[Congressional Record Volume 155, Number 76 (Monday, May 18, 2009)]
[Senate]
[Pages S5556-S5561]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BINGAMAN:
  S. 1060. A bill to comprehensively prevent, treat, and decrease 
overweight and obesity in our Nation's populations; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the Obesity 
Prevention, Treatment and Research Act of 2009. This legislation would 
develop a national strategy to organize our efforts to combat childhood 
and adult obesity. It would help foster unprecedented collaborations 
and collective actions across agencies, and among private entities, 
individuals, and communities.
  The prevalence of obesity in the U.S. has grown to staggering 
proportions. According to the Centers for Disease Control and 
Prevention National Center for Health Statistics, 66 percent of adults 
and 32 percent of children are considered either overweight or obese. 
Over the past 30 years, the obesity rate has more than doubled across 
all age groups. The U.S. now has the highest prevalence of obesity 
among the developed nations. In fact, the prevalence of obesity in the 
U.S. in 2006, 34 percent, is more than twice the average for other 
developed nations.
  The Obesity Prevention, Treatment and Research Act of 2009 
comprehensively addresses the obesity and overweight epidemic by 
focusing on coordinating and augmenting existing prevention and 
treatment activities. This legislation is based on recommendations of 
the Institutes of Medicine, IOM, to confront the obesity epidemic. It 
focuses on developing dynamic new collaborations and will improve 
access for beneficiaries in Medicare, Medicaid, and other Federal 
programs to nutritional counseling, prevention services, and physical 
education programs.

[[Page S5557]]

  Obesity is a costly problem for the U.S. both in terms of health care 
expenditures and the loss of life. The incidence of type 2 diabetes, 
high blood pressure, and progressive liver disease--ailments once 
associated only with adults--is rising among overweight children. These 
health risks compound with age, since overweight children and 
adolescents are more likely to become obese adults. For the first time 
in our history, the lifespan of a child born today may be less than 
that of his or her parents. Interventions aimed at significantly 
decreasing the prevalence of these illnesses are extremely cost 
effective and are critical to overall disease prevention and health 
promotion efforts. The Trust for America's Health recently reported 
that an investment of just $10 per person per year in proven community-
based disease prevention programs would yield a $2.8 billion annual 
health expenditure reduction. Put another way, our nation would recoup 
nearly $1 over and above the cost of a comprehensive disease prevention 
and health promotion program for every $1 invested in the first 1 to 2 
years of the program. To that end, my legislation creates grant 
programs to provide funding to schools, community health centers, 
academic institutions, State medical societies, State health 
departments, and communities to reduce the prevalence of obesity and 
improve the prevention and treatment of individuals who are obese or 
overweight.
  The Obesity Prevention, Treatment and Research Act of 2009 
establishes the U.S. Council on Overweight & Obesity Prevention, USCO-
OP, which is charged with creating a comprehensive strategy to prevent, 
treat and reduce the prevalence of overweight individuals and obesity. 
This advisory council will update Federal guidelines; identify best 
practices; conduct ongoing surveillance and monitoring of existing 
Federal programs; and make recommendations to coordinate budgets, 
policies, and programs across Federal agencies in collaboration with 
private and public partners. In addition, the Council will help develop 
and update the daily physical activity requirements in our schools, and 
identify activities that families can do together.
  It is also critical to recognize that certain populations are more 
vulnerable than others to the obesity epidemic. Minorities, especially 
from Hispanic and Native American communities, are disproportionately 
affected by this disease. For example, in my home State of New Mexico, 
approximately 26 percent of Hispanic and 32 percent of Native American 
adolescents, grades 9-12, are overweight or obese; the rate of 
prevalence is less than 20 percent among white, non-Hispanic 
adolescents. I have, therefore, prioritized grants in this legislation 
to these populations and required Federal reporting on research and 
data related to obesity in disproportionately affected groups. This 
includes grants aimed at behavioral risk factors such as sedentary 
lifestyles and poor nutrition.
  This bill will help further develop and then increase funding to the 
Department of Agriculture's Fresh Fruit and Vegetable Program. This 
will help ensure that low-income children will have access to healthier 
foods within their schools. In addition, the Secretary of Health and 
Human Services and the Secretary of Agriculture will be tasked to 
consult with the USCO-OP to update and reform Federal oversight of food 
and beverage labeling. Such reforms include improving the transparency 
of labeling with regard to nutritional and caloric value of food and 
beverages.
  I think it is imperative that we provide treatment to those 
individuals who are likely to develop obesity-related ailments before 
the full onset of disease. The Obesity Prevention, Treatment and 
Research Act of 2009 does this by expanding coverage of Medicare to 
include medical nutritional counseling for beneficiaries who are 
overweight or obese and are considered pre-diabetics. In addition, my 
legislation gives States the option to include medical nutrition 
therapy services in Medicaid and SCHIP.
  There is no doubt that the obesity epidemic has grown immensely. I am 
confident, however, that it can be stopped but it requires a nationwide 
commitment for resolution. I look forward to working with my colleagues 
to enact this legislation this year.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was orderd to be 
printed in the Record, as follows:

