[Congressional Record Volume 149, Number 80 (Tuesday, June 3, 2003)]
[Senate]
[Pages S7246-S7250]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Bingaman, Mr. Dodd, Mr. DeWine, 
        Mrs. Clinton, Mr. Warner, Mrs. Murray, Mr. Lugar, Ms. Landrieu, 
        Mr. Sessions, and Mr. Alexander):
  S. 1172. A bill to establish grants to provide health services for 
improved nutrition, increased physical activity, obesity prevention, 
and for other purposes; to the Committee on Health, Education, Labor, 
and Pensions.
  Mr. FRIST. Mr. President, I rise today to discuss a particular public 
health problem--the growing rates of obesity. This epidemic has 
steadily increased to a level twice what it was thirty years ago. 
Obesity now affects over sixty percent of adults and thirteen percent 
of children and adolescents. Among young people, it is escalating at an 
alarming rate. This condition causes three hundred thousand deaths a 
year and is second only to smoking as the Nation's leading cause of 
preventable death. Overweight and obesity are associated with increased 
risk for heart disease, the leading cause of death, cancer, the second 
leading cause of death, diabetes, the seventh leading cause of death, 
and musculoskeletal disorders. Anyone with this condition has at least 
a 50 percent chance of a premature death.
  As obesity continues to mount, the morbidity, mortality and health 
care costs associated with these disorders will skyrocket. Just this 
last month, a Health Affairs article estimated that nearly one-tenth of 
U.S. health care costs are attributable to conditions resulting from 
obesity or being overweight. In 2002 dollars, the authors of this 
article estimate that obesity and overweight-related conditions cost 
$92.6 billion. Of which, half is financed by Medicare and Medicaid.
  Healthy People 2010 calls overweight and obesity one of the Nation's 
leading health problems and prioritizes efforts to increase the 
proportion of adults who are at a healthy weight, and reduce the levels 
of obesity and overweight among adults, children and adolescents. The 
Surgeon General's report ``A Call to Action'' lists the treatment and 
prevention of obesity as a top national priority.
  Now, if this condition was linked to an infectious or bioterrorist 
agent, the public outcry would be deafening, and the action to control 
it swift. But it is not. Obesity and being overweight is often seen as 
an individual problem and a personal choice, and thus does not receive 
much attention. Most people do not choose to be overweight. Overweight 
and obesity result from daily lifestyle choices that gradually 
accumulate. Weight gain occurs slowly, often unnoticed. Today, many 
Americans struggle to control their weight, collectively spending 
billions of dollars each year on weight loss products and programs.
  The good news is that, with healthy eating and regular physical 
activity, obesity is preventable and treatable. That is why I, along 
with Senator Bingaman, Senator Dodd, and others, am reintroducing the 
``Improved Nutrition and Physical Activity, IMPACT, Act.'' I am pleased 
that Representatives Mary Bono and Kay Granger, along with other co-
sponsors, introduced companion legislation in the House of 
Representatives earlier this year. This bill will help Americans make 
healthy decisions about nutrition and physical activity. It emphasizes 
youth education so that healthy habits can begin early. Finally, it 
funds demonstration projects to find innovative ways of improving 
eating and exercise habits.
  There is no single solution to the growing epidemic of obesity. That 
is why the IMPACT Act takes a multifaceted approach. It implements 
evidence-based programs, where available, and includes rigorous 
evaluation of demonstration projects so we can learn what works best. 
This important legislation has a modest price tag, reflecting the 
appropriate role of the Federal Government. Most importantly, the 
IMPACT Act does not attempt to mandate what Americans eat or drink or 
to transfer to the Federal Government decisions that are best made at 
local levels.
  Let me be clear that I am not against people making choices. I am all 
for choice, informed choice. What has happened, though, is that we as a 
society and as individuals have made choices about eating and activity, 
gradually and incrementally, without understanding or considering the 
consequences. Finally, and most importantly, this bill does not intend 
to and should not be considered to stigmatize those who struggle to 
control their weight or to demonize any sector of the country by 
blaming them for this epidemic. The IMPACT Act represents a bipartisan 
agreement that the problem of obesity is important, and takes an 
approach that is supported by a broad spectrum of interested parties. 
With the Federal Government providing assistance, all sectors of 
society will need to work together to help produce a healthier nation.
  I believe we have crafted a good first response to the growing rates 
of obesity. A number of public health and industry experts support the 
passage of this important legislation. I ask unanimous consent that a 
list of the organizations supporting the legislation and the text of 
the bill be printed in the Record.
  I want to thank Senators Bingaman and Dodd for their work on this 
bill. I also want to thank Senator Gregg for his assistance in ensuring 
that this legislation can become law. Senator Gregg has worked 
tirelessly with my staff to ensure that we craft legislation that can 
be quickly passed by the Senate, and I appreciate his efforts. I look 
forward to having this bill become law this year.
  There being no objection, the list and the bill were ordered to be 
printed in the Record, as follows:

