II 

108TH CONGRESS 

2D SESSION S. 2399

To provide for the improvement of physical activity and nutrition and the 

prevention of obesity for all Americans. 

IN THE SENATE OF THE UNITED STATES 

MAY 10, 2004

Mr. FITZGERALD (for himself and Mr. KENNEDY) introduced the following 

bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To provide for the improvement of physical activity and 

nutrition and the prevention of obesity for all Americans.

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 ‘‘Healthy Lifestyles Act 

5 of 2004’’. 

6 SEC. 2. ACTIVITIES RELATING PHYSICAL ACTIVITY. 

7 Part P of title III of the Public Health Service Act 

8 (42 U.S.C. 280g et seq.) is amended by adding at the end 

9 the following: 
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1 ‘‘SEC. 399O. INCREASING PHYSICAL ACTIVITY. 

2 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

3 with the Director of the Centers for Disease Control and 

4 Prevention, the Secretary of Education, the Secretary of 

5 Labor, and the Director of the Federal Highway Adminis6 tration, shall establish and implement activities for the 

7 purpose of increasing physical activity in schools, work8 sites, and communities. 

9 ‘‘(b) SCHOOLS.—The Director of the Centers for Dis10 ease Control and Prevention, in collaboration with the Sec11 retary of Education shall award grants to public elemen12 tary and secondary schools for programs that support—

13 ‘‘(1) the provision of daily physical education 

14 for students in kindergarten through grade 12 

15 through programs that are consistent with the 

16 Guidelines for Physical Activity as reported by Cen17 ters for Disease Control and Prevention and the 

18 American College of Sports Medicine and National 

19 Physical Education Standards; 

20 ‘‘(2) the implementation of comprehensive 

21 school curricula and school-based physical activity 

22 programs that provide education about lifelong phys23 ical activity; 

24 ‘‘(3) training for school personnel that provides 

25 the knowledge and skills needed to effectively teach 

26 lifelong physical activity; and 
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1 ‘‘(4) evaluations of school physical education 

2 programs and facilities at annual intervals to deter3 mine the extent to which national guidelines de4 scribed in paragraph (1) are met. 

5 ‘‘(c) WORKSITES.—The Director of the Centers for 

6 Disease Control and Prevention and the Secretary of 

7 Labor, shall award grants to eligible entities as deter8 mined by the Director, which may include labor organiza9 tions, trade associations, trade groups, and businesses for 

10 the establishment of projects that include—

11 ‘‘(1) the development of activity friendly work12 sites (which may include the provision of facilities 

13 for physical activity, accessible and attractive stair14 wells, walking trails, and supportive management 

15 practices) that encourage employee participation in 

16 physical activity; 

17 ‘‘(2) the development of worksite wellness pro18 grams that improve physical activity by increasing 

19 the knowledge, attitudes, skills, and behaviors of em20 ployees; and 

21 ‘‘(3) the development of employee incentive pro22 grams (such as cafeteria discounts, health club 

23 memberships, small cash bonuses, and time off) to 

24 increase the participation of employees in worksite 
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1 health promotion programs that increase physical 

2 activity. 

3 ‘‘(d) COMMUNITIES.—The Director of the Centers for 

4 Disease Control and Prevention, the Secretary of Trans5 portation, and Secretary of the Interior shall award grants 

6 for the implementation and evaluation of activities that 

7 may include—

8 ‘‘(1) projects to design pedestrian zones and 

9 construct safe walkways and cycling paths; 

10 ‘‘(2) projects that create greenways and open11 space areas linking parks, nature preserves, and cul12 tural or historic sites with each other and with popu13 lated areas such as residential communities and 

14 business locations; 

15 ‘‘(3) initiatives to increase the use of walking 

16 and bicycling as a transportation mode by creating 

17 or enhancing informational outreach to parks or 

18 community recreation centers; and 

19 ‘‘(4) community-wide campaigns designed to in20 crease physical activity as part of multicomponent 

21 efforts that include strategies such as support of self 

22 help groups, physical activity counseling, risk factor 

23 screening and education, and environmental or pol24 icy changes such as the creation of walking trails. 
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1 ‘‘(e) EVALUATION.—Not later than 2 years after the 

2 date on which a grant is awarded under this section, the 

3 grantee shall submit to the Director of the Centers for 

4 Disease Control and Prevention a report that describes the 

5 activities carried out with funds received under the grant 

6 and the effectiveness of such activities in increasing phys7 ical activity. 