                                S. 1060

       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 ``Obesity Prevention, 
     Treatment, and Research Act of 2009''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) In 2001, the United States Surgeon General released the 
     Call to Action to Prevent and Decrease Overweight and Obesity 
     to bring attention to the public health problems related to 
     obesity.
       (2) Since the Surgeon General's call to action, the 
     problems of obesity and overweight have become epidemic, 
     occurring in all ages, ethnicities and races, and individuals 
     in every State.
       (3) The United States now has the highest prevalence of 
     obesity among the developed nations, according to 2006 data 
     by the Organisation for Economic Co-operation and 
     Development. The prevalence of obesity in the United States 
     (34 percent) is more than twice the average for other 
     developed nations (13 percent). The closest nation in 
     prevalence of obesity is the United Kingdom (24 percent) 
     which is over 25 percent less than the United States.
       (4) The National Health and Nutrition Examination Survey in 
     2006 estimated that 32 percent of children and adolescents 
     aged 2 to 19 and an alarming 66 percent of adults are 
     overweight or obese.
       (5) More than 30 percent of young people in grades 9 
     through 12 do not regularly engage in vigorous intensity 
     physical activity, while almost 40 percent of adults are 
     sedentary and 70 percent report getting less than 20 minutes 
     of regular physical activity per day.
       (6) The Institute of Medicine, in their 2005 publication 
     ``Preventing Childhood Obesity: Health in the Balance'', 
     reported that over the last 3 decades, the rate of childhood 
     obesity has tripled for children aged 6 to 11 years, and 
     doubled for children aged 2 to 5 years old and in adolescents 
     aged 12 to 19 years old. In 2004, approximately 9,000,000 
     children over 6 years of age were obese. Only 2 percent of 
     children eat a healthy diet consistent with Federal nutrition 
     guidelines.
       (7) For children born in 2000, it is estimated the lifetime 
     risk of being diagnosed with type 2 diabetes is 40 percent 
     for females and 30 percent for males.
       (8) Overweight and obesity disproportionately affect 
     minority populations and women. According to the 2006 
     Behavioral Risk Factor Surveillance System of the Centers for 
     the Disease Control and Prevention, 61 percent of adults in 
     the United States are overweight or obese.
       (9) The Centers for the Disease Control and Prevention 
     estimates the annual expenditures related to overweight and 
     obesity in the United States to be $117,000,000,000 in 2001 
     and rising rapidly.
       (10) The Centers for the Disease Control and Prevention 
     estimates that the increase in the number of overweight and 
     obese Americans between 1987 and 2001 resulted in a 27 
     percent increase in per capita health costs, and that as many 
     as 112,000 deaths per year are associated with obesity.
       (11) Being overweight or obese increases the risk of 
     chronic diseases including diabetes, heart disease, stroke, 
     certain cancers, arthritis, and other health problems.
       (12) According to the National Institute of Diabetes and 
     Digestive and Kidney Diseases, individuals who are obese have 
     a 50 to 100 percent increased risk of premature death.
       (13) Healthy People 2010 goals identify overweight and 
     obesity as 1 of the Nation's leading health problems and 
     include objectives for 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.
       (14) Another Healthy People 2010 goal is to eliminate 
     health disparities among different segments of the 
     population. Obesity is a health problem that 
     disproportionally impacts medically underserved populations.
       (15) Food and beverage advertisers are estimated to spend 
     $10,000,000 to $12,000,000,000 per year to target children 
     and youth.
       (16) The United States spends less than 2 percent of its 
     annual health expenditures on prevention.
       (17) Employer health promotion investments net a return of 
     $3 for every $1 invested.
       (18) High-energy dense and low-nutrient dense foods 
     represent 30 percent of American's total calorie intake. Fast 
     food company menus are twice the energy density of 
     recommended healthful diets.
       (19) Research suggests that individuals eat too much high-
     energy dense foods without feeling full because the brain's 
     pathways that regulate hunger and influence normal food 
     intake are not triggered by these foods.
       (20) Packaging, product placement, and high-energy dense 
     food content manipulation contribute to the overweight and 
     obesity epidemic in the United States.
       (21) Such marketing and content manipulation techniques 
     have been used by other industries to encourage consumption 
     at the expense of health. To help individuals make

[[Page S5558]]

     healthy choices, education and information must be available 
     with clear, consistent, and accurate labeling.

