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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 716 Introduced in House (IH)]

108th CONGRESS
  1st Session
                                H. R. 716

To establish grants to provide health services for improved nutrition, 
    increased physical activity, obesity prevention, and for other 
                               purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 2003

Mrs. Bono (for herself, Ms. Granger, Mrs. Lowey, Mr. Wamp, Mr. LaHood, 
Mr. Payne, Mr. Kennedy of Rhode Island, Mr. Blumenauer, Mr. Castle, Mr. 
  Johnson of Illinois, and Mrs. McCarthy of New York) introduced the 
   following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committees on Agriculture, 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 establish grants to provide health services for improved nutrition, 
    increased physical activity, obesity 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) An estimated 61 percent of United States adults and 13 
        percent of children and adolescents are overweight or obese.
            (2) The prevalence of obesity and being overweight is 
        increasing among all age groups. There are twice the number of 
        overweight children and 3 times the number of overweight 
        adolescents as there were 29 years ago.
            (3) An estimated 300,000 deaths a year are associated with 
        being overweight or obese.
            (4) Obesity and being overweight are associated with 
        increased risk for heart disease (the leading cause of death), 
        cancer (the second leading cause of death), diabetes (the 6th 
        leading cause of death), and musculoskeletal disorders.
            (5) Individuals who are obese have a 50 to 100 percent 
        increased risk of premature death.
            (6) The Healthy People 2010 goals identify obesity and 
        being overweight as one of the Nation's leading health problems 
        and include objectives of 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.
            (7) 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.
            (8) The United States Surgeon General's report ``A Call To 
        Action'' lists the treatment and prevention of obesity as a top 
        national priority.
            (9) The estimated direct and indirect annual cost of 
        obesity in the United States is $117,000,000,000, which exceeds 
        the cost of tobacco-related illnesses and appears to be rising 
        dramatically.
            (10) 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 ``A Call 
        to Action'' and other documents prepared by the Department of 
        Health and Human Services and other agencies.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Obese.--The term ``obese'' means an adult with a Body 
        Mass Index (BMI) of 30 kg/m<SUP>2</SUP> or greater.
            (2) Overweight.--The term ``overweight'' means an adult 
        with a Body Mass Index (BMI) of 25 to 29.9 kg/m<SUP>2</SUP> 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.
            (3) Secretary.--Unless otherwise indicated, term 
        ``Secretary'' means the Secretary of Health and Human Services.

                        TITLE I--TRAINING GRANTS

SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH PROFESSION STUDENTS.

    Section 747(c)(3) of title VII 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, and 
individuals (including children) who are overweight or obese (as such 
terms are defined in section 3 of the Improved Nutrition and Physical 
Activity Act) and at risk for related, serious and chronic medical 
conditions''.

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 
        ``2008'';
            (2) by redesignating subsection (b) as (c); and
            (3) by inserting after subsection (a) the following:
    ``(b) Grants.--
            ``(1) In general.--The Secretary may award grants to 
        qualified entities to train primary care physicians and other 
        licensed or certified health professionals on how to identify, 
        treat, and prevent obesity and aid individuals who are 
        overweight (as such term is defined in section 3 of the 
        Improved Nutrition and Physical Activity Act).
            ``(2) Application.--An entity that desires a grant under 
        this subsection shall submit an application at such time, in 
        such form, 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) conduct educational conferences, including 
                Internet-based courses and teleconferences, on--
                            ``(i) how to treat and prevent obesity and 
                        being overweight using nutritional counseling, 
                        methods to increase physical activity, 
                        pharmacological therapies, motivational 
                        counseling to promote positive changes in 
                        health behaviors and to assist patients in 
                        identifying potential barriers to adhering to 
                        medical recommendations, and other proven 
                        interventions;
                            ``(ii) how to discuss varied strategies to 
                        promote positive behavior change and healthy 
                        lifestyles to avoid obesity, being overweight, 
                        and other eating disorders;
                            ``(iii) how to identify overweight and 
                        obese patients and those who are at risk for 
                        obesity and being overweight and therefore at 
                        risk for related serious and chronic medical 
                        conditions;
                            ``(iv) how to conduct a comprehensive 
                        assessment of individual and familial health 
                        risk factors, such as poor nutritional status, 
                        physical inactivity, and personal and family 
                        history of obesity and related serious and 
                        chronic medical conditions; and
                            ``(v) how to educate patients and their 
                        families about effective strategies to improve 
                        dietary habits and establish appropriate levels 
                        of physical activity;
                    ``(B) conduct training to enhance cultural and 
                linguistic competency and communication skills needed 
                to effectively interact with patients from diverse 
                populations regarding weight, health, and nutritional 
                status, including raising awareness of issues regarding 
                stigma and prejudice about obesity or being overweight;
                    ``(C) evaluate the effectiveness of the training 
                provided by such entity in increasing knowledge and 
                changing attitudes and behaviors of trainees;
                    ``(D) develop training materials and course content 
                using evidence-based findings or recommendations that 
                pertain to obesity and overweight treatment and 
                prevention ; and
                    ``(E) collaborate with other training programs 
                related to overweight and obesity prevention and 
                treatment.
            ``(4) Evaluation.--
                    ``(A) In general.--An entity that receives a grant 
                under this subsection shall submit to the Secretary an 
                evaluation that describes the activities carried out by 
                such entity with funds received under this section.
                    ``(B) Contents.--Such evaluation shall include an 
                assessment of the effectiveness of the activities in 
                increasing physical activity, improving nutrition, and 
                preventing individuals from becoming overweight or 
                obese, treating individuals who are overweight or 
                obese, and any other information that the Secretary may 
                require.''.