8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section, 

10 such sums as may be necessary for each of fiscal years 

11 2005 through 2009.’’. 

12 SEC. 3. IMPROVING NUTRITIONAL INTAKE. 

13 Section 301 of the The National Nutrition Moni14 toring and Related Research Act of 1990 (7 U.S.C. 5341) 

15 is amended to read as follows: 

16 ‘‘SEC. 301. DIETARY GUIDELINES. 

17 ‘‘(a) IN GENERAL.—Not later than 3 months after 

18 the date of enactment of the Healthy Lifestyles Act of 

19 2004, and at least every 5 years thereafter, the Secretary 

20 of Health and Human Services shall enter into a contract 

21 with the Institute of Medicine for the development and 

22 publication of a report containing the ‘Dietary Guidelines 

23 for Americans’. 

24 ‘‘(b) GUIDELINES.—Each report under subsection (a) 

25 shall—
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1 ‘‘(1) be complete within 1 year of the date on 

2 which the contract was entered into under such sub3 section for such report; and 

4 ‘‘(2) contain—

5 ‘‘(A) an evaluation of scientific and med6 ical knowledge relating to healthy diets and nu7 trition; 

8 ‘‘(B) dietary guidelines for Americans, 

9 with specifications for different ages and other 

10 segments of the population as determined ap11 propriate by the Institute of Medicine. 

12 ‘‘(c) SUBMISSION.—The Institute of Medicine shall 

13 submit a final report under each contract under subsection 

14 (a) to the Secretary of Health and Human Services, ap15 propriate committees of Congress, and the general public. 

16 ‘‘(d) USE.—The Secretary of Health and Human 

17 Services shall ensure that dietary guidelines established 

18 under this section serve as the basis of any food, nutrition 

19 or health program conducted or operated by each Federal 

20 health agency. 

21 ‘‘(e) FOOD GUIDE PYRAMID.—In accordance with the 

22 dietary guidelines published in the report under subsection 

23 (b), the Secretary shall publish revisions to the guide com24 monly known as the ‘food guide pyramid’ or any successor 

25 to such guide.’’. 
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1 SEC. 4. IMPROVING THE USE OF DIETARY INFORMATION 

2 AND GUIDELINES. 

3 (a) IN GENERAL.—The Secretary of Health and 

4 Human Services shall enter into a contract with the Insti5 tute of Medicine for the conduct of a study and the mak6 ing of recommendations concerning the implementation 

7 and dissemination of dietary information and nutrition 

8 guidelines. 

9 (b) CONTENT.—The recommendations made under 

10 subsection (a) shall address the following: 

11 (1) The implementation of nutrition guidelines 

12 and dietary information in Federal programs. 

13 (2) The dissemination of nutrition guidelines 

14 and dietary information to the public. 

15 (3) The coordination, collaboration, and inte16 gration of nutrition activities within and across the 

17 Federal agencies and programs. 

18 (4) A means for ensuring scientific integrity in 

19 the implementation and dissemination of dietary in20 formation and nutrition guidelines. 

21 (5) A means for evaluating the impact of nutri22 tion guidelines and dietary information. 

23 (6) Other issues determined appropriate by the 

24 Institute of Medicine. 

25 (c) SUBMISSION.—Not later than 1 year after the 

26 date of enactment of this Act, the Institute of Medicine 
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1 shall submit to the Secretary of Health and Human Serv2 ices, the appropriate committees of Congress, and the pub3 lic, a report that contains the findings of the study and 

4 recommendations under subsection (a). 

