[Senate Report 108-245]
[From the U.S. Government Publishing Office]
108th Congress Report
SENATE
2d Session 108-245
======================================================================
IMPROVED NUTRITION AND PHYSICAL ACTIVITY ACT
_______
March 18, 2004.--Ordered to be printed
Filed, under authority of the order of the Senate of March 12, 2004
_______
Mr. Gregg, from the Committee on Health, Education, Labor, and
Pensions, submitted the following
R E P O R T
together with
ADDITIONAL VIEWS
[To accompany S. 1172]
The Committee on Health, Education, Labor, and Pensions, to
which was referred the bill (S. 1172) to establish grants to
provide health services for improved nutrition, increased
physical activity, obesity prevention, and for other purposes,
having considered the same, reports favorably thereon with an
amendment in the nature of a substitute and recommends that the
bill (as amended) do pass.
CONTENTS
Page
I. Purpose and need for legislation.................................1
II. Summary..........................................................2
III. History of legislation and votes in committee....................2
IV. Explanation of bill and committee views..........................3
V. Cost estimate....................................................3
VI. Regulatory impact statement......................................3
VII. Application of law to the legislative branch.....................3
VIII.Section-by-section analysis......................................4
IX. Additional views.................................................6
X. Changes in existing law..........................................9
I. Purpose and Need for Legislation
Overweight and obesity result from daily lifestyle choices,
the consequences of which gradually accumulate. Overweight and
obesity are associated with increased risk for heart disease
(the leading cause of death), cancer (the second leading cause
of death), diabetes (the seventh leading cause of death), and
musculoskeletal disorders. Public health officials are
increasingly concerned that growing rates of obesity and
overweight now affect over 60 percent of adults and 13 percent
of children and adolescents--twice the levels seen 30 years
ago.
Unfortunately, obesity is particularly prevalent among
African-American, Hispanic-American and American Indian
communities. On average, American Indian and Alaska Native
adults are 2.6 times more likely to have diabetes than non-
Hispanic whites of similar age. At current rates, nearly half
of all African-American and Hispanic-American children will
develop type-2 diabetes within their lifetimes.
Although the Federal role in preventing and reversing
obesity may be limited, nonetheless, U.S. taxpayers will still
bear a large share of the cost of responding to the
consequences of obesity. A recent report estimated the annual
medical costs attributed to obesity to be $75 billion with
approximately half of these costs financed by Medicare and
Medicaid. As rates of obesity continue to mount, the morbidity,
mortality and health care costs associated with obesity will
skyrocket. It is estimated that one-tenth of all health care
costs in the United States are associated with conditions
related, in part, to overweight and obesity.
High rates of obesity and diabetes among adults can be
countered by making positive choices, such as healthy eating
and regular physical activity. There is a clear limit to what
the Federal Government can do in this area. In addressing
obesity among children, the fundamental responsibility for
healthy choices rests with parents in their local communities.
An increasing problem of overweight and obesity among children
may suggest societal shifts with respect to parental
supervision of nutrition and parental expectations regarding
physical activity.
II. Summary
S. 1172, the Improved Nutrition and Physical Activity
(IMPACT) Act, addresses the problem of obesity, overweight and
eating disorders, primarily by expanding existing authorities
under which the Department of Health and Human Services
operates programs that seek to reduce obesity.
Due to its multifaceted nature, the bill takes a broad
approach to avoid relying on a single solution to this complex
problem. Where scientific evidence suggests certain approaches,
the legislation appropriately encourages programs and policies
to align with these scientific approaches. Where such
information is not available, the bill allows for the support
of scientifically rigorous research. IMPACT takes a
collaborative, rather than confrontational, approach with the
private sector. The bill allows for communities to develop
their own approaches to the problem and compete for dollars,
rather than imposing a federal one-size-fits-all approach.
III. History of Legislation and Votes in Committee
On June 3, 2003, Senator Frist, for himself and Senators
Bingaman, Dodd, DeWine, Clinton, Warner, Murray, Lugar,
Landrieu, Sessions and Alexander, introduced S. 1172, to
establish grants to provide health services for improved
nutrition, increased physical activity, obesity prevention, and
for other purposes. On October 29, 2003, the committee held an
executive session to consider S. 1172. The committee approved
S. 1172 with amendment by unanimous voice vote.
IV. Explanation of Bill and Committee Views
The committee recognizes the growing epidemic of obesity
and overweight in our country and this legislation seeks to
address the problem by promoting programs to increase physical
activity and improve nutrition. Reasons for the increase in
obesity rates are linked to changes in families, employment
trends, technological advances, consumer choices, and
entertainment, among many other factors. While there is a limit
to what the Federal Government can do in this area, it can play
an important role in providing health information to the public
and to healthproviders in order to facilitate informed
decision-making, and to support basic and applied research.
