II 

111TH CONGRESS 

1ST SESSION S. 1503 

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 

JULY 22, 2009 

Mrs. GILLIBRAND 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improved Nutrition 

5 and Physical Activity Act’’ or the ‘‘IMPACT Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) In July 2004, the Secretary of Health and 

9 Human Service recognized ‘‘obesity is a critical pubVerDate Nov 24 2008 04:52 Jul 23, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1503.IS S1503

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1 lic health problem in our country’’ and under the 

2 Medicare program language was removed from the 

3 coverage manual stating that obesity is not an ill4 ness. 

5 (2) The National Health and Nutrition Exam6 ination Survey for 2002 found that an estimated 65 

7 percent of adults are overweight and 31 percent of 

8 adults are obese and 16 percent of children and ado9 lescents in the United States are overweight or 

10 obese. 

11 (3) The Institute of Medicine reported in ‘‘Pre12 venting Childhood Obesity’’ (2004) that approxi13 mately 60 percent of obese children between 5 and 

14 10 years of age have at least one cardiovascular dis15 ease risk factor and 25 percent have two or more 

16 such risk factors. 

17 (4) According to Centers for Disease Control 

18 and Prevention, children who are obese are at great19 er risk for psychological problems such as stig20 matization and poor self-esteem. Obese children and 

21 adolescents are targets of early and systematic social 

22 discrimination. The psychological stress of social 

23 stigmatization can cause low self-esteem which, in 

24 turn, can hinder academic and social functioning, 

25 and persist into adulthood. 


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1 (5) The Ophelia Project reports that approxi2 mately 30 percent of youth in the United States are 

3 estimated to be actively involved in bullying, either 

4 as a bully, target, or both. ABC News reports that 

5 58 percent of children admit that someone has said 

6 mean or hurtful things to them online. The emo7 tional safety of children who are overweight or obese 

8 is threatened since they are often the targets of bul9 lying and relational aggression, which can have seri10 ous effects on their physical and emotional health. 

11 (6) The Institute of Medicine reports that the 

12 prevalence of overweight and obesity is increasing 

13 among all age groups. There is twice the number of 

14 overweight children between 2 and 5 years of age 

15 and adolescents between 12 and 19 years of age, 

16 and 3 times the number of children between 6 and 

17 11 years of age as there were 30 years ago. 

18 (7) According to the Centers for Disease Con19 trol and Prevention, low income and minority girls 

20 have the highest rates of childhood obesity. His21 panic, African-American, and Native American chil22 dren are disproportionately affected by obesity, with 

23 the highest prevalence found among African-Amer24 ican and Hispanic girls (‘‘The New Normal?: What 

25 Girls Say about Healthy Living’’ 2006). 


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1 (8) According to the 2004 Institute of Medicine 

2 report, obesity-associated annual hospital costs for 

3 children and youth more than tripled over 2 decades, 

4 rising from $35,000,000 in the period 1979 through 

5 1981 to $127,000,000 in the period 1997 through 

6 1999. 

7 (9) The Centers for Disease Control and Pre8 vention reports have estimated that as many as 

9 365,000 deaths a year are associated with being 

10 overweight or obese. Overweight and obesity are as11 sociated with an increased risk for heart disease (the 

12 leading cause of death), cancer (the second leading 

13 cause of death), diabetes (the sixth leading cause of 

14 death), and musculoskeletal disorders. 

15 (10) According to the National Institute of Dia16 betes and Digestive and Kidney Diseases, individuals 

17 who are obese have a 50 to 100 percent increased 

18 risk of premature death. 

19 (11) The Centers for Disease Control and Pre20 vention reports that children spend a considerable 

21 amount of time with media. One study found that 

22 time spent watching TV, videos, DVDs, and movies 

23 averaged slightly over 3 hours per day among chil24 dren aged 8–18 years. Several studies have found a 

25 positive association between the time spent viewing 


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1 television and increased prevalence of obesity in chil2 dren. This time with the media can damage girls’ 

3 physical and emotional health. The Geena Davis In4 stitute on Gender in the Media reports that in many 

5 forms of media, girls and women are often depicted 

6 as sexualized objects, which can damage girls’ body 

7 images. 

8 (12) The Healthy People 2010 goals identify 

9 overweight and obesity as one of the Nation’s lead10 ing health problems and include objectives for in11 creasing the proportion of adults who are at a 

12 healthy weight, reducing the proportion of adults 

13 who are obese, and reducing the proportion of chil14 dren and adolescents who are overweight or obese. 

15 (13) Another goal of Healthy People 2010 is to 

16 eliminate health disparities among different seg17 ments of the population. Obesity is a health problem 

18 that disproportionally impacts medically underserved 

19 populations. 