         TITLE I--OBESITY TREATMENT, PREVENTION, AND REDUCTION

     SEC. 101. UNITED STATES COUNCIL ON OVERWEIGHT-OBESITY 
                   PREVENTION.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by--
       (1) redesignating section 399R (as inserted by section 2 of 
     Public Law 110-373) as section 399S;
       (2) redesignating section 399R (as inserted by section 3 of 
     Public Law 110-374) as section 399T; and
       (3) adding at the end the following:

     ``SEC. 399U. UNITED STATES COUNCIL ON OVERWEIGHT-OBESITY 
                   PREVENTION.

       ``(a) Establishment.--The Secretary shall convene a United 
     States Council on Overweight-Obesity Prevention (referred to 
     in this section as `USCO-OP').
       ``(b) Membership.--
       ``(1) In general.--USCO-OP shall be composed of 20 members, 
     which shall consist of--
       ``(A) the Secretary;
       ``(B) the Secretary (or his or her designee) of--
       ``(i) the Department of Agriculture;
       ``(ii) the Department of Education;
       ``(iii) the Department of Housing and Urban Development;
       ``(iv) the Department of the Interior
       ``(v) the Federal Trade Commission;
       ``(vi) the Department of Transportation; and
       ``(vii) any other Federal agency that the Secretary of 
     Health and Human Services determines appropriate;
       ``(C) the Chairman (or his or her designee) of the Federal 
     Communications Commission;
       ``(D) the Director (or his or her designee) of the Centers 
     for Disease Control and Prevention, the National Institutes 
     of Health, and the Agency for Healthcare Research and 
     Quality;
       ``(E) the Administrator of the Centers for Medicare and 
     Medicaid Services (or his or her designee);
       ``(F) the Commissioner of Food and Drugs (or his or her 
     designee); and
       ``(G) a minimum of 5 representatives, appointed by the 
     Secretary, of expert organizations such as public health 
     associations, key healthcare provider groups, planning and 
     development organizations, education associations, advocacy 
     groups, relevant industries, State and local leadership, and 
     other entities as determined appropriate by the Secretary.
       ``(2) Appointments.--The Secretary shall accept nominations 
     for representation on USCO-OP through public comment before 
     the initial appointment of members of USCO-OP under paragraph 
     (1)(G), and on a regular basis for open positions thereafter, 
     but not less than every 2 years.
       ``(3) Chairperson.--The chairperson of USCO-OP shall be--
       ``(A) an individual appointed by the President; and
       ``(B) until the date that an individual is appointed under 
     subparagraph (A), the Secretary.
       ``(c) Meetings.--
       ``(1) In general.--USCO-OP shall meet--
       ``(A) not later than 180 days after the date of enactment 
     of the Obesity Prevention, Treatment, and Research Act of 
     2009; and
       ``(B) at the call of the chairperson thereafter, but in no 
     case less often than 2 times per year.
       ``(2) Meetings of federal agencies.--The representatives of 
     the Federal agencies on USCO-OP shall meet on a regular 
     basis, as determined by the Secretary, to develop strategies 
     to coordinate budgets and discuss other issues that are not 
     otherwise permitted to be discussed in a public forum. The 
     purpose of such meetings shall be to allow more rapid 
     interagency strategic planning and intervention 
     implementation to address the overweight and obesity 
     epidemic.
       ``(d) Duties of USCO-OP.--USCO-OP shall--
       ``(1) develop strategies to comprehensively prevent, treat, 
     and reduce overweight and obesity;
       ``(2) coordinate interagency cooperation and action related 
     to the prevention, treatment, and reduction of overweight and 
     obesity in the United States;
       ``(3) identify best practices in communities to address 
     overweight and obesity;
       ``(4) work with appropriate entities to evaluate the 
     effectiveness of obesity and overweight interventions;
       ``(5) update the National Institutes of Health 1998 
     `Clinical Guidelines on the Identification, Evaluation, and 
     Treatment of Overweight and Obesity in Adults: The Evidence 
     Report' and include sections on childhood obesity in such 
     updated report;
       ``(6) conduct ongoing surveillance and monitoring using 
     tools such as the National Health and Nutrition Examination 
     Survey and the Behavioral Risk Factor Surveillance System and 
     assure adequate and consistent funding to support data 
     collection and analysis to inform policy;
       ``(7) make recommendations to coordinate budgets, grant and 
     pilot programs, policies, and programs across Federal 
     agencies to cohesively address overweight and obesity, 
     including with respect to the grant programs carried out 
     under sections 306(n), 399V, and 1904(a)(1)(H);
       ``(8) make recommendations to update and improve the daily 
     physical activity requirements for students under the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     6301 et seq.) and include recommendations about physical 
     activities that families can do together, and involving 
     parents in these activities;
       ``(9) make recommendations about coverage for obesity-
     related services and for an early and periodic screening, 
     diagnostic, and treatment services program under the State 
     Children's Health Insurance Program established under title 
     XXI of the Social Security Act;
       ``(10) make recommendations for obesity-related 
     information, including height, weight, and body mass index, 
     to be included in electronic health records for the purpose 
     of ongoing surveillance and monitoring; and
       ``(11) provide guidelines for childhood obesity health care 
     related treatment under the early and periodic screening, 
     diagnostic, and treatment services program under the Medicaid 
     program established under title XIX of the Social Security 
     Act and otherwise described in section 2103(c)(5) of such 
     Act.
       ``(e) Report.--Not later than 18 months after the date of 
     enactment of the Obesity Prevention, Treatment, and Research 
     Act of 2009, and on an annual basis thereafter, USCO-OP shall 
     submit to the President and to the relevant committees of 
     Congress, a report that--
       ``(1) summarizes the activities and efforts of USCO-OP 
     under this section to coordinate interagency prevention, 
     treatment, and reduction of obesity and overweight, including 
     a detailed strategic plan with recommendations for each 
     Federal agency;
       ``(2) evaluates the effectiveness of these coordinated 
     interventions and conducts interim assessments and reporting 
     of health outcomes, achievement of milestones, and 
     implementation of strategic plan goals starting with the 
     second report, and yearly thereafter; and
       ``(3) makes recommendations for the following year's 
     strategic plan based on data and findings from the previous 
     year.
       ``(f) Technical Assistance.--The Department of Health and 
     Human Services may provide technical assistance to USCO-OP to 
     carry out the activities under this section.
       ``(g) Permanence of Committee.--Section 14 of the Federal 
     Advisory Committee Act (5 U.S.C. App.) shall not apply to 
     USCO-OP.''.

