,,ii #aadth ,,congress #ast ,session ,s4 #ahfe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bg1 #bjae,ms4 ,klobuchar 7for herself1 ,ms4 ,ayotte1 ,mrs4 ,capito1 and ,ms4 ,baldwin7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act with respect to eating disorders1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,anna ,westin ,act of #bjae4 #b4 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,sec4 #c4 ,findings4 ,sec4 #d4 ,definition4 ,sec4 #e4 ,training and education4 ,sec4 #f4 ,education and training for health professionals4 ,sec4 #g4 ,education and training for school and higher education professionals4 ,sec4 #h4 ,public service announcements4 ,sec4 #i4 ,clarifying application of existing parity law4 ,sec4 #aj4 ,prohibition on new appropriations4 #c4 ,findings ,the ,congress finds the following3 7#a7 ,risk of death among individuals with anorexia nervosa is #ah times greater than among individuals of the same age without anorexia4 ,it is estimated that at least one person dies every #fb minutes from an eating disorder3 at least #bc persons each day4 7#b7 ,health consequences such as osteoporosis 7brittle bones71 gastrointestinal complications1 cardiac1 and dental problems are significant health and financial burdens throughout life4 7#c7 ,at lowest estimate1 #ad1ejj1jjj people in the ,united ,states suffer from eating disorders4 ,one percent of adolescent boys and #b percent of adolescent girls suffer from eating disorders4 ,eating disorders account for at least #d percent of all childhood hospitalizations4 7#d7 ,eating disorders are treatable biopsychosocial illnesses4 ,there is a high rate of comorbidity with other illnesses such as depression1 substance abuse1 or anxiety disorders4 7#e7 ,anorexia nervosa is an eating disorder characterized by self-starvation1 weight loss1 fear of gaining weight1 and disturbances in the way in which one's body weight or shape is experienced4 7#f7 ,anorexia nervosa is associated with serious health consequences including heart failure1 kidney failure1 osteoporosis1 and death4 ,people who suffer anorexia nervosa are #eg times more likely to die of suicide than their peers4 7#g7 ,current estimates of the lifetime prevalence of bulimia nervosa are between #j4i and #a4e percent among women and between #j4a and #j4e percent among men4 7#h7 ,bulimia nervosa is associated with serious health consequences1 including cardiac1 gastrointestinal1 and dental problems including irregular heartbeats1 gastric rupture1 peptic ulcer1 tooth decay1 and death4 7#i7 ,binge eating disorder is characterized by frequent episodes of uncontrolled overeating4 ,binge eating disorder is common3 at lowest estimate1 #c4e percent of women in the ,united ,states and #b4j percent of men in the ,united ,states will suffer from this disorder in their lifetimes4 7#aj7 ,binge eating is often associated with obesity1 high blood pressure1 elevated cholesterol levels1 elevated triglyceride levels1 increased risk of bowel1 breast1 and reproductive cancers1 increased risk of diabetes1 and increased risk of arthritic damage to the joints4 7#aa7 ,many suffer from some1 but not all1 of the symptoms of anorexia nervosa1 bulimia nervosa1 or binge eating disorder1 which is referred to as other specified feeding or eating disorder or ,,osfed4 ,between #d percent and #bj percent of young women practice unhealthy patterns of dieting1 purging1 and binge eating4 7#ab7 ,eating disorders are more common in women1 but they do occur in men4 ,rates of binge eating disorder are similar in females and males4 7#ac7 ,academic evidence has demonstrated a connection between the use of very thin models in advertising and consumer attitudes toward a brand based on such advertising1 as well as a material influence of the use of such models on consumer purchase intent1 conduct1 and reliance4 7#ad7 ,eating disorders appear across all age groups1 races1 ethnicities1 and socioeconomic groups in the ,united ,states and are associated with substantial psychological problems1 including depression1 substance abuse1 and suicide4 ,for children #ab years of age and younger1 hospitalizations for eating disorders increased by #aai percent between #aiii and #bjjf4 #d4 ,definitions ,in this ,act-- 7#a7 the term eating disorder includes anorexia nervosa1 bulimia nervosa1 binge eating disorder1 and other specified feeding or eating disorders1 as defined in the fifth edition of ,diagnostic and ,statistical ,manual of ,mental ,disorders1 published by the ,american ,psychiatric ,association or1 if applicable1 the most recent successor edition2 and 7#b7 the