I
108TH CONGRESS
1ST SESSION
H. R. 2363
To improve early learning opportunities and promote preparedness by increas-
ing the availability of Head Start programs, to increase the availability
and affordability of quality child care, to reduce child hunger and encour-
age healthy eating habits, to facilitate parental involvement, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 5, 2003
Ms. DELAURO (for herself, Mr. CUMMINGS, Mrs. JONES of Ohio, Ms. WOOL-
SEY, Mr. MCNULTY, Mr. OWENS, Mr. SANDERS, Ms. SOLIS, Ms. KAP-
TUR, Mr. PALLONE, Mr. SERRANO, Mr. WAXMAN, Ms. JACKSON-LEE of
Texas, Mr. RODRIGUEZ, Mr. FROST, Ms. LOFGREN, Mr. CONYERS, Mr.
ALLEN, and Mr. BROWN of Ohio) introduced the following bill; which was
referred to the Committee on Education and the Workforce, and in addi-
tion to the Committees on Energy and Commerce, Ways and Means,
House Administration, Government Reform, and Agriculture, for a period
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To improve early learning opportunities and promote pre-
paredness by increasing the availability of Head Start
programs, to increase the availability and affordability
of quality child care, to reduce child hunger and encour-
age healthy eating habits, to facilitate parental involve-
ment, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Right Start Act of 2003’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I—INVESTING IN HEAD START
Sec. 101. Authorization of appropriations.
TITLE II—IMPROVING THE AFFORDABILITY AND QUALITY OF
CHILD CARE FOR WORKING FAMILIES
Sec. 201. Increase in funding for child care.
Sec. 202. Clarification of authority of States to use TANF funds carried over
from prior years to provide TANF benefits and services.
TITLE III—FIGHTING CHILDHOOD HUNGER AND PROMOTING
HEALTHY EATING HABITS
Sec. 301. Short title.
Sec. 302. Findings.
Sec. 303. Definitions.
Subtitle A—Training Grants
Sec. 311. Grants to provide training for health profession students.
Sec. 312. Grants to provide training for health professionals.
Subtitle B—Local Grants
Sec. 321. Grants to increase physical activity and improve nutrition.
Subtitle C—School Health Program
Sec. 331. Establishment of a coordinated school health program.
Sec. 332. National Center for Health Statistics.
Subtitle D—Institute of Medicine Study
Sec. 341. Study of the food supplement and nutrition programs of the Depart-
ment of Agriculture.
Subtitle E—Agency for Healthcare Research and Quality Studies
Sec. 351. Evidence report on weight reduction programs.
Sec. 352. Health disparities report.
care are essential to maximize the development proc-
ess.
(4) Young children receive care in a wide vari-
ety of settings. While 38 percent of young children
receive care solely from their parents, the remaining
62 percent receive care through a variety of full-time
and part-time arrangements, including by relatives,
by nonrelatives (in a variety of home-based settings),
and through center-based programs.
(5) The cognitive, social, and emotional develop-
ment of young children can be enhanced through pa-
rental involvement and high-quality early care, and
developmentally appropriate early education activi-
ties.
(6) Research indicates that successful academic
achievement in education programs for children in
kindergarten and grades 1 through 12 is linked to
participation in high quality early care, including ac-
cess to health care and nutrition, and early edu-
cation activities.
(7) The United States will be stronger now and
in the future if the Nation invests in its children
today.
TITLE I—INVESTING IN HEAD
START
SEC. 101. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—Section 639(a) of the Head Start
Act (42 U.S.C. 9834(a)) is amended by striking ‘‘such
sums’’ and all that follows and inserting the following:
‘‘$7,500,000,000 for fiscal year 2004, $8,290,000,000 for
fiscal year 2005, $9,040,000,000 for fiscal year 2006,
$9,890,000,000 
for 
fiscal 
year 
2007, 
and
$10,890,000,000 for fiscal year 2008.’’.
(b) CONFORMING AMENDMENTS.—
(1) RESERVATIONS.—Paragraphs (1) and (3) of
section 639(b) of the Head Start Act (42 U.S.C.
9834(b)) are amended by striking ‘‘2003’’ and in-
serting ‘‘2008’’.
(2) DISTRIBUTION.—Paragraphs (3)(A)(i)(I)
and (6)(A) of section 640(a) of the Head Start Act
(42 U.S.C. 9835(a)) are amended by striking ‘‘fiscal
year 2003’’ and inserting ‘‘each of fiscal years 2004
through 2008’’.
TITLE II—IMPROVING THE AF-
FORDABILITY AND QUALITY
OF CHILD CARE FOR WORK-
ING FAMILIES
SEC. 201. INCREASE IN FUNDING FOR CHILD CARE.
