[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1172 Referred in House (RFH)]
2d Session
S. 1172
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 20, 2004
Referred to the Committee on Energy and Commerce
_______________________________________________________________________
AN ACT
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 adults and 13 percent of
children and adolescents in the Nation are overweight or obese.
(2) The prevalence of obesity and being overweight is
increasing among all age groups. There are twice the number of
overweight children and 3 times the number of overweight
adolescents as there were 29 years ago.
(3) An estimated 300,000 deaths a year are associated with
being overweight or obese.
(4) Obesity and being overweight are associated with an
increased risk for heart disease (the leading cause of death),
cancer (the second leading cause of death), diabetes (the 6th
leading cause of death), and musculoskeletal disorders.
(5) Individuals who are obese have a 50 to 100 percent
increased risk of premature death.
(6) The Healthy People 2010 goals identify obesity and
being overweight as one of the Nation's leading health problems
and include objectives of increasing the proportion of adults
who are at a healthy weight, reducing the proportion of adults
who are obese, and reducing the proportion of children and
adolescents who are overweight or obese.
(7) Another goal of Healthy People 2010 is to eliminate
health disparities among different segments of the population.
Obesity is a health problem that disproportionally impacts
medically underserved populations.
(8) The United States Surgeon General's report ``A Call To
Action'' lists the treatment and prevention of obesity as a top
national priority.
(9) The estimated direct and indirect annual cost of
obesity in the United States is $117,000,000,000 (exceeding the
cost of tobacco-related illnesses) and appears to be rising
dramatically. This cost can potentially escalate markedly as
obesity rates continue to rise and the medical complications of
obesity are emerging at even younger ages. Therefore, the total
disease burden will most likely increase, as well as the
attendant health-related costs.
(10) Weight control programs should promote a healthy
lifestyle including regular physical activity and healthy
eating, as consistently discussed and identified in a variety
of public and private consensus documents, including ``A Call
To Action'' and other documents prepared by the Department of
Health and Human Services and other agencies.
(11) Eating preferences and habits are established in
childhood.
(12) Poor eating habits are a risk factor for the
development of eating disorders and obesity.
(13) Simply urging overweight individuals to be thin has
not reduced the prevalence of obesity and may result in other
problems including body dissatisfaction, low self-esteem, and
eating disorders.
(14) Effective interventions for promoting healthy eating
behaviors should promote healthy lifestyle and not
inadvertently promote unhealthy weight management techniques.
(15) Binge Eating is associated with obesity, heart
disease, gall bladder disease, and diabetes.
(16) Anorexia Nervosa, an eating disorder from which 0.5 to
3.7 percent of American women will suffer in their lifetime, is
associated with serious health consequences including heart
failure, kidney failure, osteoporosis, and death. In fact,
Anorexia Nervosa has the highest mortality rate of all
psychiatric disorders, placing a young woman with Anorexia
Nervosa at 18 times the risk of death of other women her age.
(17) Anorexia Nervosa and Bulimia Nervosa usually appears
in adolescence.
(18) Bulimia Nervosa, an eating disorder from which an
estimated 1.1 to 4.2 percent of American women will suffer in
their lifetime, is associated with cardiac, gastrointestinal,
and dental problems, including irregular heartbeats, gastric
ruptures, peptic ulcers, and tooth decay.
(19) On the 1999 Youth Risk Behavior Survey, 7.5 percent of
high school girls reported recent use of laxatives or vomiting
to control their weight.
(20) Binge Eating Disorder is characterized by frequent
episodes of uncontrolled overeating, with an estimated 2 to 5
percent of Americans experiencing this disorder in a 6-month
period.
(21) Eating disorders are commonly associated with
substantial psychological problems, including depression,
substance abuse, and suicide.
(22) Eating disorders of all types are more common in women
than men.
TITLE I--TRAINING GRANTS
SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION STUDENTS.
Section 747(c)(3) of title VII of the Public Health Service Act (42
U.S.C. 293k(c)(3)) is amended by striking ``and victims of domestic
violence'' and inserting ``victims of domestic violence, individuals
(including children) who are overweight or obese (as such terms are
defined in section 399W(j)) and at risk for related serious and chronic
medical conditions, and individuals who suffer from eating disorders''.
SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSIONALS.