Obesity will only be prevented or reversed by sustained
behavior change in a variety of areas of life. However, the
goals of improving nutrition and increasing physical activity
do not allow for programs to target only one behavior.
Therefore, the bill supports programs and education to
generally increase physical activity and improving nutrition.
Because the causes of obesity are complex, there is no one
targeted food or behavior to blame. Funds received under this
act should not be used to convey negative messages about
specific foods, beverages, or commodities. Moreover, it is
critical that the government not make the mistake of promoting
an oversimplified message unsupported by long-term scientific
data.
The bill requires a report on the Department's Youth Media
Campaign. This program has been appropriated a total of more
than $200 million during the past 3 years. First-year
evaluation results are encouraging in that certain groups
within the targeted populations appear to have added some
physical activity to their lives in response to the campaign.
The committee expects that the report required in the bill will
address not only the physical activity changes in targeted
populations, but also the impact of the campaign on actual
obesity rates.
V. Cost Estimate
Due to time constraints the Congressional Budget Office
estimate was not included in the report. When received by the
committee, it will appear in the Congressional Record at a
later time.
VI. Regulatory Impact Statement
In accordance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the committee has determined that
there will be minimal increases in the regulatory burden
imposed by the bill.
VII. Application of Law to the Legislative Branch
The committee has determined that there is no legislative
impact.
VIII. Section-By-Section Analysis
SECTION 1. SHORT TITLE
Section 1 establishes the short title as the ``Improved
Nutrition and Physical Activity Act'' or the ``IMPACT Act.''
SECTION 2. FINDINGS
Section 2 makes certain findings regarding the prevalence
and issues related to obesity, being overweight, and eating
disorders.
Title I--Training Grants
This title has 2 sections--(1) adding obesity, being
overweight, and eating disorders to the list of priority
conditions to be addressed in health professions Title VII
training grants and (2) training practicing health
professionals about proper methods to diagnose, treat and
prevent obesity, being overweight, and eating disorders among
their patients. Both of these new training activities are
written into current grant programs. As such, no additional
authorization of appropriations is required.
Title II--Community-Based Solutions to Increase Physical Activity and
Improve Nutrition
SECTION 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION
This section creates a demonstration program that funds
community organizations to conduct programs to curb obesity,
overweight and eating disorders. These programs focus on
providing specific community interventions, school-based
activities, and health care delivery system programs, while
focusing on education, outreach, and interventional techniques.
This program is authorized for $60 M in FY04, with $5 M being
allocated to eating disorder activities during that period.
SECTION 202. NATIONAL CENTER FOR HEALTH STATISTICS
Section 202 provides additional authority for the CDC to
collect information regarding fitness levels and energy
expenditure among children. This additional authorization is
added to a current program; and thus, requires no additional
authorization of appropriations.
SECTION 203. HEALTH DISPARITIES REPORT
Section 203 states that the Agency for Healthcare Research
and Quality should review any new information relating to
obesity trends among various sub-populations and include such
information, where it is relevant, in its health disparities
report.
SECTION 204. PREVENTIVE HEALTH SERVICES BLOCK GRANT
This section allows states to use their Preventive Services
Block Grant money for community education on nutrition and
increased physical activity. State block grants can be use for
a variety of purposes, and this section only adds obesity to
the list of alternatives. States still decide how to use their
block grants.
SECTION 205. REPORT ON OBESITY RESEARCH
This section instructs the Secretary to report on what
research has been conducted on obesity treatment and
prevention, what has been learned from this research, and what
future research should be conducted. Given that obesity
research is conducted in several agencies and institutes, this
study will assist in collating the results of this research and
coordinating departmental research in the future.
SECTION 206. REPORT ON A NATIONAL CAMPAIGN TO CHANGE CHILDREN'S HEALTH
BEHAVIORS AND REDUCE OBESITY
Given the widespread use of the Youth Media Campaign, this
section asks the Secretary to report on its effectiveness in
changing children's behaviors and reducing obesity.
IX. ADDITIONAL VIEWS OF SENATORS KENNEDY, BINGAMAN, DODD, CLINTON,
MURRAY, MIKULSKI, REED AND HARKIN
Underlying Causative Factors for Overweight and Obesity
The signatories of these ``Additional Views'' believe that
this report's opening statement, ``overweight and obesity
result from daily lifestyle choices,'' is overly simplistic.
