I 

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.

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 ‘‘Improved Nutrition 

5 and Physical Activity Act’’ or the ‘‘IMPACT Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 
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1 (1) An estimated 61 percent of United States 

2 adults and 13 percent of children and adolescents 

3 are overweight or obese. 

4 (2) The prevalence of obesity and being over5 weight is increasing among all age groups. There are 

6 twice the number of overweight children and 3 times 

7 the number of overweight adolescents as there were 

8 29 years ago. 

9 (3) An estimated 300,000 deaths a year are as10 sociated with being overweight or obese. 

11 (4) Obesity and being overweight are associated 

12 with increased risk for heart disease (the leading 

13 cause of death), cancer (the second leading cause of 

14 death), diabetes (the 6th leading cause of death), 

15 and musculoskeletal disorders. 

16 (5) Individuals who are obese have a 50 to 100 

17 percent increased risk of premature death. 

18 (6) The Healthy People 2010 goals identify 

19 obesity and being overweight as one of the Nation’s 

20 leading health problems and include objectives of in21 creasing the proportion of adults who are at a 

22 healthy weight, reducing the proportion of adults 

23 who are obese, and reducing the proportion of chil24 dren and adolescents who are overweight or obese. 
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1 (7) Another goal of Healthy People 2010 is to 

2 eliminate health disparities among different seg3 ments of the population. Obesity is a health problem 

4 that disproportionally impacts medically underserved 

5 populations. 

6 (8) The United States Surgeon General’s report 

7 ‘‘A Call To Action’’ lists the treatment and preven8 tion of obesity as a top national priority. 

9 (9) The estimated direct and indirect annual 

10 cost of obesity in the United States is 

11 $117,000,000,000, which exceeds the cost of to12 bacco-related illnesses and appears to be rising dra13 matically. 

14 (10) Weight control programs should promote a 

15 healthy lifestyle including regular physical activity 

16 and healthy eating, as consistently discussed and 

17 identified in a variety of public and private con18 sensus documents, including ‘‘A Call to Action’’ and 

19 other documents prepared by the Department of 

20 Health and Human Services and other agencies. 

21 SEC. 3. DEFINITIONS. 

22 In this Act: 

23 (1) OBESE.—The term ‘‘obese’’ means an adult 

with a Body Mass Index (BMI) of 30 kg/m2 24 or 

25 greater. 
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1 (2) OVERWEIGHT.—The term ‘‘overweight’’ 

2 means an adult with a Body Mass Index (BMI) of 

25 to 29.9 kg/m2 3 and a child or adolescent with a 

4 BMI at or above the 95th percentile on the revised 

5 Centers for Disease Control and Prevention growth 

6 charts or another appropriate childhood definition as 

7 defined by the Secretary. 

8 (3) SECRETARY.—Unless otherwise indicated, 

9 term ‘‘Secretary’’ means the Secretary of Health 

10 and Human Services. 

11 TITLE I—TRAINING GRANTS 

12 SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH 

13 PROFESSION STUDENTS. 

14 Section 747(c)(3) of title VII of the Public Health 

15 Service Act (42 U.S.C. 293k(c)(3)) is amended by striking 

16 ‘‘and victims of domestic violence’’ and inserting ‘‘victims 

17 of domestic violence, and individuals (including children) 

18 who are overweight or obese (as such terms are defined 

19 in section 3 of the Improved Nutrition and Physical Activ20 ity Act) and at risk for related, serious and chronic med21 ical conditions’’. 

22 SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH 

23 PROFESSIONALS. 

24 Section 399Z of the Public Health Service Act (42 

25 U.S.C. 280h–3) is amended—
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1 (1) in subsection (b), by striking ‘‘2005’’ and 

2 inserting ‘‘2008’’; 

3 (2) by redesignating subsection (b) as (c); and 

4 (3) by inserting after subsection (a) the fol5 lowing: 

6 ‘‘(b) GRANTS.—

7 ‘‘(1) IN GENERAL.—The Secretary may award 

8 grants to qualified entities to train primary care 

9 physicians and other licensed or certified health pro10 fessionals on how to identify, treat, and prevent obe11 sity and aid individuals who are overweight (as such 

12 term is defined in section 3 of the Improved Nutri13 tion and Physical Activity Act). 

14 ‘‘(2) APPLICATION.—An entity that desires a 

15 grant under this subsection shall submit an applica16 tion at such time, in such form, and containing such 

17 information as the Secretary may require, including 

18 a plan for the use of funds that may be awarded and 

19 an evaluation of the training that will be provided. 

20 ‘‘(3) USE OF FUNDS.—An entity that receives 

21 a grant under this subsection shall use the funds 

22 made available through such grant to—

23 ‘‘(A) conduct educational conferences, in24 cluding Internet-based courses and telecon25 ferences, on—
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1 ‘‘(i) how to treat and prevent obesity 

2 and being overweight using nutritional 

3 counseling, methods to increase physical 

4 activity, pharmacological therapies, motiva5 tional counseling to promote positive 

6 changes in health behaviors and to assist 

7 patients in identifying potential barriers to 

8 adhering to medical recommendations, and 

9 other proven interventions; 

10 ‘‘(ii) how to discuss varied strategies 

11 to promote positive behavior change and 

12 healthy lifestyles to avoid obesity, being 

13 overweight, and other eating disorders; 

14 ‘‘(iii) how to identify overweight and 

15 obese patients and those who are at risk 

16 for obesity and being overweight and there17 fore at risk for related serious and chronic 

18 medical conditions; 

19 ‘‘(iv) how to conduct a comprehensive 

20 assessment of individual and familial 

21 health risk factors, such as poor nutri22 tional status, physical inactivity, and per23 sonal and family history of obesity and re24 lated serious and chronic medical condi25 tions; and 
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1 ‘‘(v) how to educate patients and their 

2 families about effective strategies to im3 prove dietary habits and establish appro4 priate levels of physical activity; 

5 ‘‘(B) conduct training to enhance cultural 

6 and linguistic competency and communication 

7 skills needed to effectively interact with patients 

8 from diverse populations regarding weight, 

9 health, and nutritional status, including raising 

10 awareness of issues regarding stigma and preju11 dice about obesity or being overweight; 

12 ‘‘(C) evaluate the effectiveness of the train13 ing provided by such entity in increasing knowl14 edge and changing attitudes and behaviors of 

15 trainees; 

16 ‘‘(D) develop training materials and course 

17 content using evidence-based findings or rec18 ommendations that pertain to obesity and over19 weight treatment and prevention ; and 

20 ‘‘(E) collaborate with other training pro21 grams related to overweight and obesity preven22 tion and treatment. 

