[Congressional Record Volume 149, Number 176 (Tuesday, December 9, 2003)]
[Senate]
[Pages S16094-S16100]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
IMPROVED NUTRITION AND PHYSICAL ACTIVITY ACT
Mr. FRIST. Mr. President, I ask unanimous consent that the Senate now
proceed to the consideration of Calendar No. 417, S. 1172.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 1172) to establish grants to provide health
services for improved nutrition, increased physical activity,
obesity prevention, and for other purposes.
There being no objection, the Senate proceeded to consider the bill
which had been reported from the Committee on Health, Education, Labor,
and Pensions with an amendment in the nature of a substitute, as
follows:
(Strike the part shown in black brackets and insert the part printed
in italic.)
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.
[[Page S16095]]
[(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 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; and
[``(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;
[[Page S16096]]
[``(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 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/m\2\ or greater.
[``(7) Overweight.--The term `overweight' means an adult
with a Body Mass Index (BMI) of 25 to 29.9 kg/m\2\ 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)).
[[Page S16097]]
[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.''.
[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.''.]
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,
[[Page S16098]]
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
[[Page S16099]]
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.''.
Mr. HARKIN. Mr. President, I wish to engage in a colloquy with the
distinguished majority leader, the Senator from Tennessee, Mr. Frist.
From time to time, Congress is confronted with a public health crisis
of such magnitude that we have no choice but to act. For a number of
reasons, including the changing physical environment, eating and
physical activity habits, obesity has now emerged as a serious new
public health threat. More than 65 percent of American adults and 15
percent of children are obese or overweight. These figures double the
levels during the 1980s for adults and triple the levels for children.
Obesity now contributes to an estimated 300,000 deaths annually. We
also know that obesity contributes to diabetes, high blood pressure,
high cholesterol, cancers and heart disease. The economic impact also
is alarming. The Surgeon General reports that obesity costs the Nation
over $117 billion directly and indirectly. These tends will continue if
we do not develop a comprehensive strategy to prevent and treat this
condition.
I commend Senator Frist and others for introducing the Improved
Nutrition and Physical Activity Act to begin to tackle this challenge.
Senator Frist as a physician certainly understands the impact of rising
obesity rates. I commend his leadership on this issue. I believe that
he and I agree that this IMPACT bill is an important step forward, but
that more may need to be done to prevent and treat obesity. In view of
the continuing and growing public health threat, I wonder if my friend
and colleague would agree with me now that the Health, Education, Labor
and Pensions Committee, as the committee of jurisdiction in this policy
area, should devote further attention to this problem next year. I
wonder whether he, as a fellow member of that HELP Committee, would
agree with me now to urge chairman and ranking member of that committee
to hold a hearing early in the next session of this Congress for that
purpose.
Mr. FRIST. I thank my colleague for his kind remarks. As he knows, I
believe this issue of obesity is one of the largest unaddressed public
health issues we face today, and I am pleased by the action we are
taking today. I agree that it is critical that we continue to direct
our attention to this issue, and it is my hope that the HELP Committee
will continue to examine the issue, including by holding a hearing next
year.
Mr. HARKIN. I appreciate the attention of the majority leader to this
subject. I commend his work and congratulate him on passage of this
bill. I look forward to sending a joint letter to the HELP Committee,
requesting a hearing, and I look forward to working with the Senator
from Tennessee and others to build on this important start in combating
harmful obesity.
Mr. FRIST. Mr. President, I ask unanimous consent that the committee
substitute amendment be agreed to, the bill, as amended, be read a
third time and passed, the motion to reconsider be laid upon the table,
and that any statements relating to the bill be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The committee amendment in the nature of a substitute was agreed to.
The bill (S. 1172), as amended, was read the third time and passed.
Mr. FRIST. Mr. President, this bill we just passed does exactly as
stated. It establishes grants to address health services for nutrition,
for increased physical activity, and for obesity prevention.
It is late in the day, and a little bit later we will bring this
session to a close. I am delighted personally, as a physician and as a
Senator, that this body came forward to pass this important piece of
legislation. I draw the attention of my colleagues to last week's
edition of Newsweek magazine. It features a special section on the top
10 health stories of 2003. Weighing in as No. 1 in the Newsweek story
in the judgment of its editor is the obesity epidemic in America. That
comes before depression, it comes before cancer, and it comes before
even the SARS virus.
The magazine reports that more than 65 percent of Americans are
overweight or obese and rates of obesity-related illnesses are
skyrocketing. Fifteen percent of America's children are seriously
overweight, triple the number in 1970. It is an epidemic that is
getting worse day by day, week by week, month by month, and year by
year.
As a physician and as a Senator, this particular issue is one about
which I care passionately. I have spoken to this issue frequently in
the Senate and I return tonight to do so for a few moments. I applaud
the media outlets because they have done a very good job in
highlighting and spotlighting this new epidemic. They are taking this
obesity threat seriously and helping to communicate that around the
United States of America.
The message is simple, that obesity, which is growing day by day, is
debilitating. It is effectively debilitating millions of Americans.
Indeed, it has reached epidemic proportions in all ages but in
particular in children.
Historically, obesity was considered just another lifestyle choice.