                         TITLE II--LOCAL GRANTS

SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE NUTRITION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

``SEC. 399AA. GRANTS TO INCREASE PHYSICAL ACTIVITY AND IMPROVE 
              NUTRITION.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in consultation with 
Administrator of the Health Resources and Services Administration, the 
Director of the Indian Health Service, and the heads of other 
appropriate agencies, shall award competitive grants to cities, 
counties, tribes, and States to plan, implement, and evaluate 
culturally and linguistically appropriate and competent community-based 
programs and promote good nutrition and physical activity to prevent 
overweight, obesity (as such terms are defined in section 3 of the 
Improved Nutrition and Physical Activity Act), and related serious and 
chronic medical conditions that may result from being overweight or 
obese (as such terms are defined in section 3 of the Improved Nutrition 
and Physical Activity Act).
    ``(b) Award of Grants.--A city, county, tribe, or State desiring a 
grant under this section shall submit an application to the Secretary 
at such time, in such form, and containing such information as the 
Secretary may require, including a plan describing how funds received 
through a grant under this section will be used and an evaluation of 
the programs that will be provided. In awarding grants under this 
section, the Secretary shall ensure that the proposed programs are 
coordinated in substance and format with programs currently funded 
through other Federal agencies and operating within the community.
    ``(c) Use of Funds.--A city, county, tribe, or State that receives 
a grant under this section shall use the funds made available through 
the grant to carry out 3 or more of the following activities:
            ``(1) Planning for and promotion of bike paths, walking 
        paths, or other similar or related environmental changes that 
        promote physical activity.
            ``(2) Forming partnerships and activities with businesses 
        and other entities to increase activity levels at the workplace 
        and while traveling to and from the workplace, develop wellness 
        programs that relate to overweight and obesity, and to enhance 
        nutritional status by improving food options.
            ``(3) Establishing tax and other incentives for businesses 
        to increase the activity levels and improve the nutrition of 
        their employees by encouraging such employees to--
                    ``(A) walk or bike to work;
                    ``(B) engage in other physical activity during 
                working hours; and
                    ``(C) improve available food options.
            ``(4) Forming partnerships with public and private entities 
        including schools, faith-based entities, and other facilities 
        providing recreational services to establish programs that use 
        their facilities for after-school and weekend activities for 
        the community.
            ``(5) Establishing incentives for retail food stores, 
        farmer's markets, food coops, grocery stores, and other retail 
        food outlets that offer nutritious foods, to encourage such 
        stores and outlets to locate in economically depressed areas to 
        improve the nutritional status of the community.
            ``(6) Forming partnerships with senior centers and nursing 
        homes to establish programs for older people to foster physical 
        activity and improved nutrition, including strength, 
        flexibility, and aerobic classes.
            ``(7) Providing educational activities targeting healthier 
        eating, such as cooking and shopping demonstrations, onsite 
        consultation by nutrition professionals at restaurants, and 
        community educational outreach using evidence-based nutrition 
        recommendations.
            ``(8) Forming partnerships with day care facilities to 
        establish programs that promote improved nutritional status and 
        physical activity.
            ``(9) Providing training and supervision of community 
        health workers by health professionals to--
                    ``(A) educate families regarding the relationship 
                between nutrition, eating habits, physical activity, 
                and obesity;
                    ``(B) educate families about effective strategies 
                to improve nutrition, establish healthy eating 
                patterns, and establish appropriate levels of physical 
                activity;
                    ``(C) educate and guide parents regarding the 
                ability to model and communicate positive health 
                behaviors; and
                    ``(D) educate and refer individuals to appropriate 
                health care agencies and community-based programs and 
                organizations in order to increase access to quality 
                health care services, including preventive health 
                services.
            ``(10) Other activities as deemed appropriate by the 
        Secretary.
    ``(d) Evaluation.--A city, county, tribe, or State that receives a 
grant under this section shall submit to the Secretary an evaluation, 
in collaboration with an academic health center or other qualified 
community-based entity, that describes activities carried out with 
funds received under this section, the long-term effectiveness of such 
activities in increasing physical activity, improving nutrition, and 
preventing individuals from becoming overweight or obese, and such 
other information as the Secretary may require.
    ``(e) Matching Funds.--In awarding grants under subsection (a), the 
Secretary may give priority to applicants who provide matching funds.
    ``(f) Technical Assistance.--The Secretary may set aside an amount 
not to exceed 15 percent of the total amount appropriated for a fiscal 
year under subsection (g) to permit the Director of the Centers for 
Disease Control and Prevention to--
            ``(1) provide grantees with technical support in the 
        development, implementation, and evaluation of programs under 
        this section; and
            ``(2) disseminate culturally and linguistically appropriate 
        and competent information about strategies and interventions in 
        preventing and treating obesity through the promotion of good 
        nutrition and physical activity.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $40,000,000 for fiscal year 
2004, and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

