mr. speaker , reclaiming my time , i thank the gentleman for his learned information for our colleagues to be aware of not only head start but about prenatal care .  one program i want to mention , the national nurse-family partnership , is a great example of success .  it is a public-private nonprofit center .  i believe it is centered in colorado , with over 700 nurses delivering in-home prenatal care and early infant care to more than 13 , 000 low-income families throughout the nation .  interestingly enough , they were able to demonstrate they could return $ 4 savings for every $ 1 invested in these services by the time the children reach age 15 by reducing expenditures for such things as special education , emergency room visits .  again , when we use a more comprehensive patient care model , we look at the whole family and not just the individual disease , we can save money and provide care .  secondly , i also applaud my colleague for bringing up those aspects about head start and early head start , so critically important for families who are struggling to make ends meet to have this system that really puts the parent at the center of the child 's care , making sure they are involved in all the decisions , making sure they have the information they need to have , making sure that they are , in essence , put into the role of parent and not government in the role of parent ; and that makes all the difference in the world .  let me shift into another area here , however , that is also critically important and something we dealt with today .  at any point if my colleague has comments he wants to make , i certainly would encourage him to do so .  but this is the area of childhood obesity .  today , we passed a bill out of the house that said that we can not just be blaming restaurants and fast-food companies and food manufacturers when someone has obesity problems .  indeed , it is something we all have to work on and have responsibility for because whether they are healthy snacks that a person eats too much of or unhealthy snacks , whatever that is , we have to make sure that we watch our diet and have proper exercise .  unfortunately , what has happened in this nation , i believe it may only be the state of illinois that still requires gym class in school , and as such , children spend much more sedentary time at home , playing video games or in front of the television , less active , and eating more during that time .  this is a major contributor to childhood obesity .  and what has happened in the last 10 years , and look here , the proportion of obese children has tripled since 1970 .  it has doubled in the last 10 years , tripled among teenagers actually during this time period , and increased incidences of disease associated with that , including such things as now we see adult onset diabetes showing up in our children .  we also see heart problems showing up .  we see the risks that take place with blood pressures that are showing up in children who really did not have these problems before .  this is an estimated annual cost of obesity-related diseases in the united states : $ 100 billion .  $ 100 billion annual cost of obesity-related diseases .  this is not something that is cured by simply having government come in and tell people what they can and can not eat .  something has broken down in our families and our communities where we are no longer telling kids they have had enough to eat or they are not going to eat any more of that or they need to get out and play .  the annual hospital costs for obesity-related disorders in children ages 6 to 17 years of age increased from $ 35 million to $ 127 million between 1979 and 2000 .  it is a lack of physical exercise ; 38.6 percent of united states adults report they have no leisure-time physical activity at all .  the annual estimated cost for diseases associated with this physical activity in 2000 was $ 76 million , but we know that daily participation in physical ed classes by high school students has dropped from 42 percent in 1991 to 29 percent in 1999 and continues to decline .  even though we have data that continues to tell us physical exercise is critical and important , not just for a child 's physical health , but really , as we are looking at ways of managing this , we can not continue to just pump money into the medicaid system and into our insurance systems to cover the costs of the outcome at the end of the line .  we need to go upstream and work on some basic prevention , and that means , quite frankly , mothers and fathers across america have to work on these issues of teaching their children to be responsible for their own bodies , making sure that we , as members of congress , are talking about these issues , but making sure as we monitor how money is spent we are much better off looking at ways that funding could be given to communities , programs , to schools , to hospitals to help make sure we are working on prevention of obesity rather than paying the high costs at the end of the line for so much of the increases in health care because obesity has continued to climb .  now , with obesity often comes behavioral disorders as a matter of fact .  many a child i saw in my clinical practice as a psychologist oftentimes came in a child who was well overweight , teased by their peers , struggled with this on top of their other physical problems .  they oftentimes got in this downward spiral , less activity , more socially isolated .  perhaps they were teased by other kids , the butt of jokes , a sad condition , and many of these children also suffered problems with mental health .  what happens in the area of mental health is sometimes in this chamber and our nation , we look down upon it from a couple of different angles .  we see perhaps mental health problems are some sign of softness , that perhaps people should be a little tougher , take it on the chin , not be so sensitive .  sometimes i am not sure we have advanced from the days of the salem witch trials , and blame those who suffer from mental illness and say somehow you should have done more .  sometimes we ridicule those who are on medication .  jokes still abound on television calling people crazy , loony , out of control , retarded , in derogatory terms , for something that we continue to see in this nation as a sign of weakness instead of a real disease .  again , if we are going to deal with things in the health care area , to truly reduce costs and deal with patients , we have to understand in the area of children 's mental health psychological disorders are real .  they are not made up .  they are not indications where someone is weaker and ineffective .  there is a very strong and consistent scientific basis to say that the myth of psychological disorders and psychiatric disorders has to be debunked .  kids do have real problems .  adolescents have more problems .  adults have even more problems , and all these grow when we do not deal with these problems at an early level .  there are biological and environmental causes .  it is interesting , you can have some children face tremendous difficulties in their life and they do not seem to show problems in mental outcomes , but that does not mean that those who do have problems are simply weak .  just like some of us may be exposed to the flu , some of us may eat different , and be around those who smoke and never develop any symptoms at all , where others are susceptible to them as part of their own biological genetic makeup .  again , it does not mean they are weak or ineffective .  it means a combination of the biological and environmental factors that caused this .  you can not simply say if we take care of these environmental causes it will never occur .  