20 (14) The 2005 Surgeon General’s report ‘‘The 

21 Year of the Healthy Child’’ lists the treatment and 

22 prevention of obesity as a national priority. 

23 (15) The Institute of Medicine report ‘‘Pre24 venting Childhood Obesity’’ (2004) finds that ‘‘child25 hood obesity is a serious nationwide health problem 


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1 requiring urgent attention and a population-based 

2 prevention approach . . .’’. 

3 (16) The Centers for Disease Control and Pre4 vention estimates the annual expenditures related to 

5 overweight and obesity in adults in the United 

6 States to be $264,000,000,000 (exceeding the cost 

7 of tobacco-related illnesses) and appears to be rising 

8 dramatically. This cost can potentially escalate 

9 markedly as obesity rates continue to rise and the 

10 medical complications of obesity are emerging at 

11 even younger ages. Therefore, the total disease bur12 den will most likely increase, as well as the attend13 ant health-related costs. 

14 (17) Weight control programs should promote a 

15 healthy lifestyle including regular physical activity 

16 and healthy eating, as consistently discussed and 

17 identified in a variety of public and private con18 sensus documents, including the 2001 U.S. Surgeon 

19 General’s report ‘‘A Call To Action’’ and other docu20 ments prepared by the Department of Health and 

21 Human Services and other agencies. 

22 (18) The Institute of Medicine reports that 

23 poor eating habits are a risk factor for the develop24 ment of eating disorders and obesity. In 2002, more 

25 than 35,000,000 Americans experienced limited acVerDate Nov 24 2008 04:52 Jul 23, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1503.IS S1503

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1 cess to nutritious food on a regular basis. The avail2 ability of high-calorie, low-nutrient foods have in3 creased in low-income neighborhoods due to many 

4 factors. 

5 (19) Effective interventions for promoting 

6 healthy eating behaviors should promote healthy life7 style and not inadvertently promote unhealthy 

8 weight management techniques. 

9 (20) The National Institutes of Health reports 

10 that eating disorders are commonly associated with 

11 substantial psychological problems, including depres12 sion, substance abuse, and suicide. 

13 (21) The National Association of Anorexia 

14 Nervosa and Associated Disorders estimates there 

15 are 8,000,000 Americans experience eating dis16 orders. Eating disorders of all types are more com17 mon in women than men. 

18 (22) The health risks of Binge Eating Disorder 

19 are those associated with obesity and include heart 

20 disease, gall bladder disease, and diabetes. 

21 (23) According to the National Institute of 

22 Mental Health, Binge Eating Disorder is character23 ized by frequent episodes of uncontrolled overeating, 

24 with an estimated 2 to 5 percent of Americans expe25 riencing this disorder in a 6-month period. 


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1 (24) Additionally, the National Institute of 

2 Mental Health reports that Anorexia Nervosa, an 

3 eating disorder from which 0.5 to 3.7 percent of 

4 American women will suffer in their lifetime, is asso5 ciated with serious health consequences including 

6 heart failure, kidney failure, osteoporosis, and death. 

7 According to the National Institute of Mental 

8 Health, Anorexia Nervosa has one of the highest 

9 mortality rates of all psychiatric disorders, placing a 

10 young woman with Anorexia Nervosa at 12 times 

11 the risk of death of other women her age. 

12 (25) In 2001, the National Institute of Mental 

13 Health reported that 1.1 to 4.2 percent of American 

14 women will suffer from Bulimia Nervosa in their 

15 lifetime. Bulimia Nervosa is an eating disorder that 

16 is associated with cardiac, gastrointestinal, and den17 tal problems, including irregular heartbeats, gastric 

18 ruptures, peptic ulcers, and tooth decay. 

19 (26) On the 2007 Youth Risk Behavior Survey, 

20 4.3 percent of high school students reported recent 

21 use of laxatives or vomiting to control their weight. 

22 (27) The Girl Scout Research Institute found 

23 that most girls have a holistic view of health and be24 lieve physical and emotional health are of equal im25 portance. This connection is reflected in their behavVerDate Nov 24 2008 05:50 Jul 23, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1503.IS S1503

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1 ior and attitudes toward diet and exercise. Diet and 

2 exercise patterns are linked to emotional health, self3 esteem, and body image, which all play a critical role 

4 in how girls define health (‘‘The New Normal?: 

5 What Girls Say about Healthy Living’’ 2006). 

6 (28) A strict focus on physical health does not 

7 resonate emotionally with girls. Any reframing or re8 defining of health needs, including nutrition and 

9 physical activity, needs to focus on the positive emo10 tional outcomes that are likely to result from healthy 

11 behavior (other than maintaining normal weight and 

12 eating nourishing foods). For girls, being healthy 

13 means not only eating right and looking good, but 

14 also feeling good about oneself and having a good re15 lationship with one’s peers (‘‘The New Normal?: 

16 What Girls Say about Healthy Living’’ 2006). 

17 (29) The Girl Scout Research Institute reports 

18 that emotional safety is a top concern for girls. Rela19 tional aggression, or emotional bullying, threatens 

20 girls’ emotional and physical safety. Efforts to im21 prove girls’ health should include the prevention of 

22 relational aggression, since most girls define safety 

23 in terms of relationships and healthy relationships 

24 are crucial to girls’ physical and emotional health 

25 (‘‘Feeling Safe: What Girls Say’’ 2003 and ‘‘The 


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1 New Normal?: What Girls Say about Healthy Liv2 ing’’ 2006). 

