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[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1325 Introduced in Senate (IS)]

109th CONGRESS
  1st Session
                                S. 1325

To establish grants to provide health services for improved nutrition, 
 increased physical activity, obesity and eating disorder prevention, 
                        and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 28, 2005

   Mr. Frist (for himself, Mr. Bingaman, Mr. Dodd, Mrs. Clinton, Ms. 
  Collins, Mr. Alexander, Mr. Lugar, Ms. Murkowski, and Mr. Stevens) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To establish grants to provide health services for improved nutrition, 
 increased physical activity, obesity and eating disorder 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) In July 2004, the Secretary of Health and Human Service 
        recognized ``obesity is a critical public health problem in our 
        country'' and under the medicare program language was removed 
        from the coverage manual stating that obesity is not an 
        illness.
            (2) The National Health and Nutrition Examination Survey 
        for 2002 found that an estimated 65 percent of adults are 
        overweight and 31 percent of adults are obese and 16 percent of 
        children and adolescents in the United States are overweight or 
        obese.
            (3) The Institute of Medicine reported in ``Preventing 
        Childhood Obesity'' (2004) that approximately 60 percent of 
        obese children between 5 and 10 years of age have at least one 
        cardiovascular disease risk factor and 25 percent have two or 
        more such risk factors.
            (4) The Institute of Medicine reports that the prevalence 
        of overweight and obesity is increasing among all age groups. 
        There is twice the number of overweight children between 2 and 
        5 years of age and adolescents between 12 and 19 years of age, 
        and 3 times the number of children between 6 and 11 years of 
        age as there were 30 years ago.
            (5) According to the 2004 Institute of Medicine report, 
        obesity-associated annual hospital costs for children and youth 
        more than tripled over 2 decades, rising from $35,000,000 in 
        the period 1979 through 1981 to $127,000,000 in the period 1997 
        through 1999.
            (6) The Centers for Disease Control and Prevention reports 
        have estimated that as many as 365,000 deaths a year are 
        associated with being overweight or obese. Overweight and 
        obesity 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.
            (7) According to the National Institute of Diabetes and 
        Digestive and Kidney Diseases, individuals who are obese have a 
        50 to 100 percent increased risk of premature death.
            (8) The Healthy People 2010 goals identify overweight and 
        obesity as one of the Nation's leading health problems and 
        include objectives for increasing the proportion of adults who 
        are at a healthy weight, reducing the proportion of adults who 
        are obese, and reducing the proportion of children and 
        adolescents who are overweight or obese.
            (9) 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.
            (10) The 2005 Surgeon General's report ``The Year of the 
        Healthy Child'' lists the treatment and prevention of obesity 
        as a national priority.
            (11) The Institute of Medicine report ``Preventing 
        Childhood Obesity'' (2004) finds that ``childhood obesity is a 
        serious nationwide health problem requiring urgent attention 
        and a population-based prevention approach...''.
            (12) The Centers for Disease Control and Prevention 
        estimates the annual expenditures related to overweight and 
        obesity in adults in the United States to be $264,000,000,000 
        (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.
            (13) 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 the 2001 
        U.S. Surgeon General's report ``A Call To Action'' and other 
        documents prepared by the Department of Health and Human 
        Services and other agencies.
            (14) The Institute of Medicine reports that poor eating 
        habits are a risk factor for the development of eating 
        disorders and obesity. In 2002, more than 35,000,000 Americans 
        experienced limited access to nutritious food on a regular 
        basis. The availability of high-calorie, low nutrient foods 
        have increased in low-income neighborhoods due to many factors.
            (15) Effective interventions for promoting healthy eating 
        behaviors should promote healthy lifestyle and not 
        inadvertently promote unhealthy weight management techniques.
            (16) The National Institutes of Health reports that eating 
        disorders are commonly associated with substantial 
        psychological problems, including depression, substance abuse, 
        and suicide.
            (17) The National Association of Anorexia Nervosa and 
        Associated Disorders estimates there are 8,000,000 Americans 
        experience eating disorders. Eating disorders of all types are 
        more common in women than men.
            (18) The health risks of Binge Eating Disorder are those 
        associated with obesity and include heart disease, gall bladder 
        disease, and diabetes.
            (19) According to the National Institute of Mental Health, 
        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.
            (20) Additionally, the National Institute of Mental Health 
        reports that 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. According to the National Institute of Mental Health, 
        Anorexia Nervosa has one of the highest mortality rates of all 
        psychiatric disorders, placing a young woman with Anorexia 
        Nervosa at 12 times the risk of death of other women her age.
            (21) In 2001, the National Institute of Mental Health 
        reported that 1.1 to 4.2 percent of American women will suffer 
        from Bulimia Nervosa in their lifetime. Bulimia Nervosa is an 
        eating disorder that is associated with cardiac, 
        gastrointestinal, and dental problems, including irregular 
        heartbeats, gastric ruptures, peptic ulcers, and tooth decay.
            (22) On the 2003 Youth Risk Behavior Survey, 6 percent of 
        high school students reported recent use of laxatives or 
        vomiting to control their weight.