term ,secretary means the ,secretary of ,health and ,human ,services4 #e4 ,training and education ,subject to section #aj1 the ,secretary1 acting through the ,director of the ,office on ,women's ,health of the ,department of ,health and ,human ,services and in consultation with the ,secretary of ,education1 shall-- 7#a7 revise and then reinstate the ,body,wise ,handbook of the ,department of ,education and related fact sheets and resource lists available on the public ,internet ,website of the ,national ,women's ,health ,information ,center sponsored by the ,office on ,women's ,health1 to include-- 7,a7 updated findings and conclusions as needed2 and 7,b7 thorough information about eating disorders relating to males and females2 7#b7 incorporate1 as appropriate1 information from such ,body,wise ,handbook and related fact sheets and resource lists into the curriculum of the ,body,works obesity prevention program developed by the ,office on ,women's ,health1 and training modules used in such obesity prevention program2 and 7#c7 promote and make publicly available 7through a public ,internet ,website or other method that does not impose a fee on users7 the ,body,wise ,handbook and related fact sheets and resource lists1 as updated under paragraph 7#a71 and the ,body,works obesity prevention program1 as updated under paragraph 7#b71 including for purposes of educating universities and nonprofit entities on eating disorders4 #f4 ,education and training for health professionals 7a7 ,in general ,subject to section #aj1 the ,secretary1 acting through the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall award grants to eligible entities to integrate training into existing curricula for primary care physicians1 other licensed or certified health and mental health professionals1 and public health professionals that may include-- 7#a7 early intervention and identification of eating disorders2 7#b7 levels of treatment 7including family-based1 in-patient1 residential1 partial hospitalization programming1 and intensive outpatient and outpatient treatment72 7#c7 how to properly refer patients to treatment2 7#d7 steps to aid in the prevention of the development of eating disordered behaviors2 and 7#e7 how to treat individuals with eating disorders4 7b7 ,application ,an entity desiring a grant under this section shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan for the use of funds that may be awarded and an evaluation of the training that will be provided4 7c7 ,use of funds ,an entity that receives a grant under this section shall use the funds made available through such grant to-- 7#a7 develop a training program containing evidence-based findings1 promising emerging best practices1 or recommendations that pertain to the identification of1 early intervention in1 prevention of the development of1 and treatment of1 eating disorders to conduct educational training and conferences1 which may include ,internet-based courses and teleconferences1 on-- 7,a7 how to help prevent the development of eating disordered behaviors1 identify1 intervene early1 and appropriately and adequately treat eating disordered patients2 7,b7 how to identify individuals with eating disorders1 and those who are at risk for suffering from eating disorders and1 therefore1 at risk for related severe medical and mental health conditions2 7,c7 how to conduct a comprehensive assessment of individual and familial health risk factors2 and 7,d7 how to conduct a comprehensive assessment of a treatment plan2 and 7#b7 evaluate and report to the ,secretary on the effectiveness of the training provided by such entity in increasing knowledge and changing attitudes and behaviors of trainees4 #g4 ,education and training for school and higher education professionals 7a7 ,grants ,subject to section #aj1 the ,secretary1 acting through the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall award grants to eligible entities-- 7#a7 to conduct educational seminars for school personnel on early identification of1 intervention in1 and prevention of1 behaviors that are often associated with the development of eating disordered behaviors2 and 7#b7 to make resources available to individuals affected by eating disorders4 7b7 ,educational seminars ,as a condition on the receipt of a grant under this subsection1 an eligible entity shall agree to conduct educational seminars under subsection 7a77#a71 taking into consideration educational materials made available through the ,body,wise eating disorder initiative of the ,department of ,health and ,human ,services and relevant research on