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 ap-
propriate 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 aca-
demic health center or other qualified community-based 
entity, that describes activities carried out with funds re-
ceived under this section, the long-term effectiveness of 
such activities in increasing physical activity, improving 
nutrition, and preventing individuals from becoming over-
weight or obese, and such other information as the Sec-
retary may require. 
‘‘(e) MATCHING FUNDS.—In awarding grants under 
subsection (a), the Secretary may give priority to appli-
cants 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 strate-
gies 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 Ad-
ministrator of the Health Resources and Services Admin-
istration, the Secretary of Education, the Secretary of Ag-
riculture, and the Secretary of the Interior, shall, as part 
of the Centers for Disease Control and Prevention’s co-
ordinated school health program currently operated pursu-
ant 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 cur-
ricula 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 edu-
cation 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 para-
graphs (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 com-
petitive 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 collabo-
ration with statewide coordinated school health pro-
grams, 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 describ-
ing 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 empha-
sis on nutrition and physical activity for each 
grade level. 
‘‘(B) Planning and implementing a phys-
ical education and activity curriculum or pro-
gram for each grade level and purchasing ap-
propriate equipment, with no more than 15 per-
cent 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 nu-
trition and physical activity practices. 
‘‘(G) Other activities as deemed appro-
priate by the Secretary.
‘‘(4) EVALUATION.—An agency that receives a 
grant under this subsection shall submit to the Sec-
retary an evaluation, in collaboration with an aca-
demic 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 Sec-
retary may require. 
‘‘(c) COMMUNITY EDUCATIONAL GRANTS.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Centers for Disease Control and Preven-
tion, 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 iden-
tify 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 appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary 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 re-
gional 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.—Informa-
tion 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 de-
scribed 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 strate-
gies 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 fit-
ness 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 maxi-
mize the data quality and comparability with other stud-
ies.’’. 
TITLE IV—INSTITUTE OF 
MEDICINE STUDY 
SEC. 401. STUDY OF THE FOOD SUPPLEMENT AND NUTRI-
TION 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 lat-
est scientific evidence; 
(2) investigate whether the food assistance pro-
grams contribute to either preventing or enhancing
obesity and being overweight in children, adoles-
cents, and adults; 
(3) investigate whether the food assistance pro-
grams 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 PRO-
GRAMS. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity, shall conduct or support an evidence report on the ef-
fectiveness 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 modifica-
tion, 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 re-
port that describes the results of the evidence report de-
scribed 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 impor-
tant 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 add-
ing at the end the following: 
‘‘(H) Activities and community education pro-
grams designed to address and prevent overweight, 
obesity, and eating disorders through effective pro-
grams to promote healthy eating, and exercise habits 
and behaviors.’’. 
TITLE 
VII—MEDICARE 
NUTRI-
TION THERAPY DEMONSTRA-
TION PROJECT 
SEC. 701. DEMONSTRATION PROJECT TO REDUCE OBESITY 
AND OTHER CHRONIC DISEASE RISKS. 
(a) DEMONSTRATION.—The Secretary, in consulta-
tion 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 de-
termines to be appropriate; 
(4) provide ongoing support to reduce risk fac-
tors and promote the appropriate use of preventive 
and screening benefits; and 
(5) improve health outcomes, satisfaction, qual-
ity 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 dif-
ferent segments of the population including racial
and ethnic minority groups and persons of lower so-
cioeconomic status. The demonstration is completely 
voluntary on the part of target individuals. 
(2) SELF-ASSESSMENT.—The term ‘‘self-assess-
ment’’ 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 Sec-
retary determines appropriate. 
(3) ONGOING
SUPPORT.—The term ‘‘ongoing 
support’’ means—
(A) to provide target individuals with in-
formation, feedback, health coaching, and rec-
ommendations 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 includ-
ing medical nutrition therapy; 
(B) to provide target individuals with re-
ferrals to community resources and programs 
(such as senior centers) available to assist the 
target individual in reducing health risks; 
(C) information on available volunteer op-
portunities 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 Sec-
retary shall design the demonstration project. The 
demonstration should draw upon promising, innova-
tive models and incentives to reduce behavioral risk 
factors. The Administrator of the Centers for Medi-
care & Medicaid Services shall consult with the Di-
rector of the Centers for Disease Control and Pre-
vention, the Director of the Office of Minority 
Health, and the heads of other agencies in the De-
partment of Health and Human Services, and pro-
fessional organizations, as the Secretary determines 
to be appropriate on the design, conduct, and eval-
uation 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 pro-
grams should be implemented for the general medi-
care 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, evalu-
ates the beneficiary satisfaction under the project, and in-
cludes 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 So-
cial Security Act (42 U.S.C. 1395 et seq.) to such extent 
and for such period as the Secretary determines is nec-
essary 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 
DEMONSTRA-
TION PROJECTS 
SEC. 801. GRANTS TO LOCAL HEALTHCARE DELIVERY SYS-
TEMS. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) as amended in section 201, is further amend-
ed 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 sec-
tion 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, In-
dian 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 con-
taining such information as the Secretary may require, in-
cluding 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 avail-
able through the grant to carry out 3 or more of the fol-
lowing activities in a culturally and linguistically appro-
priate 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 nutri-
tion and physical activity by a health professional to 
provide better understanding of the relationship be-
tween 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 individ-
uals to appropriate health care agencies and commu-
nity-based programs and organizations in order to 
increase access to quality health care services, in-
cluding preventive health services. 