     SEC. 102. GRANTS AND DEMONSTRATION PROGRAMS TO PROMOTE 
                   POSITIVE HEALTH BEHAVIORS IN POPULATIONS 
                   DISPROPORTIONATELY AFFECTED BY OBESITY AND 
                   OVERWEIGHT.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.), as amended by section 101, is amended 
     by adding at the end the following:

     ``SEC. 399V. GRANTS AND DEMONSTRATION PROGRAMS TO PROMOTE 
                   POSITIVE HEALTH BEHAVIORS IN POPULATIONS 
                   DISPROPORTIONATELY AFFECTED BY OBESITY AND 
                   OVERWEIGHT.

       ``(a) Eligible Entity.--For purposes of this section, the 
     term `eligible entity' means--
       ``(1) a city, county, Indian tribe, tribal organization, 
     territory, or State;
       ``(2) a local, tribal, or State educational agency;
       ``(3) a Federal medical facility, including a federally 
     qualified health center (as defined in section 1861(aa)(4) of 
     the Social Security Act), an Indian Health Service hospital 
     or clinic, any health facility or program operated by or 
     pursuant to a contractor grant from the Indian Health 
     Service, an Indian Health Service entity, an urban Indian 
     center, an Indian tribal clinic, a health care for the 
     homeless center, a rural health center, migrant health 
     center, and any other Federal medical facility;
       ``(4) any entity meeting the criteria for medical home 
     under section 204 of the Tax Relief and Health Care Act of 
     2006 (Public Law 109-432);
       ``(5) a nonprofit organization (such as an academic health 
     center or community health center);
       ``(6) a health department;
       ``(7) any licensed or certified health provider;
       ``(8) an accredited university or college;
       ``(9) a community-based organization;
       ``(10) a local city planning agency; and
       ``(11) any other entity determined appropriate by the 
     Secretary.
       ``(b) Application.--An eligible entity that desires a grant 
     under this section 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 any training that 
     will be provided under such grant.
       ``(c) Grant Demonstration and Pilot Program.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     and in consultation with the United States Council on 
     Overweight-Obesity Prevention under section 399U, shall 
     establish and evaluate a grant demonstration and pilot 
     program for entities to--
       ``(A) prevent, treat, or otherwise reduce overweight and 
     obesity;
       ``(B) increase the number of children and adults who safely 
     walk or bike to school or work;
       ``(C) increase the availability and affordability of fresh 
     fruits and vegetables in the community;
       ``(D) expand safe and accessible walking paths and 
     recreational facilities to encourage physical activity, and 
     other interventions to create healthy communities;