3 (30) Girls’ body images affect their emotional 

4 and physical health, such as self-esteem and eating 

5 and exercise habits. External factors such as family, 

6 celebrities, and the media also have an effect on 

7 girls’ perception of their bodies. Therefore, pro8 moting healthy media images of girls and woman 

9 can help improve their physical and emotional health 

10 (‘‘The New Normal?: What Girls Say about Healthy 

11 Living’’ 2006). 

12 (31) According to the Girl Scout Research In13 stitute, parents—especially mothers in the case of 

14 girls—are important influences and role models. Ef15 forts to inspire and motive girls to make healthier 

16 choices must focus on helping parents support their 

17 children and teach parents that their choices model 

18 behaviors for how to live a healthy life (‘‘The New 

19 Normal?: What Girls Say about Healthy Living’’ 

20 2006). 

21 (32) There is a tension between health aware22 ness and behavior among children and youth. Al23 though girls demonstrate basic knowledge about 

24 healthy foods and eating behaviors, they are not put25 ting this knowledge into practice and it is normal for 


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1 many girls to make poor choices with respect to diet 

2 and exercise. Teaching healthy nutrition and exer3 cise habits should make healthy living seem reason4 able, socially acceptable, applicable and attainable 

5 (‘‘The New Normal?: What Girls Say about Healthy 

6 Living’’ 2006). 

7 (33) According to the American Academy of 

8 Pediatrics, the current epidemic of inactivity and the 

9 associated epidemic of obesity are being driven by 

10 multiple factors (societal, technologic, industrial, 

11 commercial, financial) and must be addressed like12 wise on several fronts. Success is more likely to be 

13 achieved by the implementation of sustainable, eco14 nomically viable, culturally acceptable active-living 

15 policies that can be integrated into multiple sectors 

16 of society (‘‘Pediatrics’’ Vol. 117 No. 5 May 2006, 

17 pp. 1834–1842 (doi:10.1542/peds.2006–0472) (‘‘Ac18 tive Healthy Living: Prevention of Childhood Obesity 

19 Through Increased Physical Activity’’)). 

20 (34) According to the 2006 School Health Poli21 cies and Programs Study, conducted by the Centers 

22 for Disease Control and Prevention, only 3.8 percent 

23 of elementary schools, 7.9 percent of middle schools, 

24 and 2.1 percent of high schools provided daily phys25 ical education or its equivalent for the entire school 


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1 year for students in all grades. Overall, about 22 

2 percent of schools did not require students to take 

3 any physical education. 

4 (35) Additionally, the 2006 School Health Poli5 cies and Programs Study revealed that 64.4 percent 

6 of schools with primary responsibility for food prepa7 ration reported they did not reduce the amount of 

8 fats and oils used in recipes or use low-fat recipes 

9 when preparing school meals. Nationwide, 21.1 per10 cent of elementary schools, 62.4 percent of middle 

11 schools, and 85.8 percent of high schools had one or 

12 more vending machines from which students could 

13 purchase food or beverages. 

14 (36) The Institute of Medicine reports that tak15 ing action against childhood obesity must address 

16 the factors that influence both eating and physical 

17 activity. According to the Institute of Medicine, 

18 ‘‘[a]lthough a number of organizations, industries, 

19 institutions, and agencies must be involved in de20 signing and implementing changes, efforts cannot 

21 succeed unless they also engage the families, schools, 

22 and communities that create the environments in 

23 which children live and their behaviors are formed’’. 


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1 TITLE I—TRAINING GRANTS 

2 SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH 

3 PROFESSION STUDENTS. 

4 Section 747(c)(3) of the Public Health Service Act 

5 (42 U.S.C. 293k(c)(3)) is amended by striking ‘‘and vic6 tims of domestic violence’’ and inserting ‘‘victims of do7 mestic violence, individuals (including children) who are 

8 overweight or obese (as such terms are defined in section 

9 399W(j)) and at-risk for related serious and chronic med10 ical conditions, and individuals who suffer from eating dis11 orders’’. 

