```

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1503 Introduced in Senate (IS)]

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.

    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) According to Centers for Disease Control and 
        Prevention, children who are obese are at greater risk for 
        psychological problems such as stigmatization and poor self-
        esteem. Obese children and adolescents are targets of early and 
        systematic social discrimination. The psychological stress of 
        social stigmatization can cause low self-esteem which, in turn, 
        can hinder academic and social functioning, and persist into 
        adulthood.
            (5) The Ophelia Project reports that approximately 30 
        percent of youth in the United States are estimated to be 
        actively involved in bullying, either as a bully, target, or 
        both. ABC News reports that 58 percent of children admit that 
        someone has said mean or hurtful things to them online. The 
        emotional safety of children who are overweight or obese is 
        threatened since they are often the targets of bullying and 
        relational aggression, which can have serious effects on their 
        physical and emotional health.
            (6) 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.
            (7) According to the Centers for Disease Control and 
        Prevention, low income and minority girls have the highest 
        rates of childhood obesity. Hispanic, African-American, and 
        Native American children are disproportionately affected by 
        obesity, with the highest prevalence found among African-
        American and Hispanic girls (``The New Normal?: What Girls Say 
        about Healthy Living'' 2006).
            (8) 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.
            (9) 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 sixth leading cause of death), and 
        musculoskeletal disorders.
            (10) 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.
            (11) The Centers for Disease Control and Prevention reports 
        that children spend a considerable amount of time with media. 
        One study found that time spent watching TV, videos, DVDs, and 
        movies averaged slightly over 3 hours per day among children 
        aged 8-18 years. Several studies have found a positive 
        association between the time spent viewing television and 
        increased prevalence of obesity in children. This time with the 
        media can damage girls' physical and emotional health. The 
        Geena Davis Institute on Gender in the Media reports that in 
        many forms of media, girls and women are often depicted as 
        sexualized objects, which can damage girls' body images.
            (12) 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.
            (13) 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.
            (14) The 2005 Surgeon General's report ``The Year of the 
        Healthy Child'' lists the treatment and prevention of obesity 
        as a national priority.
            (15) 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 . . .''.
            (16) 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.
            (17) 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.
            (18) 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.
            (19) Effective interventions for promoting healthy eating 
        behaviors should promote healthy lifestyle and not 
        inadvertently promote unhealthy weight management techniques.
            (20) The National Institutes of Health reports that eating 
        disorders are commonly associated with substantial 
        psychological problems, including depression, substance abuse, 
        and suicide.
            (21) 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.
            (22) The health risks of Binge Eating Disorder are those 
        associated with obesity and include heart disease, gall bladder 
        disease, and diabetes.
            (23) 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.
            (24) 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.
            (25) 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.
            (26) On the 2007 Youth Risk Behavior Survey, 4.3 percent of 
        high school students reported recent use of laxatives or 
        vomiting to control their weight.
            (27) The Girl Scout Research Institute found that most 
        girls have a holistic view of health and believe physical and 
        emotional health are of equal importance. This connection is 
        reflected in their behavior and attitudes toward diet and 
        exercise. Diet and exercise patterns are linked to emotional 
        health, self-esteem, and body image, which all play a critical 
        role in how girls define health (``The New Normal?: What Girls 
        Say about Healthy Living'' 2006).
            (28) A strict focus on physical health does not resonate 
        emotionally with girls. Any reframing or redefining of health 
        needs, including nutrition and physical activity, needs to 
        focus on the positive emotional outcomes that are likely to 
        result from healthy behavior (other than maintaining normal 
        weight and eating nourishing foods). For girls, being healthy 
        means not only eating right and looking good, but also feeling 
        good about oneself and having a good relationship with one's 
        peers (``The New Normal?: What Girls Say about Healthy Living'' 
        2006).
            (29) The Girl Scout Research Institute reports that 
        emotional safety is a top concern for girls. Relational 
        aggression, or emotional bullying, threatens girls' emotional 
        and physical safety. Efforts to improve girls' health should 
        include the prevention of relational aggression, since most 
        girls define safety in terms of relationships and healthy 
        relationships are crucial to girls' physical and emotional 
        health (``Feeling Safe: What Girls Say'' 2003 and ``The New 
        Normal?: What Girls Say about Healthy Living'' 2006).
            (30) Girls' body images affect their emotional and physical 
        health, such as self-esteem and eating and exercise habits. 
        External factors such as family, celebrities, and the media 
        also have an effect on girls' perception of their bodies. 
        Therefore, promoting healthy media images of girls and woman 
        can help improve their physical and emotional health (``The New 
        Normal?: What Girls Say about Healthy Living'' 2006).
