II 

114TH CONGRESS 

1ST SESSION S. 1865 

To amend the Public Health Service Act with respect to eating disorders, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 27, 2015 

Ms. KLOBUCHAR (for herself, Ms. AYOTTE, Mrs. CAPITO, and Ms. BALDWIN) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act with respect to 

eating disorders, 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 ‘‘Anna Westin Act of 

5 2015’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

Sec. 4. Definition. 

Sec. 5. Training and education. 

Sec. 6. Education and training for health professionals. 


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Sec. 7. Education and training for school and higher education professionals. 

Sec. 8. Public service announcements. 

Sec. 9. Clarifying application of existing parity law. 

Sec. 10. Prohibition on new appropriations. 

1 SEC. 3. FINDINGS. 

2 The Congress finds the following: 

3 (1) Risk of death among individuals with ano4 rexia nervosa is 18 times greater than among indi5 viduals of the same age without anorexia. It is esti6 mated that at least one person dies every 62 minutes 

7 from an eating disorder: at least 23 persons each 

8 day. 

9 (2) Health consequences such as osteoporosis 

10 (brittle bones), gastrointestinal complications, car11 diac, and dental problems are significant health and 

12 financial burdens throughout life. 

13 (3) At lowest estimate, 14,500,000 people in 

14 the United States suffer from eating disorders. One 

15 percent of adolescent boys and 2 percent of adoles16 cent girls suffer from eating disorders. Eating dis17 orders account for at least 4 percent of all childhood 

18 hospitalizations. 

19 (4) Eating disorders are treatable biopsycho20 social illnesses. There is a high rate of comorbidity 

21 with other illnesses such as depression, substance 

22 abuse, or anxiety disorders. 


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1 (5) Anorexia nervosa is an eating disorder char2 acterized by self-starvation, weight loss, fear of gain3 ing weight, and disturbances in the way in which 

4 one’s body weight or shape is experienced. 

5 (6) Anorexia nervosa is associated with serious 

6 health consequences including heart failure, kidney 

7 failure, osteoporosis, and death. People who suffer 

8 anorexia nervosa are 57 times more likely to die of 

9 suicide than their peers. 

10 (7) Current estimates of the lifetime prevalence 

11 of bulimia nervosa are between 0.9 and 1.5 percent 

12 among women and between 0.1 and 0.5 percent 

13 among men. 

14 (8) Bulimia nervosa is associated with serious 

15 health consequences, including cardiac, gastro16 intestinal, and dental problems including irregular 

17 heartbeats, gastric rupture, peptic ulcer, tooth 

18 decay, and death. 

19 (9) Binge eating disorder is characterized by 

20 frequent episodes of uncontrolled overeating. Binge 

21 eating disorder is common: at lowest estimate, 3.5 

22 percent of women in the United States and 2.0 per23 cent of men in the United States will suffer from 

24 this disorder in their lifetimes. 


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1 (10) Binge eating is often associated with obe2 sity, high blood pressure, elevated cholesterol levels, 

3 elevated triglyceride levels, increased risk of bowel, 

4 breast, and reproductive cancers, increased risk of 

5 diabetes, and increased risk of arthritic damage to 

6 the joints. 

7 (11) Many suffer from some, but not all, of the 

8 symptoms of anorexia nervosa, bulimia nervosa, or 

9 binge eating disorder, which is referred to as other 

10 specified feeding or eating disorder or ‘‘OSFED’’. 

11 Between 4 percent and 20 percent of young women 

12 practice unhealthy patterns of dieting, purging, and 

13 binge eating. 

14 (12) Eating disorders are more common in 

15 women, but they do occur in men. Rates of binge 

16 eating disorder are similar in females and males. 

17 (13) Academic evidence has demonstrated a 

18 connection between the use of very thin models in 

19 advertising and consumer attitudes toward a brand 

20 based on such advertising, as well as a material in21 fluence of the use of such models on consumer pur22 chase intent, conduct, and reliance. 

23 (14) Eating disorders appear across all age 

24 groups, races, ethnicities, and socioeconomic groups 

25 in the United States and are associated with subVerDate Sep 11 2014 06:43 Jul 28, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1865.IS S1865

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1 stantial psychological problems, including depression, 

2 substance abuse, and suicide. For children 12 years 

3 of age and younger, hospitalizations for eating dis4 orders increased by 119 percent between 1999 and 

5 2006. 

6 SEC. 4. DEFINITIONS. 

7 In this Act— 

8 (1) the term ‘‘eating disorder’’ includes ano9 rexia nervosa, bulimia nervosa, binge eating dis10 order, and other specified feeding or eating dis11 orders, as defined in the fifth edition of ‘‘Diagnostic 

12 and Statistical Manual of Mental Disorders’’, pub13 lished by the American Psychiatric Association or, if 

14 applicable, the most recent successor edition; and 

15 (2) the term ‘‘Secretary’’ means the Secretary 

16 of Health and Human Services. 

