I 

115TH CONGRESS 

1ST SESSION H. R. 1413 

To provide for a grants program to develop and enhance integrated nutrition 

and physical activity curricula in medical schools. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2017 

Mr. RYAN of Ohio (for himself, Mr. TIBERI, Mr. MCGOVERN, Mr. BLUMENAUER, and Ms. PINGREE) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To provide for a grants program to develop and enhance 

integrated nutrition and physical activity curricula in 

medical schools. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Expanding Nutrition’s 

5 Role in Curricula and Healthcare Act’’ or the ‘‘ENRICH 

6 Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


rfrederick on DSKBCBPHB2PROD with BILLS
2 

•HR 1413 IH

1 (1) In 2012, United States health care spend2 ing was about $8,915 per resident and accounted for 

3 17.2 percent of the Nation’s gross domestic product, 

4 which is among the highest of all industrialized 

5 countries. 

6 (2) Expenditures in the United States on health 

7 care surpassed $2.3 trillion in 2008, more than 

8 three times the $714 billion spent in 1990, and over 

9 eight times the $253 billion spent in 1980. Cardio10 vascular disease cost American’s $555 billion in 

11 2016 alone. 

12 (3) It is estimated that health care costs for 

13 chronic disease treatment account for over 75 per14 cent of national health expenditures. 

15 (4) In March 2003, a report from the World 

16 Health Organization concluded diet was a major fac17 tor in the cause of chronic diseases. 

18 (5) Seven out of 10 deaths among Americans 

19 each year are from chronic diseases. Heart disease, 

20 cancer, and stroke—each of which has been strongly 

21 linked to dietary and lifestyle choices—account for 

22 more than 50 percent of all deaths each year. 

23 (6) In 2015, 102.7 million people in the United 

24 States had at least one form of cardiovascular dis25 ease. Approximately 2,300 Americans die every day 


rfrederick on DSKBCBPHB2PROD with BILLS
3 

•HR 1413 IH

1 from cardiovascular disease. In 2010, cardiovascular 

2 disease cost American taxpayers $189.4 billion. The 

3 American Heart Association estimates that, by 

4 2035, costs related to cardiovascular disease will tri5 ple to around $1.1 trillion. Research has shown that 

6 following a healthful diet can not only reduce symp7 toms related to heart disease but also reverse the 

8 damage done to the arteries. 

9 (7) Two-thirds of the American population is 

10 currently overweight, half of whom are obese. One in 

11 three children is now overweight, and one-fifth of 

12 children are obese. In 2008, the United States spent 

13 $190 billion on obesity-related health care costs. 

14 (8) An estimated 29 million Americans have di15 abetes. Another 86 million adults have prediabetes. 

16 The Centers for Disease Control and Prevention pre17 dict that one in three children born in 2000 will de18 velop diabetes at some point in their lives. Diabetes 

19 cost the government $116 billion in 2007. Research 

20 has shown that nutrition therapy is a key component 

21 of diabetes management and can improve clinical 

22 outcomes. 

23 (9) Cancer kills approximately 570,000 Ameri24 cans each year, accounting for one in every four 

25 deaths. More than 1.5 million new cancer cases are 


rfrederick on DSKBCBPHB2PROD with BILLS
4 

•HR 1413 IH

1 diagnosed annually. In 2010, the direct costs of can2 cer were $102.8 billion and that number is expected 

3 to rise to $172 billion by 2020. More than 33 per4 cent of cancers are diet related and could be pre5 vented with a healthful diet. 

6 (10) Eating is a complex social phenomenon in7 fluenced by family, social networks, culture, socio8 economic and educational status. An interprofes9 sional approach to nutrition education for clinicians 

10 may not necessarily overcome these forces but may 

11 help the health professions team, including physi12 cians and non-physicians, identify effective strategies 

13 for nutrition counseling and management. 

14 (11) Physicians are an important source of in15 formation and motivation for patients’ health behav16 ior. Multiple studies have shown that physician 

17 counseling on weight loss increases the likelihood 

18 that patients will attempt weight loss, increase phys19 ical activity, improve diet, and lose weight. 

20 (12) Leading medical bodies recommend that 

21 physicians address diet with overweight patients. 

22 Guidelines from leading medical bodies such as the 

23 National Institutes of Health, the American Heart 

24 Association, the American College of Cardiology, and 

25 the Obesity Society recommend that physicians 


rfrederick on DSKBCBPHB2PROD with BILLS
5 

•HR 1413 IH

1 counsel overweight and obese patients on the bene2 fits of lifestyle changes through lifestyle changes 

3 such as diet and physical activity. 

4 SEC. 3. GRANTS PROGRAM TO DEVELOP OR ENHANCE IN5 TEGRATED NUTRITION CURRICULA IN MED6 ICAL SCHOOLS. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services, acting through the Administrator of the 

9 Health Resources and Services Administration and in con10 junction with the National Institutes of Health National 

11 Heart, Lung, and Blood Institute, shall establish a com12 petitive grants program under which the Secretary may 

13 award grants to medical schools in the United States for 

14 the purpose described in subsection (b)(1). 