                    TITLE III--SCHOOL HEALTH PROGRAM

SEC. 301. ESTABLISHMENT OF A COORDINATED SCHOOL HEALTH PROGRAM.

    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.

    ``(a) State Educational Grants.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention and in 
consultation with the Administrator of the Health Resources and 
Services Administration, the Secretary of Education, the Secretary of 
Agriculture, and the Secretary of the Interior, shall, as part of the 
Centers for Disease Control and Prevention's coordinated school health 
program currently operated pursuant to the Director's general 
authority, award competitive grants to State, tribal, and local 
educational agencies (where applicable) to--
            ``(1) develop and disseminate school-based curricula or 
        programs that focus on a healthy lifestyle that includes 
        promotion of balanced dietary patterns and physical activity to 
        prevent becoming overweight or obese and related, serious, and 
        chronic medical conditions that are associated with being 
        overweight or obese (as such terms are defined in section 3 of 
        the Improved Nutrition and Physical Activity Act);
            ``(2) provide education and training to education 
        professionals, including health education, physical education, 
        and food service professionals;
            ``(3) develop and implement policies that create a healthy 
        school environment in relation to nutrition and physical 
        activity; and
            ``(4) evaluate activities conducted under paragraphs (1) 
        through (3).
    ``(b) Local Educational Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention and 
        in consultation with the Secretary of Education, the Secretary 
        of Agriculture, and the Secretary of the Interior, shall award 
        competitive grants to local educational agencies to plan, 
        implement, and evaluate culturally and linguistically 
        appropriate and competent programs to promote a healthy 
        lifestyle, including programs that, in collaboration with 
        statewide coordinated school health programs, when applicable, 
        increase physical activity and improve the nutritional status 
        of the students at elementary and secondary schools.
            ``(2) Award of grants.--A local educational agency desiring 
        a grant under this subsection shall submit an application to 
        the Secretary at such time, in such manner, and containing such 
        information as the Secretary may require, including a plan 
        describing how funds received under this section will be used 
        and an evaluation of the program.
            ``(3) Use of funds.--A local educational agency that 
        receives a grant under this subsection shall use the funds made 
        available through the grant to carry out 4 or more of the 
        following activities:
                    ``(A) Planning and implementing a healthy lifestyle 
                curriculum or program with an emphasis on nutrition and 
                physical activity for each grade level.
                    ``(B) Planning and implementing a physical 
                education and activity curriculum or program for each 
                grade level and purchasing appropriate equipment, with 
                no more than 15 percent of a grant award used for 
                purchasing such equipment.
                    ``(C) Planning and implementing healthy lifestyle 
                classes or programs for parents and guardians, with an 
                emphasis on nutrition and physical activity.
                    ``(D) Planning and implementing after-hours 
                physical activity programs.
                    ``(E) Creating opportunities for students to choose 
                foods to improve nutritional status.
                    ``(F) Training teachers and staff, including food 
                service workers, on how to teach good nutrition and 
                physical activity practices.
                    ``(G) Other activities as deemed appropriate by the 
                Secretary.
            ``(4) Evaluation.--An agency that receives a grant under 
        this subsection shall submit to the Secretary an evaluation, in 
        collaboration with an academic department or other qualified 
        community-based entity, describing the activities carried out 
        under the grant, the effectiveness of the activities in 
        increasing physical activity, improving nutrition, and 
        preventing individuals from becoming overweight and obese, and 
        such other information as the Secretary may require.
    ``(c) Community Educational Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Centers for Disease Control and Prevention, shall award 
        competitive grants to universities, colleges, or community-
        based nonprofit organizations to develop, implement, and 
        evaluate programs to promote healthy eating and physical 
        activity in youth and to conduct effectiveness reports to 
        identify programs that have demonstrated effectiveness in 
        improving nutritional status and physical activity in youth.
            ``(2) Award of grants.--A university, college, or 
        community-based nonprofit organization desiring a grant under 
        this subsection shall submit an application to the Secretary at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            ``(3) Geographic diversity and food-based research.--In 
        awarding grants under this section, the Secretary shall take 
        into consideration whether grantees are geographically 
        dispersed to ensure regional balance, including proposal 
        submissions with multiple institutions, and ensure that the set 
        of grants awarded under this section focus on physical activity 
        and food-based research, realizing that land-grant colleges 
        historically have been known to have strength in food-based 
        research.
            ``(4) Information availability.--Information about programs 
        funded with grants authorized under this subsection shall be 
        made available to State, tribal, and local educational agencies 
        and may be used in planning and implementing programs described 
        in subsections (a) and (b).
    ``(d) Technical Assistance.--The Secretary may set aside an amount 
not to exceed 15 percent of the total amount appropriated for a fiscal 
year under subsection (e) to permit the Director of the Centers for 
Disease Control and Prevention to--
            ``(1) provide grantees with technical support in the 
        development, implementation, and evaluation of programs under 
        this section; and
            ``(2) disseminate culturally and linguistically appropriate 
        and competent information about strategies and interventions in 
        preventing and treating obesity through the promotion of good 
        nutrition and physical activity.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $40,000,000 for fiscal year 
2004, and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

