I 

114TH CONGRESS 

1ST SESSION H. R. 2515 

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

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 21, 2015 

Mr. DEUTCH (for himself and Ms. ROS-LEHTINEN) introduced the following 

bill; which was referred to the Committee on Energy and Commerce, and 

in addition to the Committees on Education and the Workforce and Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

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. 


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Sec. 4. Definition. 

Sec. 5. Training and education. 

Sec. 6. Education and training for health professionals. 

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. Report by Federal Trade Commission. 

Sec. 11. 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 their same 

5 age peers without anorexia. It is estimated that at 

6 least one person dies every 62 minutes from an eat7 ing disorder; at least 23 persons each day. 

8 (2) Health consequences such as osteoporosis 

9 (brittle bones), gastrointestinal complications, car10 diac, and dental problems are significant health and 

11 financial burdens throughout life. 

12 (3) At lowest estimate, 14.5 million Americans 

13 suffer from eating disorders. One percent of adoles14 cent boys and two percent of adolescent girls suffer 

15 from eating disorders; eating disorders account for 

16 at least four percent of all childhood hospitalizations. 

17 (4) Eating disorders are treatable biopsycho18 social illnesses. There is a high rate of co-morbidity 

19 with other illnesses such as depression, substance 

20 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 (body 

5 image disturbance). 

6 (6) Anorexia nervosa is associated with serious 

7 health consequences including heart failure, kidney 

8 failure, osteoporosis, and death. People who suffer 

9 anorexia nervosa are 57 times more likely to die of 

10 suicide than their peers. 

11 (7) Current estimates of the lifetime prevalence 

12 of bulimia nervosa are between 0.9 and 1.5 percent 

13 among women and between 0.1 and 0.5 percent 

14 among men. 

15 (8) Bulimia nervosa is associated with serious 

16 health consequences, including cardiac, gastro17 intestinal, and dental problems including irregular 

18 heartbeats, gastric rupture, peptic ulcer, tooth 

19 decay, and death. 

20 (9) Binge eating disorder is characterized by 

21 frequent episodes of uncontrolled overeating. Binge 

22 eating disorder is common: at lowest estimate, 3.5 

23 percent of American women and 2.0 percent of 

24 American men will suffer from this disorder in their 

25 lifetime. 


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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 di5 abetes, and increased risk of arthritic damage to the 

6 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 (OSFED). Be11 tween 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 

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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. DEFINITION. 

7 In this Act, the term ‘‘eating disorder’’ includes ano8 rexia nervosa, bulimia nervosa, binge eating disorder, and 

9 other specified feeding or eating disorder (OSFED), as de10 fined in the fifth edition of ‘‘Diagnostic and Statistical 

11 Manual of Mental Disorders’’ or, if applicable, the most 

12 recent successor edition. 

13 SEC. 5. TRAINING AND EDUCATION. 

14 Subject to section 11, the Secretary of Health and 

15 Human Services, acting through the Director of the Office 

16 on Women’s Health of the Department of Health and 

17 Human Services and in consultation with the Secretary 

18 of Education, shall— 

19 (1) revise and then reinstate the BodyWise 

20 Handbook and related fact sheets and resource lists 

21 available on the public Internet site of the National 

22 Women’s Health Information Center sponsored by 

23 the Office on Women’s Health, to include— 

24 (A) updated findings and conclusions as 

25 needed; and 


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1 (B) thorough information about eating dis2 orders relating to males as well as females; 

3 (2) incorporate, as appropriate, information 

4 from such BodyWise Handbook and related facts 

5 sheets and resource lists into the curriculum of the 

6 BodyWorks obesity prevention program developed by 

7 the Office on Women’s Health and training modules 

8 used in such obesity prevention program; and 

9 (3) promote and make publicly available 

10 (whether through a public Internet site or other 

11 method that does not impose a fee on users) the 

12 BodyWise Handbook and related fact sheets and re13 source lists, as updated under paragraph (1), and 

14 the BodyWorks obesity prevention program, as up15 dated under paragraph (2), including for purposes of 

16 educating universities and nonprofit entities on eat17 ing disorders. 

