Modifies an existing grant program funding the training of health profession personnel to include the treatment of overweight and obesity among categories to which the Secretary of Health and Human Services is directed to give special consideration. Creates a grant program to fund the training of health professionals to: (1) treat and prevent obesity; and (2) aid people who are overweight.
Creates grant programs at the local level to promote increased physical activity and improved nutrition. Targets partnerships with businesses, schools, senior centers, day care facilities and other institutions.
Expands an existing coordinated school health program to include grants for the development of programs which focus on healthy lifestyle, including balanced diet and physical activity.
Permits the use of preventive health and health services block grants for community education programs which promote healthy eating and exercise habits. Directs the Secretary to consider geographic diversity in issuing such grants and to ensure that such grants focus on physical activity and food-based research.
Creates a Medicare demonstration project to reduce obesity and other chronic disease risks in older Americans.
Makes grants available to local healthcare delivery systems for overweight and obesity treatment and prevention demonstration programs.
Makes grants available for a national campaign to change children's health behaviors.
Promoting Healthy Eating Behaviors in Youth Act - Directs the Secretary, acting through the Director of the Centers for Disease Control and Prevention, to award competitive grants to States, political subdivisions of States, and other entities for the implementation of State and community-based intervention programs to promote good nutrition, including in children and adolescents. Sets forth a sunset date for such grants of five years after the enactment of this Act.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 716 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 716
To establish grants to provide health services for improved nutrition,
increased physical activity, obesity prevention, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 12, 2003
Mrs. Bono (for herself, Ms. Granger, Mrs. Lowey, Mr. Wamp, Mr. LaHood,
Mr. Payne, Mr. Kennedy of Rhode Island, Mr. Blumenauer, Mr. Castle, Mr.
Johnson of Illinois, and Mrs. McCarthy of New York) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Agriculture, and Ways
and Means, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish grants to provide health services for improved nutrition,
increased physical activity, obesity prevention, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improved Nutrition and Physical
Activity Act'' or the ``IMPACT Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) An estimated 61 percent of United States adults and 13
percent of children and adolescents are overweight or obese.
(2) The prevalence of obesity and being overweight is
increasing among all age groups. There are twice the number of
overweight children and 3 times the number of overweight
adolescents as there were 29 years ago.
(3) An estimated 300,000 deaths a year are associated with
being overweight or obese.
(4) Obesity and being overweight are associated with
increased risk for heart disease (the leading cause of death),
cancer (the second leading cause of death), diabetes (the 6th
leading cause of death), and musculoskeletal disorders.
(5) Individuals who are obese have a 50 to 100 percent
increased risk of premature death.
(6) The Healthy People 2010 goals identify obesity and
being overweight as one of the Nation's leading health problems
and include objectives of increasing the proportion of adults
who are at a healthy weight, reducing the proportion of adults
who are obese, and reducing the proportion of children and
adolescents who are overweight or obese.
(7) Another goal of Healthy People 2010 is to eliminate
health disparities among different segments of the population.
Obesity is a health problem that disproportionally impacts
medically underserved populations.
(8) The United States Surgeon General's report ``A Call To
Action'' lists the treatment and prevention of obesity as a top
national priority.
(9) The estimated direct and indirect annual cost of
obesity in the United States is $117,000,000,000, which exceeds
the cost of tobacco-related illnesses and appears to be rising
dramatically.
(10) Weight control programs should promote a healthy
lifestyle including regular physical activity and healthy
eating, as consistently discussed and identified in a variety
of public and private consensus documents, including ``A Call
to Action'' and other documents prepared by the Department of
Health and Human Services and other agencies.
SEC. 3. DEFINITIONS.
In this Act:
(1) Obese.--The term ``obese'' means an adult with a Body
Mass Index (BMI) of 30 kg/m<SUP>2</SUP> or greater.
(2) Overweight.--The term ``overweight'' means an adult
with a Body Mass Index (BMI) of 25 to 29.9 kg/m<SUP>2</SUP> 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.
(3) Secretary.--Unless otherwise indicated, term
``Secretary'' means the Secretary of Health and Human Services.
TITLE I--TRAINING GRANTS
SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION STUDENTS.
Section 747(c)(3) of title VII of the Public Health Service Act (42
U.S.C. 293k(c)(3)) is amended by striking ``and victims of domestic
violence'' and inserting ``victims of domestic violence, and
individuals (including children) who are overweight or obese (as such
terms are defined in section 3 of the Improved Nutrition and Physical
Activity Act) and at risk for related, serious and chronic medical
conditions''.
SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSIONALS.
Section 399Z of the Public Health Service Act (42 U.S.C. 280h-3) is
amended--
(1) in subsection (b), by striking ``2005'' and inserting
``2008'';
(2) by redesignating subsection (b) as (c); and
(3) by inserting after subsection (a) the following:
``(b) Grants.--
``(1) In general.--The Secretary may award grants to
qualified entities to train primary care physicians and other
licensed or certified health professionals on how to identify,
treat, and prevent obesity and aid individuals who are
overweight (as such term is defined in section 3 of the
Improved Nutrition and Physical Activity Act).
``(2) Application.--An entity that desires a grant under
this subsection shall submit an application at such time, in
such form, 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) conduct educational conferences, including
Internet-based courses and teleconferences, on--
``(i) how to treat and prevent obesity and
being overweight using nutritional counseling,
methods to increase physical activity,
pharmacological therapies, motivational
counseling to promote positive changes in
health behaviors and to assist patients in
identifying potential barriers to adhering to
medical recommendations, and other proven
interventions;
``(ii) how to discuss varied strategies to
promote positive behavior change and healthy
lifestyles to avoid obesity, being overweight,
and other eating disorders;
``(iii) how to identify overweight and
obese patients and those who are at risk for
obesity and being overweight and therefore at
risk for related serious and chronic medical
conditions;
``(iv) how to conduct a comprehensive
assessment of individual and familial health
risk factors, such as poor nutritional status,
physical inactivity, and personal and family
history of obesity and related serious and
chronic medical conditions; and
``(v) how to educate patients and their
families about effective strategies to improve
dietary habits and establish appropriate levels
of physical activity;
``(B) conduct training to enhance cultural and
linguistic competency and communication skills needed
to effectively interact with patients from diverse
populations regarding weight, health, and nutritional
status, including raising awareness of issues regarding
stigma and prejudice about obesity or being overweight;
``(C) evaluate the effectiveness of the training
provided by such entity in increasing knowledge and
changing attitudes and behaviors of trainees;
``(D) develop training materials and course content
using evidence-based findings or recommendations that
pertain to obesity and overweight treatment and
prevention ; and
``(E) collaborate with other training programs
related to overweight and obesity prevention and
treatment.
``(4) Evaluation.--
``(A) In general.--An entity that receives a grant
under this subsection shall submit to the Secretary an
evaluation that describes the activities carried out by
such entity with funds received under this section.
``(B) Contents.--Such evaluation shall include an
assessment of the effectiveness of the activities in
increasing physical activity, improving nutrition, and
preventing individuals from becoming overweight or
obese, treating individuals who are overweight or
obese, and any other information that the Secretary may
require.''.
TITLE II--LOCAL GRANTS
SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following:
``SEC. 399AA. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE
NUTRITION.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention and in consultation with
Administrator of the Health Resources and Services Administration, the
Director of the Indian Health Service, and the heads of other
appropriate agencies, shall award competitive grants to cities,
counties, tribes, and States to plan, implement, and evaluate
culturally and linguistically appropriate and competent community-based
programs and promote good nutrition and physical activity to prevent
overweight, obesity (as such terms are defined in section 3 of the
Improved Nutrition and Physical Activity Act), and related serious and
chronic medical conditions that may result from being overweight or
obese (as such terms are defined in section 3 of the Improved Nutrition
and Physical Activity Act).
``(b) Award of Grants.--A city, county, tribe, or State desiring a
grant under this section shall submit an application to the Secretary
at such time, in such form, and containing such information as the
Secretary may require, including a plan describing how funds received
through a grant under this section will be used and an evaluation of
the programs that will be provided. 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.
``(c) Use of Funds.--A city, county, tribe, or State that receives
a grant under this section shall use the funds made available through
the grant to carry out 3 or more of the following activities:
``(1) Planning for and promotion of bike paths, walking
paths, or other similar or related environmental changes that
promote physical activity.
``(2) Forming partnerships and activities with businesses
and other entities to increase activity levels at the workplace
and while traveling to and from the workplace, develop wellness
programs that relate to overweight and obesity, and to enhance
nutritional status by improving food options.
``(3) Establishing tax and other incentives for businesses
to increase the activity levels and improve the nutrition of
their employees by encouraging such employees to--
``(A) walk or bike to work;
``(B) engage in other physical activity during
working hours; and
``(C) improve available food options.
