I 
109TH CONGRESS 
2D SESSION 
H. R. 5698 
To establish grants to provide health services for improved nutrition, increased 
physical activity, obesity and eating disorder prevention, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 28, 2006 
Mrs. BONO (for herself, Ms. GRANGER, Mr. BLUMENAUER, Mr. WAMP, and 
Mrs. LOWEY) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To establish grants to provide health services for improved 
nutrition, increased physical activity, obesity and eating 
disorder prevention, 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. 
This Act may be cited as the ‘‘Improved Nutrition 
and Physical Activity Act’’ or the ‘‘IMPACT Act’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) In July 2004, the Secretary of Health and 
Human Service recognized ‘‘obesity is a critical pub-
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lic health problem in our country’’ and under the 
medicare program language was removed from the 
coverage manual stating that obesity is not an ill-
ness. 
(2) The National Health and Nutrition Exam-
ination Survey for 2002 found that an estimated 65 
percent of adults are overweight and 31 percent of 
adults are obese and 16 percent of children and ado-
lescents in the United States are overweight or 
obese. 
(3) The Institute of Medicine reported in ‘‘Pre-
venting Childhood Obesity’’ (2004) that approxi-
mately 60 percent of obese children between 5 and 
10 years of age have at least one cardiovascular dis-
ease risk factor and 25 percent have two or more 
such risk factors. 
(4) The Institute of Medicine reports that the 
prevalence of overweight and obesity is increasing 
among all age groups. There is twice the number of 
overweight children between 2 and 5 years of age 
and adolescents between 12 and 19 years of age, 
and 3 times the number of children between 6 and 
11 years of age as there were 30 years ago. 
(5) According to the 2004 Institute of Medicine 
report, obesity-associated annual hospital costs for 
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children and youth more than tripled over 2 decades, 
rising from $35,000,000 in the period 1979 through 
1981 to $127,000,000 in the period 1997 through 
1999. 
(6) The Centers for Disease Control and Pre-
vention reports have estimated that as many as 
365,000 deaths a year are associated with being 
overweight or obese. Overweight and obesity are as-
sociated with an 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. 
(7) According to the National Institute of Dia-
betes and Digestive and Kidney Diseases, individuals 
who are obese have a 50 to 100 percent increased 
risk of premature death. 
(8) The Healthy People 2010 goals identify 
overweight and obesity as one of the Nation’s lead-
ing health problems and include objectives for 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. 
(9) Another goal of Healthy People 2010 is to 
eliminate health disparities among different seg-
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ments of the population. Obesity is a health problem 
that disproportionally impacts medically underserved 
populations. 
(10) The 2005 Surgeon General’s report ‘‘The 
Year of the Healthy Child’’ lists the treatment and 
prevention of obesity as a national priority. 
(11) The Institute of Medicine report ‘‘Pre-
venting Childhood Obesity’’ (2004) finds that ‘‘child-
hood obesity is a serious nationwide health problem 
requiring urgent attention and a population-based 
prevention approach . . .’’. 
(12) The Centers for Disease Control and Pre-
vention estimates the annual expenditures related to 
overweight and obesity in adults in the United 
States to be $264,000,000,000 (exceeding the cost 
of tobacco-related illnesses) and appears to be rising 
dramatically. This cost can potentially escalate 
markedly as obesity rates continue to rise and the 
medical complications of obesity are emerging at 
even younger ages. Therefore, the total disease bur-
den will most likely increase, as well as the attend-
ant health-related costs. 
(13) Weight control programs should promote a 
healthy lifestyle including regular physical activity 
and healthy eating, as consistently discussed and 
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identified in a variety of public and private con-
sensus documents, including the 2001 U.S. Surgeon 
General’s report ‘‘A Call To Action’’ and other docu-
ments prepared by the Department of Health and 
Human Services and other agencies. 
(14) The Institute of Medicine reports that 
poor eating habits are a risk factor for the develop-
ment of eating disorders and obesity. In 2002, more 
than 35,000,000 Americans experienced limited ac-
cess to nutritious food on a regular basis. The avail-
ability of high-calorie, low nutrient foods have in-
creased in low-income neighborhoods due to many 
factors. 
(15) Effective interventions for promoting 
healthy eating behaviors should promote healthy life-
style and not inadvertently promote unhealthy 
weight management techniques. 
(16) The National Institutes of Health reports 
that eating disorders are commonly associated with 
substantial psychological problems, including depres-
sion, substance abuse, and suicide. 