SEC. 302. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306 of the Public Health Service Act (42 U.S.C. 242k) is 
amended by striking subsection (n) and inserting the following:
    ``(n)(1) The Secretary, acting through the Center, may provide for 
the--
            ``(A) collection of data for determining the fitness levels 
        of children and youth; and
            ``(B) 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 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.''.

                 TITLE IV--INSTITUTE OF MEDICINE STUDY

SEC. 401. STUDY OF THE FOOD SUPPLEMENT AND NUTRITION PROGRAMS OF THE 
              DEPARTMENT OF AGRICULTURE.

    (a) In General.--The Secretary of Agriculture shall request that 
the Institute of Medicine conduct, or contract with another entity to 
conduct, a study on the food and nutrition assistance programs run by 
the Department of Agriculture.
    (b) Content.--Such study shall--
            (1) investigate whether the nutrition programs and 
        nutrition recommendations are based on the latest scientific 
        evidence;
            (2) investigate whether the food assistance programs 
        contribute to either preventing or enhancing obesity and being 
        overweight in children, adolescents, and adults;
            (3) investigate whether the food assistance programs can be 
        improved or altered to contribute to the prevention of obesity 
        and becoming overweight; and
            (4) identify obstacles that prevent or hinder the programs 
        from achieving their objectives.
    (c) Report.--Not later than 24 months after the date of enactment 
of this Act, the Secretary of Agriculture shall submit to the 
appropriate committees of Congress a report containing the results of 
the Institute of Medicine study authorized under this section.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $750,000 for fiscal years 2004 
and 2005.

      TITLE V--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY STUDIES

SEC. 501. EVIDENCE REPORT ON WEIGHT REDUCTION PROGRAMS.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality, shall conduct or support an 
evidence report on the effectiveness of weight reduction programs.
    (b) Content.--The study described in subsection (a) shall evaluate 
the available scientific evidence regarding the safety and 
effectiveness of the programs, including programs that use dietary 
supplements, behavior modification, and other weight loss methods, and 
how successful the programs are in helping individuals achieve short-
term weight loss and sustain long-term weight maintenance.
    (c) Report.--The Secretary shall, not later than 18 months after 
the date of enactment of this Act, prepare and submit to the relevant 
committees of Congress a report that describes the results of the 
evidence report described in this section. Such report shall be made 
available on the web site of the Agency for Healthcare Research and 
Quality.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $500,000 for fiscal year 2004.

SEC. 502. 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 outlined in 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)).

      TITLE VI--PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT

SEC. 601. USE OF ALLOTMENTS.

    Section 1904(a)(1) of title XIX 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.''.

      TITLE VII--MEDICARE NUTRITION THERAPY DEMONSTRATION PROJECT

SEC. 701. DEMONSTRATION PROJECT TO REDUCE OBESITY AND OTHER CHRONIC 
              DISEASE RISKS.