``(4) Forming partnerships with public and private entities
including schools, faith-based entities, and other facilities
providing recreational services to establish programs that use
their facilities for after-school and weekend activities for
the community.
``(5) Establishing incentives for retail food stores,
farmer's markets, food coops, grocery stores, and other retail
food outlets that offer nutritious foods, to encourage such
stores and outlets to locate in economically depressed areas to
improve the nutritional status of the community.
``(6) Forming partnerships with senior centers and nursing
homes to establish programs for older people to foster physical
activity and improved nutrition, including strength,
flexibility, and aerobic classes.
``(7) Providing educational activities targeting healthier
eating, such as cooking and shopping demonstrations, onsite
consultation by nutrition professionals at restaurants, and
community educational outreach using evidence-based nutrition
recommendations.
``(8) Forming partnerships with day care facilities to
establish programs that promote improved nutritional status and
physical activity.
``(9) Providing training and supervision of community
health workers by health professionals to--
``(A) educate families regarding the relationship
between nutrition, eating habits, physical activity,
and obesity;
``(B) educate families about effective strategies
to improve nutrition, establish healthy eating
patterns, and establish appropriate levels of physical
activity;
``(C) educate and guide parents regarding the
ability to model and communicate positive health
behaviors; and
``(D) educate and refer individuals to appropriate
health care agencies and community-based programs and
organizations in order to increase access to quality
health care services, including preventive health
services.
``(10) Other activities as deemed appropriate by the
Secretary.
``(d) Evaluation.--A city, county, tribe, or State that receives a
grant under this section shall submit to the Secretary an evaluation,
in collaboration with an academic health center or other qualified
community-based entity, that describes activities carried out with
funds received under this section, the long-term effectiveness of such
activities in increasing physical activity, improving nutrition, and
preventing individuals from becoming overweight or obese, and such
other information as the Secretary may require.
``(e) Matching Funds.--In awarding grants under subsection (a), the
Secretary may give priority to applicants who provide matching funds.
``(f) Technical Assistance.--The Secretary may set aside an amount
not to exceed 15 percent of the total amount appropriated for a fiscal
year under subsection (g) to permit the Director of the Centers for
Disease Control and Prevention to--
``(1) provide grantees with technical support in the
development, implementation, and evaluation of programs under
this section; and
``(2) disseminate culturally and linguistically appropriate
and competent information about strategies and interventions in
preventing and treating obesity through the promotion of good
nutrition and physical activity.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $40,000,000 for fiscal year
2004, and such sums as may be necessary for each of fiscal years 2005
through 2008.''.
TITLE III--SCHOOL HEALTH PROGRAM
SEC. 301. ESTABLISHMENT OF A COORDINATED SCHOOL HEALTH PROGRAM.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280h et seq.) is amended by striking section 399W and inserting the
following:
``SEC. 399W. GRANTS.
``(a) State Educational Grants.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention and in
consultation with the Administrator of the Health Resources and
Services Administration, the Secretary of Education, the Secretary of
Agriculture, and the Secretary of the Interior, shall, as part of the
Centers for Disease Control and Prevention's coordinated school health
program currently operated pursuant to the Director's general
authority, award competitive grants to State, tribal, and local
educational agencies (where applicable) to--
``(1) develop and disseminate school-based curricula or
programs that focus on a healthy lifestyle that includes
promotion of balanced dietary patterns and physical activity to
prevent becoming overweight or obese and related, serious, and
chronic medical conditions that are associated with being
overweight or obese (as such terms are defined in section 3 of
the Improved Nutrition and Physical Activity Act);
``(2) provide education and training to education
professionals, including health education, physical education,
and food service professionals;
``(3) develop and implement policies that create a healthy
school environment in relation to nutrition and physical
activity; and
``(4) evaluate activities conducted under paragraphs (1)
through (3).
``(b) Local Educational Grants.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention and
in consultation with the Secretary of Education, the Secretary
of Agriculture, and the Secretary of the Interior, shall award
competitive grants to local educational agencies to plan,
implement, and evaluate culturally and linguistically
appropriate and competent programs to promote a healthy
lifestyle, including programs that, in collaboration with
statewide coordinated school health programs, when applicable,
increase physical activity and improve the nutritional status
of the students at elementary and secondary schools.