12 SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH 

13 PROFESSIONALS. 

14 Section 399Z of the Public Health Service Act (42 

15 U.S.C. 280h–3) is amended— 

16 (1) in subsection (b), by striking ‘‘2005’’ and 

17 inserting ‘‘2010’’; 

18 (2) by redesignating subsection (b) as sub19 section (c); 

20 (3) by inserting after subsection (a) the fol21 lowing: 

22 ‘‘(b) GRANTS.— 

23 ‘‘(1) IN GENERAL.—The Secretary may award 

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1 sionals on how to identify, properly refer or treat, 

2 and prevent obesity or eating disorders and aid indi3 viduals who are overweight, obese, or who suffer 

4 from eating disorders. 

5 ‘‘(2) APPLICATION.—An entity that desires a 

6 grant under this subsection shall submit an applica7 tion at such time, in such manner, and containing 

8 such information as the Secretary may require, in9 cluding a plan for the use of funds that may be 

10 awarded and an evaluation of the training that will 

11 be provided. 

12 ‘‘(3) USE OF FUNDS.—An entity that receives 

13 a grant under this subsection shall use the funds 

14 made available through such grant to— 

15 ‘‘(A) use evidence-based findings or rec16 ommendations that pertain to the prevention 

17 and treatment of obesity, being overweight, and 

18 eating disorders to conduct educational con19 ferences, including Internet-based courses and 

20 teleconferences, on— 

21 ‘‘(i) how to treat or prevent obesity, 

22 being overweight, and eating disorders; 

23 ‘‘(ii) the link between obesity, being 

24 overweight, eating disorders and related se25 rious and chronic medical conditions; 


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1 ‘‘(iii) holistic health: the connection 

2 between emotional and physical health; 

3 ‘‘(iv) how to discuss varied strategies 

4 with patients from at-risk and diverse pop5 ulations to promote positive behavior 

6 change and healthy lifestyles to avoid obe7 sity, being overweight, and eating dis8 orders; 

9 ‘‘(v) how to identify overweight, obese, 

10 individuals with eating disorders, and those 

11 who are at risk for obesity and being over12 weight or suffer from eating disorders and, 

13 therefore, at risk for related serious and 

14 chronic medical conditions; and 

15 ‘‘(vi) how to conduct a comprehensive 

16 assessment of individual and familial 

17 health risk factors; and 

18 ‘‘(B) evaluate the effectiveness of the 

19 training provided by such entity in increasing 

20 knowledge and changing attitudes and behav21 iors of trainees.’’; and 

22 (4) in subsection (c) (as so redesignated)— 

23 (A) by striking ‘‘There are authorized to 

24 be appropriated to carry out this section’’ and 


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1 all that follows and inserting the following: 

2 ‘‘There are authorized to be appropriated— 

3 ‘‘(1) to carry out subsection (a),’’; and 

4 (B) by adding at the end the following: 

5 ‘‘(2) to carry out subsection (b), $10,000,000 

6 for fiscal year 2010, and such sums as may be nec7 essary for each of fiscal years 2011 through 2014.’’. 

8 TITLE II—COMMUNITY-BASED 

9 SOLUTIONS TO INCREASE 

10 PHYSICAL ACTIVITY, IM11 PROVE NUTRITION, AND PRO12 MOTE EMOTIONAL WELLNESS 

13 AND HEALTHY EATING BE14 HAVIORS 

15 SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND 

16 EMOTIONAL WELLNESS, IMPROVE NUTRI17 TION, AND PROMOTE HEALTHY EATING BE18 HAVIORS. 

19 Part Q of title III of the Public Health Service Act 

20 (42 U.S.C. 280h et seq.) is amended by striking section 

21 399W and inserting the following: 


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1 ‘‘SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY 

2 AND EMOTIONAL WELLNESS, IMPROVE NU3 TRITION, AND PROMOTE HEALTHY EATING 

4 BEHAVIORS AND HEALTHY LIVING. 

5 ‘‘(a) ESTABLISHMENT.— 

6 ‘‘(1) IN GENERAL.—The Secretary, acting 

7 through the Director of the Centers for Disease 

8 Control and Prevention and in coordination with the 

9 Administrator of the Health Resources and Services 

10 Administration, the Director of the Indian Health 

11 Service, the Secretary of Education, the Secretary of 

12 Agriculture, the Secretary of the Interior, the Direc13 tor of the National Institutes of Health, the Director 

14 of the Office of Women’s Health, and the heads of 

15 other appropriate agencies, shall award competitive 

16 grants to eligible entities to plan and implement pro17 grams that promote healthy eating behaviors, phys18 ical activity, emotional wellness, and healthy living, 

19 and to prevent eating disorders, obesity, being over20 weight, and related serious and chronic medical con21 ditions. Such grants may be awarded to target at22 risk populations including youth, adolescent girls, 

23 health disparity populations (as defined in section 

24 485E(d)), and the underserved. 