(17) The National Association of Anorexia 
Nervosa and Associated Disorders estimates there 
are 8,000,000 Americans experience eating dis-
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orders. Eating disorders of all types are more com-
mon in women than men. 
(18) The health risks of Binge Eating Disorder 
are those associated with obesity and include heart 
disease, gall bladder disease, and diabetes. 
(19) According to the National Institute of 
Mental Health, Binge Eating Disorder is character-
ized by frequent episodes of uncontrolled overeating, 
with an estimated 2 to 5 percent of Americans expe-
riencing this disorder in a 6-month period. 
(20) Additionally, the National Institute of 
Mental Health reports that Anorexia Nervosa, an 
eating disorder from which 0.5 to 3.7 percent of 
American women will suffer in their lifetime, is asso-
ciated with serious health consequences including 
heart failure, kidney failure, osteoporosis, and death. 
According to the National Institute of Mental 
Health, Anorexia Nervosa has one of the highest 
mortality rates of all psychiatric disorders, placing a 
young woman with Anorexia Nervosa at 12 times 
the risk of death of other women her age. 
(21) In 2001, the National Institute of Mental 
Health reported that 1.1 to 4.2 percent of American 
women will suffer from Bulimia Nervosa in their 
lifetime. Bulimia Nervosa is an eating disorder that 
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is associated with cardiac, gastrointestinal, and den-
tal problems, including irregular heartbeats, gastric 
ruptures, peptic ulcers, and tooth decay. 
(22) On the 2003 Youth Risk Behavior Survey, 
6 percent of high school students reported recent use 
of laxatives or vomiting to control their weight. 
TITLE I—TRAINING GRANTS 
SEC. 101. GRANTS TO PROVIDE TRAINING FOR HEALTH 
PROFESSION STUDENTS. 
Section 747(c)(3) of the Public Health Service Act 
(42 U.S.C. 293k(c)(3)) is amended by striking ‘‘and vic-
tims of domestic violence’’ and inserting ‘‘victims of do-
mestic violence, individuals (including children) who are 
overweight or obese (as such terms are defined in section 
399W(j)) and at risk for related serious and chronic med-
ical conditions, and individuals who suffer from eating dis-
orders’’. 
SEC. 102. GRANTS TO PROVIDE TRAINING FOR HEALTH 
PROFESSIONALS. 
Section 399Z of the Public Health Service Act (42 
U.S.C. 280h–3) is amended— 
(1) in subsection (b), by striking ‘‘2005’’ and 
inserting ‘‘2008’’; 
(2) by redesignating subsection (b) as sub-
section (c); and 
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(3) by inserting after subsection (a) the fol-
lowing: 
‘‘(b) GRANTS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
grants to eligible entities to train primary care phy-
sicians and other licensed or certified health profes-
sionals on how to identify, treat, and prevent obesity 
or eating disorders and aid individuals who are over-
weight, obese, or who suffer from eating disorders. 
‘‘(2) APPLICATION.—An entity that desires a 
grant under this subsection shall submit an applica-
tion at such time, in such manner, and containing 
such information as the Secretary may require, in-
cluding 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) use evidence-based findings or rec-
ommendations that pertain to the prevention 
and treatment of obesity, being overweight, and 
eating disorders to conduct educational con-
ferences, including Internet-based courses and 
teleconferences, on— 
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‘‘(i) how to treat or prevent obesity, 
being overweight, and eating disorders; 
‘‘(ii) the link between obesity, being 
overweight, eating disorders and related se-
rious and chronic medical conditions; 
‘‘(iii) how to discuss varied strategies 
with patients from at-risk and diverse pop-
ulations to promote positive behavior 
change and healthy lifestyles to avoid obe-
sity, being overweight, and eating dis-
orders; 
‘‘(iv) how to identify overweight, 
obese, individuals with eating disorders, 
and those who are at risk for obesity and 
being overweight or suffer from eating dis-
orders and, therefore, at risk for related 
serious and chronic medical conditions; and 
‘‘(v) how to conduct a comprehensive 
assessment of individual and familial 
health risk factors; and 
‘‘(B) evaluate the effectiveness of the 
training provided by such entity in increasing 
knowledge and changing attitudes and behav-
iors of trainees. 
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‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, $10,000,000 for fiscal year 2007, 
and such sums as may be necessary for each of fis-
cal years 2008 through 2011.’’. 