``(2) Award of grants.--A local educational agency desiring
a grant under this subsection shall submit an application to
the Secretary at such time, in such manner, and containing such
information as the Secretary may require, including a plan
describing how funds received under this section will be used
and an evaluation of the program.
``(3) Use of funds.--A local educational agency that
receives a grant under this subsection shall use the funds made
available through the grant to carry out 4 or more of the
following activities:
``(A) Planning and implementing a healthy lifestyle
curriculum or program with an emphasis on nutrition and
physical activity for each grade level.
``(B) Planning and implementing a physical
education and activity curriculum or program for each
grade level and purchasing appropriate equipment, with
no more than 15 percent of a grant award used for
purchasing such equipment.
``(C) Planning and implementing healthy lifestyle
classes or programs for parents and guardians, with an
emphasis on nutrition and physical activity.
``(D) Planning and implementing after-hours
physical activity programs.
``(E) Creating opportunities for students to choose
foods to improve nutritional status.
``(F) Training teachers and staff, including food
service workers, on how to teach good nutrition and
physical activity practices.
``(G) Other activities as deemed appropriate by the
Secretary.
``(4) Evaluation.--An agency that receives a grant under
this subsection shall submit to the Secretary an evaluation, in
collaboration with an academic department or other qualified
community-based entity, describing the activities carried out
under the grant, the effectiveness of the activities in
increasing physical activity, improving nutrition, and
preventing individuals from becoming overweight and obese, and
such other information as the Secretary may require.
``(c) Community Educational Grants.--
``(1) In general.--The Secretary, acting through the
Centers for Disease Control and Prevention, shall award
competitive grants to universities, colleges, or community-
based nonprofit organizations to develop, implement, and
evaluate programs to promote healthy eating and physical
activity in youth and to conduct effectiveness reports to
identify programs that have demonstrated effectiveness in
improving nutritional status and physical activity in youth.
``(2) Award of grants.--A university, college, or
community-based nonprofit organization desiring a grant under
this subsection shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require.
``(3) Geographic diversity and food-based research.--In
awarding grants under this section, the Secretary shall take
into consideration whether grantees are geographically
dispersed to ensure regional balance, including proposal
submissions with multiple institutions, and ensure that the set
of grants awarded under this section focus on physical activity
and food-based research, realizing that land-grant colleges
historically have been known to have strength in food-based
research.
``(4) Information availability.--Information about programs
funded with grants authorized under this subsection shall be
made available to State, tribal, and local educational agencies
and may be used in planning and implementing programs described
in subsections (a) and (b).
``(d) Technical Assistance.--The Secretary may set aside an amount
not to exceed 15 percent of the total amount appropriated for a fiscal
year under subsection (e) to permit the Director of the Centers for
Disease Control and Prevention to--
``(1) provide grantees with technical support in the
development, implementation, and evaluation of programs under
this section; and
``(2) disseminate culturally and linguistically appropriate
and competent information about strategies and interventions in
preventing and treating obesity through the promotion of good
nutrition and physical activity.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $40,000,000 for fiscal year
2004, and such sums as may be necessary for each of fiscal years 2005
through 2008.''.
SEC. 302. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306 of the Public Health Service Act (42 U.S.C. 242k) is
amended by striking subsection (n) and inserting the following:
``(n)(1) The Secretary, acting through the Center, may provide for
the--
``(A) collection of data for determining the fitness levels
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 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.''.
TITLE IV--INSTITUTE OF MEDICINE STUDY
SEC. 401. STUDY OF THE FOOD SUPPLEMENT AND NUTRITION PROGRAMS OF THE
DEPARTMENT OF AGRICULTURE.
(a) In General.--The Secretary of Agriculture shall request that
the Institute of Medicine conduct, or contract with another entity to
conduct, a study on the food and nutrition assistance programs run by
the Department of Agriculture.
(b) Content.--Such study shall--
(1) investigate whether the nutrition programs and
nutrition recommendations are based on the latest scientific
evidence;
(2) investigate whether the food assistance programs
contribute to either preventing or enhancing obesity and being
overweight in children, adolescents, and adults;
(3) investigate whether the food assistance programs can be
improved or altered to contribute to the prevention of obesity
and becoming overweight; and
(4) identify obstacles that prevent or hinder the programs
from achieving their objectives.
(c) Report.--Not later than 24 months after the date of enactment
of this Act, the Secretary of Agriculture shall submit to the
appropriate committees of Congress a report containing the results of
the Institute of Medicine study authorized under this section.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $750,000 for fiscal years 2004
and 2005.