                        TITLE I--TRAINING GRANTS

SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION STUDENTS.

    Section 747(c)(3) 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, being 
                        overweight, eating disorders and related 
                        serious and chronic medical conditions;
                            ``(iii) how to discuss varied strategies 
                        with patients from at-risk and diverse 
                        populations to promote positive behavior change 
                        and healthy lifestyles to avoid obesity, being 
                        overweight, and eating disorders;
                            ``(iv) how to identify overweight, obese, 
                        individuals with eating disorders, and those 
                        who are at risk for obesity and being 
                        overweight or suffer from eating disorders and, 
                        therefore, at risk for related serious and 
                        chronic medical conditions; and
                            ``(v) how to conduct a comprehensive 
                        assessment of individual and familial health 
                        risk factors; and
                    ``(B) evaluate the effectiveness of the training 
                provided by such entity in increasing knowledge and 
                changing attitudes and behaviors of trainees.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        $10,000,000 for fiscal year 2006, and such sums as may be 
        necessary for each of fiscal years 2007 through 2010.''.

  TITLE II--COMMUNITY-BASED SOLUTIONS TO INCREASE PHYSICAL ACTIVITY, 
        IMPROVE NUTRITION, AND PROMOTE HEALTHY EATING BEHAVIORS

SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY, IMPROVE NUTRITION, AND 
              PROMOTE HEALTHY EATING BEHAVIORS.

    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, IMPROVE NUTRITION, 
              AND PROMOTE HEALTHY EATING BEHAVIORS.

    ``(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) governors' councils for physical activity and 
                good nutrition;
                    ``(F) State and local parks and recreation 
                departments; and
                    ``(G) 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, 
                nursing facilities, retirement communities, and 
                assisted living facilities 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) developing and evaluating community 
                educational activities targeting good nutrition and 
                promoting healthy eating behaviors;
            ``(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 (including evaluation or identification and 
        dissemination of outcomes and best practices).
    ``(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 promoting 
healthy eating behaviors and physical activity in youth. Such review 
shall include an identification of model curricula, best practices, and 
lessons learned, as well as recommendations for next steps to reduce 
overweight, obesity, and eating disorders. Information derived from 
such review, including model program curricula, shall be disseminated 
to the public.
    ``(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 
2006 and such sums as may be necessary for each of fiscal years 2007 
through 2010. 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 2006.
            ``(2) $5,500,000 for fiscal year 2007.
            ``(3) $6,000,000 for fiscal year 2008.
            ``(4) $6,500,000 for fiscal year 2009.
            ``(5) $1,000,000 for fiscal year 2010.''.

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 carried out under this Act (and the amendments made by this 
Act) and determine if particular information may be important to the 
report on health disparities required by section 903(c)(3) of the 
Public Health Service Act (42 U.S.C. 299a-1(c)(3)).

SEC. 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 AND EATING DISORDERS RESEARCH.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Energy and Commerce of the House of 
Representatives a report on research conducted on causes and health 
implications (including mental health implications) of being 
overweight, obesity, and eating disorders.
    (b) Content.--The report described in subsection (a) shall 
contain--
            (1) descriptions on the status of relevant, current, 
        ongoing research being conducted in the Department of Health 
        and Human Services including research at the National 
        Institutes of Health, the Centers for Disease Control and 
        Prevention, the Agency for Healthcare Research and Quality, the 
        Health Resources and Services Administration, and other offices 
        and agencies;
            (2) information about what these studies have shown 
        regarding the causes, prevention, and treatment of, being 
        overweight, obesity, and eating disorders; and
            (3) recommendations on further research that is needed, 
        including research among diverse populations, the plan of the 
        Department of Health and Human Services for conducting such 
        research, and how current knowledge can be disseminated.

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.''.
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