23 ‘‘(4) EVALUATION.—

24 ‘‘(A) IN GENERAL.—An entity that re25 ceives a grant under this subsection shall sub-
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1 mit to the Secretary an evaluation that de2 scribes the activities carried out by such entity 

3 with funds received under this section. 

4 ‘‘(B) CONTENTS.—Such evaluation shall 

5 include an assessment of the effectiveness of the 

6 activities in increasing physical activity, improv7 ing nutrition, and preventing individuals from 

8 becoming overweight or obese, treating individ9 uals who are overweight or obese, and any other 

10 information that the Secretary may require.’’. 

11 TITLE II—LOCAL GRANTS 

12 SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY AND 

13 IMPROVE NUTRITION. 

14 Title III of the Public Health Service Act (42 U.S.C. 

15 241 et seq.) is amended by adding at the end the fol16 lowing: 

17 ‘‘SEC. 399AA. GRANTS TO INCREASE PHYSICAL ACTIVITY 

18 AND IMPROVE NUTRITION. 

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

20 the Director of the Centers for Disease Control and Pre21 vention and in consultation with Administrator of the 

22 Health Resources and Services Administration, the Direc23 tor of the Indian Health Service, and the heads of other 

24 appropriate agencies, shall award competitive grants to 

25 cities, counties, tribes, and States to plan, implement, and 
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1 evaluate culturally and linguistically appropriate and com2 petent community-based programs and promote good nu3 trition and physical activity to prevent overweight, obesity 

4 (as such terms are defined in section 3 of the Improved 

5 Nutrition and Physical Activity Act), and related serious 

6 and chronic medical conditions that may result from being 

7 overweight or obese (as such terms are defined in section 

8 3 of the Improved Nutrition and Physical Activity Act). 

9 ‘‘(b) AWARD OF GRANTS.—A city, county, tribe, or 

10 State desiring a grant under this section shall submit an 

11 application to the Secretary at such time, in such form, 

12 and containing such information as the Secretary may re13 quire, including a plan describing how funds received 

14 through a grant under this section will be used and an 

15 evaluation of the programs that will be provided. In 

16 awarding grants under this section, the Secretary shall en17 sure that the proposed programs are coordinated in sub18 stance and format with programs currently funded 

19 through other Federal agencies and operating within the 

20 community. 

21 ‘‘(c) USE OF FUNDS.—A city, county, tribe, or State 

22 that receives a grant under this section shall use the funds 

23 made available through the grant to carry out 3 or more 

24 of the following activities: 
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1 ‘‘(1) Planning for and promotion of bike paths, 

2 walking paths, or other similar or related environ3 mental changes that promote physical activity. 

4 ‘‘(2) Forming partnerships and activities with 

5 businesses and other entities to increase activity lev6 els at the workplace and while traveling to and from 

7 the workplace, develop wellness programs that relate 

8 to overweight and obesity, and to enhance nutri9 tional status by improving food options. 

10 ‘‘(3) Establishing tax and other incentives for 

11 businesses to increase the activity levels and improve 

12 the nutrition of their employees by encouraging such 

13 employees to—

14 ‘‘(A) walk or bike to work; 

15 ‘‘(B) engage in other physical activity dur16 ing working hours; and 

17 ‘‘(C) improve available food options. 

18 ‘‘(4) Forming partnerships with public and pri19 vate entities including schools, faith-based entities, 

20 and other facilities providing recreational services to 

21 establish programs that use their facilities for after22 school and weekend activities for the community.

23 ‘‘(5) Establishing incentives for retail food 

24 stores, farmer’s markets, food coops, grocery stores, 

25 and other retail food outlets that offer nutritious 
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1 foods, to encourage such stores and outlets to locate 

2 in economically depressed areas to improve the nu3 tritional status of the community. 

4 ‘‘(6) Forming partnerships with senior centers 

5 and nursing homes to establish programs for older 

6 people to foster physical activity and improved nutri7 tion, including strength, flexibility, and aerobic class8 es. 

9 ‘‘(7) Providing educational activities targeting 

10 healthier eating, such as cooking and shopping dem11 onstrations, onsite consultation by nutrition profes12 sionals at restaurants, and community educational 

13 outreach using evidence-based nutrition rec14 ommendations. 

15 ‘‘(8) Forming partnerships with day care facili16 ties to establish programs that promote improved 

17 nutritional status and physical activity. 

18 ‘‘(9) Providing training and supervision of com19 munity health workers by health professionals to—

20 ‘‘(A) educate families regarding the rela21 tionship between nutrition, eating habits, phys22 ical activity, and obesity; 

23 ‘‘(B) educate families about effective strat24 egies to improve nutrition, establish healthy 
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1 eating patterns, and establish appropriate levels 

2 of physical activity; 

3 ‘‘(C) educate and guide parents regarding 

4 the ability to model and communicate positive 

5 health behaviors; and 

6 ‘‘(D) educate and refer individuals to ap7 propriate health care agencies and community8 based programs and organizations in order to 

9 increase access to quality health care services, 

10 including preventive health services. 

11 ‘‘(10) Other activities as deemed appropriate by 

12 the Secretary. 