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1 ‘‘(2) TERM.—The Secretary shall award grants 

2 under this subsection for a period not to exceed 4 

3 years. 

4 ‘‘(b) AWARD OF GRANTS.—An eligible entity desiring 

5 a grant under this section shall submit an application to 

6 the Secretary at such time, in such manner, and con7 taining such information as the Secretary may require, in8 cluding— 

9 ‘‘(1) a plan describing a comprehensive pro10 gram of approaches to encourage healthy living, 

11 emotional wellness, healthy eating behaviors, and 

12 healthy levels of physical activity; 

13 ‘‘(2) the manner in which the eligible entity will 

14 coordinate with appropriate State and local authori15 ties and community-based organizations, including— 

16 ‘‘(A) State and local educational agencies; 

17 ‘‘(B) departments of health; 

18 ‘‘(C) chronic disease directors; 

19 ‘‘(D) State directors of programs under 

20 section 17 of the Child Nutrition Act of 1966 

21 (42 U.S.C. 1786); 

22 ‘‘(E) governors’ councils for physical activ23 ity and good nutrition; 

24 ‘‘(F) State and local parks and recreation 

25 departments; 


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1 ‘‘(G) State and local departments of trans2 portation and city planning; and 

3 ‘‘(H) community-based organizations serv4 ing youth; and 

5 ‘‘(3) the manner in which the applicant will 

6 evaluate the effectiveness of the program carried out 

7 under this section. 

8 ‘‘(c) COORDINATION.—In awarding grants under this 

9 section, the Secretary shall ensure that the proposed pro10 grams show a history of addressing these issues, have pro11 gram evaluations that show success, and are coordinated 

12 in substance and format with programs currently funded 

13 through other Federal agencies and operating within the 

14 community including the Physical Education Program 

15 (PEP) of the Department of Education. 

16 ‘‘(d) ELIGIBLE ENTITY.—In this section, the term 

17 ‘eligible entity’ means— 

18 ‘‘(1) a city, county, tribe, territory, or State; 

19 ‘‘(2) a State educational agency; 

20 ‘‘(3) a tribal educational agency; 

21 ‘‘(4) a local educational agency; 

22 ‘‘(5) a federally qualified health center (as de23 fined in section 1861(aa)(4) of the Social Security 

24 Act); 

25 ‘‘(6) a rural health clinic; 


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1 ‘‘(7) a health department; 

2 ‘‘(8) an Indian Health Service hospital or clinic; 

3 ‘‘(9) an Indian tribal health facility; 

4 ‘‘(10) an urban Indian facility; 

5 ‘‘(11) any health provider; 

6 ‘‘(12) an accredited university or college; 

7 ‘‘(13) a youth serving organization; 

8 ‘‘(14) a community-based organization; 

9 ‘‘(15) a local city planning agency; 

10 ‘‘(16) a State or local parks and recreation de11 partment; or 

12 ‘‘(17) any other entity determined appropriate 

13 by the Secretary. 

14 ‘‘(e) USE OF FUNDS.—An eligible entity that receives 

15 a grant under this section shall use the funds made avail16 able through the grant to— 

17 ‘‘(1) carry out community-based activities in18 cluding— 

19 ‘‘(A) city planning, transportation initia20 tives, and environmental changes that help pro21 mote physical activity, such as increasing the 

22 use of walking or bicycling as a mode of trans23 portation; 

24 ‘‘(B) forming partnerships and activities 

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1 tions, and other entities to increase physical ac2 tivity levels and promote holistic health includ3 ing promote healthy eating behaviors and the 

4 prevention of relational aggression in schools 

5 and while traveling to and from schools; 

6 ‘‘(C) forming partnerships with entities, in7 cluding schools, faith-based entities, commu8 nity-based organizations, and other organiza9 tions providing recreational services, to estab10 lish programs that use their facilities or other 

11 resources for after-school, weekend, and sum12 mer community activities, especially those that 

13 promote emotional and social wellness or involve 

14 physical activity; 

15 ‘‘(D) establishing incentives for retail food 

16 stores, farmer’s markets, food co-ops, grocery 

17 stores, and other retail food outlets that offer 

18 fresh fruits and vegetables and other nutritious 

19 foods to encourage such stores and outlets to 

20 locate in economically depressed areas; 

21 ‘‘(E) forming partnerships with senior cen22 ters, nursing facilities, retirement communities, 

23 and assisted living facilities to establish pro24 grams for older people to foster physical activ25 ity and healthy eating behaviors; 


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1 ‘‘(F) forming partnerships with daycare 

2 and after-school entities to establish programs 

3 that promote healthy eating behaviors and 

4 physical activity and that address health holis5 tically, including building strong and healthy re6 lationships; 