TITLE 
II—COMMUNITY-BASED 
SOLUTIONS 
TO 
INCREASE 
PHYSICAL 
ACTIVITY, 
IM-
PROVE NUTRITION, AND PRO-
MOTE HEALTHY EATING BE-
HAVIORS 
SEC. 201. GRANTS TO INCREASE PHYSICAL ACTIVITY, IM-
PROVE NUTRITION, AND PROMOTE HEALTHY 
EATING BEHAVIORS. 
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 TO INCREASE PHYSICAL ACTIVITY, IM-
PROVE NUTRITION, AND PROMOTE HEALTHY 
EATING BEHAVIORS. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention and in coordination with the 
Administrator of the Health Resources and Services 
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Administration, the Director of the Indian Health 
Service, the Secretary of Education, the Secretary of 
Agriculture, the Secretary of the Interior, the Direc-
tor of the National Institutes of Health, the Director 
of the Office of Women’s Health, and the heads of 
other appropriate agencies, shall award competitive 
grants to eligible entities to plan and implement pro-
grams that promote healthy eating behaviors and 
physical activity to prevent eating disorders, obesity, 
being overweight, and related serious and chronic 
medical conditions. Such grants may be awarded to 
target at-risk populations including youth, adoles-
cent girls, health disparity populations (as defined in 
section 485E(d)), and the underserved. 
‘‘(2) TERM.—The Secretary shall award grants 
under this subsection for a period not to exceed 4 
years. 
‘‘(b) 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— 
‘‘(1) a plan describing a comprehensive pro-
gram of approaches to encourage healthy eating be-
haviors and healthy levels of physical activity; 
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‘‘(2) the manner in which the eligible entity will 
coordinate with appropriate State and local authori-
ties, including— 
‘‘(A) State and local educational agencies; 
‘‘(B) departments of health; 
‘‘(C) chronic disease directors; 
‘‘(D) State directors of programs under 
section 17 of the Child Nutrition Act of 1966 
(42 U.S.C. 1786); 
‘‘(E) governors’ councils for physical activ-
ity and good nutrition; 
‘‘(F) State and local parks and recreation 
departments; and 
‘‘(G) State and local departments of trans-
portation and city planning; and 
‘‘(3) the manner in which the applicant will 
evaluate the effectiveness of the program carried out 
under this section. 
‘‘(c) COORDINATION.—In awarding grants under this 
section, the Secretary shall ensure that the proposed pro-
grams are coordinated in substance and format with pro-
grams currently funded through other Federal agencies 
and operating within the community including the Phys-
ical Education Program (PEP) of the Department of Edu-
cation. 
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‘‘(d) ELIGIBLE ENTITY.—In this section, the term 
‘eligible entity’ means— 
‘‘(1) a city, county, tribe, territory, or State; 
‘‘(2) a State educational agency; 
‘‘(3) a tribal educational agency; 
‘‘(4) a local educational agency; 
‘‘(5) a federally qualified health center (as de-
fined in section 1861(aa)(4) of the Social Security 
Act (42 U.S.C. 1395x(aa)(4)); 
‘‘(6) a rural health clinic; 
‘‘(7) a health department; 
‘‘(8) an Indian Health Service hospital or clinic; 
‘‘(9) an Indian tribal health facility; 
‘‘(10) an urban Indian facility; 
‘‘(11) any health provider; 
‘‘(12) an accredited university or college; 
‘‘(13) a community-based organization; 
‘‘(14) a local city planning agency; or 
‘‘(15) any other entity determined appropriate 
by the Secretary. 
