[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.

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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.

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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.

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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.

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                           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) * * *

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          (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.

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