7 ‘‘(G) developing and evaluating community 

8 educational activities targeting healthy relation9 ships, good nutrition, and promoting healthy 

10 eating behaviors to bridge the gap between chil11 dren’s behavior and their awareness and knowl12 edge of healthy eating and exercise habits; 

13 ‘‘(H) providing, directly or in cooperation 

14 with State and local parks and recreation de15 partments, programs and other opportunities 

16 for daily physical activity; 

17 ‘‘(I) identifying and combating issues such 

18 as bullying and relational aggression, that cause 

19 overeating, physical inactivity, eating disorders, 

20 and other unhealthy behaviors; 

21 ‘‘(J) forming partnerships with parents 

22 and caregivers to form programs that educate 

23 adults about healthy living and how to teach 

24 their children self-esteem and healthy eating 

25 and exercise habits; and 


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1 ‘‘(K) creating educational and media lit2 eracy programs to inform the public, busi3 nesses, community-based organizations, and 

4 other entities about unhealthy media images 

5 and their effect on girls’ body image and eating 

6 habits; 

7 ‘‘(2) carry out age-appropriate school-based ac8 tivities including— 

9 ‘‘(A) developing and testing educational 

10 curricula and intervention programs designed to 

11 promote healthy eating behaviors and habits in 

12 youth, which may include— 

13 ‘‘(i) after hours physical activity pro14 grams; 

15 ‘‘(ii) increasing opportunities for stu16 dents to make informed choices regarding 

17 healthy eating behaviors and forming 

18 healthy lifestyles; and 

19 ‘‘(iii) science-based interventions with 

20 multiple components to prevent eating dis21 orders including nutritional content, under22 standing and responding to hunger and sa23 tiety, positive body image development, 

24 positive self-esteem development, and 

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1 ment, media literacy, communication skills, 

2 problem-solving and decisionmaking skills), 

3 as well as consideration of cultural and de4 velopmental issues, and the role of family, 

5 school, and community; 

6 ‘‘(B) providing education and training to 

7 educational professionals and adult volunteers 

8 for community based organizations regarding— 

9 ‘‘(i) a healthy lifestyle and a healthy 

10 school environment; 

11 ‘‘(ii) healthy relationships and emo12 tional wellness through the prevention of 

13 relational aggression; 

14 ‘‘(iii) integrating eating disorder pre15 vention and awareness in physical edu16 cation, health, and after-school curriculum 

17 to the maximum extent possible; and 

18 ‘‘(iv) establishing policies on relational 

19 aggression; 

20 ‘‘(C) planning and implementing a healthy 

21 lifestyle curriculum or program with an empha22 sis on healthy eating behaviors, physical activ23 ity, and emotional wellness, including the role 

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1 lying, such as relational aggression and 

2 cyberbullying; and 

3 ‘‘(D) planning and implementing healthy 

4 lifestyle classes or programs for parents or 

5 guardians, with an emphasis on healthy eating 

6 behaviors, physical activity, emotional wellness, 

7 and the connection between emotional and 

8 physical health; 

9 ‘‘(3) carry out activities through the local 

10 health care delivery systems including— 

11 ‘‘(A) promoting healthy eating behaviors 

12 and physical activity services and emotional 

13 wellness to treat or prevent eating disorders, 

14 being overweight, and obesity; 

15 ‘‘(B) providing patient education and coun16 seling to increase physical activity, promote 

17 healthy eating behaviors, and improve emotional 

18 wellness; and 

19 ‘‘(C) providing community education on 

20 good nutrition, physical activity, and emotional 

21 wellness to develop a better understanding of 

22 the relationship between diet, physical activity, 

23 and emotional wellness and eating disorders, 

24 obesity, or being overweight; or 


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1 ‘‘(4) other activities determined appropriate by 

2 the Secretary (including evaluation or identification 

3 and dissemination of outcomes and best practices). 

4 ‘‘(f) MATCHING FUNDS.—In awarding grants under 

5 subsection (a), the Secretary may give priority to eligible 

6 entities who provide matching contributions. Such non7 Federal contributions may be cash or in kind, fairly evalu8 ated, including plant, equipment, training, curriculum, or 

9 a preexisting evaluation framework. 

10 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary may 

11 set aside an amount not to exceed 10 percent of the total 

12 amount appropriated for a fiscal year under subsection (k) 

13 to permit the Director of the Centers for Disease Control 

14 and Prevention to provide grantees with technical support 

15 in the development, implementation, and evaluation of 

16 programs under this section and to disseminate informa17 tion about effective strategies and interventions in pre18 venting and treating obesity and eating disorders through 

19 the promotion of healthy eating behaviors, physical activ20 ity, and emotional wellness. 