TITLE V--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY STUDIES
SEC. 501. EVIDENCE REPORT ON WEIGHT REDUCTION PROGRAMS.
(a) In General.--The Secretary, acting through the Director of the
Agency for Healthcare Research and Quality, shall conduct or support an
evidence report on the effectiveness of weight reduction programs.
(b) Content.--The study described in subsection (a) shall evaluate
the available scientific evidence regarding the safety and
effectiveness of the programs, including programs that use dietary
supplements, behavior modification, and other weight loss methods, and
how successful the programs are in helping individuals achieve short-
term weight loss and sustain long-term weight maintenance.
(c) Report.--The Secretary shall, not later than 18 months after
the date of enactment of this Act, prepare and submit to the relevant
committees of Congress a report that describes the results of the
evidence report described in this section. Such report shall be made
available on the web site of the Agency for Healthcare Research and
Quality.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $500,000 for fiscal year 2004.
SEC. 502. HEALTH DISPARITIES REPORT.
Not later than 18 months after the date of enactment of this Act,
and annually thereafter, the Director of the Agency for Healthcare
Research and Quality shall review all research that results from the
activities outlined in this Act and determine if particular information
may be important to the report on health disparities required by
section 903(c)(3) of the Public Health Service Act (42 U.S.C. 299a-
1(c)(3)).
TITLE VI--PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT
SEC. 601. USE OF ALLOTMENTS.
Section 1904(a)(1) of title XIX 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.''.
TITLE VII--MEDICARE NUTRITION THERAPY DEMONSTRATION PROJECT
SEC. 701. DEMONSTRATION PROJECT TO REDUCE OBESITY AND OTHER CHRONIC
DISEASE RISKS.
(a) Demonstration.--The Secretary, in consultation with the
Administrator of the Centers for Medicare & Medicaid Services, shall
conduct a demonstration project to develop a comprehensive and
systematic model for improving the health of older Americans.
(b) Content.--The demonstration project described in subsection (a)
shall--
(1) identify, through self-assessment, behavioral risk
factors, such as obesity and overweight, poor nutrition,
physical inactivity, alcohol use, tobacco use, and mental
health problems among those target individuals;
(2) identify, through self-assessment, needed medicare
clinical preventive and screening benefits among those target
individuals;
(3) identify, through self-assessment, functional and self-
management information the Secretary determines to be
appropriate;
(4) provide ongoing support to reduce risk factors and
promote the appropriate use of preventive and screening
benefits; and
(5) improve health outcomes, satisfaction, quality of life,
and appropriate use of medicare-covered services among those
target individuals.
(c) Definitions.--In this section:
(1) Target individuals.--The term ``target individuals''
means individuals who are medicare beneficiaries under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) who
shall include different segments of the population including
racial and ethnic minority groups and persons of lower
socioeconomic status. The demonstration is completely voluntary
on the part of target individuals.
(2) Self-assessment.--The term ``self-assessment'' means a
form delivered by the Secretary to each target individual
that--
(A) includes questions regarding--
(i) behavioral risk factors;
(ii) needed preventive and screening
services; and
(iii) target individuals' preferences for
receiving followup information; and
(B) is then assessed using such computer generated
assessment programs and provides ongoing support to the
individual as the Secretary determines appropriate.
(3) Ongoing support.--The term ``ongoing support'' means--
(A) to provide target individuals with information,
feedback, health coaching, and recommendations
regarding--
(i) the results of the self-assessment;
(ii) behavior modification based on the
self-assessment; and
(iii) any need for clinical preventive and
screening services or treatment including
medical nutrition therapy;
(B) to provide target individuals with referrals to
community resources and programs (such as senior
centers) available to assist the target individual in
reducing health risks;
(C) information on available volunteer
opportunities to promote active engagement in the
community; and
(D) to provide the information described in
subparagraph (A) to a health care provider, if
designated by the target individual to receive such
information.
(d) Program Design.--
(1) Initial design.--Not later than 1 year after the date
of enactment of this Act, the Secretary shall design the
demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce
behavioral risk factors. The Administrator of the Centers for
Medicare & Medicaid Services shall consult with the Director of
the Centers for Disease Control and Prevention, the Director of
the Office of Minority Health, and the heads of other agencies
in the Department of Health and Human Services, and
professional organizations, as the Secretary determines to be
appropriate on the design, conduct, and evaluation of the
demonstration.