Section 399Z of the Public Health Service Act (42 U.S.C. 280h-3) is
amended--
(1) in subsection (b), by striking ``2005'' and inserting
``2007'';
(2) by redesignating subsection (b) as subsection (c); and
(3) by inserting after subsection (a) the following:
``(b) Grants.--
``(1) In general.--The Secretary may award grants to
eligible entities to train primary care physicians and other
licensed or certified health professionals on how to identify,
treat, and prevent obesity or eating disorders and aid
individuals who are overweight, obese, or who suffer from
eating disorders.
``(2) Application.--An entity that desires a grant under
this subsection shall submit an application at such time, in
such manner, and containing such information as the Secretary
may require, including a plan for the use of funds that may be
awarded and an evaluation of the training that will be
provided.
``(3) Use of funds.--An entity that receives a grant under
this subsection shall use the funds made available through such
grant to--
``(A) use evidence-based findings or
recommendations that pertain to the prevention and
treatment of obesity, being overweight, and eating
disorders to conduct educational conferences, including
Internet-based courses and teleconferences, on--
``(i) how to treat or prevent obesity,
being overweight, and eating disorders;
``(ii) the link between obesity and being
overweight and related serious and chronic
medical conditions;
``(iii) how to discuss varied strategies
with patients from at-risk and diverse
populations to promote positive behavior change
and healthy lifestyles to avoid obesity, being
overweight, and eating disorders;
``(iv) how to identify overweight and obese
patients and those who are at risk for obesity
and being overweight or suffer from eating
disorders and, therefore, at risk for related
serious and chronic medical conditions;
``(v) how to conduct a comprehensive
assessment of individual and familial health
risk factors; and
``(B) evaluate the effectiveness of the training
provided by such entity in increasing knowledge and
changing attitudes and behaviors of trainees.''.
TITLE II--COMMUNITY-BASED SOLUTIONS TO INCREASE PHYSICAL ACTIVITY AND
IMPROVE NUTRITION
SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280h et seq.) is amended by striking section 399W and inserting the
following:
``SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE
NUTRITION.
``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention and
in coordination with the Administrator of the Health Resources
and Services Administration, the Director of the Indian Health
Service, the Secretary of Education, the Secretary of
Agriculture, the Secretary of the Interior, the Director of the
National Institutes of Health, the Director of the Office of
Women's Health, and the heads of other appropriate agencies,
shall award competitive grants to eligible entities to plan and
implement programs that promote healthy eating behaviors and
physical activity to prevent eating disorders, obesity, being
overweight, and related serious and chronic medical conditions.
Such grants may be awarded to target at-risk populations
including youth, adolescent girls, health disparity populations
(as defined in section 485E(d)), and the underserved.
``(2) Term.--The Secretary shall award grants under this
subsection for a period not to exceed 4 years.
``(b) Award of Grants.--An eligible entity desiring a grant under
this section shall submit an application to the Secretary at such time,
in such manner, and containing such information as the Secretary may
require, including--
``(1) a plan describing a comprehensive program of
approaches to encourage healthy eating behaviors and healthy
levels of physical activity;
``(2) the manner in which the eligible entity will
coordinate with appropriate State and local authorities,
including--
``(A) State and local educational agencies;
``(B) departments of health;
``(C) chronic disease directors;
``(D) State directors of programs under section 17
of the Child Nutrition Act of 1966 (42 U.S.C. 1786);
``(E) 5-a-day coordinators;
``(F) Governors' councils for physical activity and
good nutrition;
``(G) State and local parks and recreation
departments; and
``(H) State and local departments of transportation
and city planning; and
``(3) the manner in which the applicant will evaluate the
effectiveness of the program carried out under this section.
``(c) Coordination.--In awarding grants under this section, the
Secretary shall ensure that the proposed programs are coordinated in
substance and format with programs currently funded through other
Federal agencies and operating within the community including the
Physical Education Program (PEP) of the Department of Education.
``(d) Eligible Entity.--In this section, the term `eligible entity'
means--
``(1) a city, county, tribe, territory, or State;
``(2) a State educational agency;
``(3) a tribal educational agency;
``(4) a local educational agency;
``(5) a federally qualified health center (as defined in
section 1861(aa)(4) of the Social Security Act (42 U.S.C.
1395x(aa)(4));
``(6) a rural health clinic;
``(7) a health department;
``(8) an Indian Health Service hospital or clinic;
``(9) an Indian tribal health facility;
``(10) an urban Indian facility;
``(11) any health provider;
``(12) an accredited university or college;
``(13) a community-based organization;
``(14) a local city planning agency; or
``(15) any other entity determined appropriate by the
Secretary.