13 ‘‘(d) EVALUATION.—A city, county, tribe, or State 

14 that receives a grant under this section shall submit to 

15 the Secretary an evaluation, in collaboration with an aca16 demic health center or other qualified community-based 

17 entity, that describes activities carried out with funds re18 ceived under this section, the long-term effectiveness of 

19 such activities in increasing physical activity, improving 

20 nutrition, and preventing individuals from becoming over21 weight or obese, and such other information as the Sec22 retary may require. 

23 ‘‘(e) MATCHING FUNDS.—In awarding grants under 

24 subsection (a), the Secretary may give priority to appli25 cants who provide matching funds. 
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1 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary may 

2 set aside an amount not to exceed 15 percent of the total 

3 amount appropriated for a fiscal year under subsection (g) 

4 to permit the Director of the Centers for Disease Control 

5 and Prevention to—

6 ‘‘(1) provide grantees with technical support in 

7 the development, implementation, and evaluation of 

8 programs under this section; and 

9 ‘‘(2) disseminate culturally and linguistically 

10 appropriate and competent information about strate11 gies and interventions in preventing and treating 

12 obesity through the promotion of good nutrition and 

13 physical activity. 

14 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

16 $40,000,000 for fiscal year 2004, and such sums as may 

17 be necessary for each of fiscal years 2005 through 2008.’’. 

18 TITLE III—SCHOOL HEALTH 

19 PROGRAM 

20 SEC. 301. ESTABLISHMENT OF A COORDINATED SCHOOL 

21 HEALTH PROGRAM. 

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

23 (42 U.S.C. 280h et seq.) is amended by striking section 

24 399W and inserting the following: 
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1 ‘‘SEC. 399W. GRANTS. 

2 ‘‘(a) STATE EDUCATIONAL GRANTS.—The Secretary, 

3 acting through the Director of the Centers for Disease 

4 Control and Prevention and in consultation with the Ad5 ministrator of the Health Resources and Services Admin6 istration, the Secretary of Education, the Secretary of Ag7 riculture, and the Secretary of the Interior, shall, as part 

8 of the Centers for Disease Control and Prevention’s co9 ordinated school health program currently operated pursu10 ant to the Director’s general authority, award competitive 

11 grants to State, tribal, and local educational agencies 

12 (where applicable) to—

13 ‘‘(1) develop and disseminate school-based cur14 ricula or programs that focus on a healthy lifestyle 

15 that includes promotion of balanced dietary patterns 

16 and physical activity to prevent becoming overweight 

17 or obese and related, serious, and chronic medical 

18 conditions that are associated with being overweight 

19 or obese (as such terms are defined in section 3 of 

20 the Improved Nutrition and Physical Activity Act); 

21 ‘‘(2) provide education and training to edu22 cation professionals, including health education, 

23 physical education, and food service professionals; 

24 ‘‘(3) develop and implement policies that create 

25 a healthy school environment in relation to nutrition 

26 and physical activity; and 
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1 ‘‘(4) evaluate activities conducted under para2 graphs (1) through (3). 

3 ‘‘(b) LOCAL EDUCATIONAL GRANTS.—

4 ‘‘(1) IN GENERAL.—The Secretary, acting 

5 through the Director of the Centers for Disease 

6 Control and Prevention and in consultation with the 

7 Secretary of Education, the Secretary of Agriculture, 

8 and the Secretary of the Interior, shall award com9 petitive grants to local educational agencies to plan, 

10 implement, and evaluate culturally and linguistically 

11 appropriate and competent programs to promote a 

12 healthy lifestyle, including programs that, in collabo13 ration with statewide coordinated school health pro14 grams, when applicable, increase physical activity 

15 and improve the nutritional status of the students at 

16 elementary and secondary schools.

17 ‘‘(2) AWARD OF GRANTS.—A local educational 

18 agency desiring a grant under this subsection shall 

19 submit an application to the Secretary at such time, 

20 in such manner, and containing such information as 

21 the Secretary may require, including a plan describ22 ing how funds received under this section will be 

23 used and an evaluation of the program. 

24 ‘‘(3) USE OF FUNDS.—A local educational 

25 agency that receives a grant under this subsection 
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1 shall use the funds made available through the grant 

2 to carry out 4 or more of the following activities: 

3 ‘‘(A) Planning and implementing a healthy 

4 lifestyle curriculum or program with an empha5 sis on nutrition and physical activity for each 

6 grade level. 

7 ‘‘(B) Planning and implementing a phys8 ical education and activity curriculum or pro9 gram for each grade level and purchasing ap10 propriate equipment, with no more than 15 per11 cent of a grant award used for purchasing such 

12 equipment. 

13 ‘‘(C) Planning and implementing healthy 

14 lifestyle classes or programs for parents and 

15 guardians, with an emphasis on nutrition and 

16 physical activity. 

17 ‘‘(D) Planning and implementing after18 hours physical activity programs. 

19 ‘‘(E) Creating opportunities for students to 

20 choose foods to improve nutritional status. 

21 ‘‘(F) Training teachers and staff, including 

22 food service workers, on how to teach good nu23 trition and physical activity practices. 

24 ‘‘(G) Other activities as deemed appro25 priate by the Secretary. 
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1 ‘‘(4) EVALUATION.—An agency that receives a 

2 grant under this subsection shall submit to the Sec3 retary an evaluation, in collaboration with an aca4 demic department or other qualified community5 based entity, describing the activities carried out 

6 under the grant, the effectiveness of the activities in 

7 increasing physical activity, improving nutrition, and 

8 preventing individuals from becoming overweight 

9 and obese, and such other information as the Sec10 retary may require. 

11 ‘‘(c) COMMUNITY EDUCATIONAL GRANTS.—

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Centers for Disease Control and Preven14 tion, shall award competitive grants to universities, 

15 colleges, or community-based nonprofit organizations 

16 to develop, implement, and evaluate programs to 

17 promote healthy eating and physical activity in 

18 youth and to conduct effectiveness reports to iden19 tify programs that have demonstrated effectiveness 

20 in improving nutritional status and physical activity 

21 in youth. 