(2) Number and project areas.--Not later than 2 years after
the date of enactment of this Act, the Secretary shall
implement 1 demonstration project designed to determine whether
similar programs should be implemented for the general medicare
population.
(e) Report to Congress.--Not later than 3 years after the date the
Secretary implements the demonstration project under this section, the
Secretary shall submit to Congress a report that describes the project,
evaluates the effectiveness and cost effectiveness of the project,
evaluates the beneficiary satisfaction under the project, and includes
any other information the Secretary determines to be appropriate.
(f) Waiver Authority.--The Secretary shall waive compliance with
the requirements of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) to such extent and for such period as the Secretary
determines is necessary to conduct the demonstration project under this
section.
(g) Funding.--The Secretary shall provide for the transfer from the
Federal Hospital Insurance Trust Fund and the Federal Supplementary
Insurance Trust Fund under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) an amount not to exceed $25,000,000 for the costs
of designing, implementing, and evaluating the demonstration project
under this section.
TITLE VIII--OVERWEIGHT AND OBESITY TREATMENT AND PREVENTION
DEMONSTRATION PROJECTS
SEC. 801. GRANTS TO LOCAL HEALTHCARE DELIVERY SYSTEMS.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
as amended in section 201, is further amended by adding at the end the
following:
``SEC. 399BB. GRANTS TO LOCAL HEALTHCARE DELIVERY SYSTEMS.
``(a) In General.--The Secretary shall award grants to eligible
entities to implement demonstration overweight and obesity (as such
terms are defined in section 3 of the Improved Nutrition and Physical
Activity Act) treatment and prevention programs using evidence-based
recommendations.
``(b) Eligible Entity.--In this section, the term `eligible entity'
means a federally qualified health center (as defined in section
1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4)), rural
health clinic, health department, Indian Health Service hospital or
clinic, Indian tribal health facility, urban Indian facility, or other
health care service provider, as determined appropriate by the
Secretary.
``(c) 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 a plan for the use of funds awarded under the grant
and an evaluation of the program.
``(d) Use of Funds.--An eligible entity that receives a grant under
this section shall use the funds made available through the grant to
carry out 3 or more of the following activities in a culturally and
linguistically appropriate and competent manner:
``(1) Providing nutrition and physical activity services by
a health professional to treat or prevent overweight and
obesity.
``(2) Providing patient education and counseling to
increase physical activity and improve nutrition.
``(3) Providing community education on nutrition and
physical activity by a health professional to provide better
understanding of the relationship between diet, physical
activity, and obesity.
``(4) Training health professionals on how to identify and
treat obese and overweight individuals which may include
nutrition and physical activity counseling.
``(5) Providing education and referring individuals to
appropriate health care agencies and community-based programs
and organizations in order to increase access to quality health
care services, including preventive health services.
``(6) Training and supervising community health workers by
qualified health professionals to--
``(A) educate families regarding the relationship
between nutrition, eating habits, physical activity,
and obesity;
``(B) educate families about effective strategies
to improve nutrition, establish healthy eating patterns
and establish appropriate levels of physical activity;
and
``(C) educate and guide parents regarding the
ability to model and communicate positive health
behaviors.
``(7) Other activities that are deemed appropriate by the
Secretary.
``(e) Evaluation.--An eligible entity that receives a grant under
this section shall, in collaboration with an academic health center or
other qualified community-based entity, submit to the Secretary a
report describing the activities carried out under the grant, the
effectiveness of the activities in increasing physical activity,
improving nutrition, and preventing overweight and obesity, and such
other information as the Secretary may require.
``(f) Technical Assistance.--The Secretary may set aside an amount
not to exceed 15 percent of the total amount appropriated for a fiscal
year under subsection (g) to--
``(1) provide grantees with technical support in the
development, implementation, and evaluation of programs under
this section; and
``(2) disseminate culturally and linguistically appropriate
and competent information about strategies and interventions in
preventing and treating obesity through the promotion of good
nutrition and physical activity.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $40,000,000 for fiscal year
2004, and such sums as may be necessary for each of fiscal years 2005
through 2008.''.
TITLE IX--RESEARCH ON OBESITY
SEC. 901. REPORT ON OBESITY RESEARCH.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary 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 on causes and health implications of obesity and being
overweight.