                    Groups Supporting the IMPACT Act

       The Advertising Council, Inc.;
       Consortium for Citizens with Disabilities Prevention Task 
     Force;
       Council on State and Territorial Epidemiologists;
       Endocrine Society;
       FamilyCook Productions: Bringing Families Together Through 
     Fresh Food;
       Grocery Manufacturers of America;
       National Alliance for Nutrition and Activity;
       National Recreation and Parks Association;
       Research against Inactivity-related Disorders (RID);
       Samuels & Associates: Public Health Research, Evaluation, 
     and Policy Consultants;
       Society for Nutrition Education;
       Structure House;
       University of North Carolina at Chapel Hill, School of 
     Public Health; and
       YMCA.
                                  ____


                                S. 1172

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

     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.

[[Page S7247]]

       (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 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, racial and ethnic minorities, 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; and
       ``(G) State and local parks and recreation departments; 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;

[[Page S7248]]

       ``(10) an urban Indian facility;
       ``(11) any health care service provider;
       ``(12) an accredited university or college; or
       ``(13) 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) planning and implementing environmental changes that 
     promote physical activity;
       ``(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 coops, 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 day care 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 by striking subsection (n) and inserting 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. STUDY OF THE FOOD SUPPLEMENT AND NUTRITION PROGRAMS 
                   OF THE DEPARTMENT OF AGRICULTURE.

       (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.
       (b) Content.--Such study shall--
       (1) investigate whether the nutrition programs and 
     nutrition recommendations are based on the latest scientific 
     evidence;
       (2) investigate whether the food assistance programs 
     contribute to either preventing or enhancing obesity and 
     being overweight in children, adolescents, and adults;
       (3) investigate whether the food assistance programs can be 
     improved or altered to contribute to the prevention of 
     obesity and becoming overweight; and
       (4) identify obstacles that prevent or hinder the programs 
     from achieving their objectives.
       (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.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $750,000 for 
     fiscal years 2003 and 2004.

     SEC. 204. 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. 205. 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.''.

[[Page S7249]]

     SEC. 206. 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. 207. 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.''.
  Mr. BINGAMAN. Mr. President, I rise today in support of the Improved 
Nutrition and Physical Activity or IMPACT Bill that Senator Frist has 
introduced with myself and Senators Dodd, DeWine, Clinton, Warner, 
Murray, Lugar, Landrieu, and Sessions. This is a bill that is critical 
in this era of chronic disease, as it addresses the mounting public 
health concerns of obesity, overweight, eating disorders, and their 
related diseases such as diabetes and cardiovascular disease.
  Approximately 61 percent of adults and 13 percent of children and 
adolescents in our Nation today are overweight or obese. These 
individuals have a significantly greater risk of diseases such as 
diabetes, heart disease, and stroke than their healthy weight peers. 
Another 5 to 10 percent of Americans are suffering from eating 
disorders that can also manifest themselves in a number of physical and 
psychological illnesses including heart disease, osteoporosis, kidney 
failure, depression, anxiety, and suicide. Unfortunately, these rates 
of overweight, obesity, and eating disorders are rising in both adult 
and child populations. Since obesity is a health problem that 
disproportionately impacts medically underserved populations, it is 
rapidly increasing the medical burden on these already overburdened 
populations.
  The economic implications of the obesity epidemic are equally 
disturbing. The estimated direct and indirect annual cost of obesity in 
the United States is now 117 billion dollars--exceeding the cost of 
tobacco-related illnesses. These costs will only continue to climb 
unless we make a concerted effort to stem this dangerous tide by 
initiating primary and secondary prevention programs.
  It is this conclusion that led the United States Surgeon General to 
issue a Call to Action listing the treatment and prevention of obesity 
as a top national priority. It is this conclusion that has led 
Secretary Thompson to implement the Steps to a Healthier US initiative. 
And it is this reality that makes passing the IMPACT bill a critical 
step towards improving our nation's future health and well-being.
  Obesity and eating disorders are complex diseases and as such require 
comprehensive multidisciplinary solutions. IMPACT aims to move us 
toward those solutions by addressing these diseases on a number of 
levels. First, it aims to prepare the health care community to deal 
with obesity from prevention to diagnosis to intervention by adding 
obesity, overweight, and eating disorders to the list of priority 
conditions to be addressed in the health professions Title VII training 
grants.
  Second, IMPACT supports community-based solutions to increase 
physical activity and improve nutrition on a number of levels. It 
provides funding for demonstration projects in communities, schools, 
health care organizations, and other qualified entities that promote 
fitness or healthy nutrition. It authorizes the CDC to collect fitness 
and energy expenditure information from children. It directs AHRQ to 
review any new information relating to obesity trends among various 
sub-populations and include such information in its health disparities 
report. It allows states to use their Preventive Services Block Grant 
money for community education on nutrition and increased physical 
activity. It instructs the Secretary to report on what research has 
been done in the area of obesity, what has been learned from this 
research, and what future research should be conducted. And finally, it 
asks the secretary to report on the effectiveness of the Youth Media 
Campaign in changing children's behaviors and reducing obesity.