5 (d) IMPLEMENTATION.—

6 (1) IN GENERAL.—Not later than 1 year after 

7 the submission of the report under subsection (c), 

8 the Secretary of Health and Human Services, in col9 laboration with the Secretary of Agriculture, shall 

10 prepare and publish a plan relating to the strategy 

11 of the Secretary to implement the recommendations 

12 made pursuant to subsection (a). 

13 (2) PUBLIC COMMENT.—The Secretary of 

14 Health and Human Services shall request public re15 view and comment during the development of the 

16 plan under paragraph (1). The final plan shall de17 scribe the comments received and how comments 

18 were incorporated into the plan. 

19 (3) IMPLEMENTATION REPORTS.—Not later 

20 than 3 years after the date of enactment of this Act, 

21 and biennially thereafter, the Secretary of Health 

22 and Human Services shall evaluate and report to 

23 Congress on the efforts of the Department of Health 

24 and Human Services to implement the recommenda25 tions made pursuant to subsection (a). 
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•S 2399 IS 

1 SEC. 5. INCREASING THE INTAKE OF NUTRITIONAL FOODS. 

2 Part P of title III of the Public Health Service Act 

3 (42 U.S.C. 280g et seq.), as amended by section 2, is fur4 ther amended by adding at the end the following: 

5 ‘‘SEC. 399P. INCREASING THE INTAKE OF NUTRITIONAL 

6 FOODS. 

7 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

8 with the Director of the Centers for Disease Control and 

9 Prevention, the Secretary of Education, and the Secretary 

10 of Agriculture, shall establish and implement activities to 

11 improve the consumption of nutritional foods (such as 

12 fruits and vegetables, and foods that are low in fat, sugar, 

13 and salt) in communities. 

14 ‘‘(b) COMMUNITIES.—The Secretary, acting through 

15 the Director of the Centers of Disease Control and Preven16 tion, shall award grants for projects that—

17 ‘‘(1) implement campaigns, in communities at 

18 risk for poor nutrition, that are designed to promote 

19 the intake of foods consistent with established die20 tary guidelines through the use of different types of 

21 media including television, radio, newspapers, movie 

22 theaters, billboards, and mailings; 

23 ‘‘(2) implement campaigns, in communities at 

24 risk for poor nutrition, that promote water as the 

25 main daily drink choice through the use of different 
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1 types of media including television, radio, news2 papers, movie theaters, billboards, and mailings; 

3 ‘‘(3) conduct outreach to commercial food es4 tablishments, grocery stores, and other food sup5 pliers, to increase the availability and accessibility of 

6 healthy foods and beverages; 

7 ‘‘(4) partner with national programs that pro8 vide parents and mentors with the skills to help 

9 guide and influence healthy meals and snack selec10 tions for children and adolescents; and 

11 ‘‘(5) partner with national afterschool and sum12 mer programs that provide children with the edu13 cation and skills needed to make healthy meal and 

14 snack selections. 

15 ‘‘(c) HEALTH PROFESSIONALS.—The Secretary, act16 ing through the Administrator of the Health Resources 

17 and Services Administration, shall award grants to—

18 ‘‘(1) support the development, implementation, 

19 and evaluation of curricula to educate and train 

20 health professionals about effective nutrition edu21 cation and counseling strategies for obese individuals 

22 and parents of overweight children, with emphasis 

23 on the Dietary Guidelines for Americans or other 

24 nationally accepted standards; and
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1 ‘‘(2) use information technology to develop, im2 plement, and evaluate the effectiveness of dietary 

3 counseling in health care settings. 

4 ‘‘(d) EVALUATION.—Not later than 12 months after 

5 the date on which a grant is awarded under this section, 

6 the grantee shall submit to the Director of the Centers 

7 for Disease Control and Prevention a report that describes 

8 the activities carried out with funds received under the 

9 grant and the effectiveness of such activities in improving 

10 the intake of nutritional foods. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section, 

13 such sums as may be necessary for each of fiscal years 

14 2005 through 2009. 