‘‘(e) USE OF FUNDS.—An eligible entity that receives 
a grant under this section shall use the funds made avail-
able through the grant to— 
‘‘(1) carry out community-based activities in-
cluding— 
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‘‘(A) city planning, transportation initia-
tives, and environmental changes that help pro-
mote physical activity, such as increasing the 
use of walking or bicycling as a mode of trans-
portation; 
‘‘(B) forming partnerships and activities 
with businesses and other entities to increase 
physical activity levels and promote healthy eat-
ing behaviors at the workplace and while trav-
eling to and from the workplace; 
‘‘(C) forming partnerships with entities, in-
cluding schools, faith-based entities, and other 
facilities providing recreational services, to es-
tablish programs that use their facilities for 
after school and weekend community activities; 
‘‘(D) establishing incentives for retail food 
stores, farmer’s markets, food co-ops, grocery 
stores, and other retail food outlets that offer 
nutritious foods to encourage such stores and 
outlets to locate in economically depressed 
areas; 
‘‘(E) forming partnerships with senior cen-
ters, nursing facilities, retirement communities, 
and assisted living facilities to establish pro-
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grams for older people to foster physical activ-
ity and healthy eating behaviors; 
‘‘(F) forming partnerships with daycare fa-
cilities to establish programs that promote 
healthy eating behaviors and physical activity; 
and 
‘‘(G) developing and evaluating community 
educational activities targeting good nutrition 
and promoting healthy eating behaviors; 
‘‘(2) carry out age-appropriate school-based ac-
tivities including— 
‘‘(A) developing and testing educational 
curricula and intervention programs designed to 
promote healthy eating behaviors and habits in 
youth, which may include— 
‘‘(i) after hours physical activity pro-
grams; 
‘‘(ii) increasing opportunities for stu-
dents to make informed choices regarding 
healthy eating behaviors; and 
‘‘(iii) science-based interventions with 
multiple components to prevent eating dis-
orders including nutritional content, under-
standing and responding to hunger and sa-
tiety, positive body image development, 
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positive 
self-esteem 
development, 
and 
learning life skills (such as stress manage-
ment, communication skills, problem-solv-
ing and decisionmaking skills), as well as 
consideration of cultural and develop-
mental issues, and the role of family, 
school, and community; 
‘‘(B) providing education and training to 
educational professionals regarding a healthy 
lifestyle and a healthy school environment; 
‘‘(C) planning and implementing a healthy 
lifestyle curriculum or program with an empha-
sis on healthy eating behaviors and physical ac-
tivity; and 
‘‘(D) planning and implementing healthy 
lifestyle classes or programs for parents or 
guardians, with an emphasis on healthy eating 
behaviors and physical activity; 
‘‘(3) carry out activities through the local 
health care delivery systems including— 
‘‘(A) promoting healthy eating behaviors 
and physical activity services to treat or prevent 
eating disorders, being overweight, and obesity; 
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‘‘(B) providing patient education and coun-
seling to increase physical activity and promote 
healthy eating behaviors; and 
‘‘(C) providing community education on 
good nutrition and physical activity to develop 
a better understanding of the relationship be-
tween diet, physical activity, and eating dis-
orders, obesity, or being overweight; or 
‘‘(4) other activities determined appropriate by 
the Secretary (including evaluation or identification 
and dissemination of outcomes and best practices). 
‘‘(f) MATCHING FUNDS.—In awarding grants under 
subsection (a), the Secretary may give priority to eligible 
entities who provide matching contributions. Such non- 
Federal contributions may be cash or in kind, fairly evalu-
ated, including plant, equipment, or services. 
‘‘(g) TECHNICAL ASSISTANCE.—The Secretary may 
set aside an amount not to exceed 10 percent of the total 
amount appropriated for a fiscal year under subsection (k) 
to permit the Director of the Centers for Disease Control 
and Prevention to provide grantees with technical support 
in the development, implementation, and evaluation of 
programs under this section and to disseminate informa-
tion about effective strategies and interventions in pre-
venting and treating obesity and eating disorders through 
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the promotion of healthy eating behaviors and physical ac-
tivity. 
‘‘(h) LIMITATION ON ADMINISTRATIVE COSTS.—An 
eligible entity awarded a grant under this section may not 
use more than 10 percent of funds awarded under such 
grant for administrative expenses. 
‘‘(i) REPORT.—Not later than 6 years after the date 
of enactment of the Improved Nutrition and Physical Ac-
tivity Act, the Director of the Centers for Disease Control 
and Prevention shall review the results of the grants 
awarded under this section and other related research and 
identify programs that have demonstrated effectiveness in 
promoting healthy eating behaviors and physical activity 
in youth. Such review shall include an identification of 
model curricula, best practices, and lessons learned, as 
well as recommendations for next steps to reduce over-
weight, obesity, and eating disorders. Information derived 
from such review, including model program curricula, shall 
be disseminated to the public. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) ANOREXIA NERVOSA.—The term ‘Anorexia 
Nervosa’ means an eating disorder characterized by 
self-starvation and excessive weight loss. 
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‘‘(2) BINGE
EATING
DISORDER.—The term 
‘binge eating disorder’ means a disorder character-
ized by frequent episodes of uncontrolled eating. 