[[Page S5559]]

       ``(E) create advertising, social marketing, and public 
     health campaigns promoting healthier food choices, increased 
     physical activity, and healthier lifestyles targeted to 
     individuals and to families;
       ``(F) promote increased rates and duration of breast-
     feeding; and
       ``(G) increase worksite and employer promotion of and 
     involvement in community initiatives that prevent, treat, or 
     otherwise reduce overweight and obesity.
       ``(2) Special priority.--Special priority will be given to 
     grant proposals that target communities or populations 
     disproportionately affected by overweight or obesity, 
     including Native Americans, other minorities, and women.
       ``(d) Grants To Promote Positive Health Behaviors in 
     Populations Disproportionately Affected by Obesity and 
     Overweight.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may award grants to eligible entities to promote health 
     behaviors for women and children in target populations, 
     especially racial and ethnic minority populations in 
     medically underserved communities.
       ``(2) Use of funds.--An award under this section shall be 
     used to carry out any of the following:
       ``(A) To educate, promote, prevent, treat and determine 
     best practices in overweight and obese populations.
       ``(B) To address behavioral risk factors including 
     sedentary lifestyle, poor nutrition, being overweight or 
     obese, and use of tobacco, alcohol or other substances that 
     increase the risk of morbidity and mortality. Special 
     priority will be given to grant applications that--
       ``(i) propose interventions that address embedded levels of 
     influence on behavior, including the individual, family, 
     peers, community and society; and
       ``(ii) utilize techniques that promote community 
     involvement in the design and implementation of interventions 
     including community diagnosis and community-based 
     participatory research.
       ``(C) To develop and implement interventions to promote a 
     balance of energy consumption and expenditure, to attain 
     healthier weight, prevent obesity, and reduce morbidity and 
     mortality associated with overweight and obesity.
       ``(D)(i) 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.
       ``(ii) To 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, being overweight, eating 
     disorders 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, obese, individuals with 
     eating disorders, 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 evaluate the 
     effectiveness of the training provided by such entity in 
     increasing knowledge and changing attitudes and behaviors of 
     trainees.
       ``(iii) In awarding a grant to carry out an activity under 
     this subparagraph, preference shall be given to an entity 
     described in subsection (a)(4).
       ``(e) Reporting to Congress.--Not later than 3 years after 
     the date of enactment of this section, the Director of the 
     Centers for Disease Control and Prevention shall submit to 
     the Secretary and Congress a report concerning the result of 
     the activities conducted through the grants awarded under 
     this section.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $50,000,000 for fiscal year 2010, and such sums as may be 
     necessary for each of fiscal years 2011 through 2013.''.

     SEC. 103. 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 adults, 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. 104. 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 carried out under this Act 
     (and the amendments made by 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. 105. 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. 106. REPORT ON OBESITY AND EATING DISORDERS 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 
     (including mental health implications) of being overweight, 
     obesity, and eating disorders.
       (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, prevention, and treatment of, being 
     overweight, obesity, and eating disorders; and
       (3) recommendations on further research that is needed, 
     including research among diverse populations, the plan of the 
     Department of Health and Human Services for conducting such 
     research, and how current knowledge can be disseminated.

        TITLE II--FOOD AND BEVERAGE LABELING FOR HEALTHY CHOICES

     SEC. 201. FOOD AND BEVERAGE LABELING FOR HEALTHY CHOICES.

       (a) USCO-OP.--In this section, the term ``USCO-OP'' means 
     the United States Council on Overweight-Obesity Prevention 
     under section 399U of the Public Health Service Act (as added 
     by section 101).
       (b) Reform of Food and Beverage Labeling.--The Secretary of 
     Health and Human Services and the Secretary of Agriculture, 
     in consultation with the USCO-OP, shall, through regulation 
     or other appropriate action, update and reform Federal 
     oversight of food and beverage labeling. Such reform shall 
     include improving the transparency of such labeling with 
     regard to nutritional and caloric value of food and 
     beverages.

         TITLE III--HEALTHY CHOICES FOOD AND BEVERAGE PROGRAMS

     SEC. 301. FRESH FRUIT AND VEGETABLE PROGRAM.