            (31) According to the Girl Scout Research Institute, 
        parents--especially mothers in the case of girls--are important 
        influences and role models. Efforts to inspire and motive girls 
        to make healthier choices must focus on helping parents support 
        their children and teach parents that their choices model 
        behaviors for how to live a healthy life (``The New Normal?: 
        What Girls Say about Healthy Living'' 2006).
            (32) There is a tension between health awareness and 
        behavior among children and youth. Although girls demonstrate 
        basic knowledge about healthy foods and eating behaviors, they 
        are not putting this knowledge into practice and it is normal 
        for many girls to make poor choices with respect to diet and 
        exercise. Teaching healthy nutrition and exercise habits should 
        make healthy living seem reasonable, socially acceptable, 
        applicable and attainable (``The New Normal?: What Girls Say 
        about Healthy Living'' 2006).
            (33) According to the American Academy of Pediatrics, the 
        current epidemic of inactivity and the associated epidemic of 
        obesity are being driven by multiple factors (societal, 
        technologic, industrial, commercial, financial) and must be 
        addressed likewise on several fronts. Success is more likely to 
        be achieved by the implementation of sustainable, economically 
        viable, culturally acceptable active-living policies that can 
        be integrated into multiple sectors of society (``Pediatrics'' 
        Vol. 117 No. 5 May 2006, pp. 1834-1842 (doi:10.1542/peds.2006-
        0472) (``Active Healthy Living: Prevention of Childhood Obesity 
        Through Increased Physical Activity'')).
            (34) According to the 2006 School Health Policies and 
        Programs Study, conducted by the Centers for Disease Control 
        and Prevention, only 3.8 percent of elementary schools, 7.9 
        percent of middle schools, and 2.1 percent of high schools 
        provided daily physical education or its equivalent for the 
        entire school year for students in all grades. Overall, about 
        22 percent of schools did not require students to take any 
        physical education.
            (35) Additionally, the 2006 School Health Policies and 
        Programs Study revealed that 64.4 percent of schools with 
        primary responsibility for food preparation reported they did 
        not reduce the amount of fats and oils used in recipes or use 
        low-fat recipes when preparing school meals. Nationwide, 21.1 
        percent of elementary schools, 62.4 percent of middle schools, 
        and 85.8 percent of high schools had one or more vending 
        machines from which students could purchase food or beverages.
            (36) The Institute of Medicine reports that taking action 
        against childhood obesity must address the factors that 
        influence both eating and physical activity. According to the 
        Institute of Medicine, ``[a]lthough a number of organizations, 
        industries, institutions, and agencies must be involved in 
        designing and implementing changes, efforts cannot succeed 
        unless they also engage the families, schools, and communities 
        that create the environments in which children live and their 
        behaviors are formed''.

                        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 
        ``2010'';
            (2) by redesignating subsection (b) as subsection (c);
            (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, 
        properly refer or 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) holistic health: the connection 
                        between emotional and physical health;
                            ``(iv) 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;
                            ``(v) 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
                            ``(vi) 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.''; and
            (4) in subsection (c) (as so redesignated)--
                    (A) by striking ``There are authorized to be 
                appropriated to carry out this section'' and all that 
                follows and inserting the following: ``There are 
                authorized to be appropriated--
            ``(1) to carry out subsection (a),''; and
                    (B) by adding at the end the following:
            ``(2) to carry out subsection (b), $10,000,000 for fiscal 
        year 2010, and such sums as may be necessary for each of fiscal 
        years 2011 through 2014.''.

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

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

    ``(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, 
        physical activity, emotional wellness, and healthy living, and 
        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 living, emotional wellness, 
        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 and 
        community-based organizations, 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;
                    ``(G) State and local departments of transportation 
                and city planning; and
                    ``(H) community-based organizations serving youth; 
                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 show a history of 
addressing these issues, have program evaluations that show success, 
and 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);
            ``(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 youth serving organization;
            ``(14) a community-based organization;
            ``(15) a local city planning agency;
            ``(16) a State or local parks and recreation department; or
            ``(17) 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, community-based organizations, and other 
                entities to increase physical activity levels and 
                promote holistic health including promote healthy 
                eating behaviors and the prevention of relational 
                aggression in schools and while traveling to and from 
                schools;
                    ``(C) forming partnerships with entities, including 
                schools, faith-based entities, community-based 
                organizations, and other organizations providing 
                recreational services, to establish programs that use 
                their facilities or other resources for after-school, 
                weekend, and summer community activities, especially 
                those that promote emotional and social wellness or 
                involve physical activity;
                    ``(D) establishing incentives for retail food 
                stores, farmer's markets, food co-ops, grocery stores, 
                and other retail food outlets that offer fresh fruits 
                and vegetables and other 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 and after-
                school entities to establish programs that promote 
                healthy eating behaviors and physical activity and that 
                address health holistically, including building strong 
                and healthy relationships;
                    ``(G) developing and evaluating community 