‘‘(3) BULIMIA
NERVOSA.—The term ‘Bulimia 
Nervosa’ means an eating disorder characterized by 
excessive food consumption, followed by inappro-
priate compensatory behaviors, such as self-induced 
vomiting, misuse of laxatives, fasting, or excessive 
exercise. 
‘‘(4) EATING
DISORDERS.—The term ‘eating 
disorders’ means disorders of eating, including Ano-
rexia Nervosa, Bulimia Nervosa, and binge eating 
disorder. 
‘‘(5) HEALTHY EATING BEHAVIORS.—The term 
‘healthy eating behaviors’ means— 
‘‘(A) eating in quantities adequate to meet, 
but not in excess of, daily energy needs; 
‘‘(B) choosing foods to promote health and 
prevent disease; 
‘‘(C) eating comfortably in social environ-
ments that promote healthy relationships with 
family, peers, and community; and 
‘‘(D) eating in a manner to acknowledge 
internal signals of hunger and satiety. 
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‘‘(6) OBESE.—The term ‘obese’ means an adult 
with a Body Mass Index (BMI) of 30 kg/m2 or 
greater. 
‘‘(7) 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 or another appropriate childhood definition, 
as defined by the Secretary. 
‘‘(8) YOUTH.—The term ‘youth’ means individ-
uals not more than 18 years old. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$60,000,000 for fiscal year 2007, and such sums as may 
be necessary for each of fiscal years 2008 through 2011. 
Of the funds appropriated pursuant to this subsection, the 
following amounts shall be set aside for activities related 
to eating disorders: 
‘‘(1) $5,000,000 for fiscal year 2007. 
‘‘(2) $5,500,000 for fiscal year 2008. 
‘‘(3) $6,000,000 for fiscal year 2009. 
‘‘(4) $6,500,000 for fiscal year 2010. 
‘‘(5) $1,000,000 for fiscal year 2011.’’. 
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SEC. 202. NATIONAL CENTER FOR HEALTH STATISTICS. 
Section 306 of the Public Health Service Act (42 
U.S.C. 242k) is amended— 
(1) in subsection (m)(4)(B), by striking ‘‘sub-
section (n)’’ each place it appears and inserting 
‘‘subsection (o)’’; 
(2) by redesignating subsection (n) as sub-
section (o); and 
(3) by inserting after subsection (m) the fol-
lowing: 
‘‘(n)(1) The Secretary, acting through the Center, 
may provide for the— 
‘‘(A) collection of data for determining the fit-
ness levels and energy expenditure 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 entities, 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.’’. 
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SEC. 203. 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 carried out 
under this Act (and the amendments made by this Act) 
and determine if particular information may be important 
to the report on health disparities required by section 
903(c)(3) of the Public Health Service Act (42 U.S.C. 
299a–1(c)(3)). 
SEC. 204. PREVENTIVE HEALTH SERVICES BLOCK GRANT. 
Section 1904(a)(1) of the Public Health Service Act 
(42 U.S.C. 300w–3(a)(1)) is amended by adding at the 
end the following: 
‘‘(H) Activities and community education 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.’’. 
SEC. 205. REPORT ON OBESITY AND EATING DISORDERS 
RESEARCH. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
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Representatives a report on research conducted on causes 
and health implications (including mental health implica-
tions) of being overweight, obesity, and eating disorders. 
(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 of Health and Human Services including 
research at the National Institutes of Health, the 
Centers for Disease Control and Prevention, the 
Agency for Healthcare Research and Quality, the 
Health Resources and Services Administration, and 
other offices and agencies; 
(2) information about what these studies have 
shown regarding the causes, prevention, and treat-
ment of, being overweight, obesity, and eating dis-
orders; and 
(3) recommendations on further research that 
is needed, including research among diverse popu-
lations, the plan of the Department of Health and 
Human Services for conducting such research, and 
how current knowledge can be disseminated. 
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SEC. 206. REPORT ON A NATIONAL CAMPAIGN TO CHANGE 
CHILDREN’S HEALTH BEHAVIORS AND RE-
DUCE OBESITY. 
Section 399Y of the Public Health Service Act (42 
U.S.C. 280h–2) is amended— 
(1) by redesignating subsection (b) as sub-
section (c); and 
(2) by inserting after subsection (a) the fol-
lowing: 
‘‘(b) REPORT.—The Secretary shall evaluate the ef-
fectiveness of the campaign described in subsection (a) in 
changing children’s behaviors and reducing obesity and 
shall report such results to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives.’’. 
Æ 
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