    (a) Demonstration.--The Secretary, in consultation with the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
conduct a demonstration project to develop a comprehensive and 
systematic model for improving the health of older Americans.
    (b) Content.--The demonstration project described in subsection (a) 
shall--
            (1) identify, through self-assessment, behavioral risk 
        factors, such as obesity and overweight, poor nutrition, 
        physical inactivity, alcohol use, tobacco use, and mental 
        health problems among those target individuals;
            (2) identify, through self-assessment, needed medicare 
        clinical preventive and screening benefits among those target 
        individuals;
            (3) identify, through self-assessment, functional and self-
        management information the Secretary determines to be 
        appropriate;
            (4) provide ongoing support to reduce risk factors and 
        promote the appropriate use of preventive and screening 
        benefits; and
            (5) improve health outcomes, satisfaction, quality of life, 
        and appropriate use of medicare-covered services among those 
        target individuals.
    (c) Definitions.--In this section:
            (1) Target individuals.--The term ``target individuals'' 
        means individuals who are medicare beneficiaries under title 
        XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) who 
        shall include different segments of the population including 
        racial and ethnic minority groups and persons of lower 
        socioeconomic status. The demonstration is completely voluntary 
        on the part of target individuals.
            (2) Self-assessment.--The term ``self-assessment'' means a 
        form delivered by the Secretary to each target individual 
        that--
                    (A) includes questions regarding--
                            (i) behavioral risk factors;
                            (ii) needed preventive and screening 
                        services; and
                            (iii) target individuals' preferences for 
                        receiving followup information; and
                    (B) is then assessed using such computer generated 
                assessment programs and provides ongoing support to the 
                individual as the Secretary determines appropriate.
            (3) Ongoing support.--The term ``ongoing support'' means--
                    (A) to provide target individuals with information, 
                feedback, health coaching, and recommendations 
                regarding--
                            (i) the results of the self-assessment;
                            (ii) behavior modification based on the 
                        self-assessment; and
                            (iii) any need for clinical preventive and 
                        screening services or treatment including 
                        medical nutrition therapy;
                    (B) to provide target individuals with referrals to 
                community resources and programs (such as senior 
                centers) available to assist the target individual in 
                reducing health risks;
                    (C) information on available volunteer 
                opportunities to promote active engagement in the 
                community; and
                    (D) to provide the information described in 
                subparagraph (A) to a health care provider, if 
                designated by the target individual to receive such 
                information.
    (d) Program Design.--
            (1) Initial design.--Not later than 1 year after the date 
        of enactment of this Act, the Secretary shall design the 
        demonstration project. The demonstration should draw upon 
        promising, innovative models and incentives to reduce 
        behavioral risk factors. The Administrator of the Centers for 
        Medicare & Medicaid Services shall consult with the Director of 
        the Centers for Disease Control and Prevention, the Director of 
        the Office of Minority Health, and the heads of other agencies 
        in the Department of Health and Human Services, and 
        professional organizations, as the Secretary determines to be 
        appropriate on the design, conduct, and evaluation of the 
        demonstration.
            (2) Number and project areas.--Not later than 2 years after 
        the date of enactment of this Act, the Secretary shall 
        implement 1 demonstration project designed to determine whether 
        similar programs should be implemented for the general medicare 
        population.
    (e) Report to Congress.--Not later than 3 years after the date the 
Secretary implements the demonstration project under this section, the 
Secretary shall submit to Congress a report that describes the project, 
evaluates the effectiveness and cost effectiveness of the project, 
evaluates the beneficiary satisfaction under the project, and includes 
any other information the Secretary determines to be appropriate.
    (f) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) to such extent and for such period as the Secretary 
determines is necessary to conduct the demonstration project under this 
section.
    (g) Funding.--The Secretary shall provide for the transfer from the 
Federal Hospital Insurance Trust Fund and the Federal Supplementary 
Insurance Trust Fund under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) an amount not to exceed $25,000,000 for the costs 
of designing, implementing, and evaluating the demonstration project 
under this section.

