o); and
            (3) by inserting after subsection (m) the following:
    ``(n)(1) The Secretary, acting through the Center, may provide for 
the--
            ``(A) collection of data for determining the fitness levels 
        and energy expenditure of children and youth; and
            ``(B) analysis of data collected as part of the National 
        Health and Nutrition Examination Survey and other data sources.
    ``(2) In carrying out paragraph (1), the Secretary, acting through 
the Center, may make grants to States, public entities, and nonprofit 
entities.
    ``(3) The Secretary, acting through the Center, may provide 
technical assistance, standards, and methodologies to grantees 
supported by this subsection in order to maximize the data quality and 
comparability with other studies.''.

SEC. 203. HEALTH DISPARITIES REPORT.

    Not later than 18 months after the date of enactment of this Act, 
and annually thereafter, the Director of the Agency for Healthcare 
Research and Quality shall review all research that results from the 
activities outlined in this Act and determine if particular information 
may be important to the report on health disparities required by 
section 903(c)(3) of the Public Health Service Act (42 U.S.C. 299a-
1(c)(3)).

SEC. 204. PREVENTIVE HEALTH SERVICES BLOCK GRANT.

    Section 1904(a)(1) of the Public Health Service Act (42 U.S.C. 
300w-3(a)(1)) is amended by adding at the end the following:
            ``(H) Activities and community education programs designed 
        to address and prevent overweight, obesity, and eating 
        disorders through effective programs to promote healthy eating, 
        and exercise habits and behaviors.''.

SEC. 205. REPORT ON OBESITY RESEARCH.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Energy and Commerce of the House of 
Representatives a report on research conducted on causes and health 
implications of obesity and being overweight.
    (b) Content.--The report described in subsection (a) shall 
contain--
            (1) descriptions on the status of relevant, current, 
        ongoing research being conducted in the Department of Health 
        and Human Services including research at the National 
        Institutes of Health, the Centers for Disease Control and 
        Prevention, the Agency for Healthcare Research and Quality, the 
        Health Resources and Services Administration, and other offices 
        and agencies;
            (2) information about what these studies have shown 
        regarding the causes of, prevention of, and treatment of, 
        overweight and obesity; and
            (3) recommendations on further research that is needed, 
        including research among diverse populations, the department's 
        plan for conducting such research, and how current knowledge 
        can be disseminated.

SEC. 206. REPORT ON A NATIONAL CAMPAIGN TO CHANGE CHILDREN'S HEALTH 
              BEHAVIORS AND REDUCE OBESITY.

    Section 399Y of the Public Health Service Act (42 U.S.C. 280h-2) is 
amended--
            (1) by redesignating subsection (b) as subsection (c); and
            (2) by inserting after subsection (a) the following:
    ``(b) Report.--The Secretary shall evaluate the effectiveness of 
the campaign described in subsection (a) in changing children's 
behaviors and reducing obesity and shall report such results to the 
Committee on Health, Education, Labor, and Pensions of the Senate and 
the Committee on Energy and Commerce of the House of 
Representatives.''.




                                                       Calendar No. 417

108th CONGRESS

  1st Session

                                S. 1172

_______________________________________________________________________

                                 A BILL

To establish grants to provide health services for improved nutrition, 
    increased physical activity, obesity prevention, and for other 
                               purposes.

_______________________________________________________________________

                           November 25, 2003

                       Reported with an amendment