21 ‘‘(h) LIMITATION ON ADMINISTRATIVE COSTS.—An 

22 eligible entity awarded a grant under this section may not 

23 use more than 10 percent of funds awarded under such 

24 grant for administrative expenses. 


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1 ‘‘(i) REPORT.—Not later than 6 years after the date 

2 of enactment of the Improved Nutrition and Physical Ac3 tivity Act, the Director of the Centers for Disease Control 

4 and Prevention shall review the results of the grants 

5 awarded under this section and other related research and 

6 identify programs that have demonstrated effectiveness in 

7 promoting healthy eating behaviors, physical activity, and 

8 emotional wellness in youth. Such review shall include an 

9 identification of model curricula, best practices, and les10 sons learned, as well as recommendations for next steps 

11 to reduce overweight, obesity, and eating disorders. Infor12 mation derived from such review, including model program 

13 curricula, shall be disseminated to the public. 

14 ‘‘(j) DEFINITIONS.—In this section: 

15 ‘‘(1) ANOREXIA NERVOSA.—The term ‘Anorexia 

16 Nervosa’ means an eating disorder characterized by 

17 self-starvation and excessive weight loss. 

18 ‘‘(2) BINGE EATING DISORDER.—The term 

19 ‘binge eating disorder’ means a disorder character20 ized by frequent episodes of uncontrolled eating. 

21 ‘‘(3) BULIMIA NERVOSA.—The term ‘Bulimia 

22 Nervosa’ means an eating disorder characterized by 

23 excessive food consumption, followed by inappro24 priate compensatory behaviors, such as self-induced 


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1 vomiting, misuse of laxatives, fasting, or excessive 

2 exercise. 

3 ‘‘(4) EATING DISORDERS.—The term ‘eating 

4 disorders’ means disorders of eating, including Ano5 rexia Nervosa, Bulimia Nervosa, binge eating dis6 order, and eating disorders not otherwise specified. 

7 ‘‘(5) HEALTHY EATING BEHAVIORS.—The term 

8 ‘healthy eating behaviors’ means— 

9 ‘‘(A) eating in quantities adequate to meet, 

10 but not in excess of, daily energy needs; 

11 ‘‘(B) choosing foods to promote health and 

12 prevent disease; 

13 ‘‘(C) eating comfortably in social environ14 ments that promote healthy relationships with 

15 family, peers, and community; and 

16 ‘‘(D) eating in a manner to acknowledge 

17 internal signals of hunger and satiety. 

18 ‘‘(6) OBESE.—The term ‘obese’ means an adult 

with a Body Mass Index (BMI) of 30 kg/m2 19 or 

20 greater. 

21 ‘‘(7) OVERWEIGHT.—The term ‘overweight’ 

22 means an adult with a Body Mass Index (BMI) of 

25 to 29.9 kg/m2 23 and a child or adolescent with a 

24 BMI at or above the 95th percentile on the revised 

25 Centers for Disease Control and Prevention growth 


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1 charts or another appropriate childhood definition, 

2 as defined by the Secretary. 

3 ‘‘(8) YOUTH.—The term ‘youth’ means individ4 uals not more than 18 years old. 

5 ‘‘(9) EMOTIONAL WELLNESS.—The term ‘emo6 tional wellness’ means the quality or state of being 

7 in good mental health and maintaining high self-es8 teem, a strong self-image, and healthy relationships. 

9 ‘‘(10) HOLISTIC HEALTH.—The term ‘holistic 

10 health’ means the many components of health, in11 cluding physical, mental, emotional, and social 

12 health. 

13 ‘‘(11) RELATIONAL AGGRESSION.—The term 

14 ‘relational aggression’ means behaviors that harm 

15 youth by damaging, threatening, or manipulating re16 lationships with their peers or by injuring a child’s 

17 feeling of social acceptance. 

18 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section, 

20 $60,000,000 for fiscal year 2010, and such sums as may 

21 be necessary for each of fiscal years 2011 through 2014. 

22 Of the funds appropriated pursuant to this subsection, the 

23 following amounts shall be set aside for activities related 

24 to eating disorders: 

25 ‘‘(1) $5,000,000 for fiscal year 2010. 


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1 ‘‘(2) $5,500,000 for fiscal year 2011. 

2 ‘‘(3) $6,000,000 for fiscal year 2012. 

3 ‘‘(4) $6,500,000 for fiscal year 2013. 

4 ‘‘(5) $1,000,000 for fiscal year 2014.’’. 