(a) INCREASE IN FUNDING.—Section 418(a)(3) of
the Social Security Act (42 U.S.C. 618(a)(3)) is
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (E);
(2) by striking the period at the end of sub-
paragraph (F) and inserting a semicolon; and
(3) by adding at the end the following:
‘‘(G) $3,717,000,000 for fiscal year 2004;
‘‘(H) $4,217,000,000 for fiscal year 2005;
‘‘(I) $4,917,000,000 for fiscal year 2006;
‘‘(J) $5,617,000,000 for fiscal year 2007;
and
‘‘(K) 
$6,367,000,000 
for 
fiscal 
year
2008.’’.
(b) INCREASE IN SET ASIDE FOR CHILD CARE QUAL-
ITY.—Section 658G of the Child Care and Development
Block Grant Act of 1990 (42 U.S.C. 9858e) is amended
by striking ‘‘4 percent’’ and inserting ‘‘10 percent’’.
(c) INDIAN TRIBES AND PUERTO RICO.—
(1) IN GENERAL.—Section 418(a) of the Social
Security Act (42 U.S.C. 618(a)) is amended by
striking paragraph (4) and inserting the following:
‘‘(4) AMOUNTS RESERVED.—
‘‘(A) INDIAN TRIBES.—The Secretary shall
reserve 2 percent of the aggregate amount ap-
propriated to carry out this section under para-
graphs (3) and (5) for each fiscal year for pay-
ments to Indian tribes and tribal organizations
for each such fiscal year for the purpose of pro-
viding child care assistance.
‘‘(B) PUERTO RICO.—The Secretary shall
reserve $10,000,000 of the amount appro-
priated under paragraph (3) for each fiscal year
for payments to the Commonwealth of Puerto
Rico for each such fiscal year for the purpose
of providing child care assistance.’’.
(2) 
CONFORMING
AMENDMENT.—Section
1108(a)(2) of the Social Security Act (42 U.S.C.
1308(a)(2)) is amended by striking ‘‘or 413(f)’’ and
inserting ‘‘413(f), or 418(a)(4)(B)’’.
SEC. 202. CLARIFICATION OF AUTHORITY OF STATES TO
USE TANF FUNDS CARRIED OVER FROM
PRIOR YEARS TO PROVIDE TANF BENEFITS
AND SERVICES.
Section 404(e) of the Social Security Act (42 U.S.C.
604(e)) is amended—
(1) in the subsection heading, by striking ‘‘AS-
SISTANCE’’ and inserting ‘‘BENEFITS OR SERVICES’’;
and
(2) after the heading, by striking ‘‘assistance’’
and inserting ‘‘any benefit or service that may be
provided’’.
TITLE 
III—FIGHTING 
CHILD-
HOOD 
HUNGER 
AND 
PRO-
MOTING 
HEALTHY 
EATING
HABITS
SEC. 301. SHORT TITLE.
This title may be cited as the ‘‘Improved Nutrition
and Physical Activity Act’’ or the ‘‘IMPACT Act’’.
SEC. 302. 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 over-
weight 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 as-
sociated 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 in-
creasing the proportion of adults who are at a
healthy weight, reducing the proportion of adults
who are obese, and reducing the proportion of chil-
dren and adolescents who are overweight or obese.
(7) Another goal of Healthy People 2010 is to
eliminate health disparities among different seg-
ments 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 preven-
tion 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 to-
bacco-related illnesses and appears to be rising dra-
matically.
(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 con-
sensus documents, including ‘‘A Call to Action’’ and
other documents prepared by the Department of
Health and Human Services and other agencies.
SEC. 303. DEFINITIONS.
In this title:
(1) OBESE.—The term ‘‘obese’’ means an adult
with a Body Mass Index (BMI) of 30 kg/m2 or
greater.
(2) OVERWEIGHT.—The term ‘‘overweight’’
means an adult with a Body Mass Index (BMI) of
25 to 29.9 kg/m2 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.
(3) SECRETARY.—Unless otherwise indicated,
term ‘‘Secretary’’ means the Secretary of Health
and Human Services.
Subtitle A—Training Grants
SEC. 311. 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 303 of the Improved Nutrition and Physical Ac-
tivity Act) and at risk for related, serious and chronic
medical conditions’’.
SEC. 312. GRANTS TO PROVIDE TRAINING FOR HEALTH
PROFESSIONALS.
Section 399Z of the Public Health Service Act (42
U.S.C. 280h–3) is amended by striking subsection (b) and
inserting 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 pro-
fessionals on how to identify, treat, and prevent obe-
sity and aid individuals who are overweight (as such
term is defined in section 303 of the Improved Nu-
trition and Physical Activity Act).