It was a tolerable consequence of eating food, eating good food, and
eating lots of food. It was a consequence of driving instead of
walking. But now we know obesity literally causes heart disease. Heart
disease is the No. 1 killer in Americans. Now we know that obesity
causes diabetes, causes cancer, contributes to stroke. Indeed, a
whopping 300,000 deaths a year can be linked directly to fat. And it is
spreading. It is spreading in children. The percentage of kids age 6 to
19 who are overweight has not just doubled, not just tripled but almost
quadrupled since the 1960s.
Nationwide, type 2 diabetes, which is the kind associated with being
overweight, being obese, has skyrocketed. The Centers for Disease
Control and Prevention estimates that one in three Americans born
today--they studied the year 2000--will develop diabetes in their
lifetime. It is the type of diabetes that can be prevented and it can
be treated.
With African-American children and you look at Hispanic children,
that number jumps to nearly half; one out of two African American and
Hispanic babies born this year or last year will develop diabetes. As
adults, we know it is hard to battle being overweight. But imagine, for
a 10-year-old child, the challenge to both prevent and to treat this
epidemic.
Diabetes leads to a whole host of chronic illnesses. It is the
leading cause of amputations in our society today. It is the leading
cause of blindness in our society today. It is the
[[Page S16100]]
leading cause of heart disease and kidney disease in our society today.
With regard to children, teachers can tell the story. Teachers have
the opportunity to see children in classrooms on a regular basis. They
say they see kids out of breath simply walking up the stairs in school.
They tell us about kids who, when they get outside of the school and go
to the schoolyard, are out of breath or, they come back exhausted from
a simple field trip.
Activities that we associate with exercise such as kick ball, jumping
rope, climbing trees, for many kids today these are grueling exercises,
grueling activities that are to be avoided at all cost because of their
feeling of overexertion and being out of breath. Twenty-five percent of
our Nation's children say they do not participate in any vigorous
activity. That is one in four. Obesity is robbing them not only of
enjoying the normal traditional childhood pastimes but it also is
literally robbing them of their childhood years. By that I mean that
obesity is associated with the early onset of puberty among girls.
According to a study from the University of North Carolina, 48 percent
of African-American girls begin puberty by age 8, over a quarter by age
7.
Indeed, this is a national health crisis. It is harming our children
in ways we can readily observe. It is also harming our children in ways
we do not so readily observe that will not become apparent until later
in life. Yes, you observe the obesity but you do not see the side
effects of the obesity until much later. Those side effects, as I
mentioned before, are heart disease, amputation, blindness, a
debilitating disease that condemns them to more illness, condemns them
to a shorter life.
Again, this is a new phenomena. If we look at the history of medicine
in this country, back a few hundred years, we are going along like this
and in the 1960s or 1970s we have hit epidemic proportions. The reason
I talk about it in the Senate and the reason why the bill just passed,
the IMPACT Act, is so important is because this trend can be reversed.
If we reverse it, we also reverse heart disease, lung disease, stroke,
various types of cancer. That is what this body should be about. That
is what this body is about and we demonstrated it by passing this so-
called IMPACT Act that looks at nutrition, looks at physical activity,
that focuses on young people. We are taking action; we are offering
solutions. We cannot solve it all with this particular bill, but we
show we are addressing identified problems; we are reversing problems
that are apparent in our society.
In this session, the Committee on Health, Education, Labor, and
Pensions unanimously approved the IMPACT Act, which we just passed in
the Senate, the Improved Nutrition and Physical Activity Act. It was
introduced earlier this year by myself with Senators Bingaman, Dodd,
and others. This IMPACT Act uses a multifaceted approach that
emphasizes youth education to jump-start healthy habits early. It funds
demonstration projects to find innovative ways, creative ways, to
improve eating and exercise. In addition--and this is critically
important--it includes rigorous evaluation so we can learn what is
best.
We see many different proposals. We cannot turn on television without
seeing the latest fad, the latest diet or the latest cure. It is a huge
industry. What we in the Government can do and should be doing is
evaluating what works best in terms of what we implement through this
program. This bill does not attempt to control what Americans eat or
what Americans do not eat. This bill does not outlaw bad foods. It does
not attempt to replicate in any way that $1 billion diet and fitness
industry. It does have a modest pricetag and that reflects the
appropriate role of the Federal Government.
Working with the chairman of the HELP Committee, Senator Judd Gregg,
and Senator Dodd, Senator Bingaman, and others, I am delighted--I am
delighted--that we have, as authors, as sponsors, just seen this bill
pass by unanimous consent.
I do hope the House of Representatives will join us early next year
in sending this legislation to the President of the United States for
his signature.
Again, this is not ``the'' solution. There is no single solution to
this growing epidemic of obesity, but there are solutions. This
epidemic can be reversed, and the start is awareness and then action.
That is why, indeed, I am speaking at this fairly late hour on this
particular issue, because we have just demonstrated, through action,
that this body will work toward solutions, and to also state the
importance of the awareness, especially awareness among children. And
that is where this IMPACT bill will have a direct impact.
We know the consequences of obesity. We can and we should keep our
kids safe by helping to keep them fit. Tonight, in this body, we
demonstrated the start.
Mr. President, I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. DASCHLE. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Fitzgerald). Without objection, it is so
ordered.
____________________