                educational activities targeting healthy relationships, 
                good nutrition, and promoting healthy eating behaviors 
                to bridge the gap between children's behavior and their 
                awareness and knowledge of healthy eating and exercise 
                habits;
                    ``(H) providing, directly or in cooperation with 
                State and local parks and recreation departments, 
                programs and other opportunities for daily physical 
                activity;
                    ``(I) identifying and combating issues such as 
                bullying and relational aggression, that cause 
                overeating, physical inactivity, eating disorders, and 
                other unhealthy behaviors;
                    ``(J) forming partnerships with parents and 
                caregivers to form programs that educate adults about 
                healthy living and how to teach their children self-
                esteem and healthy eating and exercise habits; and
                    ``(K) creating educational and media literacy 
                programs to inform the public, businesses, community-
                based organizations, and other entities about unhealthy 
                media images and their effect on girls' body image and 
                eating habits;
            ``(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 forming healthy 
                        lifestyles; 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, media literacy, 
                        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 and adult volunteers for 
                community based organizations regarding--
                            ``(i) a healthy lifestyle and a healthy 
                        school environment;
                            ``(ii) healthy relationships and emotional 
                        wellness through the prevention of relational 
                        aggression;
                            ``(iii) integrating eating disorder 
                        prevention and awareness in physical education, 
                        health, and after-school curriculum to the 
                        maximum extent possible; and
                            ``(iv) establishing policies on relational 
                        aggression;
                    ``(C) planning and implementing a healthy lifestyle 
                curriculum or program with an emphasis on healthy 
                eating behaviors, physical activity, and emotional 
                wellness, including the role of healthy relationships 
                and prevention of bullying, such as relational 
                aggression and cyberbullying; and
                    ``(D) planning and implementing healthy lifestyle 
                classes or programs for parents or guardians, with an 
                emphasis on healthy eating behaviors, physical 
                activity, emotional wellness, and the connection 
                between emotional and physical health;
            ``(3) carry out activities through the local health care 
        delivery systems including--
                    ``(A) promoting healthy eating behaviors and 
                physical activity services and emotional wellness to 
                treat or prevent eating disorders, being overweight, 
                and obesity;
                    ``(B) providing patient education and counseling to 
                increase physical activity, promote healthy eating 
                behaviors, and improve emotional wellness; and
                    ``(C) providing community education on good 
                nutrition, physical activity, and emotional wellness to 
                develop a better understanding of the relationship 
                between diet, physical activity, and emotional wellness 
                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, training, curriculum, or 
a preexisting evaluation framework.
    ``(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, 
physical activity, and emotional wellness.
    ``(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, physical activity, and emotional wellness 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, binge eating disorder, and eating disorders not 
        otherwise specified.
            ``(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/m\2\ or greater.
            ``(7) Overweight.--The term `overweight' means an adult 
        with a Body Mass Index (BMI) of 25 to 29.9 kg/m\2\ 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.
            ``(9) Emotional wellness.--The term `emotional wellness' 
        means the quality or state of being in good mental health and 
        maintaining high self-esteem, a strong self-image, and healthy 
        relationships.
            ``(10) Holistic health.--The term `holistic health' means 
        the many components of health, including physical, mental, 
        emotional, and social health.
            ``(11) Relational aggression.--The term `relational 
        aggression' means behaviors that harm youth by damaging, 
        threatening, or manipulating relationships with their peers or 
        by injuring a child's feeling of social acceptance.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $60,000,000 for fiscal year 
2010, and such sums as may be necessary for each of fiscal years 2011 
through 2014. 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 2010.
            ``(2) $5,500,000 for fiscal year 2011.
            ``(3) $6,000,000 for fiscal year 2012.
            ``(4) $6,500,000 for fiscal year 2013.
            ``(5) $1,000,000 for fiscal year 2014.''.

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) data collection of student fitness levels and 
        physical activity and nutritional behaviors among a nationally 
        representative sample of students from grades 1-12 that can be 
        linked to school-level data on physical education, physical 
        activity, and school nutrition policies and programs, and with 
        individual data on academic performance;
            ``(B) collection and analysis of data for determining the 
        connection between children and youth's physical and emotional 
        health; and
            ``(C) 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, and emotional and social 
        wellness.''.

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 disorder, as well as the 
        connection between physical health and emotional health, 
        especially in youths;
            (3) recommendations on further research that is needed, 
        including research among diverse populations (including diverse 
        women and girls), the plan of the Department of Health and 
        Human Services for conducting such research, and how current 
        knowledge can be disseminated; and
            (4) information on the effect media images have on youth's 
        body image, emotional health, and eating and exercise habits.

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, identifying the connection between emotional and physical 
health, promoting both emotional and physical health as a way to 
increase general health in youth, including preventing and reducing 
childhood obesity and eating disorders, 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.''.
                                 <all>
```