eating disorders4 7c7 ,eligible entity ,in this section1 the term eligible entity means any ,state1 territory1 or possession of the ,united ,states1 the ,district of ,columbia1 any ,indian tribe or tribal organization 7as defined in subsections 7e7 and 7l71 respectively1 of section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b771 or a public or private educational institution1 including an institution of higher education4 #h4 ,public service announcements 7a7 ,in general ,subject to section #aj1 the ,director of the ,national ,institute of ,mental ,health shall conduct a program of public service announcements to educate the public on-- 7#a7 the types of eating disorders2 7#b7 the seriousness of eating disorders 7including prevalence1 comorbidities1 and physical and mental health consequences72 7#c7 how to identify1 intervene1 refer for treatment1 and prevent behaviors that often lead to the development of eating disordered behaviors2 7#d7 discrimination and bullying based on body size2 7#e7 the effects of media on self-esteem and body image2 and 7#f7 the signs and symptoms of eating disorders4 7b7 ,collaboration ,the ,director of the ,national ,institute of ,mental ,health shall conduct the program under subsection 7a7 in collaboration with-- 7#a7 centers of excellence2 and 7#b7 community-based national nonprofit resources that support individuals affected by eating disorders and work to prevent eating disorders and address body image and weight issues4 #i4 ,clarifying application of existing parity law 7a7 ,,phsa ,section #bgbf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7 is amended-- 7#a7 in subsection 7a77#c71 by adding at the end the following new subparagraph3 7,c7 ,treatment of permanent exclusions under mental health and substance use disorder benefits ,a group health plan or health insurance issuer offering group or individual health insurance coverage to which subparagraph 7,a7 applies shall be considered in violation of subparagraph 7,a77ii7 if the mental health or substance use disorder benefits under such plan or coverage provides for a permanent exclusion from such benefits for a particular condition or disorder4 2 and 7#b7 by adding at the end the following new subsection3 7f7 ,residential treatment ,for purposes of this section1 mental health and substance use disorder benefits include residential treatment4 4 7b7 ,,erisa ,section #gab of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a7 is amended-- 7#a7 in subsection 7a77#c71 by adding at the end the following new subparagraph3 7,c7 ,treatment of permanent exclusions under mental health and substance use disorder benefits ,a group health plan 7or health insurance coverage offered in connection with such a plan7 to which subparagraph 7,a7 applies shall be considered in violation of subparagraph 7,a77ii7 if the mental health or substance use disorder benefits under such plan 7or coverage7 provides for a permanent exclusion from such benefits for a particular condition or disorder4 2 and 7#b7 by adding at the end the following new subsection3 7h7 ,residential treatment ,for purposes of this section1 mental health and substance use disorder benefits include residential treatment4 4 7c7 ,,irc ,section #ihab of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 in subsection 7a77#c71 by adding at the end the following new subparagraph3 7,c7 ,treatment of permanent exclusions under mental health and substance use disorder benefits ,a group health plan to which subparagraph 7,a7 applies shall be considered in violation of subparagraph 7,a77ii7 if the mental health or substance use disorder benefits under such plan provides for a permanent exclusion from such benefits for a particular condition or disorder4 2 and 7#b7 by adding at the end the following new subsection3 7f7 ,residential treatment ,for purposes of this section1 mental health and substance use disorder benefits include residential treatment4 4 7d7 ,limitation ,nothing in this section or the amendments made by this section shall be construed as adding or expanding the scope of mental health or addiction services included under section #bgbf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf71 section #gab of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a71 or section #ihab of the ,internal ,revenue ,code of #aihf4 #aj4 ,prohibition on new appropriations ,no additional funds are authorized to be appropriated to carry out this ,act or the amendments made by this ,act4 ,this ,act and such amendments shall be carried out using amounts otherwise made available for such purposes4