       Section 19(i) of the Richard B. Russell National School 
     Lunch Act (42 U.S.C. 1769a(i)) is amended--
       (1) by redesignating paragraphs (3) through (7) as 
     paragraphs (4) through (8); and
       (2) by inserting after paragraph (2) the following:
       ``(3) Additional mandatory funding.--
       ``(A) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, the Secretary of the Treasury shall 
     transfer to the Secretary of Agriculture to carry out and 
     expand the program under this section, to remain available 
     until expended--
       ``(i) on October 1, 2009, $80,000,000;
       ``(ii) on July 1, 2010, $130,000,000;
       ``(iii) on July 1, 2011, $202,000,000;
       ``(iv) on July 1, 2012, $300,000,000; and
       ``(v) on July 1, 2013, and on each July 1 thereafter, the 
     amount made available for the previous fiscal year, as 
     adjusted under subparagraph (B).
       ``(B) Adjustment.--On July 1, 2013, and on each July 1 
     thereafter the amount made available under subparagraph 
     (A)(v) shall be calculated by adjusting the amount made 
     available for the previous fiscal year to reflect changes in 
     the Consumer Price Index of the Bureau of Labor Statistics 
     for fresh fruits and vegetables, with the adjustment--
       ``(i) rounded down to the nearest dollar increment; and
       ``(ii) based on the unrounded amounts for the preceding 12-
     month period.
       ``(C) Allocation.--Funds made available under this 
     paragraph shall be allocated among the States and the 
     District of Columbia in the same manner as funds made 
     available under paragraph (1).''.

            TITLE IV--AMENDMENTS TO THE SOCIAL SECURITY ACT

     SEC. 401. COVERAGE OF EVIDENCE-BASED PREVENTIVE SERVICES 
                   UNDER MEDICARE, MEDICAID, AND SCHIP.

       (a) Medicare.--Section 1861(ddd) of the Social Security 
     Act, as added by section 101 of

[[Page S5560]]

     the Medicare Improvements for Patients and Providers Act of 
     2008, is amended--
       (1) in paragraph (2), by striking ``paragraph (1)'' and 
     inserting ``paragraphs (1) and (3)''; and
       (2) by adding at the end the following new paragraph:
       ``(3) The term `additional preventive services' includes 
     any evidence-based preventive services which the Secretary 
     has determined are reasonable and necessary, including, as so 
     determined, smoking cessation and prevention services, diet 
     and exercise counseling, and healthy weight and obesity 
     counseling.''.
       (b) State Option to Provide Medical Assistance for 
     Evidence-Based Preventive Services.--
       (1) In general.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (A) in subsection (a)--
       (i) in paragraph (27), by striking ``and'' at the end;
       (ii) by redesignating paragraph (28) as paragraph (29); and
       (iii) by inserting after paragraph (27) the following:
       ``(28) evidence-based preventive services described in 
     subsection (y); and''; and
       (B) by adding at the end the following:
       ``(y) For purposes of subsection (a)(28), evidence-based 
     preventive services described in this subsection are any 
     preventive services which the Secretary has determined are 
     reasonable and necessary through the process for making 
     national coverage determinations (as defined in section 
     1869(f)(1)(B)) under title XVIII, including, as so 
     determined, smoking cessation and prevention services, diet 
     and exercise counseling, and healthy weight and obesity 
     counseling.''.
       (2) Conforming amendment.--Section 1902(a)(10)(C)(iv) of 
     such Act is amended by inserting ``, and (28)'' after 
     ``(24)''.
       (c) State Option To Provide Child Health Assistance for 
     Evidence-Based Preventive Services.--Section 2110(a) of the 
     Social Security Act (42 U.S.C. 1397jj(a)) is amended--
       (1) by redesignating paragraph (28) as paragraph (29); and
       (2) by inserting after paragraph (27) the following:
       ``(28) Evidence-based preventive services described in 
     section 1905(y).''.

     SEC. 402. COVERAGE OF MEDICAL NUTRITION COUNSELING UNDER 
                   MEDICARE, MEDICAID, AND SCHIP.