Expert reports, including those from the Federal health
agencies, the Institute of Medicine, and a host of other
academic centers and professional organizations, uniformly
describe a complex interplay of behavioral, environmental and
genetic factors that leads to the development of overweight and
obesity.
Behavioral and environmental factors, which are modifiable
risk factors for overweight and obesity, are receiving
dramatically increased attention from scientific investigators.
According to the National Institutes of Health, these factors
can be described as technological advances in the workplace and
activities of daily living that reduce the need for physical
labor; increased time spent in sedentary activities due to
television watching and computer use; a bountiful food supply
with abundant choices of relatively inexpensive, calorically-
dense food products that are convenient and tasty; and
increases in the sizes of food portions in restaurants and at
home.
Federal Role in Reducing Overweight and Obesity
It is unreasonable to expect that Americans will easily
improve their ``daily lifestyle choices'' when so many forces
in the social, cultural, and physical environment work against
such change. Building an infrastructure to support healthy
diets and regular physical activity requires a commitment on
the local, State and Federal level to develop and sustain
health promotion policies, resources, and practices. The
signatories of these ``Additional Views'' strongly disagree
with this report's assertion that the role of the Federal
government may be limited. On the contrary, the tremendous
health and financial consequences of overweight and obesity
compel a greater Federal role in the war against obesity. As
stated by HHS Secretary Tommy Thompson (September 2001) ``We
need to act, individually and as a nation, to prevent obesity
and diabetes.''
A number of Federal initiatives could meaningfully effect
change in the levels of overweight and obesity across the
nation. This bill provides a minimum of support for education,
research, and community-based interventions, which certainly
represent an important first step. However, scientific and
medical experts have recommended additional Federal strategies
that could have an even greater impact. A few examples of such
strategies include the following:
Require all foods sold in schools to meet
established dietary guidelines for nutrition and
portion size;
Restrict the extent and type of advertising
to which children are exposed;
Require all schools to provide daily
physical activity for K-12 children;
Provide tax incentives for worksites to
develop and implement wellness programs;
Encourage food labeling for nutritional
content of foods sold in worksites, chain restaurants
and other commercial food outlets;
Design transportation infrastructure and
public policy that supports active modes of
transportation, such as walking and biking, for both
utilitarian and recreational purposes; and
Require that zoning regulations support the
creation and maintenance of green space and public
parks.
Parental Role in Childhood Obesity
The signatories of these ``Additional Views'' agree with
the report language that states that the increase in overweight
and obesity among children may reflect reduced parental
supervision of nutrition and parental expectations of physical
activity. However, once again, this statement is overly
simplistic and should be greatly expanded to include discussion
of other causative factors. For example, school policies have a
tremendous influence on the nutrition of children. Because of
budget shortfalls, many schools rely upon sales of competitive
foods, including those in vending machines, for
additionalrevenue. Competitive foods, which typically are ``junk
foods'' with minimal nutritional value, are not required to meet
federal guidelines for nutrition or portion sizes. Similarly, budget
constraints have eliminated physical education for children in many
schools--only one school-aged child in four gets the recommended amount
of physical activity. Unfortunately, this bill makes no attempt to
meaningfully address these serious issues.
Even if one did ignore the impact of school policies on the
nutrition and physical activity of children, one could hardly
fault parents when considering the barriers that they encounter
when trying to keep their children healthy. Many parents,
particularly those in low-income neighborhoods, do not enjoy
access to public spaces and facilities where their children can
engage safely in physical activity. Moreover, adequate
information is frequently unavailable to help parents make
appropriate nutritional choices for their children,
particularly for meals outside of the home.
In one study conducted by the Center for Science in the
Public Interest and New York University, researchers found that
even well-trained nutrition professionals could not accurately
estimate the calorie content of typical restaurant meals. These
professionals underestimated total calories by up to 48
percent. If experts in the field of nutrition are unable to
accurately estimate the caloric content of restaurant foods,
parents are unlikely to do better. Parents need substantial
help, which this bill does not provide.
Healthy Foods
This report states that because the causes of obesity are
complex, there is no one targeted food or behavior to blame.
The signatories of these ``Additional Views'' agree that no one
food should be blamed in isolation for the obesity epidemic.
However, we also note what some experts have described as a
``toxic food environment,'' in which there is unprecedented
exposure to energy dense, oversized, ``fast or junk foods''
that are inexpensive, heavily marketed, and ubiquitous. The
Federal government should aggressively support interventions
that minimize the effects of this environment on the nutrition
of adults and children alike.