15 (b) USE OF GRANT FUNDS.— 

16 (1) IN GENERAL.—A medical school receiving a 

17 grant under this section shall use the grant to create 

18 new or expand existing integrated nutrition and 

19 physical activity curriculum described in paragraph 

20 (2) for the medical school. 

21 (2) INTEGRATED NUTRITION CURRICULUM.— 

22 For purposes of paragraph (1), an integrated nutri23 tion and physical activity curriculum— 

24 (A) shall be designed based on the best 

25 possible evidence to improve communication and 


rfrederick on DSKBCBPHB2PROD with BILLS
6 

•HR 1413 IH

1 provider preparedness in the prevention, man2 agement, and, as possible, reversal of obesity, 

3 cardiovascular disease, diabetes, and cancer; 

4 and 

5 (B) shall, to the greatest extent prac6 ticable, address such additional topics, including 

7 nutrition across the life cycle of individuals who 

8 are members of at-risk populations, physical ac9 tivity training and programs for such individ10 uals, food insecurity among such individuals, 

11 and malnutrition among such individuals. 

12 (c) ELIGIBILITY.—To be eligible to receive a grant 

13 under this section, an eligible entity shall— 

14 (1) be a medical school in the United States 

15 that is accredited by the Liaison Committee on Med16 ical Education and Residency Program Accreditation 

17 Council for Graduate Education or by the American 

18 Osteopathic Association Commission on Osteopathic 

19 College Accreditation; and 

20 (2) submit an application to the Secretary, in 

21 accordance with such time, form, and manner and 

22 containing such information as specified by the Sec23 retary, including— 

24 (A) a description of how the medical school 

25 intends to implement the integrated nutrition 


rfrederick on DSKBCBPHB2PROD with BILLS
7 

•HR 1413 IH

1 and physical activity curriculum described in 

2 subsection (b)(2); and 

3 (B) a description of benchmarks to meas4 ure the success of the implementation of such 

5 curriculum. 

6 (d) ADMINISTRATIVE PROVISIONS.— 

7 (1) DURATION OF PROGRAM.—A grant awarded 

8 to a medical school under this section shall be for a 

9 three-year period, beginning on the date of the es10 tablishment of the grants program under subsection 

11 (a). 

12 (2) LIMITATIONS.— 

13 (A) GRANT AMOUNTS.—A grant awarded 

14 to a medical school under this section may not 

15 exceed $500,000. 

16 (B) ONE GRANT PER SCHOOL.—A medical 

17 school shall not be eligible for more than one 

18 grant under this section and may not renew 

19 such a grant. 

20 (3) PRIORITY.—In awarding grants, the Sec21 retary shall give priority to medical schools— 

22 (A) that submit applications under sub23 section (c)(1) that describe an integrated nutri24 tion and physical activity curriculum that will 


rfrederick on DSKBCBPHB2PROD with BILLS
8 

•HR 1413 IH

1 be implemented through the use of such a 

2 grant— 

3 (i) that is coordinated with a resi4 dency program; or 

5 (ii) provides that students of such 

6 school should receive at least 25 hours of 

7 nutrition education; or 

8 (B) that, for purposes of carrying out such 

9 curriculum through the use of such a grant, 

10 partner with education programs for both phy11 sicians and non-physician health professionals. 

12 (e) REPORTS.— 

13 (1) PERIODIC REPORTS DURING GRANTS PRO14 GRAM.— 

15 (A) IN GENERAL.—For each school year 

16 ending during the duration of the grants pro17 gram under this section, the Secretary shall 

18 submit to Congress a report on the grants pro19 gram. 

20 (B) REPORT ELEMENTS.—Each such re21 port shall include— 

22 (i) the findings and conclusions of the 

23 Secretary with respect to the integration of 

24 nutrition and physical activity curriculum 

25 into the curriculum of the medical schools 


rfrederick on DSKBCBPHB2PROD with BILLS
9 

•HR 1413 IH

1 receiving a grant under the grants pro2 gram; 

3 (ii) an assessment of the benefits of 

4 the grants program for— 

5 (I) establishing best practices for 

6 providers to advise patients in the 

7 clinical setting; 

8 (II) providing greater nutrition 

9 and physical activity awareness to 

10 physicians and other health profes11 sionals and patients of such physi12 cians and professionals; and 

13 (III) improving healthfulness of 

14 patients’ diets and improving patient 

15 health outcomes; and 

16 (iii) suggestions on how to promote 

17 the integration of nutrition curriculum in 

18 medical schools around the United States. 

19 (2) FINAL REPORT.—Not later than 180 days 

20 after the last day of the grants program under this 

21 section, the Secretary shall submit to Congress a re22 port detailing the recommendations of the Secretary 

23 as to any benefits or barriers of integrating nutrition 

24 and physical activity curriculum at both the medical 

25 school and residency levels. 


rfrederick on DSKBCBPHB2PROD with BILLS
10 

•HR 1413 IH

1 (f) FUNDING.—No additional funds are authorized to 

2 carry out the requirements of this section. The Secretary 

3 shall carry out such requirements by using, from amounts 

4 otherwise authorized or appropriated, up to $5,000,000 

5 for each of fiscal years 2018 through 2020. 

Æ 


rfrederick on DSKBCBPHB2PROD with BILLS