15 SEC. 6. FEDERAL OBESITY PREVENTION AND CONTROL AC16 TIVITIES. 

17 Part P of title III of the Public Health Service Act 

18 (42 U.S.C. 280g et seq.), as amended by section 5, is fur19 ther amended by adding at the end the following: 

20 ‘‘SEC. 399Q. FEDERAL OBESITY PREVENTION AND CONTROL 

21 ACTIVITIES. 

22 ‘‘(a) IN GENERAL.—The Secretary, acting through 

23 the Director of the Centers for Disease Control and Pre24 vention, shall directly or through a grant to an eligible 

25 entity, conduct, support, and promote the coordination of 
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1 research, investigations, demonstrations, training, and 

2 studies relating to the prevention, control, and surveillance 

3 of obesity. 

4 ‘‘(b) DUTIES OF THE SECRETARY.—The activities of 

5 the Secretary under subsection (a) shall include—

6 ‘‘(1) the collection, publication, and analysis of 

7 data on the prevalence and incidence of obesity; 

8 ‘‘(2) the development of uniform data sets for 

9 public health surveillance and clinical quality im10 provement activities; 

11 ‘‘(3) the identification of evidence-based and 

12 cost-effective best practices for the prevention, diag13 nosis, management, and treatment of obesity; 

14 ‘‘(4) research, including research on behavioral 

15 interventions to prevent obesity and on other evi16 dence-based best practices relating to obesity preven17 tion, diagnosis, management, and care; and 

18 ‘‘(5) demonstration projects, including commu19 nity-based programs of obesity prevention and con20 trol, and similar collaborations with academic insti21 tutions, hospitals, health insurers, researchers, 

22 health professionals, and nonprofit organizations. 

23 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.—With 

24 respect to the planning, development, and operation of any 

25 activity carried out under subsection (a), the Secretary 
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1 may provide training, technical assistance, supplies, equip2 ment, or services, and may assign any officer or employee 

3 of the Department of Health and Human Services to a 

4 State or local health agency, or to any public or nonprofit 

5 entity designated by a State health agency, in lieu of pro6 viding grant funds under this section. 

7 ‘‘(d) OBESITY PREVENTION AND CONTROL RE8 SEARCH AT THE CENTERS FOR DISEASE CONTROL AND

9 PREVENTION CENTERS.—The Secretary shall provide ad10 ditional grant support under this section for research 

11 projects at the Centers for Prevention Research of the 

12 Centers for Disease Control and Prevention to encourage 

13 the expansion of research portfolios at the Centers for 

14 Prevention Research to include obesity specific research 

15 activities related to the prevention and control of obesity. 

16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

18 such sums as may be necessary for each of fiscal years 

19 2005 through 2009.’’. 

20 SEC. 7. STATE OBESITY PREVENTION AND CONTROL AC21 TIVITIES. 

22 Part P of title III of the Public Health Service Act 

23 (42 U.S.C. 280g et seq.), as amended by section 6, is fur24 ther amended by adding at the end the following: 
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1 ‘‘SEC. 399R. STATE OBESITY PREVENTION AND CONTROL 

2 PROGRAMS. 

3 ‘‘(a) IN GENERAL.—The Secretary shall award 

4 grants to eligible entities to provide support for com5 prehensive obesity prevention and control programs and 

6 to enable such entities to provide public health surveil7 lance, prevention, and control activities related to obesity. 