Scientific Investigation
The report's assertion that promotion of ``over-simplified
message[s] unsupported by long-term scientific data'' would be
a ``mistake'' is unclear and potentially dangerous to the
health of Americans. If rigorous scientific investigation finds
that certain foods or activities are harmful, then there should
be no requirement that the study is ``long-term'' for
government to act and protect the health of consumers.
Decisions relating to conduct of scientific studies are best
left to scientists and not to Congress.
The CDC Youth Media Campaign
Although the report is correct in noting that the Youth
Media Campaign has received approximately $200 million in
appropriations, it fails to mention that only the first year of
this campaign received full funding at $125 million. Because of
reduced funding, the campaign was significantly reduced in
magnitude and scope, which will undoubtedly affect second and
third year evaluative findings. The report also downplays the
first-year evaluation results, which should not be described as
``encouraging'' but instead as statistically significant.
Target groups significantly increased their physical activity
when compared to control populations. Experts have noted that
the Youth Media Campaign has been the most successful media
campaign to date. The signatories of these ``Additional Views''
support continued investment in proven and effective strategies
to increase physical activity in children.
This bill only mandates an evaluation of the effectiveness
of the campaign in changing children's behaviors and reducing
obesity, and not an evaluation of actual obesity rates. The
signatories of these ``Additional Views'' understand that the
primary focus of this campaign is on increasing levels of
physical activity in tweens, which correlates with long-term
healthy lifestyles, including weight control. It would be
unreasonable to expect to find changes in actual obesity rates
on such a short-term basis, particularly with insufficient
campaign funding and without controlling for other factors that
may or may not affect rates of obesity.
Patty Murray.
Hillary Rodham Clinton.
Jeff Bingaman.
Barbara A. Mikulski.
Jack Reed.
Tom Harkin.
Chris Dodd.
Ted Kennedy.
X. Changes in Existing Law
In compliance with rule XXVI paragraph 12 of the Standing
Rules of the Senate, the following provides a print of the
statute or the part or section thereof to be amended or
replaced (existing law proposed to be omitted is enclosed in
black brackets, new matter is printed in italic, existing law
in which no change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
Improved Nutrition and Physical Activity Act
NATIONAL CENTER FOR HEALTH STATISTICS
Sec. 306. (a) * * *
* * * * * * *
(m)(I) * * *
* * * * * * *
(4)(A) * * *
(B) The provisions of subparagraph (A) shall be
effective with respect to a fiscal year only to the
extent that funds are appropriated pursuant to
paragraph (3) of [subection (n)] subsection (o), and
only if the amounts appropriated for such fiscal year
pursuant to each of paragraphs (1) and (2) of
[subsection (n)] subsection (o) equal or exceed the
amounts so appropriated for fiscal year 1997.
(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.
[(n)](o)(1) For health statistical and epidemiological
activities undertaken or supported under subsections (a)
through (l), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 1991 through
2003.
* * * * * * *
PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN
[SEC. 399W. GRANTS TO PROMOTE CHILDHOOD NUTRITION AND PHYSICAL
ACTIVITY.
[(a) In General.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall award competitive grants to States and political
subdivisions of States for the development and implementation
of State and community-based intervention programs to promote
good nutrition and physical activity in children and
adolescents.
[(b) Eligibility.--To be eligible to receive a grant under
this section a State or political subdivision of a State shall
prepare and submit to the Secretary an application at such
time, in such manner, and containing such information as the
Secretary may require, including a plan that describes--
[(1) how the applicant proposes to develop a
comprehensive program of school- and community-based
approaches to encourage and promote good nutrition and
appropriate levels of physical activity with respect to
children or adolescents in local communities;
[(2) the manner in which the applicant shall
coordinate with appropriate State and local
authorities, such as State and local school
departments, State departments of health, chronic
disease directors, State directors of programs under
section 17 of the Child Nutrition Act of 1966, 5-a-day
coordinators, governors councils for physical activity
and good nutrition, and 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) Use of Funds.--A State or political subdivision of a
State shall use amount received under a grant under this
section to--
[(1) develop, implement, disseminate, and evaluate
school- and community-based strategies in States to
reduce inactivity and improve dietary choices among
children and adolescents;
[(2) expand opportunities for physical activity
programs in school- and community-based settings; and
[(3) develop, implement, and evaluate programs that
promote good eating habits and physical activity
including opportunities for children with cognitive and
physical disabilities.