‘‘(6) Training and supervising community 
health workers by qualified health professionals to—
‘‘(A) educate families regarding the rela-
tionship between nutrition, eating habits, phys-
ical activity, and obesity; 
‘‘(B) educate families about effective strat-
egies 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 appro-
priate 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 strate-
gies 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 Pen-
sions 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, cur-
rent, ongoing research being conducted in the de-
partment including—
(A) the types and numbers of studies com-
pleted or being conducted by the National Insti-
tutes of Health on—
(i) mechanisms responsible for obesity 
(including nutrition, physical activity, ge-
netic causes such as syndrome X), the pre-
vention of and the treatment for obesity 
and related, serious, and chronic medical
conditions (including diabetes and cardio-
vascular disease); and 
(ii) psychosocial aspects of obesity; 
(B) the types and number of studies com-
pleted or being conducted by the Centers for 
Disease Control and Prevention on individual 
and community interventions to prevent individ-
uals from becoming overweight or obese; 
(C) the types of studies completed or being 
conducted by the Agency for Healthcare Re-
search and Quality on the treatment and pre-
vention of overweight and obesity; 
(D) the types of studies being conducted 
by the Health Resources and Services Adminis-
tration on the prevention of overweight and obe-
sity; 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 popu-
lations, the department’s plan for conducting such 
research, and how current knowledge can be dissemi-
nated.
TITLE X—YOUTH MEDIA 
CAMPAIGN 
SEC. 1001. GRANTS AND CONTRACTS FOR A NATIONAL CAM-
PAIGN TO CHANGE CHILDREN’S HEALTH BE-
HAVIORS. 
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 sub-
section (c); and 
(3) by inserting after subsection (a) the fol-
lowing: 
‘‘(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 con-
tracts to eligible entities to design and implement 
culturally and linguistically appropriate and com-
petent campaigns to change children’s health behav-
iors. 
‘‘(2) ELIGIBLE ENTITY.—In this subsection, the 
term ‘eligible entity’ means a marketing, public rela-
tions, advertising, or other appropriate entity.
‘‘(3) CONTENT.—An eligible entity that receives 
a grant under this subsection shall use funds re-
ceived through such grant or contract to utilize mar-
keting 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 activi-
ties; 
‘‘(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 improv-
ing nutrition, how to maintain healthy behav-
iors for the entire family, and how to encourage 
children to develop good nutrition and physical 
activity habits; and 
‘‘(E) discourage stigmatization and dis-
crimination based on body size or shape. 
‘‘(4) REPORT.—The Secretary shall evaluate 
the effectiveness of the campaign described in para-
graph (1) in changing children’s behaviors and re-
port such results to the Committee on Health, Edu-
cation, 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 adoles-
cence.
(6) Bulimia Nervosa is an eating disorder char-
acterized by excessive food consumption followed by 
inappropriate compensatory behaviors, such as self-
induced vomiting, misuse of laxatives, fasting, or ex-
cessive 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 ir-
regular heartbeats, gastric rupture, peptic ulcer, and 
tooth decay. 
(9) Bulimia Nervosa usually appears in adoles-
cence. 
(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 esti-
mated 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 insuffi-
cient 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 estab-
lished 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 dis-
satisfaction, low self-esteem, and eating disorders. 
(21) Therefore, effective interventions for pro-
moting healthy eating behaviors in youth should pro-
mote 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 de-
signed 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 behav-
iors in youth. 
(3) To identify and disseminate effective inter-
vention 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 NUTRI-
TION 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 coordina-
tion with the Office of Women’s Health and the National 
Institutes of Health, shall award competitive grants to 
States, political subdivisions of States, accredited univer-
sities, colleges, or nonprofit organizations, for the imple-
mentation of State and community-based intervention pro-
grams 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 com-
munities; 
‘‘(2) the manner in which the applicant shall 
coordinate with appropriate State and local authori-
ties, such as State and local school departments, 
State departments of health, chronic disease direc-
tors, State directors of programs under section 17 of 
the Child Nutrition Act of 1966, 5-a-day coordina-
tors, governors councils for physical activity and 
good nutrition, and State and local parks and recre-
ation 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 com-
munity; 
‘‘(2) develop, implement, disseminate, and 
evaluate school and community-based strategies to 
reduce inactivity and improve nutrition among chil-
dren 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 activ-
ity including opportunities for children and adoles-
cents 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 treat-
ing 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 sub-
division 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 appe-
tite and satiety, and eating in a healthy manner in 
ordinary social environments to promote healthy so-
cial 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 ef-
fectiveness in promoting healthy eating behaviors and hab-
its in youth. Such programs shall be referred to as ‘‘Pro-
grams 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.’’.
Æ