22 ‘‘(2) AWARD OF GRANTS.—A university, college, 

23 or community-based nonprofit organization desiring 

24 a grant under this subsection shall submit an appli25 cation to the Secretary at such time, in such man-
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1 ner, and containing such information as the Sec2 retary may require. 

3 ‘‘(3) GEOGRAPHIC DIVERSITY AND FOOD-BASED

4 RESEARCH.—In awarding grants under this section, 

5 the Secretary shall take into consideration whether 

6 grantees are geographically dispersed to ensure re7 gional balance, including proposal submissions with 

8 multiple institutions, and ensure that the set of 

9 grants awarded under this section focus on physical 

10 activity and food-based research, realizing that land11 grant colleges historically have been known to have 

12 strength in food-based research. 

13 ‘‘(4) INFORMATION AVAILABILITY.—Informa14 tion about programs funded with grants authorized 

15 under this subsection shall be made available to 

16 State, tribal, and local educational agencies and may 

17 be used in planning and implementing programs de18 scribed in subsections (a) and (b). 

19 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may 

20 set aside an amount not to exceed 15 percent of the total 

21 amount appropriated for a fiscal year under subsection (e) 

22 to permit the Director of the Centers for Disease Control 

23 and Prevention to—
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1 ‘‘(1) provide grantees with technical support in 

2 the development, implementation, and evaluation of 

3 programs under this section; and 

4 ‘‘(2) disseminate culturally and linguistically 

5 appropriate and competent information about strate6 gies and interventions in preventing and treating 

7 obesity through the promotion of good nutrition and 

8 physical activity. 

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

10 is authorized to be appropriated to carry out this section 

11 $40,000,000 for fiscal year 2004, and such sums as may 

12 be necessary for each of fiscal years 2005 through 2008.’’. 

13 SEC. 302. NATIONAL CENTER FOR HEALTH STATISTICS. 

14 Section 306 of the Public Health Service Act (42 

15 U.S.C. 242k) is amended by striking subsection (n) and 

16 inserting the following: 

17 ‘‘(n)(1) The Secretary, acting through the Center, 

18 may provide for the—

19 ‘‘(A) collection of data for determining the fit20 ness levels of children and youth; and 

21 ‘‘(B) analysis of data collected as part of the 

22 National Health and Nutrition Examination Survey 

23 and other data sources. 
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1 ‘‘(2) In carrying out paragraph (1), the Secretary, 

2 acting through the Center, may make grants to states, 

3 public and nonprofit entities. 

4 ‘‘(3) The Secretary, acting through the Center, may 

5 provide technical assistance, standards, and methodologies 

6 to grantees supported by this subsection in order to maxi7 mize the data quality and comparability with other stud8 ies.’’. 

9 TITLE IV—INSTITUTE OF 

10 MEDICINE STUDY 

11 SEC. 401. STUDY OF THE FOOD SUPPLEMENT AND NUTRI12 TION PROGRAMS OF THE DEPARTMENT OF 

13 AGRICULTURE. 

14 (a) IN GENERAL.—The Secretary of Agriculture shall 

15 request that the Institute of Medicine conduct, or contract 

16 with another entity to conduct, a study on the food and 

17 nutrition assistance programs run by the Department of 

18 Agriculture. 

19 (b) CONTENT.—Such study shall—

20 (1) investigate whether the nutrition programs 

21 and nutrition recommendations are based on the lat22 est scientific evidence; 

23 (2) investigate whether the food assistance pro24 grams contribute to either preventing or enhancing 
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1 obesity and being overweight in children, adoles2 cents, and adults; 

3 (3) investigate whether the food assistance pro4 grams can be improved or altered to contribute to 

5 the prevention of obesity and becoming overweight; 

6 and 

7 (4) identify obstacles that prevent or hinder the 

8 programs from achieving their objectives. 

9 (c) REPORT.—Not later than 24 months after the 

10 date of enactment of this Act, the Secretary of Agriculture 

11 shall submit to the appropriate committees of Congress 

12 a report containing the results of the Institute of Medicine 

13 study authorized under this section. 

14 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

16 $750,000 for fiscal years 2004 and 2005. 

17 TITLE V—AGENCY FOR 

18 HEALTHCARE RESEARCH 

19 AND QUALITY STUDIES 

20 SEC. 501. EVIDENCE REPORT ON WEIGHT REDUCTION PRO21 GRAMS. 

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

23 Director of the Agency for Healthcare Research and Qual24 ity, shall conduct or support an evidence report on the ef25 fectiveness of weight reduction programs. 
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1 (b) CONTENT.—The study described in subsection (a) 

2 shall evaluate the available scientific evidence regarding 

3 the safety and effectiveness of the programs, including 

4 programs that use dietary supplements, behavior modifica5 tion, and other weight loss methods, and how successful 

6 the programs are in helping individuals achieve short-term 

7 weight loss and sustain long-term weight maintenance. 

8 (c) REPORT.—The Secretary shall, not later than 18 

9 months after the date of enactment of this Act, prepare 

10 and submit to the relevant committees of Congress a re11 port that describes the results of the evidence report de12 scribed in this section. Such report shall be made available 

13 on the web site of the Agency for Healthcare Research 

14 and Quality. 

15 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated to carry out this section, 

17 $500,000 for fiscal year 2004. 

18 SEC. 502. HEALTH DISPARITIES REPORT. 

19 Not later than 18 months after the date of enactment 

20 of this Act, and annually thereafter, the Director of the 

21 Agency for Healthcare Research and Quality shall review 

22 all research that results from the activities outlined in this 

23 Act and determine if particular information may be impor24 tant to the report on health disparities required by section 
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1 903(c)(3) of the Public Health Service Act (42 U.S.C. 

2 299a–1(c)(3)). 