(b) Content.--The report described in subsection (a) shall
contain--
(1) descriptions on the status of relevant, current,
ongoing research being conducted in the department including--
(A) the types and numbers of studies completed or
being conducted by the National Institutes of Health
on--
(i) mechanisms responsible for obesity
(including nutrition, physical activity,
genetic causes such as syndrome X), the
prevention of and the treatment for obesity and
related, serious, and chronic medical
conditions (including diabetes and
cardiovascular disease); and
(ii) psychosocial aspects of obesity;
(B) the types and number of studies completed or
being conducted by the Centers for Disease Control and
Prevention on individual and community interventions to
prevent individuals from becoming overweight or obese;
(C) the types of studies completed or being
conducted by the Agency for Healthcare Research and
Quality on the treatment and prevention of overweight
and obesity;
(D) the types of studies being conducted by the
Health Resources and Services Administration on the
prevention of overweight and obesity; and
(E) what these studies have shown about the causes
of, prevention of, and treatment of overweight and
obesity; and
(2) recommendations on further research that is needed,
including research among diverse populations, the department's
plan for conducting such research, and how current knowledge
can be disseminated.
TITLE X--YOUTH MEDIA CAMPAIGN
SEC. 1001. GRANTS AND CONTRACTS FOR A NATIONAL CAMPAIGN TO CHANGE
CHILDREN'S HEALTH BEHAVIORS.
Section 399Y of the Public Health Service Act (42 U.S.C. 280h-2) is
amended--
(1) in subsection (b), by striking ``2005'' and inserting
``2008'';
(2) by redesignating subsection (b) as subsection (c); and
(3) by inserting after subsection (a) the following:
``(b) Grants.--
``(1) In general.--As part of the campaign described in
subsection (a), the Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall award
grants or contracts to eligible entities to design and
implement culturally and linguistically appropriate and
competent campaigns to change children's health behaviors.
``(2) Eligible entity.--In this subsection, the term
`eligible entity' means a marketing, public relations,
advertising, or other appropriate entity.
``(3) Content.--An eligible entity that receives a grant
under this subsection shall use funds received through such
grant or contract to utilize marketing and communication
strategies to--
``(A) communicate messages to help young people
develop habits that will foster good health over a
lifetime;
``(B) provide young people with motivation to
engage in sports and other physical activities;
``(C) influence youth to develop good health habits
such as regular physical activity and good nutrition;
``(D) educate parents of young people on the
importance of physical activity and improving
nutrition, how to maintain healthy behaviors for the
entire family, and how to encourage children to develop
good nutrition and physical activity habits; and
``(E) discourage stigmatization and discrimination
based on body size or shape.
``(4) Report.--The Secretary shall evaluate the
effectiveness of the campaign described in paragraph (1) in
changing children's behaviors and 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.''.
TITLE XI--EATING DISORDERS
SEC. 1101. SHORT TITLE.
This title may be cited as the ``Promoting Healthy Eating Behaviors
in Youth Act''.
SEC. 1102. FINDINGS.
Congress makes the following findings:
(1) Anorexia Nervosa is an eating disorder characterized by
self-starvation and excessive weight loss.
(2) Anorexia Nervosa is common: an estimated .5 to 3.7
percent of American women will suffer from this disorder in
their lifetime.
(3) Anorexia Nervosa is associated with serious health
consequences including heart failure, kidney failure,
osteoporosis, and death.
(4) Anorexia Nervosa has the highest mortality rate of all
psychiatric disorders. A young woman is 12 times more likely to
die than other women her age without Anorexia.
(5) Anorexia Nervosa usually appears in adolescence.
(6) Bulimia Nervosa is 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.
(7) Bulimia Nervosa is common: an estimated 1.1 to 4.2
percent of American women will suffer from this disorder in
their lifetime.
(8) Bulimia Nervosa is associated with cardiac,
gastrointestinal, and dental problems including irregular
heartbeats, gastric rupture, peptic ulcer, and tooth decay.
(9) Bulimia Nervosa usually appears in adolescence.
(10) On the 1999 Youth Risk Behavior Survey, 7.5 percent of
high school girls reported recent use of laxatives or vomiting
to control their weight.
(11) Binge Eating Disorder is characterized by frequent
episodes of uncontrolled overeating.
(12) Binge Eating Disorder is common: an estimated 2 to 5
percent of Americans experience this disorder in a 6-month
period.
(13) Binge Eating is associated with obesity, heart
disease, gall bladder disease, and diabetes.
(14) Eating disorders are commonly associated with
substantial psychological problems, including depression,
substance abuse, and suicide.