17 SEC. 5. TRAINING AND EDUCATION. 

18 Subject to section 10, the Secretary, acting through 

19 the Director of the Office on Women’s Health of the De20 partment of Health and Human Services and in consulta21 tion with the Secretary of Education, shall— 

22 (1) revise and then reinstate the BodyWise 

23 Handbook of the Department of Education and re24 lated fact sheets and resource lists available on the 

25 public Internet Website of the National Women’s 


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1 Health Information Center sponsored by the Office 

2 on Women’s Health, to include— 

3 (A) updated findings and conclusions as 

4 needed; and 

5 (B) thorough information about eating dis6 orders relating to males and females; 

7 (2) incorporate, as appropriate, information 

8 from such BodyWise Handbook and related fact 

9 sheets and resource lists into the curriculum of the 

10 BodyWorks obesity prevention program developed by 

11 the Office on Women’s Health, and training modules 

12 used in such obesity prevention program; and 

13 (3) promote and make publicly available 

14 (through a public Internet Website or other method 

15 that does not impose a fee on users) the BodyWise 

16 Handbook and related fact sheets and resource lists, 

17 as updated under paragraph (1), and the 

18 BodyWorks obesity prevention program, as updated 

19 under paragraph (2), including for purposes of edu20 cating universities and nonprofit entities on eating 

21 disorders. 

22 SEC. 6. EDUCATION AND TRAINING FOR HEALTH PROFES23 SIONALS. 

24 (a) IN GENERAL.—Subject to section 10, the Sec25 retary, acting through the Administrator of the Substance 


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1 Abuse and Mental Health Services Administration, shall 

2 award grants to eligible entities to integrate training into 

3 existing curricula for primary care physicians, other li4 censed or certified health and mental health professionals, 

5 and public health professionals that may include— 

6 (1) early intervention and identification of eat7 ing disorders; 

8 (2) levels of treatment (including family-based, 

9 in-patient, residential, partial hospitalization pro10 gramming, and intensive outpatient and outpatient 

11 treatment); 

12 (3) how to properly refer patients to treatment; 

13 (4) steps to aid in the prevention of the devel14 opment of eating disordered behaviors; and 

15 (5) how to treat individuals with eating dis16 orders. 

17 (b) APPLICATION.—An entity desiring a grant under 

18 this section shall submit to the Secretary an application 

19 at such time, in such manner, and containing such infor20 mation as the Secretary may require, including a plan for 

21 the use of funds that may be awarded and an evaluation 

22 of the training that will be provided. 

23 (c) USE OF FUNDS.—An entity that receives a grant 

24 under this section shall use the funds made available 

25 through such grant to— 


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1 (1) develop a training program containing evi2 dence-based findings, promising emerging best prac3 tices, or recommendations that pertain to the identi4 fication of, early intervention in, prevention of the 

5 development of, and treatment of, eating disorders 

6 to conduct educational training and conferences, 

7 which may include Internet-based courses and tele8 conferences, on— 

9 (A) how to help prevent the development of 

10 eating disordered behaviors, identify, intervene 

11 early, and appropriately and adequately treat 

12 eating disordered patients; 

13 (B) how to identify individuals with eating 

14 disorders, and those who are at risk for suf15 fering from eating disorders and, therefore, at 

16 risk for related severe medical and mental 

17 health conditions; 

18 (C) how to conduct a comprehensive as19 sessment of individual and familial health risk 

20 factors; and 

21 (D) how to conduct a comprehensive as22 sessment of a treatment plan; and 

23 (2) evaluate and report to the Secretary on the 

24 effectiveness of the training provided by such entity 


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1 in increasing knowledge and changing attitudes and 

2 behaviors of trainees. 

3 SEC. 7. EDUCATION AND TRAINING FOR SCHOOL AND 

4 HIGHER EDUCATION PROFESSIONALS. 

5 (a) GRANTS.—Subject to section 10, the Secretary, 

6 acting through the Administrator of the Substance Abuse 

7 and Mental Health Services Administration, shall award 

8 grants to eligible entities— 

9 (1) to conduct educational seminars for school 

10 personnel on early identification of, intervention in, 

11 and prevention of, behaviors that are often associ12 ated with the development of eating disordered be13 haviors; and 

14 (2) to make resources available to individuals 

15 affected by eating disorders. 

16 (b) EDUCATIONAL SEMINARS.—As a condition on the 

17 receipt of a grant under this subsection, an eligible entity 

18 shall agree to conduct educational seminars under sub19 section (a)(1), taking into consideration educational mate20 rials made available through the BodyWise eating disorder 

21 initiative of the Department of Health and Human Serv22 ices and relevant research on eating disorders. 

23 (c) ELIGIBLE ENTITY.—In this section, the term ‘‘el24 igible entity’’ means any State, territory, or possession of 

25 the United States, the District of Columbia, any Indian 


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1 tribe or tribal organization (as defined in subsections (e) 

2 and (l), respectively, of section 4 of the Indian Self-Deter3 mination and Education Assistance Act (25 U.S.C. 