3 TITLE VI—PREVENTIVE HEALTH 

4 AND HEALTH SERVICES 

5 BLOCK GRANT 

6 SEC. 601. USE OF ALLOTMENTS. 

7 Section 1904(a)(1) of title XIX of the Public Health 

8 Service Act (42 U.S.C. 300w–3(a)(1)) is amended by add9 ing at the end the following: 

10 ‘‘(H) Activities and community education pro11 grams designed to address and prevent overweight, 

12 obesity, and eating disorders through effective pro13 grams to promote healthy eating, and exercise habits 

14 and behaviors.’’. 

15 TITLE VII—MEDICARE NUTRI16 TION THERAPY DEMONSTRA17 TION PROJECT 

18 SEC. 701. DEMONSTRATION PROJECT TO REDUCE OBESITY 

19 AND OTHER CHRONIC DISEASE RISKS. 

20 (a) DEMONSTRATION.—The Secretary, in consulta21 tion with the Administrator of the Centers for Medicare 

22 & Medicaid Services, shall conduct a demonstration 

23 project to develop a comprehensive and systematic model 

24 for improving the health of older Americans. 
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1 (b) CONTENT.—The demonstration project described 

2 in subsection (a) shall—

3 (1) identify, through self-assessment, behavioral 

4 risk factors, such as obesity and overweight, poor 

5 nutrition, physical inactivity, alcohol use, tobacco 

6 use, and mental health problems among those target 

7 individuals; 

8 (2) identify, through self-assessment, needed 

9 medicare clinical preventive and screening benefits 

10 among those target individuals; 

11 (3) identify, through self-assessment, functional 

12 and self-management information the Secretary de13 termines to be appropriate; 

14 (4) provide ongoing support to reduce risk fac15 tors and promote the appropriate use of preventive 

16 and screening benefits; and 

17 (5) improve health outcomes, satisfaction, qual18 ity of life, and appropriate use of medicare-covered 

19 services among those target individuals. 

20 (c) DEFINITIONS.—In this section: 

21 (1) TARGET INDIVIDUALS.—The term ‘‘target 

22 individuals’’ means individuals who are medicare 

23 beneficiaries under title XVIII of the Social Security 

24 Act (42 U.S.C. 1395 et seq.) who shall include dif25 ferent segments of the population including racial 
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1 and ethnic minority groups and persons of lower so2 cioeconomic status. The demonstration is completely 

3 voluntary on the part of target individuals. 

4 (2) SELF-ASSESSMENT.—The term ‘‘self-assess5 ment’’ means a form delivered by the Secretary to 

6 each target individual that—

7 (A) includes questions regarding—

8 (i) behavioral risk factors; 

9 (ii) needed preventive and screening 

10 services; and 

11 (iii) target individuals’ preferences for 

12 receiving followup information; and

13 (B) is then assessed using such computer 

14 generated assessment programs and provides 

15 ongoing support to the individual as the Sec16 retary determines appropriate. 

17 (3) ONGOING SUPPORT.—The term ‘‘ongoing 

18 support’’ means—

19 (A) to provide target individuals with in20 formation, feedback, health coaching, and rec21 ommendations regarding—

22 (i) the results of the self-assessment; 

23 (ii) behavior modification based on the 

24 self-assessment; and 
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1 (iii) any need for clinical preventive 

2 and screening services or treatment includ3 ing medical nutrition therapy; 

4 (B) to provide target individuals with re5 ferrals to community resources and programs 

6 (such as senior centers) available to assist the 

7 target individual in reducing health risks; 

8 (C) information on available volunteer op9 portunities to promote active engagement in the 

10 community; and 

11 (D) to provide the information described in 

12 subparagraph (A) to a health care provider, if 

13 designated by the target individual to receive 

14 such information. 

15 (d) PROGRAM DESIGN.—

16 (1) INITIAL DESIGN.—Not later than 1 year 

17 after the date of enactment of this Act, the Sec18 retary shall design the demonstration project. The 

19 demonstration should draw upon promising, innova20 tive models and incentives to reduce behavioral risk 

21 factors. The Administrator of the Centers for Medi22 care & Medicaid Services shall consult with the Di23 rector of the Centers for Disease Control and Pre24 vention, the Director of the Office of Minority 

25 Health, and the heads of other agencies in the De-
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1 partment of Health and Human Services, and pro2 fessional organizations, as the Secretary determines 

3 to be appropriate on the design, conduct, and eval4 uation of the demonstration. 

5 (2) NUMBER AND PROJECT AREAS.—Not later 

6 than 2 years after the date of enactment of this Act, 

7 the Secretary shall implement 1 demonstration 

8 project designed to determine whether similar pro9 grams should be implemented for the general medi10 care population. 

11 (e) REPORT TO CONGRESS.—Not later than 3 years 

12 after the date the Secretary implements the demonstration 

13 project under this section, the Secretary shall submit to 

14 Congress a report that describes the project, evaluates the 

15 effectiveness and cost effectiveness of the project, evalu16 ates the beneficiary satisfaction under the project, and in17 cludes any other information the Secretary determines to 

18 be appropriate. 

19 (f) WAIVER AUTHORITY.—The Secretary shall waive 

20 compliance with the requirements of title XVIII of the So21 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

22 and for such period as the Secretary determines is nec23 essary to conduct the demonstration project under this 

24 section. 
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1 (g) FUNDING.—The Secretary shall provide for the 

2 transfer from the Federal Hospital Insurance Trust Fund 

3 and the Federal Supplementary Insurance Trust Fund 

4 under title XVIII of the Social Security Act (42 U.S.C. 

5 1395 et seq.) an amount not to exceed $25,000,000 for 

6 the costs of designing, implementing, and evaluating the 

7 demonstration project under this section. 