8 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

9 under this section, an entity shall—

10 ‘‘(1) be a State or an Indian tribe; and 

11 ‘‘(2) submit to the Secretary an application at 

12 such time, in such manner, and containing such 

13 agreements, assurances, and information as the Sec14 retary may require, including a comprehensive obe15 sity control and prevention plan that—

16 ‘‘(A) is developed with the advice of stake17 holders from the public, private, and nonprofit 

18 sectors that have expertise relating to obesity 

19 prevention, control, and treatment; 

20 ‘‘(B) is intended to reduce the morbidity of 

21 obesity, with priority on preventing and control22 ling obesity in at-risk populations and reducing 

23 disparities in obesity prevention, diagnosis, 

24 management, and quality of care in underserved 

25 populations; and 
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1 ‘‘(C) describes the obesity-related services 

2 and activities to be undertaken or supported by 

3 the entity. 

4 ‘‘(c) USE OF FUNDS.—An eligible entity shall use 

5 amounts received under a grant awarded under subsection 

6 (a) to conduct, in a manner consistent with the com7 prehensive obesity prevention and control plan submitted 

8 by the entity in the application under subsection (b)(2)—

9 ‘‘(1) public health surveillance and epidemiolog10 ical activities relating to the prevalence of obesity 

11 and assessment of disparities in obesity prevention, 

12 diagnosis, management, and care; and 

13 ‘‘(2) public information and education pro14 grams. 

15 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

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

17 such sums as may be necessary for each of fiscal years 

18 2005 through 2009.’’. 

19 SEC. 8. STATE OBESITY PREVENTION AND CONTROL AC20 TIVITIES. 

21 Part P of title III of the Public Health Service Act 

22 (42 U.S.C. 280g et seq.), as amended by section 7, is fur23 ther amended by adding at the end the following:
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1 ‘‘SEC. 399S. COMPREHENSIVE OBESITY PREVENTION AC2 TION GRANTS. 

3 ‘‘(a) IN GENERAL.—The Secretary shall award 

4 grants on a competitive basis to eligible entities to enable 

5 such eligible entities to assist in the implementation of a 

6 national strategy for obesity prevention and control. 

7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

8 under this section, an entity shall—

9 ‘‘(1) be a national public or private nonprofit 

10 entity; and 

11 ‘‘(2) submit to the Secretary an application at 

12 such time, in such manner, and containing such 

13 agreements, assurances, and information as the Sec14 retary may require, including a description of how 

15 funds received under a grant awarded under this 

16 section will—

17 ‘‘(A) supplement or fulfill unmet needs 

18 identified in the comprehensive obesity preven19 tion and control plan of a State or Indian tribe; 

20 and 

21 ‘‘(B) otherwise help achieve the goals of an 

22 obesity prevention strategic plan designated by 

23 the Secretary. 

24 ‘‘(c) PRIORITY.—In awarding grants under this sec25 tion, the Secretary shall give priority to eligible entities 

26 submitting applications proposing to carry out programs 
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1 for preventing and controlling obesity in at-risk popu2 lations or reducing disparities in underserved populations. 

3 ‘‘(d) USE OF FUNDS.—An eligible entity shall use 

4 amounts received under a grant awarded under subsection 

5 (a) for 1 or more of the following purposes: 

6 ‘‘(1) To expand the availability of physical ac7 tivity programs designed specifically for people with 

8 obesity. 

9 ‘‘(2) To provide awareness education to pa10 tients, family members, and health care providers, to 

11 help such individuals recognize risk factors for obe12 sity, and to address the control and prevention of 

13 obesity. 

14 ‘‘(3) To decrease the long-term consequences of 

15 obesity by making information available to individ16 uals with regard to obesity prevention. 

17 ‘‘(4) To provide information on nutrition edu18 cation programs with regard to preventing or miti19 gating the impact of obesity. 

20 ‘‘(e) EVALUATION.—An eligible entity that receives a 

21 grant under this section shall submit to the Secretary an 

22 evaluation of the operations and activities carried out 

23 under such grant that includes an analysis of increased 

24 utilization and benefit of public health programs relevant 

25 to the activities described in subsection (d). 
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

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

3 such sums as may be necessary for each of fiscal years 

4 2005 through 2009.’’.

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