‘‘(2) APPLICATION.—An entity that desires a
grant under this subsection shall submit an applica-
tion 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, in-
cluding Internet-based courses and telecon-
ferences, on—
‘‘(i) how to treat and prevent obesity
and being overweight using nutritional
counseling, methods to increase physical
activity, pharmacological therapies, motiva-
tional 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 there-
fore 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 nutri-
tional status, physical inactivity, and per-
sonal and family history of obesity and re-
lated serious and chronic medical condi-
tions; and
‘‘(v) how to educate patients and their
families about effective strategies to im-
prove dietary habits and establish appro-
priate 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 preju-
dice about obesity or being overweight;
‘‘(C) evaluate the effectiveness of the train-
ing provided by such entity in increasing knowl-
edge and changing attitudes and behaviors of
trainees;
‘‘(D) develop training materials and course
content using evidence-based findings or rec-
ommendations that pertain to obesity and over-
weight treatment and prevention ; and
‘‘(E) collaborate with other training pro-
grams related to overweight and obesity preven-
tion and treatment.
‘‘(4) EVALUATION.—
‘‘(A) IN
GENERAL.—An entity that re-
ceives a grant under this subsection shall sub-
mit to the Secretary an evaluation that de-
scribes 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, improv-
ing nutrition, and preventing individuals from
becoming overweight or obese, treating individ-
uals who are overweight or obese, and any other
information that the Secretary may require.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$10,000,000 for fiscal year 2004, and such sums as may
be necessary for each of the fiscal years 2005 through
2008.’’.
Subtitle B—Local Grants
SEC. 321. 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 fol-
lowing:
‘‘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 Pre-
vention and in consultation with Administrator of the
Health Resources and Services Administration, the Direc-
tor 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 com-
petent community-based programs and promote good nu-
trition and physical activity to prevent overweight, obesity
(as such terms are defined in section 303 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
303 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 re-
quire, 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 en-
sure that the proposed programs are coordinated in sub-
stance 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 environ-
mental changes that promote physical activity.
‘‘(2) Forming partnerships and activities with
businesses and other entities to increase activity lev-
els at the workplace and while traveling to and from
the workplace, develop wellness programs that relate
to overweight and obesity, and to enhance nutri-
tional 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 dur-
ing working hours; and
‘‘(C) improve available food options.
‘‘(4) Forming partnerships with public and pri-
vate 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 tax or other incentives for re-
tail food stores, grocery stores, and other retail food
outlets that offer nutritious foods, to encourage such
stores and outlets to locate in economically de-
pressed 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 nutri-
tion, including strength, flexibility, and aerobic class-
es.
‘‘(7) Providing educational activities targeting
healthier eating, such as cooking and shopping dem-
onstrations, onsite consultation by nutrition profes-
sionals at restaurants, and community educational
outreach 
using 
evidence-based 
nutrition 
rec-
ommendations.
‘‘(8) Forming partnerships with day care facili-
ties to establish programs that promote improved
nutritional status and physical activity.
‘‘(9) Providing training and supervision of com-
munity health workers by 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;
‘‘(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.’’.
Subtitle C—School Health Program
SEC. 331. 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 303
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:
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 qualified community-based nonprofit entity desir-
ing a grant under this subsection shall submit an
application to the Secretary at such time, in such
manner, and containing such information as the Sec-
retary may require.
‘‘(3) 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. 332. 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.’’.
Subtitle D—Institute of Medicine
Study
SEC. 341. 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.
Subtitle E—Agency for Healthcare
Research and Quality Studies
SEC. 351. 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. 352. 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)).
Subtitle F—Preventive Health and
Health Services Block Grant
SEC. 361. 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.’’.
Subtitle G—Medicare Nutrition
Therapy Demonstration Project
SEC. 371. 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 other agencies in the Depart-
ment of Health and Human Services, and profes-
sional organizations, as the Secretary determines to
be appropriate on the design, conduct, and evalua-
tion 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.
Subtitle H—Overweight and Obe-
sity Treatment and Prevention
Demonstration Projects
SEC. 381. 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 321, 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 303 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.’’.
Subtitle I—Research on Obesity
SEC. 391. 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.
Subtitle J—Youth Media Campaign
SEC. 395. 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 by striking subsection (b) and
inserting 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 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.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$125,000,000 for fiscal year 2004, and such sums as nec-
essary for each of fiscal years 2005 through 2008.’’.
Subtitle K—Sense of the Senate
SEC. 399. SENSE OF THE SENATE CONCERNING NUTRITION.
(a) FINDINGS.—Congress makes the following find-
ings:
(1) Key child nutrition programs are up for re-
authorization in the 108th Congress, including the
School Breakfast Program, School Lunch Program,
Special Milk Program, Child and Adult Care Food
Program, Summer Food Service Program, and the
Women’s, Infant’s, and Children’s (WIC) Program.
(2) The United States Department of Agri-
culture reports, based on national United States
Census Bureau data, that in 2000 10.5 percent of
all 
United 
States 
households, 
representing
20,000,000 adults and 13,000,000 children, were
‘‘food insecure’’. Of the 11,000,000 households that
were food insecure, 3,300,000 suffered from food in-
security that was so severe that USDA’s very con-
servative measure classified them as ‘‘hungry’’.
2,700,000 children lived in these hungry households.