8 TITLE VIII—OVERWEIGHT AND 

9 OBESITY TREATMENT AND 

10 PREVENTION DEMONSTRA11 TION PROJECTS 

12 SEC. 801. GRANTS TO LOCAL HEALTHCARE DELIVERY SYS13 TEMS. 

14 Title III of the Public Health Service Act (42 U.S.C. 

15 241 et seq.) as amended in section 201, is further amend16 ed by adding at the end the following: 

17 ‘‘SEC. 399BB. GRANTS TO LOCAL HEALTHCARE DELIVERY 

18 SYSTEMS. 

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

20 grants to eligible entities to implement demonstration 

21 overweight and obesity (as such terms are defined in sec22 tion 3 of the Improved Nutrition and Physical Activity 

23 Act) treatment and prevention programs using evidence24 based recommendations. 
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1 ‘‘(b) ELIGIBLE ENTITY.—In this section, the term 

2 ‘eligible entity’ means a federally qualified health center 

3 (as defined in section 1861(aa)(4) of the Social Security 

4 Act (42 U.S.C. 1395x(aa)(4)), rural health clinic, health 

5 department, Indian Health Service hospital or clinic, In6 dian tribal health facility, urban Indian facility, or other 

7 health care service provider, as determined appropriate by 

8 the Secretary. 

9 ‘‘(c) AWARD OF GRANTS.—An eligible entity desiring 

10 a grant under this section shall submit an application to 

11 the Secretary at such time, in such manner, and con12 taining such information as the Secretary may require, in13 cluding a plan for the use of funds awarded under the 

14 grant and an evaluation of the program. 

15 ‘‘(d) USE OF FUNDS.—An eligible entity that receives 

16 a grant under this section shall use the funds made avail17 able through the grant to carry out 3 or more of the fol18 lowing activities in a culturally and linguistically appro19 priate and competent manner: 

20 ‘‘(1) Providing nutrition and physical activity 

21 services by a health professional to treat or prevent 

22 overweight and obesity. 

23 ‘‘(2) Providing patient education and counseling 

24 to increase physical activity and improve nutrition. 
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1 ‘‘(3) Providing community education on nutri2 tion and physical activity by a health professional to 

3 provide better understanding of the relationship be4 tween diet, physical activity, and obesity. 

5 ‘‘(4) Training health professionals on how to 

6 identify and treat obese and overweight individuals 

7 which may include nutrition and physical activity 

8 counseling.

9 ‘‘(5) Providing education and referring individ10 uals to appropriate health care agencies and commu11 nity-based programs and organizations in order to 

12 increase access to quality health care services, in13 cluding preventive health services. 

14 ‘‘(6) Training and supervising community 

15 health workers by qualified health professionals to—

16 ‘‘(A) educate families regarding the rela17 tionship between nutrition, eating habits, phys18 ical activity, and obesity; 

19 ‘‘(B) educate families about effective strat20 egies to improve nutrition, establish healthy 

21 eating patterns and establish appropriate levels 

22 of physical activity; and 

23 ‘‘(C) educate and guide parents regarding 

24 the ability to model and communicate positive 

25 health behaviors. 
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1 ‘‘(7) Other activities that are deemed appro2 priate by the Secretary. 

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

4 grant under this section shall, in collaboration with an 

5 academic health center or other qualified community6 based entity, submit to the Secretary a report describing 

7 the activities carried out under the grant, the effectiveness 

8 of the activities in increasing physical activity, improving 

9 nutrition, and preventing overweight and obesity, and such 

10 other information as the Secretary may require. 

11 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary may 

12 set aside an amount not to exceed 15 percent of the total 

13 amount appropriated for a fiscal year under subsection (g) 

14 to—

15 ‘‘(1) provide grantees with technical support in 

16 the development, implementation, and evaluation of 

17 programs under this section; and 

18 ‘‘(2) disseminate culturally and linguistically 

19 appropriate and competent information about strate20 gies and interventions in preventing and treating 

21 obesity through the promotion of good nutrition and 

22 physical activity. 

23 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section, 
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1 $40,000,000 for fiscal year 2004, and such sums as may 

2 be necessary for each of fiscal years 2005 through 2008.’’. 

3 TITLE IX—RESEARCH ON 

4 OBESITY 

5 SEC. 901. REPORT ON OBESITY RESEARCH. 

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

7 date of enactment of this Act, the Secretary shall submit 

8 to the Committee on Health, Education, Labor, and Pen9 sions of the Senate and the Committee on Energy and 

10 Commerce of the House of Representatives a report on 

11 research on causes and health implications of obesity and 

12 being overweight. 

13 (b) CONTENT.—The report described in subsection 

14 (a) shall contain—

15 (1) descriptions on the status of relevant, cur16 rent, ongoing research being conducted in the de17 partment including—

18 (A) the types and numbers of studies com19 pleted or being conducted by the National Insti20 tutes of Health on—

21 (i) mechanisms responsible for obesity 

22 (including nutrition, physical activity, ge23 netic causes such as syndrome X), the pre24 vention of and the treatment for obesity 

25 and related, serious, and chronic medical 
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1 conditions (including diabetes and cardio2 vascular disease); and 

3 (ii) psychosocial aspects of obesity; 

4 (B) the types and number of studies com5 pleted or being conducted by the Centers for 

6 Disease Control and Prevention on individual 

7 and community interventions to prevent individ8 uals from becoming overweight or obese; 

9 (C) the types of studies completed or being 

10 conducted by the Agency for Healthcare Re11 search and Quality on the treatment and pre12 vention of overweight and obesity; 

13 (D) the types of studies being conducted 

14 by the Health Resources and Services Adminis15 tration on the prevention of overweight and obe16 sity; and 

17 (E) what these studies have shown about 

18 the causes of, prevention of, and treatment of 

19 overweight and obesity; and 

20 (2) recommendations on further research that 

21 is needed, including research among diverse popu22 lations, the department’s plan for conducting such 

23 research, and how current knowledge can be dissemi24 nated. 
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1 TITLE X—YOUTH MEDIA 

2 CAMPAIGN 

3 SEC. 1001. GRANTS AND CONTRACTS FOR A NATIONAL CAM4 PAIGN TO CHANGE CHILDREN’S HEALTH BE5 HAVIORS. 

6 Section 399Y of the Public Health Service Act (42 

7 U.S.C. 280h–2) is amended—

8 (1) in subsection (b), by striking ‘‘2005’’ and 

9 inserting ‘‘2008’’; 

10 (2) by redesignating subsection (b) as sub11 section (c); and 

12 (3) by inserting after subsection (a) the fol13 lowing: 

14 ‘‘(b) GRANTS.—

15 ‘‘(1) IN GENERAL.—As part of the campaign 

16 described in subsection (a), the Secretary, acting 

17 through the Director of the Centers for Disease 

18 Control and Prevention, shall award grants or con19 tracts to eligible entities to design and implement 

20 culturally and linguistically appropriate and com21 petent campaigns to change children’s health behav22 iors. 