5 SEC. 202. NATIONAL CENTER FOR HEALTH STATISTICS. 

6 Section 306 of the Public Health Service Act (42 

7 U.S.C. 242k) is amended— 

8 (1) in subsection (m)(4)(B), by striking ‘‘sub9 section (n)’’ each place it appears and inserting 

10 ‘‘subsection (o)’’; 

11 (2) by redesignating subsection (n) as sub12 section (o); and 

13 (3) by inserting after subsection (m) the fol14 lowing: 

15 ‘‘(n)(1) The Secretary, acting through the Center, 

16 may provide for the— 

17 ‘‘(A) data collection of student fitness levels and 

18 physical activity and nutritional behaviors among a 

19 nationally representative sample of students from 

20 grades 1–12 that can be linked to school-level data 

21 on physical education, physical activity, and school 

22 nutrition policies and programs, and with individual 

23 data on academic performance; 


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1 ‘‘(B) collection and analysis of data for deter2 mining the connection between children and youth’s 

3 physical and emotional health; and 

4 ‘‘(C) analysis of data collected as part of the 

5 National Health and Nutrition Examination Survey 

6 and other data sources. 

7 ‘‘(2) In carrying out paragraph (1), the Secretary, 

8 acting through the Center, may make grants to States, 

9 public entities, and nonprofit entities. 

10 ‘‘(3) The Secretary, acting through the Center, may 

11 provide technical assistance, standards, and methodologies 

12 to grantees supported by this subsection in order to maxi13 mize the data quality and comparability with other stud14 ies.’’. 

15 SEC. 203. HEALTH DISPARITIES REPORT. 

16 Not later than 18 months after the date of enactment 

17 of this Act, and annually thereafter, the Director of the 

18 Agency for Healthcare Research and Quality shall review 

19 all research that results from the activities carried out 

20 under this Act (and the amendments made by this Act) 

21 and determine if particular information may be important 

22 to the report on health disparities required by section 

23 903(c)(3) of the Public Health Service Act (42 U.S.C. 

24 299a–1(c)(3)). 


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1 SEC. 204. PREVENTIVE HEALTH SERVICES BLOCK GRANT. 

2 Section 1904(a)(1) of the Public Health Service Act 

3 (42 U.S.C. 300w–3(a)(1)) is amended by adding at the 

4 end the following: 

5 ‘‘(H) Activities and community education pro6 grams designed to address and prevent overweight, 

7 obesity, and eating disorders through effective pro8 grams to promote healthy eating, and exercise habits 

9 and behaviors, and emotional and social wellness.’’. 

10 SEC. 205. REPORT ON OBESITY AND EATING DISORDERS 

11 RESEARCH. 

12 (a) IN GENERAL.—Not later than 1 year after the 

13 date of enactment of this Act, the Secretary of Health and 

14 Human Services shall submit to the Committee on Health, 

15 Education, Labor, and Pensions of the Senate and the 

16 Committee on Energy and Commerce of the House of 

17 Representatives a report on research conducted on causes 

18 and health implications (including mental health implica19 tions) of being overweight, obesity, and eating disorders. 

20 (b) CONTENT.—The report described in subsection 

21 (a) shall contain— 

22 (1) descriptions on the status of relevant, cur23 rent, ongoing research being conducted in the De24 partment of Health and Human Services including 

25 research at the National Institutes of Health, the 

26 Centers for Disease Control and Prevention, the 


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1 Agency for Healthcare Research and Quality, the 

2 Health Resources and Services Administration, and 

3 other offices and agencies; 

4 (2) information about what these studies have 

5 shown regarding the causes, prevention, and treat6 ment of, being overweight, obesity, and eating dis7 order, as well as the connection between physical 

8 health and emotional health, especially in youths; 

9 (3) recommendations on further research that 

10 is needed, including research among diverse popu11 lations (including diverse women and girls), the plan 

12 of the Department of Health and Human Services 

13 for conducting such research, and how current 

14 knowledge can be disseminated; and 

15 (4) information on the effect media images have 

16 on youth’s body image, emotional health, and eating 

17 and exercise habits. 

18 SEC. 206. REPORT ON A NATIONAL CAMPAIGN TO CHANGE 

19 CHILDREN’S HEALTH BEHAVIORS AND RE20 DUCE OBESITY. 

21 Section 399Y of the Public Health Service Act (42 

22 U.S.C. 280h–2) is amended— 

23 (1) by redesignating subsection (b) as sub24 section (c); and 


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1 (2) by inserting after subsection (a) the fol2 lowing: 

3 ‘‘(b) REPORT.—The Secretary shall evaluate the ef4 fectiveness of the campaign described in subsection (a) in 

5 changing children’s behaviors, identifying the connection 

6 between emotional and physical health, promoting both 

7 emotional and physical health as a way to increase general 

8 health in youth, including preventing and reducing child9 hood obesity and eating disorders, and reducing obesity 

10 and shall report such results to the Committee on Health, 

11 Education, Labor, and Pensions of the Senate and the 

12 Committee on Energy and Commerce of the House of 

13 Representatives.’’. 

Æ 


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