      TITLE VIII--OVERWEIGHT AND OBESITY TREATMENT AND PREVENTION 
                         DEMONSTRATION PROJECTS

SEC. 801. GRANTS TO LOCAL HEALTHCARE DELIVERY SYSTEMS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
as amended in section 201, is further amended by adding at the end the 
following:

``SEC. 399BB. GRANTS TO LOCAL HEALTHCARE DELIVERY SYSTEMS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to implement demonstration overweight and obesity (as such 
terms are defined in section 3 of the Improved Nutrition and Physical 
Activity Act) treatment and prevention programs using evidence-based 
recommendations.
    ``(b) Eligible Entity.--In this section, the term `eligible entity' 
means a federally qualified health center (as defined in section 
1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4)), rural 
health clinic, health department, Indian Health Service hospital or 
clinic, Indian tribal health facility, urban Indian facility, or other 
health care service provider, as determined appropriate by the 
Secretary.
    ``(c) 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 a plan for the use of funds awarded under the grant 
and an evaluation of the program.
    ``(d) Use of Funds.--An eligible entity that receives a grant under 
this section shall use the funds made available through the grant to 
carry out 3 or more of the following activities in a culturally and 
linguistically appropriate and competent manner:
            ``(1) Providing nutrition and physical activity services by 
        a health professional to treat or prevent overweight and 
        obesity.
            ``(2) Providing patient education and counseling to 
        increase physical activity and improve nutrition.
            ``(3) Providing community education on nutrition and 
        physical activity by a health professional to provide better 
        understanding of the relationship between diet, physical 
        activity, and obesity.
            ``(4) Training health professionals on how to identify and 
        treat obese and overweight individuals which may include 
        nutrition and physical activity counseling.
            ``(5) Providing education and referring individuals to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to quality health 
        care services, including preventive health services.
            ``(6) Training and supervising community health workers by 
        qualified health professionals to--
                    ``(A) educate families regarding the relationship 
                between nutrition, eating habits, physical activity, 
                and obesity;
                    ``(B) educate families about effective strategies 
                to improve nutrition, establish healthy eating patterns 
                and establish appropriate levels of physical activity; 
                and
                    ``(C) educate and guide parents regarding the 
                ability to model and communicate positive health 
                behaviors.
            ``(7) Other activities that are deemed appropriate by the 
        Secretary.
    ``(e) Evaluation.--An eligible entity that receives a grant under 
this section shall, in collaboration with an academic health center or 
other qualified community-based entity, submit to the Secretary a 
report describing the activities carried out under the grant, the 
effectiveness of the activities in increasing physical activity, 
improving nutrition, and preventing overweight and obesity, and such 
other information as the Secretary may require.
    ``(f) Technical Assistance.--The Secretary may set aside an amount 
not to exceed 15 percent of the total amount appropriated for a fiscal 
year under subsection (g) to--
            ``(1) provide grantees with technical support in the 
        development, implementation, and evaluation of programs under 
        this section; and
            ``(2) disseminate culturally and linguistically appropriate 
        and competent information about strategies and interventions in 
        preventing and treating obesity through the promotion of good 
        nutrition and physical activity.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $40,000,000 for fiscal year 
2004, and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

                     TITLE IX--RESEARCH ON OBESITY

SEC. 901. REPORT ON OBESITY RESEARCH.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary 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 on causes and health implications of obesity and being 
overweight.
    (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 including--
                    (A) the types and numbers of studies completed or 
                being conducted by the National Institutes of Health 
                on--
                            (i) mechanisms responsible for obesity 
                        (including nutrition, physical activity, 
                        genetic causes such as syndrome X), the 
                        prevention of and the treatment for obesity and 
                        related, serious, and chronic medical 
                        conditions (including diabetes and 
                        cardiovascular disease); and
                            (ii) psychosocial aspects of obesity;
                    (B) the types and number of studies completed or 
                being conducted by the Centers for Disease Control and 
                Prevention on individual and community interventions to 
                prevent individuals from becoming overweight or obese;
                    (C) the types of studies completed or being 
                conducted by the Agency for Healthcare Research and 
                Quality on the treatment and prevention of overweight 
                and obesity;
                    (D) the types of studies being conducted by the 
                Health Resources and Services Administration on the 
                prevention of overweight and obesity; and
                    (E) what these studies have shown about the causes 
                of, prevention of, and treatment of overweight and 
                obesity; and
            (2) recommendations on further research that is needed, 
        including research among diverse populations, the department's 
        plan for conducting such research, and how current knowledge 
        can be disseminated.

                     TITLE X--YOUTH MEDIA CAMPAIGN

SEC. 1001. GRANTS AND CONTRACTS FOR A NATIONAL CAMPAIGN TO CHANGE 
              CHILDREN'S HEALTH BEHAVIORS.