23 ‘‘(2) ELIGIBLE ENTITY.—In this subsection, the 

24 term ‘eligible entity’ means a marketing, public rela25 tions, advertising, or other appropriate entity. 
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1 ‘‘(3) CONTENT.—An eligible entity that receives 

2 a grant under this subsection shall use funds re3 ceived through such grant or contract to utilize mar4 keting and communication strategies to—

5 ‘‘(A) communicate messages to help young 

6 people develop habits that will foster good 

7 health over a lifetime;

8 ‘‘(B) provide young people with motivation 

9 to engage in sports and other physical activi10 ties; 

11 ‘‘(C) influence youth to develop good 

12 health habits such as regular physical activity 

13 and good nutrition; 

14 ‘‘(D) educate parents of young people on 

15 the importance of physical activity and improv16 ing nutrition, how to maintain healthy behav17 iors for the entire family, and how to encourage 

18 children to develop good nutrition and physical 

19 activity habits; and 

20 ‘‘(E) discourage stigmatization and dis21 crimination based on body size or shape. 

22 ‘‘(4) REPORT.—The Secretary shall evaluate 

23 the effectiveness of the campaign described in para24 graph (1) in changing children’s behaviors and re25 port such results to the Committee on Health, Edu-
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1 cation, Labor, and Pensions of the Senate and the 

2 Committee on Energy and Commerce of the House 

3 of Representatives.’’. 

4 TITLE XI—EATING DISORDERS 

5 SEC. 1101. SHORT TITLE. 

6 This title may be cited as the ‘‘Promoting Healthy 

7 Eating Behaviors in Youth Act’’. 

8 SEC. 1102. FINDINGS. 

9 Congress makes the following findings: 

10 (1) Anorexia Nervosa is an eating disorder 

11 characterized by self-starvation and excessive weight 

12 loss. 

13 (2) Anorexia Nervosa is common: an estimated 

14 .5 to 3.7 percent of American women will suffer 

15 from this disorder in their lifetime. 

16 (3) Anorexia Nervosa is associated with serious 

17 health consequences including heart failure, kidney 

18 failure, osteoporosis, and death. 

19 (4) Anorexia Nervosa has the highest mortality 

20 rate of all psychiatric disorders. A young woman is 

21 12 times more likely to die than other women her 

22 age without Anorexia. 

23 (5) Anorexia Nervosa usually appears in adoles24 cence. 
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1 (6) Bulimia Nervosa is an eating disorder char2 acterized by excessive food consumption followed by 

3 inappropriate compensatory behaviors, such as self4 induced vomiting, misuse of laxatives, fasting, or ex5 cessive exercise. 

6 (7) Bulimia Nervosa is common: an estimated 

7 1.1 to 4.2 percent of American women will suffer 

8 from this disorder in their lifetime. 

9 (8) Bulimia Nervosa is associated with cardiac, 

10 gastrointestinal, and dental problems including ir11 regular heartbeats, gastric rupture, peptic ulcer, and 

12 tooth decay. 

13 (9) Bulimia Nervosa usually appears in adoles14 cence. 

15 (10) On the 1999 Youth Risk Behavior Survey, 

16 7.5 percent of high school girls reported recent use 

17 of laxatives or vomiting to control their weight. 

18 (11) Binge Eating Disorder is characterized by 

19 frequent episodes of uncontrolled overeating. 

20 (12) Binge Eating Disorder is common: an esti21 mated 2 to 5 percent of Americans experience this 

22 disorder in a 6-month period. 

23 (13) Binge Eating is associated with obesity, 

24 heart disease, gall bladder disease, and diabetes. 
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1 (14) Eating disorders are commonly associated 

2 with substantial psychological problems, including 

3 depression, substance abuse, and suicide. 

4 (15) Obesity is reaching epidemic proportions: 

5 27 percent of United States adults are obese and 13 

6 percent of children and 14 percent of adolescents are 

7 seriously overweight. 

8 (16) Poor eating habits have led to a ‘‘calcium 

9 crisis’’ among American youth: only 13.5 percent of 

10 adolescent girls get the recommended daily amount 

11 of calcium, placing them at serious risk for 

12 osteoporosis and other bone diseases. Because nearly 

13 90 percent of adult bone mass is established by the 

14 end of this age range, the Nation’s youth’s insuffi15 cient calcium intake is truly a calcium crisis. 

16 (17) Eating disorders of all types are more 

17 common in women than men. 

18 (18) Eating preferences and habits are estab19 lished in childhood. 

20 (19) Poor eating habits are a risk factor for the 

21 development of eating disorders, obesity and 

22 osteoporosis. 

23 (20) However, simply urging overweight youth 

24 to be thin has not reduced the prevalence of obesity 
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1 and may result in other problems including body dis2 satisfaction, low self-esteem, and eating disorders. 

3 (21) Therefore, effective interventions for pro4 moting healthy eating behaviors in youth should pro5 mote healthy lifestyle and not inadvertently promote 

6 unhealthy weight management techniques. 

7 SEC. 1103. PURPOSES. 

8 The purposes of this title are as follows: 

9 (1) To increase preventive health activities de10 signed to promote the development of healthy eating 

11 habits and behaviors in youth. 