18 SEC. 6. EDUCATION AND TRAINING FOR HEALTH PROFES19 SIONALS. 

20 (a) IN GENERAL.—Subject to section 11, the Sec21 retary of Health and Human Services, acting through the 

22 Administrator of the Substance Abuse and Mental Health 

23 Services Administration, shall award grants to eligible en24 tities to integrate training into existing curricula for pri25 mary care physicians, other licensed or certified health 


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1 and mental health professionals, and public health profes2 sionals that may include— 

3 (1) early intervention and identification of eat4 ing disorders; 

5 (2) levels of treatment (including family-based 

6 treatment, in-patient, residential, partial hospitaliza7 tion programming, intensive outpatient and out8 patient); 

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

10 (4) steps to aid in the prevention of the devel11 opment of eating disordered behaviors; and 

12 (5) how to treat individuals with eating dis13 orders. 

14 (b) APPLICATION.—An entity that desires a grant 

15 under this section shall submit to the Secretary an appli16 cation at such time, in such manner, and containing such 

17 information as the Secretary may require, including a plan 

18 for the use of funds that may be awarded and an evalua19 tion of the training that will be provided. 

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

21 under this section shall use the funds made available 

22 through such grant to— 

23 (1) use a training program containing evidence24 based findings, promising emerging best practices, 

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1 tion, early intervention, prevention of the develop2 ment of eating disordered behaviors, and treatment 

3 of eating disorders to conduct educational training 

4 and conferences, including Internet-based courses 

5 and teleconferences, on— 

6 (A) how to help prevent the development of 

7 eating disordered behaviors, identify, intervene 

8 early, and appropriately and adequately treat 

9 eating disordered patients; 

10 (B) how to identify individuals with eating 

11 disorders, and those who are at risk for suf12 fering from eating disorders and, therefore, at 

13 risk for related severe medical and mental 

14 health conditions; 

15 (C) how to conduct a comprehensive as16 sessment of individual and familial health risk 

17 factors; and 

18 (D) how to conduct a comprehensive as19 sessment of a treatment plan; and 

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

21 effectiveness of the training provided by such entity 

22 in increasing knowledge and changing attitudes and 

23 behaviors of trainees. 


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1 SEC. 7. EDUCATION AND TRAINING FOR SCHOOL AND 

2 HIGHER EDUCATION PROFESSIONALS. 

3 (a) GRANTS.— 

4 (1) AUTHORIZATION.—Subject to section 11, 

5 the Secretary of Health and Human Services, acting 

6 through the Administrator of the Substance Abuse 

7 and Mental Health Services Administration, shall 

8 award grants to eligible entities— 

9 (A) to conduct educational seminars for 

10 school personnel on eating disorders early iden11 tification, intervention, and prevention of behav12 iors that are often associated with the develop13 ment of eating disordered behaviors; and 

14 (B) to make resources available to individ15 uals affected by eating disorders. 

16 (2) EDUCATIONAL SEMINARS.—As a condition 

17 on the receipt of a grant under this subsection, an 

18 eligible entity shall agree to conduct educational 

19 seminars under paragraph (1)(A), taking into con20 sideration educational materials made available 

21 through the BodyWise eating disorder initiative of 

22 the Department of Health and Human Services and 

23 relevant research on eating disorders. 

24 (3) ELIGIBLE ENTITY.—In this subsection, the 

25 term ‘‘eligible entity’’ means any State, territory, or 

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1 lumbia, any Indian tribe or tribal organization (as 

2 defined in subsections (e) and (l), respectively, of 

3 section 4 of the Indian Self-Determination and Edu4 cation Assistance Act (25 U.S.C. 450b)), or a public 

5 or private educational institution, including an insti6 tution of higher education. 

7 SEC. 8. PUBLIC SERVICE ANNOUNCEMENTS. 

8 (a) IN GENERAL.—Subject to section 11, the Direc9 tor of the National Institute of Mental Health shall con10 duct a program of public service announcements to edu11 cate the public on— 

12 (1) the types of eating disorders; 

13 (2) the seriousness of eating disorders (includ14 ing prevalence, comorbidities, and physical and men15 tal health consequences); 

16 (3) how to identify, intervene, refer for treat17 ment, and help prevent behaviors that often lead to 

18 the development of eating disordered behaviors; 

19 (4) discrimination and bullying based on body 

20 size; 

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

22 image; and 

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


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

2 Institute of Mental Health shall conduct the program 

3 under subsection (a) in collaboration with— 

4 (1) Centers of Excellence; and 

5 (2) community-based national nonprofit re6 sources that support individuals affected by eating 

7 disorders and work to prevent eating disorders and 

8 address body image and weight issues. 