  IMPACT is supported by a wide variety of public and private 
organizations. The National Alliance for Nutrition and Activity or 
NANA, an organization including more than 250 national, state, and 
local organizations and the single largest coalition in the U.S. 
dedicated to promoting healthy eating and physical activity and 
reducing obesity states, ``NANA strongly supports your efforts to 
reduce obesity and improve eating and activity habits in the U.S. 
through the IMPACT bill.'' Other organizations that have stated their 
support include the American Heart Association, the American Cancer 
Society, the Council for States and Territorial Epidemiologists, the 
Society for Nutrition Education, and the American Dietetic Association.
  This legislation is an excellent first step in the fight for improved 
health, but it is not the only step we must take. We need to assist our 
schools in providing healthy nutrition options and expanding physical 
activity programs. We need to grow the workforce so that people have 
access to the healthcare professionals they need to prevent, diagnose, 
and treat obesity and eating disorders. We need to look at Medicare and 
Medicaid and insure that they provide the services necessary to help 
people prevent and treat obesity and its complications so that we 
reduce the burden of these diseases in these vulnerable populations. 
And we need to promote research in the areas of obesity prevention and 
treatment so that we can offer people better and more effective 
interventions in the future. These are not small goals but they are 
critical to our nation's health. I will continue to work on additional 
legislation that will take the next steps toward addressing these and 
other related concerns.
  For today, I would like to ask all of my colleagues to join me in 
taking this very important first step toward reducing obesity and 
eating disorders by supporting this important legislation. By passing 
this bill we can truly IMPACT the health of our nation.
  Mrs. CLINTON. Mr. President, I rise today to speak about a 
frightening epidemic in our Nation. A staggering 61 percent of adults 
and 13 percent of children and adolescents in our Nation are overweight 
or obese. The number of overweight children has doubled and the number 
of overweight adolescents has tripled since 1980, according to the 
Surgeon General. The estimated direct and indirect annual cost of 
obesity in the United States is $117,000,000,000, exceeding even 
smoking-related illnesses.
  That is why I am pleased to join Senators Frist, Bingaman, Dodd and 
others in introducing the Improved Nutrition and Physical Activity Act 
of 2003. This bill takes important steps to fund programs that ensure 
healthy eating behaviors and improved physical activity. Funding this 
program will save Americans vastly more in lower health care costs. The 
bill also takes critical steps to educate health professionals to help 
us fight this epidemic. With smoking, we learned that a simple 
recommendation from a health professional to stop could have a dramatic 
impact in reducing smoking. It is just as important to make sure our 
health care providers are equipped to help mold healthy behaviors in 
our fight against obesity.
  I also appreciate Senator Frist's willingness to incorporate 
important provisions from my Promoting Healthy Eating Behaviors in 
Youth Act of 2002. While it is so important to fight the obesity 
epidemic, we should not inadvertently send the wrong message by

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telling our children and adults simply to eat less and exercise. 
Unfortunately, many adolescents misinterpret this as a message that 
they should eat to achieve the body of a runway model. Anorexia and 
bulimia are increasingingly common among our Nation's youth. Recent 
data from the 1999 Youth Risk Behavior Survey indicated that 7 percent 
of young women who were very thin (body mass index less than 15 
percentile) reported taking laxatives or vomiting to lose weight or to 
avoid gaining weight. An even larger percentage 9 percent of these very 
thin young women reported using diet pills.
  While it is important to prevent diabetes and heart disease that may 
result from obesity, eating disorders also have their own very serious 
consequences. Anorexia nervosa, which will affect 3.7 percent of 
American women sometime in their lifetime, leads to heart failure, 
kidney failure, and osteoporosis. In fact, a young woman is 12 times 
more likely to die than other women her age without anorexia.

  Poor eating habits have also led to a ``calcium crisis'' among 
American youth. Very few adolescent girls (14 percent get the 
recommended daily amount of calcium, placing them at serious risk for 
osteoporosis and other bone diseases. Because nearly 90 percent of 
adult bone mass is established by the end of adolescent growth period, 
the Nation's youth's insufficient calcium intake is truly a calcium 
crisis. The consequence of this crisis will be seen years later, when 
we are likely to face an unprecedented incidence of osteoporosis in 
women.
  That is why I am especially grateful to see the use of a balanced 
``healthy eating behavior'' definition in the bill, and to see that a 
portion of the grants in the bill are set aside for eating disorders 
education programs. While we certainly need to focus on exercise and 
appropriate nutritional behavior, it is certainly just as important to 
teach our children and adults how to engage in regular physical 
exercise and lose weight in a healthy way.
  I am proud to join Senators Frist, Bingaman, Dodd, Warner, DeWine, 
Murray, Lugar, and Landrieu in this important legislative initiative, 
and eagerly anticipate its progress as we fight a significant public 
health epidemic.
                                 ______