12 (2) To support research to develop and test 

13 educational curricula and intervention programs 

14 aimed at promoting healthy eating habits and behav15 iors in youth. 

16 (3) To identify and disseminate effective inter17 vention programs aimed at promoting healthy eating 

18 habits and behaviors in youth. 

19 SEC. 1104. AMENDMENTS. 

20 Title III of the of the Public Health Service Act (42 

21 U.S.C. 241 et seq.), as amended in section 801, is further 

22 amended by adding at the end the following: 
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1 ‘‘SEC. 399CC. GRANTS TO PROMOTE CHILDHOOD NUTRI2 TION AND PHYSICAL ACTIVITY. 

3 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

4 through the Director of the Centers for Disease Control 

5 and Prevention (hereafter the ‘Director’) and in coordina6 tion with the Office of Women’s Health and the National 

7 Institutes of Health, shall award competitive grants to 

8 States, political subdivisions of States, accredited univer9 sities, colleges, or nonprofit organizations, for the imple10 mentation of State and community-based intervention pro11 grams to promote good nutrition, including promoting

12 health eating behaviors and physical activity in children 

13 and adolescents. Such grants may be awarded to target 

14 youth or specific at-risk populations, such as adolescent 

15 girls. 

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

17 under this section a State, political subdivision of a State, 

18 university, college, or nonprofit organization shall prepare 

19 and submit to the Secretary an application at such time, 

20 in such manner, and containing such information as the 

21 Secretary may require, including a plan that describes—

22 ‘‘(1) how the applicant proposes to develop a 

23 comprehensive program of school- and community24 based approaches to encourage and promote good 

25 nutrition and appropriate levels of physical activity 
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1 with respect to children or adolescents in local com2 munities; 

3 ‘‘(2) the manner in which the applicant shall 

4 coordinate with appropriate State and local authori5 ties, such as State and local school departments, 

6 State departments of health, chronic disease direc7 tors, State directors of programs under section 17 of 

8 the Child Nutrition Act of 1966, 5-a-day coordina9 tors, governors councils for physical activity and 

10 good nutrition, and State and local parks and recre11 ation departments; and 

12 ‘‘(3) the manner in which the applicant will 

13 evaluate the effectiveness of the program carried out 

14 under this section. 

15 ‘‘(c) USE OF FUNDS.—A State, political subdivision 

16 of a State, university, college, or nonprofit organization 

17 that receives a grant under this section shall use funds 

18 received—

19 ‘‘(1) develop and test educational curricula and 

20 intervention programs designed to promote healthy 

21 eating behaviors and habits in youth, including 

22 science-based interventions with multiple components 

23 such as—

24 ‘‘(A) nutritional content; 
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1 ‘‘(B) understanding and responding to 

2 hunger and satiety; 

3 ‘‘(C) positive body image development; 

4 ‘‘(D) positive self-esteem development; and 

5 ‘‘(E) learning life skills, such as stress 

6 management, communication skills, problem 

7 solving and decision making skills, as well as 

8 consideration of cultural and developmental 

9 issues, and the role of family, school, and com10 munity; 

11 ‘‘(2) develop, implement, disseminate, and 

12 evaluate school and community-based strategies to 

13 reduce inactivity and improve nutrition among chil14 dren and adolescents; 

15 ‘‘(3) expand opportunities for physical activity 

16 programs in school- and community-based settings; 

17 and 

18 ‘‘(4) develop, implement, and evaluate programs 

19 that promote good eating habits and physical activ20 ity including opportunities for children and adoles21 cents with cognitive and physical disabilities. 

22 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may 

23 set-aside an amount not to exceed 10 percent of the 

24 amount appropriated for a fiscal year under subsection (h) 
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1 to permit the Director of the Centers for Disease Control 

2 and Prevention to—

3 ‘‘(1) provide States and political subdivisions of 

4 States with technical support in the development 

5 and implementation of programs under this section; 

6 and 

7 ‘‘(2) disseminate information about effective 

8 strategies and interventions in preventing and treat9 ing obesity through the promotion of good nutrition 

10 and physical activity. 

11 ‘‘(e) LIMITATION ON ADMINISTRATIVE COSTS.—Not 

12 to exceed 10 percent of the amount of a grant awarded 

13 to the State or political subdivision under subsection (a) 

14 for a fiscal year may be used by the State or political sub15 division for administrative expenses. 

16 ‘‘(f) TERM.—A grant awarded under subsection (a) 

17 shall be for a term of not to exceed 4 years. 

18 ‘‘(g) DEFINITIONS.—In this section: 

19 ‘‘(1) CHILDREN AND ADOLESCENTS.—The term 

20 ‘children and adolescents’ means individuals who do 

21 not exceed 18 years of age. 

22 ‘‘(2) HEALTHY EATING.—The term ‘healthy 

23 eating’ means having regular eating habits, such as 

24 eating 3 meals a day to satisfy hunger, eating for 

25 nourishment, health, and energy, eating in such a 
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1 manner as to acknowledge internal signals of appe2 tite and satiety, and eating in a healthy manner in 

3 ordinary social environments to promote healthy so4 cial relationships with family, peers, and community. 

5 ‘‘(h) REPORT.—The Director shall review the results 

6 of the grants awarded under this section and other related 

7 research and identify programs that have demonstrated ef8 fectiveness in promoting healthy eating behaviors and hab9 its in youth. Such programs shall be referred to as ‘‘Pro10 grams that Work’’. Information about Programs that 

11 Work, including program curricula, shall be made readily 

12 available to the public. 

13 ‘‘(i) SUNSET.—The provisions of this section shall be 

14 effective for 5 years after the date of enactment of this 

15 section. 

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

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

18 $5,000,000 for fiscal year 2004, $5,500,000 for fiscal year 

19 2005, $6,000,000 for fiscal year 2006, $6,500,000 for 

20 year 2007, and $1,000,000 for year 2008.’’.

Æ