``(e) Use of Funds.--An eligible entity that receives a grant under
this section shall use the funds made available through the grant to--
``(1) carry out community-based activities including--
``(A) city planning, transportation initiatives,
and environmental changes that help promote physical
activity, such as increasing the use of walking or
bicycling as a mode of transportation;
``(B) forming partnerships and activities with
businesses and other entities to increase physical
activity levels and promote healthy eating behaviors at
the workplace and while traveling to and from the
workplace;
``(C) forming partnerships with entities, including
schools, faith-based entities, and other facilities
providing recreational services, to establish programs
that use their facilities for after school and weekend
community activities;
``(D) establishing incentives for retail food
stores, farmer's markets, food co-ops, grocery stores,
and other retail food outlets that offer nutritious
foods to encourage such stores and outlets to locate in
economically depressed areas;
``(E) forming partnerships with senior centers and
nursing homes to establish programs for older people to
foster physical activity and healthy eating behaviors;
``(F) forming partnerships with daycare facilities
to establish programs that promote healthy eating
behaviors and physical activity; and
``(G) providing community educational activities
targeting good nutrition;
``(2) carry out age-appropriate school-based activities
including--
``(A) developing and testing educational curricula
and intervention programs designed to promote healthy
eating behaviors and habits in youth, which may
include--
``(i) after hours physical activity
programs;
``(ii) increasing opportunities for
students to make informed choices regarding
healthy eating behaviors; and
``(iii) science-based interventions with
multiple components to prevent eating disorders
including nutritional content, understanding
and responding to hunger and satiety, positive
body image development, positive self-esteem
development, and learning life skills (such as
stress management, communication skills,
problem-solving and decisionmaking skills), as
well as consideration of cultural and
developmental issues, and the role of family,
school, and community;
``(B) providing education and training to
educational professionals regarding a healthy lifestyle
and a healthy school environment;
``(C) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy
eating behaviors and physical activity; and
``(D) planning and implementing healthy lifestyle
classes or programs for parents or guardians, with an
emphasis on healthy eating behaviors and physical
activity;
``(3) carry out activities through the local health care
delivery systems including--
``(A) promoting healthy eating behaviors and
physical activity services to treat or prevent eating
disorders, being overweight, and obesity;
``(B) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors; and
``(C) providing community education on good
nutrition and physical activity to develop a better
understanding of the relationship between diet,
physical activity, and eating disorders, obesity, or
being overweight; or
``(4) other activities determined appropriate by the
Secretary.
``(f) Matching Funds.--In awarding grants under subsection (a), the
Secretary may give priority to eligible entities who provide matching
contributions. Such non-Federal contributions may be cash or in kind,
fairly evaluated, including plant, equipment, or services.
``(g) Technical Assistance.--The Secretary may set aside an amount
not to exceed 10 percent of the total amount appropriated for a fiscal
year under subsection (k) to permit the Director of the Centers for
Disease Control and Prevention to provide grantees with technical
support in the development, implementation, and evaluation of programs
under this section and to disseminate information about effective
strategies and interventions in preventing and treating obesity and
eating disorders through the promotion of healthy eating behaviors and
physical activity.
``(h) Limitation on Administrative Costs.--An eligible entity
awarded a grant under this section may not use more than 10 percent of
funds awarded under such grant for administrative expenses.
``(i) Report.--Not later than 6 years after the date of enactment
of the Improved Nutrition and Physical Activity Act, the Director of
the Centers for Disease Control and Prevention shall review the results
of the grants awarded under this section and other related research and
identify programs that have demonstrated effectiveness in healthy
eating behaviors and physical activity in youth.
``(j) Definitions.--In this section:
``(1) Anorexia nervosa.--The term `Anorexia Nervosa' means
an eating disorder characterized by self-starvation and
excessive weight loss.
``(2) Binge eating disorder.--The term `binge eating
disorder' means a disorder characterized by frequent episodes
of uncontrolled eating.
``(3) Bulimia nervosa.--The term `Bulimia Nervosa' means an
eating disorder characterized by excessive food consumption,
followed by inappropriate compensatory behaviors, such as self-
induced vomiting, misuse of laxatives, fasting, or excessive
exercise.
``(4) Eating disorders.--The term `eating disorders' means
disorders of eating, including Anorexia Nervosa, Bulimia
Nervosa, and binge eating disorder.
``(5) Healthy eating behaviors.--The term `healthy eating
behaviors' means--
``(A) eating in quantities adequate to meet, but
not in excess of, daily energy needs;
``(B) choosing foods to promote health and prevent
disease;
``(C) eating comfortably in social environments
that promote healthy relationships with family, peers,
and community; and
``(D) eating in a manner to acknowledge internal
signals of hunger and satiety.