    Section 399Y of the Public Health Service Act (42 U.S.C. 280h-2) is 
amended--
            (1) in subsection (b), by striking ``2005'' and inserting 
        ``2008'';
            (2) by redesignating subsection (b) as subsection (c); and
            (3) by inserting after subsection (a) the following:
    ``(b) Grants.--
            ``(1) In general.--As part of the campaign described in 
        subsection (a), the Secretary, acting through the Director of 
        the Centers for Disease Control and Prevention, shall award 
        grants or contracts to eligible entities to design and 
        implement culturally and linguistically appropriate and 
        competent campaigns to change children's health behaviors.
            ``(2) Eligible entity.--In this subsection, the term 
        `eligible entity' means a marketing, public relations, 
        advertising, or other appropriate entity.
            ``(3) Content.--An eligible entity that receives a grant 
        under this subsection shall use funds received through such 
        grant or contract to utilize marketing and communication 
        strategies to--
                    ``(A) communicate messages to help young people 
                develop habits that will foster good health over a 
                lifetime;
                    ``(B) provide young people with motivation to 
                engage in sports and other physical activities;
                    ``(C) influence youth to develop good health habits 
                such as regular physical activity and good nutrition;
                    ``(D) educate parents of young people on the 
                importance of physical activity and improving 
                nutrition, how to maintain healthy behaviors for the 
                entire family, and how to encourage children to develop 
                good nutrition and physical activity habits; and
                    ``(E) discourage stigmatization and discrimination 
                based on body size or shape.
            ``(4) Report.--The Secretary shall evaluate the 
        effectiveness of the campaign described in paragraph (1) in 
        changing children's behaviors and 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.''.

                       TITLE XI--EATING DISORDERS

SEC. 1101. SHORT TITLE.

    This title may be cited as the ``Promoting Healthy Eating Behaviors 
in Youth Act''.

SEC. 1102. FINDINGS.

    Congress makes the following findings:
            (1) Anorexia Nervosa is an eating disorder characterized by 
        self-starvation and excessive weight loss.
            (2) Anorexia Nervosa is common: an estimated .5 to 3.7 
        percent of American women will suffer from this disorder in 
        their lifetime.
            (3) Anorexia Nervosa is associated with serious health 
        consequences including heart failure, kidney failure, 
        osteoporosis, and death.
            (4) Anorexia Nervosa has the highest mortality rate of all 
        psychiatric disorders. A young woman is 12 times more likely to 
        die than other women her age without Anorexia.
            (5) Anorexia Nervosa usually appears in adolescence.
            (6) Bulimia Nervosa is 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.
            (7) Bulimia Nervosa is common: an estimated 1.1 to 4.2 
        percent of American women will suffer from this disorder in 
        their lifetime.
            (8) Bulimia Nervosa is associated with cardiac, 
        gastrointestinal, and dental problems including irregular 
        heartbeats, gastric rupture, peptic ulcer, and tooth decay.
            (9) Bulimia Nervosa usually appears in adolescence.
            (10) On the 1999 Youth Risk Behavior Survey, 7.5 percent of 
        high school girls reported recent use of laxatives or vomiting 
        to control their weight.
            (11) Binge Eating Disorder is characterized by frequent 
        episodes of uncontrolled overeating.
            (12) Binge Eating Disorder is common: an estimated 2 to 5 
        percent of Americans experience this disorder in a 6-month 
        period.
            (13) Binge Eating is associated with obesity, heart 
        disease, gall bladder disease, and diabetes.
            (14) Eating disorders are commonly associated with 
        substantial psychological problems, including depression, 
        substance abuse, and suicide.
            (15) Obesity is reaching epidemic proportions: 27 percent 
        of United States adults are obese and 13 percent of children 
        and 14 percent of adolescents are seriously overweight.
            (16) Poor eating habits have led to a ``calcium crisis'' 
        among American youth: only 13.5 percent of adolescent girls get 
        the recommended daily amount of calcium, placing them at 
        serious risk for osteoporosis and other bone diseases. Because 
        nearly 90 percent of adult bone mass is established by the end 
        of this age range, the Nation's youth's insufficient calcium 
        intake is truly a calcium crisis.
            (17) Eating disorders of all types are more common in women 
        than men.
            (18) Eating preferences and habits are established in 
        childhood.
            (19) Poor eating habits are a risk factor for the 
        development of eating disorders, obesity and osteoporosis.
            (20) However, simply urging overweight youth to be thin has 
        not reduced the prevalence of obesity and may result in other 
        problems including body dissatisfaction, low self-esteem, and 
        eating disorders.
            (21) Therefore, effective interventions for promoting 
        healthy eating behaviors in youth should promote healthy 
        lifestyle and not inadvertently promote unhealthy weight 
        management techniques.

SEC. 1103. PURPOSES.

    The purposes of this title are as follows:
            (1) To increase preventive health activities designed to 
        promote the development of healthy eating habits and behaviors 
        in youth.
            (2) To support research to develop and test educational 
        curricula and intervention programs aimed at promoting healthy 
        eating habits and behaviors in youth.
            (3) To identify and disseminate effective intervention 
        programs aimed at promoting healthy eating habits and behaviors 
        in youth.