4 450b)), or a public or private educational institution, in5 cluding an institution of higher education. 

6 SEC. 8. PUBLIC SERVICE ANNOUNCEMENTS. 

7 (a) IN GENERAL.—Subject to section 10, the Direc8 tor of the National Institute of Mental Health shall con9 duct a program of public service announcements to edu10 cate the public on— 

11 (1) the types of eating disorders; 

12 (2) the seriousness of eating disorders (includ13 ing prevalence, comorbidities, and physical and men14 tal health consequences); 

15 (3) how to identify, intervene, refer for treat16 ment, and prevent behaviors that often lead to the 

17 development of eating disordered behaviors; 

18 (4) discrimination and bullying based on body 

19 size; 

20 (5) the effects of media on self-esteem and body 

21 image; and 

22 (6) the signs and symptoms of eating disorders. 

23 (b) COLLABORATION.—The Director of the National 

24 Institute of Mental Health shall conduct the program 

25 under subsection (a) in collaboration with— 


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1 (1) centers of excellence; and 

2 (2) community-based national nonprofit re3 sources that support individuals affected by eating 

4 disorders and work to prevent eating disorders and 

5 address body image and weight issues. 

6 SEC. 9. CLARIFYING APPLICATION OF EXISTING PARITY 

7 LAW. 

8 (a) PHSA.—Section 2726 of the Public Health Serv9 ice Act (42 U.S.C. 300gg–26) is amended— 

10 (1) in subsection (a)(3), by adding at the end 

11 the following new subparagraph: 

12 ‘‘(C) TREATMENT OF PERMANENT EXCLU13 SIONS UNDER MENTAL HEALTH AND SUB14 STANCE USE DISORDER BENEFITS.—A group 

15 health plan or health insurance issuer offering 

16 group or individual health insurance coverage to 

17 which subparagraph (A) applies shall be consid18 ered in violation of subparagraph (A)(ii) if the 

19 mental health or substance use disorder benefits 

20 under such plan or coverage provides for a per21 manent exclusion from such benefits for a par22 ticular condition or disorder.’’; and 

23 (2) by adding at the end the following new sub24 section: 


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1 ‘‘(f) RESIDENTIAL TREATMENT.—For purposes of 

2 this section, mental health and substance use disorder 

3 benefits include residential treatment.’’. 

4 (b) ERISA.—Section 712 of the Employee Retire5 ment Income Security Act of 1974 (29 U.S.C. 1185a) is 

6 amended— 

7 (1) in subsection (a)(3), by adding at the end 

8 the following new subparagraph: 

9 ‘‘(C) TREATMENT OF PERMANENT EXCLU10 SIONS UNDER MENTAL HEALTH AND SUB11 STANCE USE DISORDER BENEFITS.—A group 

12 health plan (or health insurance coverage of13 fered in connection with such a plan) to which 

14 subparagraph (A) applies shall be considered in 

15 violation of subparagraph (A)(ii) if the mental 

16 health or substance use disorder benefits under 

17 such plan (or coverage) provides for a perma18 nent exclusion from such benefits for a par19 ticular condition or disorder.’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘(h) RESIDENTIAL TREATMENT.—For purposes of 

23 this section, mental health and substance use disorder 

24 benefits include residential treatment.’’. 


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1 (c) IRC.—Section 9812 of the Internal Revenue Code 

2 of 1986 is amended— 

3 (1) in subsection (a)(3), by adding at the end 

4 the following new subparagraph: 

5 ‘‘(C) TREATMENT OF PERMANENT EXCLU6 SIONS UNDER MENTAL HEALTH AND SUB7 STANCE USE DISORDER BENEFITS.—A group 

8 health plan to which subparagraph (A) applies 

9 shall be considered in violation of subparagraph 

10 (A)(ii) if the mental health or substance use 

11 disorder benefits under such plan provides for 

12 a permanent exclusion from such benefits for a 

13 particular condition or disorder.’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(f) RESIDENTIAL TREATMENT.—For purposes of 

17 this section, mental health and substance use disorder 

18 benefits include residential treatment.’’. 

19 (d) LIMITATION.—Nothing in this section or the 

20 amendments made by this section shall be construed as 

21 adding or expanding the scope of mental health or addic22 tion services included under section 2726 of the Public 

23 Health Service Act (42 U.S.C. 300gg–26), section 712 of 

24 the Employee Retirement Income Security Act of 1974 


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1 (29 U.S.C. 1185a), or section 9812 of the Internal Rev2 enue Code of 1986. 

3 SEC. 10. PROHIBITION ON NEW APPROPRIATIONS. 

4 No additional funds are authorized to be appro5 priated to carry out this Act or the amendments made 

6 by this Act. This Act and such amendments shall be car7 ried out using amounts otherwise made available for such 

8 purposes. 

Æ 


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