``(6) Obese.--The term `obese' means an adult with a Body
Mass Index (BMI) of 30 kg/m2 or greater.
``(7) Overweight.--The term `overweight' means an adult
with a Body Mass Index (BMI) of 25 to 29.9 kg/m2 and a child or
adolescent with a BMI at or above the 95th percentile on the
revised Centers for Disease Control and Prevention growth
charts or another appropriate childhood definition, as defined
by the Secretary.
``(8) Youth.--The term `youth' means individuals not more
than 18 years old.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $60,000,000 for fiscal year
2004 and such sums as may be necessary for each of fiscal years 2005
through 2008. Of the funds appropriated pursuant to this subsection,
the following amounts shall be set aside for activities related to
eating disorders:
``(1) $5,000,000 for fiscal year 2004.
``(2) $5,500,000 for fiscal year 2005.
``(3) $6,000,000 for fiscal year 2006.
``(4) $6,500,000 for fiscal year 2007.
``(5) $1,000,000 for fiscal year 2008.''.
SEC. 202. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306 of the Public Health Service Act (42 U.S.C. 242k) is
amended--
(1) in subsection (m)(4)(B), by striking ``subsection (n)''
each place it appears and inserting ``subsection (o)'';
(2) by redesignating subsection (n) as subsection (o); and
(3) by inserting after subsection (m) the following:
``(n)(1) The Secretary, acting through the Center, may provide for
the--
``(A) collection of data for determining the fitness levels
and energy expenditure of children and youth; and
``(B) analysis of data collected as part of the National
Health and Nutrition Examination Survey and other data sources.
``(2) In carrying out paragraph (1), the Secretary, acting through
the Center, may make grants to States, public entities, and nonprofit
entities.
``(3) The Secretary, acting through the Center, may provide
technical assistance, standards, and methodologies to grantees
supported by this subsection in order to maximize the data quality and
comparability with other studies.''.
SEC. 203. HEALTH DISPARITIES REPORT.
Not later than 18 months after the date of enactment of this Act,
and annually thereafter, the Director of the Agency for Healthcare
Research and Quality shall review all research that results from the
activities outlined in this Act and determine if particular information
may be important to the report on health disparities required by
section 903(c)(3) of the Public Health Service Act (42 U.S.C. 299a-
1(c)(3)).
SEC. 204. PREVENTIVE HEALTH SERVICES BLOCK GRANT.
Section 1904(a)(1) of the Public Health Service Act (42 U.S.C.
300w-3(a)(1)) is amended by adding at the end the following:
``(H) Activities and community education programs designed
to address and prevent overweight, obesity, and eating
disorders through effective programs to promote healthy eating,
and exercise habits and behaviors.''.
SEC. 205. REPORT ON OBESITY RESEARCH.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services shall submit to
the Committee on Health, Education, Labor, and Pensions of the Senate
and the Committee on Energy and Commerce of the House of
Representatives a report on research conducted on causes and health
implications of obesity and being overweight.
(b) Content.--The report described in subsection (a) shall
contain--
(1) descriptions on the status of relevant, current,
ongoing research being conducted in the Department of Health
and Human Services including research at the National
Institutes of Health, the Centers for Disease Control and
Prevention, the Agency for Healthcare Research and Quality, the
Health Resources and Services Administration, and other offices
and agencies;
(2) information about what these studies have shown
regarding the causes of, prevention of, and treatment of,
overweight and obesity; and
(3) recommendations on further research that is needed,
including research among diverse populations, the department's
plan for conducting such research, and how current knowledge
can be disseminated.
SEC. 206. REPORT ON A NATIONAL CAMPAIGN TO CHANGE CHILDREN'S HEALTH
BEHAVIORS AND REDUCE OBESITY.
Section 399Y of the Public Health Service Act (42 U.S.C. 280h-2) is
amended--
(1) by redesignating subsection (b) as subsection (c); and
(2) by inserting after subsection (a) the following:
``(b) Report.--The Secretary shall evaluate the effectiveness of
the campaign described in subsection (a) in changing children's
behaviors and reducing obesity and shall report such results to the
Committee on Health, Education, Labor, and Pensions of the Senate and
the Committee on Energy and Commerce of the House of
Representatives.''.
Passed the Senate December 9, 2003.
Attest:
EMILY J. REYNOLDS,
Secretary.