9 SEC. 9. CLARIFYING APPLICATION OF EXISTING PARITY 

10 LAW. 

11 (a) PHSA.—Section 2726 of the Public Health Serv12 ice Act (42 U.S.C. 300gg–26) is amended— 

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

14 the following new subparagraph: 

15 ‘‘(C) TREATMENT OF PERMANENT EXCLU16 SIONS UNDER MENTAL HEALTH AND SUB17 STANCE USE DISORDER BENEFITS.—A group 

18 health plan or health insurance issuer offering 

19 group or individual health insurance coverage to 

20 which subparagraph (A) applies shall be consid21 ered in violation of subparagraph (A)(ii) if the 

22 mental health or substance use disorder benefits 

23 under such plan or coverage provides for a per24 manent exclusion from such benefits for a par25 ticular condition or disorder.’’; and 


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1 (2) by adding at the end the following new sub2 section: 

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

4 this section, mental health and substance use disorder 

5 benefits include residential treatment.’’. 

6 (b) ERISA.—Section 712 of the Employee Retire7 ment Income Security Act of 1974 (29 U.S.C. 1185a) is 

8 amended— 

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

10 the following new subparagraph: 

11 ‘‘(C) TREATMENT OF PERMANENT EXCLU12 SIONS UNDER MENTAL HEALTH AND SUB13 STANCE USE DISORDER BENEFITS.—A group 

14 health plan (or health insurance coverage of15 fered in connection with such a plan) to which 

16 subparagraph (A) applies shall be considered in 

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

18 health or substance use disorder benefits under 

19 such plan (or coverage) provides for a perma20 nent exclusion from such benefits for a par21 ticular condition or disorder.’’; and 

22 (2) by adding at the end the following new sub23 section: 


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

2 this section, mental health and substance use disorder 

3 benefits include residential treatment.’’. 

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

5 of 1986 (26 U.S.C. 9812) is amended— 

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

7 the following new subparagraph: 

8 ‘‘(C) TREATMENT OF PERMANENT EXCLU9 SIONS UNDER MENTAL HEALTH AND SUB10 STANCE USE DISORDER BENEFITS.—A group 

11 health plan to which subparagraph (A) applies 

12 shall be considered in violation of subparagraph 

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

14 disorder benefits under such plan provides for 

15 a permanent exclusion from such benefits for a 

16 particular condition or disorder.’’; and 

17 (2) by adding at the end the following new sub18 section: 

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

20 this section, mental health and substance use disorder 

21 benefits include residential treatment.’’. 

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

23 amendments made by this section shall be construed as 

24 adding or expanding the scope of mental health or addic25 tion services included under section 2726 of the Public 


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

2 the Employee Retirement Income Security Act of 1974 

3 (29 U.S.C. 1185a), or section 9812 of the Internal Rev4 enue Code of 1986 (26 U.S.C. 9812). 

5 SEC. 10. REPORT BY FEDERAL TRADE COMMISSION. 

6 (a) IN GENERAL.—Not later than 18 months after 

7 the date of the enactment of this Act, the Federal Trade 

8 Commission shall submit to Congress a report that con9 tains— 

10 (1) a strategy to reduce the use, in advertising 

11 and other media for the promotion of commercial 

12 products, of images that have been altered to mate13 rially change the physical characteristics of the faces 

14 and bodies of the individuals depicted; and 

15 (2) recommendations for an appropriate, risk16 based regulatory framework with respect to such 

17 use. 

18 (b) INPUT OF EXTERNAL STAKEHOLDERS AND EX19 PERTS.—In preparing the report required under sub20 section (a), the Federal Trade Commission shall solicit 

21 input from external stakeholders and experts on the strat22 egy and recommendations required to be included in such 

23 report. The Commission, in consultation with the Director 

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1 ices Administration, shall ensure that input is obtained 

2 from an appropriate number of stakeholders and experts 

3 and, to the extent practicable, from stakeholders and ex4 perts that are geographically and culturally diverse and 

5 that include stakeholders and experts from the physical 

6 and mental health, business, and consumer advocacy com7 munities. 

8 SEC. 11. PROHIBITION ON NEW APPROPRIATIONS. 

9 No additional funds are authorized to be appro10 priated to carry out this Act or the amendments made 

11 by this Act. This Act and such amendments shall be car12 ried out using amounts otherwise made available for such 

13 purposes. 

Æ 


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