       (a) Medicare Coverage of Medical Nutrition Therapy Services 
     for People With Pre-Diabetes.--Section 1861(s)(2)(V) of the 
     Social Security Act (42 U.S.C. 1395x(s)(2)(V)) is amended by 
     inserting after ``beneficiary with diabetes'' the following 
     ``, pre-diabetes or its risk factors (including hypertension, 
     dyslipidemia, obesity, or overweight),''.
       (b) State Option To Provide Medical Assistance for Medical 
     Therapy Services.--
       (1) In general.--Section 1905(a) of the Social Security Act 
     (42 U.S.C. 1396d), as amended by section 401(b), is amended--
       (A) in paragraph (28), by striking ``and'' at the end;
       (B) by redesignating paragraph (29) as paragraph (30); and
       (C) by inserting after paragraph (28) the following:
       ``(29) medical nutrition therapy services (as defined in 
     section 1861(vv)(1)) for individuals with pre-diabetes or 
     obesity, or who are overweight (as defined by the Secretary); 
     and''.
       (2) Conforming amendment.--Section 1902(a)(10)(C)(iv) of 
     such Act, as amended by section 401(b)(2), is amended by 
     striking ``and (28)'' and inserting ``(28), and (29)''.
       (c) State Option To Provide Child Health Assistance for 
     Medical Nutrition Therapy Services.--Section 2110(a) of the 
     Social Security Act (42 U.S.C. 1397jj(a)), as amended by 
     section 401(c), is amended--
       (1) by redesignating paragraph (29) as paragraph (30); and
       (2) by inserting after paragraph (28) the following:
       ``(29) Medical nutrition therapy services (as defined in 
     section 1861(vv)(1)) for individuals with pre-diabetes or 
     obesity, or who are overweight (as defined by the 
     Secretary).''.

     SEC. 403. AUTHORIZING EXPANSION OF MEDICARE COVERAGE OF 
                   MEDICAL NUTRITION THERAPY SERVICES.

       (a) Authorizing Expanded Eligible Population.--Section 
     1861(s)(2)(V) of the Social Security Act (42 U.S.C. 
     1395x(s)(2)(V)), as amended by section 402, is amended--
       (1) by redesignating clauses (i) through (iii) as 
     subclauses (I) through (III), respectively, and indenting 
     each such clause an additional 2 ems;
       (2) by striking ``in the case of a beneficiary with 
     diabetes, pre-diabetes or its risk factors (including 
     hypertension, dyslipidemia, obesity, overweight), or a renal 
     disease who--'' and inserting ``in the case of a 
     beneficiary--
       ``(i) with diabetes, pre-diabetes or its risk factors 
     (including hypertension, dyslipidemia, obesity, overweight), 
     or a renal disease who--'';
       (3) by adding ``or'' at the end of subclause (III) of 
     clause (i), as so redesignated; and
       (4) by adding at the end the following new clause:
       ``(ii) who is not described in clause (i) but who has 
     another disease, condition, or disorder for which the 
     Secretary has made a national coverage determination (as 
     defined in section 1869(f)(1)(B)) for the coverage of such 
     services;''.
       (b) Coverage of Services Furnished by Physicians.--Section 
     1861(vv)(1) of the Social Security Act (42 U.S.C. 
     1395x(vv)(1)) is amended by inserting ``or which are 
     furnished by a physician'' before the period at the end.
       (c) National Coverage Determination Process.--In making a 
     national coverage determination described in section 
     1861(s)(2)(V)(ii) of the Social Security Act, as added by 
     subsection (a)(4), the Secretary of Health and Human 
     Services, acting through the Administrator of the Centers for 
     Medicare & Medicaid Services, shall--
       (1) consult with dietetic and nutrition professional 
     organizations in determining appropriate protocols for 
     coverage of medical nutrition therapy services for 
     individuals with different diseases, conditions, and 
     disorders; and
       (2) consider the degree to which medical nutrition therapy 
     interventions prevent or help prevent the onset or 
     progression of more serious diseases, conditions, or 
     disorders.

     SEC. 404. CLARIFICATION OF EPSDT INCLUSION OF PREVENTION, 
                   SCREENING, AND TREATMENT SERVICES FOR OBESITY 
                   AND OVERWEIGHT; SCHIP COVERAGE.