sometimes people say , well , maybe it is poverty that causes some of these difficulties with mental illness , and that is not the case at all .  depression , bipolar disorders , attention disorders , anxiety disorders occur at all lines of children .  boys sometimes have more than others , but there is this link between biological and environmental causes .  boys have more problems , for example , with attention disorders .  girls may have different symptoms with depression , but in all cases we also see there is a commonality between parents and we may see , for example , as the outcome of the hurricanes in the gulf coast that there will be some children who live through tremendous trauma , and they may have some post-traumatic stress reactions , but it may never reach the level of post-traumatic stress disorder .  it becomes a longer term debilitating factor , exhibited , for example , as such things as depression , trouble concentrating , nightmares , et cetera .  it may never reach that level because they may in their own biological factors have resilience , but their family may be there to support .  the other things here is to understand that psychological disorders do respond to treatment .  this may be pharmaceutical ; that is , medication , and it certainly is also matters of counseling and therapy .  this is not just a matter of talking to someone , giving common-sense ideas .  this is a matter of very strategic , scientifically based things such as cognitive behavioral therapy to work with patients .  we know , for example , that children with depression respond fairly well , pretty well , to some of the talk therapy or counseling to help them understand strategies to deal with problems in their life , recognize the symptoms and do their own intervention themselves to change those symptoms .  but we also know when people move from moderate to more severe levels of depression , medication , it is pretty darn helpful and sometimes almost necessary for them to have that .  it does not help when we have movie stars out there saying there is no such thing as mental illness , an irresponsible statement .  it does not make things go away just because you wish it to be so .  i do not want situations put upon our country where we see that , again , people from hollywood are saying , well , there is no such thing as mental illness , and therefore , we do not treat it .  that is wrong .  we do know that they can respond to treatment , and it is important we continue to fund in areas of medicaid and everywhere else , medicare , psychological , psychiatric treatment because it is helpful .  we also need to , however , carefully evaluate the treatment , the planning and follow-up assessment of these .  i will give you a couple of examples .  last year , there was a lot of discussion about some anti-depressant medication , and when some children took it , there was a higher risk for suicidal thinking , suicidal ideations we call it .  what did not come up in those discussions are a couple of important factors .  one , 75 percent of psychiatric medications are prescribed by nonpsychiatrists .  they may be highly qualified physicians .  in many cases , they may be general practitioners , pediatricians , family doctors , obstetricians .  seventy-five percent , however , and they may or may not be doing the other follow-up that is necessary .  what anti-depressant medications do is they can change a person 's mood .  they can help change the chemical , biological reaction that a person 's central nervous system and brain of how they process stresses that can lead to the debilitation of depression , but it does not change the way a person thinks .  that is why it is so important that we make sure we are funding programs that also provide the psychological therapy for children to help them understand what these thoughts are , to help them change the way they are thinking about the world so as they start to feel better they do not have more suicidal risks .  interestingly enough , one of the things we oftentimes taught medical students in medical schools is once patients start getting better with symptoms of depression , the risk for suicide may increase because the support systems back off and they say johnny 's feeling better , we do not need to have him in the hospital or do not need to be around him as much .  perhaps people are no longer monitoring the person 24 hours a day .  they start to go back to school , face more stresses .  as they are getting their energy up , as they are back in the world and thinking if we do not change the way they think with depressive thought patterns , if we do not interrupt that and change it , you can actually increase the risk for suicide .  that being the case , we have to make sure that as we are looking for more effective ways of spending money , the taxpayer dollars in medicaid and medicare and head start that we are working comprehensive care with the patient , with mental illness as well , such problems as i said before about bipolar ; that is , manic depressive illness , attention deficit disorder , anxiety disorders , all of these with a strong genetic component and elements where we can make huge changes in people 's lives .  it is something that we need to make sure we are no longer just criticizing about overprescribing or perhaps saying that too many kids are getting stimulant medication with attention disorder ; we should or should not do this .  here is the crux of this .  it really is a matter of having accurate diagnosis and treatment and making sure that we are not overmedicating or undermedicating our children .  somehow in this chamber we politicize this to somehow think we are doing something wrong in both areas of the conservative far right , the liberal far left , somehow accuse maybe there is some conspiracies involved in this , and there is not .  it is a matter of making sure the physicians have the training to deal with this .  they are interacting a comprehensive care model , a patient care model , disease management model , together with people of various professions and working closely with the families .  we see this in the area of children 's health when you start to look at so many aspects here that you really can make some huge differences .  i would like to point to a couple of things here and then call upon the gentleman from georgia ( mr. gingrey )  , my colleague , on a couple of questions .  but one of the things to keep in mind about depression , which is one of the most common mental illnesses affecting more than 19 million americans each year , that it can cause longer lasting forms .  you can lose pleasure in life , complicate other medical conditions , can lead to suicide , but it is also associated with many other medical issues .  for example , cancer has a higher incidence of depression , stroke .  diabetes , people with diabetes have a 25 percent chance of having depression .  that is higher than the rest of the population .  depression also affects as many as 70 percent of patients with chronic diabetic complications .  people with heart disease , 40 to 65 percent of them will have depression , and what is interesting is untreated depression in these patients can lead to complications , such as the health care costs can double .  now , i ask the gentleman from georgia ( mr. gingrey )  on this , he certainly treated many a patient who had medical complications as well as some of the psychological ones , and i would like to ask him , in looking at some of these more comprehensive chronic care models , of how we need to be moving forward in a modern system of health care and not be just looking at individual disease , but how looking at more advanced forms of bringing technology and changing the system , how he sees that affecting the patient in a cost-effective way .  