SEC. 1104. AMENDMENTS.

    Title III of the of the Public Health Service Act (42 U.S.C. 241 et 
seq.), as amended in section 801, is further amended by adding at the 
end the following:

``SEC. 399CC. GRANTS TO PROMOTE CHILDHOOD NUTRITION AND PHYSICAL 
              ACTIVITY.

    ``(a) Program Authorized.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention (hereafter 
the `Director') and in coordination with the Office of Women's Health 
and the National Institutes of Health, shall award competitive grants 
to States, political subdivisions of States, accredited universities, 
colleges, or nonprofit organizations, for the implementation of State 
and community-based intervention programs to promote good nutrition, 
including promoting health eating behaviors and physical activity in 
children and adolescents. Such grants may be awarded to target youth or 
specific at-risk populations, such as adolescent girls.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section a State, political subdivision of a State, university, college, 
or nonprofit organization shall prepare and submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require, including a plan that 
describes--
            ``(1) how the applicant proposes to develop a comprehensive 
        program of school- and community-based approaches to encourage 
        and promote good nutrition and appropriate levels of physical 
        activity with respect to children or adolescents in local 
        communities;
            ``(2) the manner in which the applicant shall coordinate 
        with appropriate State and local authorities, such as State and 
        local school departments, State departments of health, chronic 
        disease directors, State directors of programs under section 17 
        of the Child Nutrition Act of 1966, 5-a-day coordinators, 
        governors councils for physical activity and good nutrition, 
        and State and local parks and recreation departments; and
            ``(3) the manner in which the applicant will evaluate the 
        effectiveness of the program carried out under this section.
    ``(c) Use of Funds.--A State, political subdivision of a State, 
university, college, or nonprofit organization that receives a grant 
under this section shall use funds received--
            ``(1) develop and test educational curricula and 
        intervention programs designed to promote healthy eating 
        behaviors and habits in youth, including science-based 
        interventions with multiple components such as--
                    ``(A) nutritional content;
                    ``(B) understanding and responding to hunger and 
                satiety;
                    ``(C) positive body image development;
                    ``(D) positive self-esteem development; and
                    ``(E) learning life skills, such as stress 
                management, communication skills, problem solving and 
                decision making skills, as well as consideration of 
                cultural and developmental issues, and the role of 
                family, school, and community;
            ``(2) develop, implement, disseminate, and evaluate school 
        and community-based strategies to reduce inactivity and improve 
        nutrition among children and adolescents;
            ``(3) expand opportunities for physical activity programs 
        in school- and community-based settings; and
            ``(4) develop, implement, and evaluate programs that 
        promote good eating habits and physical activity including 
        opportunities for children and adolescents with cognitive and 
        physical disabilities.
    ``(d) Technical Assistance.--The Secretary may set-aside an amount 
not to exceed 10 percent of the amount appropriated for a fiscal year 
under subsection (h) to permit the Director of the Centers for Disease 
Control and Prevention to--
            ``(1) provide States and political subdivisions of States 
        with technical support in the development and implementation of 
        programs under this section; and
            ``(2) disseminate information about effective strategies 
        and interventions in preventing and treating obesity through 
        the promotion of good nutrition and physical activity.
    ``(e) Limitation on Administrative Costs.--Not to exceed 10 percent 
of the amount of a grant awarded to the State or political subdivision 
under subsection (a) for a fiscal year may be used by the State or 
political subdivision for administrative expenses.
    ``(f) Term.--A grant awarded under subsection (a) shall be for a 
term of not to exceed 4 years.
    ``(g) Definitions.--In this section:
            ``(1) Children and adolescents.--The term `children and 
        adolescents' means individuals who do not exceed 18 years of 
        age.
            ``(2) Healthy eating.--The term `healthy eating' means 
        having regular eating habits, such as eating 3 meals a day to 
        satisfy hunger, eating for nourishment, health, and energy, 
        eating in such a manner as to acknowledge internal signals of 
        appetite and satiety, and eating in a healthy manner in 
        ordinary social environments to promote healthy social 
        relationships with family, peers, and community.
    ``(h) Report.--The Director 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 and habits in youth. Such programs shall be referred 
to as ``Programs that Work''. Information about Programs that Work, 
including program curricula, shall be made readily available to the 
public.
    ``(i) Sunset.--The provisions of this section shall be effective 
for 5 years after the date of enactment of this section.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for fiscal year 
2004, $5,500,000 for fiscal year 2005, $6,000,000 for fiscal year 2006, 
$6,500,000 for year 2007, and $1,000,000 for year 2008.''.
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