       (a) In General.--Section 1905(r)(5) of the Social Security 
     Act (42 U.S.C. 1396d(r)(5)) is amended by inserting ``, 
     including weight and BMI measurement and monitoring, as well 
     as appropriate treatment services (including but not limited 
     to) medical nutrition therapy services (as defined in section 
     1861(vv)(1)), physical therapy or exercise training, and 
     behavioral health counseling, based on recommendations of the 
     United States Council on Overweight-Obesity Prevention under 
     section 399U of the Public Health Service Act and such other 
     expert recommendations and studies as determined by the 
     Secretary'' before the period.
       (b) SCHIP.--
       (1) Required coverage.--Section 2103 (42 U.S.C. 1397cc) is 
     amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``and (7)'' and inserting ``(7), and (9)''; 
     and
       (B) in subsection (c)--
       (i) by redesignating paragraph (7) as paragraph (9); and
       (ii) by inserting after paragraph (6), the following:
       ``(7) Prevention, screening, and treatment services for 
     obesity and overweight.--The child health assistance provided 
     to a targeted low-income child shall include coverage of 
     weight and BMI measurement and monitoring, as well as 
     appropriate treatment services (including but not limited to) 
     medical nutrition therapy services (as defined in section 
     1861(vv)(1)), physical therapy or exercise training, and 
     behavioral health counseling, based on recommendations of the 
     United States Council on Overweight-Obesity Prevention under 
     section 399U of the Public Health Service Act and such other 
     expert recommendations and studies as determined by the 
     Secretary.''.
       (2) Conforming amendment.--Section 2102(a)(7)(B) (42 U.S.C. 
     1397bb(c)(2)) is amended by striking ``section 2103(c)(5)'' 
     and inserting ``paragraphs (5) and (7) of section 2103(c)''.

     SEC. 405. INCLUSION OF PREVENTIVE SERVICES IN QUALITY 
                   MATERNAL AND CHILD HEALTH SERVICES.

       Section 501(b) of the Social Security Act (42 U.S.C. 
     701(b)) is amended by adding at the end the following new 
     paragraph:
       ``(5) The term `quality maternal and child health services' 
     includes the following:
       ``(A) Evidence-based preventive services described in 
     section 1905(y).
       ``(B) Medical nutrition counseling for individuals with 
     pre-diabetes or obesity, or who are overweight (as defined by 
     the Secretary).
       ``(C) Weight and BMI measurement and monitoring, as well as 
     appropriate treatment services (including but not limited to) 
     medical nutrition therapy services (as defined in section 
     1861(vv)(1)), physical therapy or exercise training, and 
     behavioral health counseling, based on recommendations of the 
     United States Council on Overweight-Obesity Prevention under 
     section 399U of the Public Health Service Act and such other 
     expert recommendations and studies as determined by the 
     Secretary.''.

     SEC. 406. CHILDHOOD OBESITY INFORMATION, GUIDELINES, AND 
                   REPORTING.

       The Secretary of Health and Human Services, acting through 
     the Administrator of the Centers for Medicare and Medicaid 
     Services, shall--
       (1) not later than 18 months after the date of the 
     enactment of this Act, provide the State agencies responsible 
     for administering the State plan approved under title XIX of 
     the Social Security Act (42 U.S.C. 1396 et seq.) and the 
     State child health plan approved under title XXI of the 
     Social Security Act (42 U.S.C. 1397aa et seq.) with relevant 
     data, information, and recommendations, as the Administrator 
     deems appropriate, regarding the risks associated with 
     childhood obesity and the importance of identifying at-risk 
     children for treatment;
       (2) not later than 18 months after the date of the 
     enactment of this Act, issue guidelines, or amend existing 
     guidelines, concerning the development of pediatric obesity 
     prevention programs for at-risk populations through the use 
     of managed care techniques, integrated service delivery 
     models, disease management programs, and other methods that 
     the Administrator deems appropriate;
       (3) provide for the annual reporting by such State agencies 
     of the number of children enrolled in a State Medicaid or 
     child health plan that are--

[[Page S5561]]

       (A) screened for overweight or obesity; and
       (B) identified as at-risk for overweight or obesity and 
     have been provided with appropriate medical follow-up 
     services or counseling; and
       (4) prepare and submit an annual report to Congress on the 
     percentage of children enrolled in a State Medicaid or child 
     health plan that are screened for overweight or obesity and, 
     for those identified as at-risk, receive appropriate medical 
     follow-up services or counseling.

     SEC. 407. EFFECTIVE DATE.

       (a) In General.--Except as provided in subsection (b), this 
     title, and the amendments made under this title, take effect 
     on October 1, 2010.
       (b) Extension of Effective Date for State Law Amendment.--
     In the case of a State plan under title XIX or XXI of the 
     Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.) 
     which the Secretary of Health and Human Services determines 
     requires State legislation in order for the plan to meet the 
     additional requirements imposed by the amendments made by 
     this section, the State plan shall not be regarded as failing 
     to comply with the requirements of such title solely on the 
     basis of its failure to meet these additional requirements 
     before the first day of the first calendar quarter beginning 
     after the close of the first regular session of the State 
     legislature that begins after the date of enactment of this 
     Act. For purposes of the previous sentence, in the case of a 
     State that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.

                          ____________________