[(d) Technical Assistance.--The Secretary may set-aside an
amount not to exceed 10 percent of the amount appropriated for
a fiscal year under subsection (h) to permit the Director of
the Centers for Disease Control and Prevention to--
[(1) provide States and political subdivisions of
States with technical support in the development and
implementation of programs under this section; and
[(2) disseminate information about effective
strategies and interventions in preventing and treating
obesity through the promotion of good nutrition and
physical activity.
[(e) Limitation on Administrative Costs.--Not to exceed 10
percent of the amount of a grant awarded to the State or
political subdivision under subsection (a) for a fiscal year
may be used by the State or political subdivision for
administrative expenses.
[(f) Term.--A grant awarded under subsection (a) shall be
for a term of 3 years.
[(g) Definition.--In this section, the term ``children and
adolescents'' means individuals who do not exceed 18 years of
age.
[(h) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of the fiscal years 2001 through 2005.]
SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION.
(a) Establishment.--
(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and
Prevention and in coordination with the Administrator
of the Health Resources and Services Administration,
the Director of the Indian Health Service, the
Secretary of Education, the Secretary of Agriculture,
the Secretary of the Interior, the Director of the
National Institutes of Health, the Director of the
Office of Women's Health, and the heads of other
appropriate agencies, shall award competitive grants to
eligible entities to plan and implement programs that
promote healthy eating behaviors and physical activity
to prevent eating disorders, obesity, being overweight,
and related serious and chronic medical conditions.
Such grants may be awarded to target at-risk
populations including youth, adolescent girls, health
disparity populations (as defined in section 485E(d)),
and the underserved.
(2) Term.--The Secretary shall award grants under
this subsection for a period not to exceed 4 years.
(b) Award of Grants.--An eligible entity desiring a grant
under this section shall submit an application to the Secretary
at such time, in such manner, and containing such information
as the Secretary may require, including--
(1) a plan describing a comprehensive program of
approaches to encourage healthy eating behaviors and
healthy levels of physical activity;
(2) the manner in which the eligible entity will
coordinate with appropriate State and local
authorities, including--
(A) State and local educational agencies;
(B) departments of health;
(C) chronic disease directors;
(D) State directors of programs under section
17 of the Child Nutrition Act of 1966 (42
U.S.C. 1786);
(E) 5-a-day coordinators;
(F) Governors' councils for physical activity
and good nutrition;
(G) State and local parks and recreation
departments; and
(H) State and local departments of
transportation and city planning; and
(3) the manner in which the applicant will evaluate
the effectiveness of the program carried out under this
section.
(c) Coordination.--In awarding grants under this section,
the Secretary shall ensure that the proposed programs are
coordinated in substance and format with programs currently
funded through other Federal agencies and operating within the
community including the Physical Education Program (PEP) of the
Department of Education.
(d) Eligible Entity.--In this section, the term ``eligible
entity'' means--
(1) a city, county, tribe, territory, or State;
(2) a State educational agency;
(3) a tribal educational agency;
(4) a local educational agency;
(5) a federally qualified health center (as defined
in section 1861(aa)(4) of the Social Security Act (42
U.S.C. 1395x(aa)(3));
(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. 399Y. EDUCATION CAMPAIGN.
(a) In General.-- * * *
* * * * * * *
(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.
[b] (c) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of the fiscal years 2001
through 2005.
* * * * * * *
SEC. 399Z. HEALTH PROFESSIONAL EDUCATION AND TRAINING.
(a) In General.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, in
collaboration with the Administrator of the Health Resources
and Services Administration and the heads of other agencies,
and in consultation with appropriate health professional
associations, shall develop and carry out a program to educate
and train health professionals in effective strategies to--
(1) * * *
(2) * * *
(3) * * *
(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; and
(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.
[(b)] (c) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of the fiscal years 2001
through [2005] 2007.
* * * * * * *
PART C--TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC
DENTISTRY
SEC. 747. FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, GENERAL DENTISTRY, PEDIATRIC DENTISTRY,
AND PHYSICIAN ASSISTANTS.
(a) Training Generally.--* * *
* * * * * * *
(c) Priority.--
(1) In general.--* * *
(2) * * *
(3) Special consideration.--In awarding grants under
this section the Secretary shall give special
consideration to projects which prepare practitioners
to care for underserved populations and other high risk
groups such as the elderly, individuals with HIV-AIDS,
substance abusers, homeless, [and victims of domestic
violence] 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.
* * * * * * *
USE OF ALLOTMENTS
Sec. 1904. (a)(1) Except as provided in subsections (b) and
(c), payments made to a State under section 1903 may be used
for the following:
(A) * * *
* * * * * * *
(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.
* * * * * * *