(15) Obesity is reaching epidemic proportions: 27 percent
of United States adults are obese and 13 percent of children
and 14 percent of adolescents are seriously overweight.
(16) Poor eating habits have led to a ``calcium crisis''
among American youth: only 13.5 percent of adolescent girls get
the recommended daily amount of calcium, placing them at
serious risk for osteoporosis and other bone diseases. Because
nearly 90 percent of adult bone mass is established by the end
of this age range, the Nation's youth's insufficient calcium
intake is truly a calcium crisis.
(17) Eating disorders of all types are more common in women
than men.
(18) Eating preferences and habits are established in
childhood.
(19) Poor eating habits are a risk factor for the
development of eating disorders, obesity and osteoporosis.
(20) However, simply urging overweight youth to be thin has
not reduced the prevalence of obesity and may result in other
problems including body dissatisfaction, low self-esteem, and
eating disorders.
(21) Therefore, effective interventions for promoting
healthy eating behaviors in youth should promote healthy
lifestyle and not inadvertently promote unhealthy weight
management techniques.
SEC. 1103. PURPOSES.
The purposes of this title are as follows:
(1) To increase preventive health activities designed to
promote the development of healthy eating habits and behaviors
in youth.
(2) To support research to develop and test educational
curricula and intervention programs aimed at promoting healthy
eating habits and behaviors in youth.
(3) To identify and disseminate effective intervention
programs aimed at promoting healthy eating habits and behaviors
in youth.
SEC. 1104. AMENDMENTS.
Title III of the of the Public Health Service Act (42 U.S.C. 241 et
seq.), as amended in section 801, is further amended by adding at the
end the following:
``SEC. 399CC. GRANTS TO PROMOTE CHILDHOOD NUTRITION AND PHYSICAL
ACTIVITY.
``(a) Program Authorized.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention (hereafter
the `Director') and in coordination with the Office of Women's Health
and the National Institutes of Health, shall award competitive grants
to States, political subdivisions of States, accredited universities,
colleges, or nonprofit organizations, for the implementation of State
and community-based intervention programs to promote good nutrition,
including promoting health eating behaviors and physical activity in
children and adolescents. Such grants may be awarded to target youth or
specific at-risk populations, such as adolescent girls.
``(b) Eligibility.--To be eligible to receive a grant under this
section a State, political subdivision of a State, university, college,
or nonprofit organization 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, political subdivision of a State,
university, college, or nonprofit organization that receives a grant
under this section shall use funds received--
``(1) develop and test educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, including science-based
interventions with multiple components such as--
``(A) nutritional content;
``(B) understanding and responding to hunger and
satiety;
``(C) positive body image development;
``(D) positive self-esteem development; and
``(E) learning life skills, such as stress
management, communication skills, problem solving and
decision making skills, as well as consideration of
cultural and developmental issues, and the role of
family, school, and community;
``(2) develop, implement, disseminate, and evaluate school
and community-based strategies to reduce inactivity and improve
nutrition among children and adolescents;
``(3) expand opportunities for physical activity programs
in school- and community-based settings; and
``(4) develop, implement, and evaluate programs that
promote good eating habits and physical activity including
opportunities for children and adolescents 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 not to exceed 4 years.
``(g) Definitions.--In this section:
``(1) Children and adolescents.--The term `children and
adolescents' means individuals who do not exceed 18 years of
age.
``(2) Healthy eating.--The term `healthy eating' means
having regular eating habits, such as eating 3 meals a day to
satisfy hunger, eating for nourishment, health, and energy,
eating in such a manner as to acknowledge internal signals of
appetite and satiety, and eating in a healthy manner in
ordinary social environments to promote healthy social
relationships with family, peers, and community.
``(h) Report.--The Director shall review the results of the grants
awarded under this section and other related research and identify
programs that have demonstrated effectiveness in promoting healthy
eating behaviors and habits in youth. Such programs shall be referred
to as ``Programs that Work''. Information about Programs that Work,
including program curricula, shall be made readily available to the
public.
``(i) Sunset.--The provisions of this section shall be effective
for 5 years after the date of enactment of this section.
``(j) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for fiscal year
2004, $5,500,000 for fiscal year 2005, $6,000,000 for fiscal year 2006,
$6,500,000 for year 2007, and $1,000,000 for year 2008.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Agriculture, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Agriculture, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Agriculture, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Agriculture, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Department Operations, Oversight, Nutrition and Forestry.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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