I 

115TH CONGRESS 

1ST SESSION H. R. 1634 

To require the Secretary of Health and Human Services to issue to Federal 

agencies guidelines for developing procedures and requirements relating 

to certain primary care Federal health professionals completing continuing medical education on nutrition and to require Federal agencies 

to submit annual reports relating to such guidelines, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 20, 2017 

Mr. GRIJALVA (for himself, Mr. GARAMENDI, Ms. JACKSON LEE, Ms. ROYBAL-ALLARD, and Mr. RYAN of Ohio) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To require the Secretary of Health and Human Services 

to issue to Federal agencies guidelines for developing 

procedures and requirements relating to certain primary 

care Federal health professionals completing continuing 

medical education on nutrition and to require Federal 

agencies to submit annual reports relating to such guidelines, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Education and Train3 ing for Health Act of 2017’’ or the ‘‘EAT for Health Act 

4 of 2017’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) According to 2013 national health expendi8 ture data, United States health care spending in9 creased 3.6 percent to reach $2.9 trillion, or $9,255 

10 per person, and accounted for 17.4 percent of Gross 

11 Domestic Product (GDP). 

12 (2) According to the Institute of Medicine, in 

13 2012 estimates of health care costs attributed over 

14 75 percent of national health expenditures to treat15 ment for chronic diseases. 

16 (3) A March 2003 report from the World 

17 Health Organization concluded diet was a major 

18 cause of chronic diseases. 

19 (4) Seven out of 10 deaths among people in the 

20 United States each year are from chronic diseases 

21 such as cardiovascular disease, obesity, diabetes, and 

22 cancer. 

23 (5) According to the Centers for Disease Con24 trol and Prevention, in 2013 heart disease was the 

25 leading cause of death for American adults. Approxi26 mately 600,000 American adults die each year from 


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1 cardiovascular disease. Coronary heart disease alone 

2 costs American taxpayers $108.9 billion each year. 

3 (6) Research has shown that following a health4 ful diet can not only reduce symptoms related to 

5 cardiovascular disease but can also actually reverse 

6 damage done to the arteries. 

7 (7) According to the Journal of the American 

8 Medical Association, two-thirds of adults in the 

9 United States are currently overweight, and half of 

10 those overweight individuals are obese. One in three 

11 children are overweight, and one-fifth of children are 

12 obese. The United States spends about $147 to 

13 $210 billion a year on obesity related diseases, in14 cluding type 2 diabetes, hypertension, heart disease, 

15 and arthritis. 

16 (8) An estimated 29.1 million people in the 

17 United States have diabetes. Another 86 million 

18 American adults have prediabetes. The Centers for 

19 Disease Control and Prevention predicts that one in 

20 three children born in 2000 will develop diabetes at 

21 some point in their lives. Total estimated costs of di22 agnosed diabetes have increased 41 percent, to $245 

23 billion in 2012 from $174 billion in 2007. 

24 (9) According to the American Cancer Society, 

25 there will be an estimated 1,658,370 new cancer 


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1 cases diagnosed and 589,430 cancer deaths in the 

2 United States in 2015. That is equivalent to about 

3 1,620 deaths per day and accounts for nearly 1 of 

4 every 4 deaths. The Agency for Healthcare Research 

5 and Quality (AHRQ) estimates that the direct med6 ical costs for cancer in the United States in 2011 

7 were $88.7 billion. 

8 (10) According to the Journal of the American 

9 College of Nutrition, in 2008 physicians felt inad10 equately trained to provide proper nutrition advice. 

11 Ninety-four percent felt nutrition counseling should 

12 be included during primary care visits, but only 14 

13 percent felt adequately trained to provide such coun14 seling. 

15 (11) A 1985 National Academy of Sciences re16 port recommended that all medical schools require at 

17 least 25 contact hours of nutrition education. Ac18 cording to a 2009 national survey of medical colleges 

19 published in Academic Medicine, only 38 percent of 

20 medical schools met these minimum standards by re21 quiring 25 hours of nutrition education as part of 

22 their general curricula in 2004. By 2010, that num23 ber had shrunk to 27 percent. In addition, 30 per24 cent of United States medical schools required a 

25 dedicated nutrition course in 2004. Most recently, 


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1 only 25 percent of such schools required such a 

2 course in 2010. 

3 (12) According to the Journal of Nutrition in 

4 Clinical Practice in 2010, more than half of grad5 uating medical students felt their nutrition edu6 cation was insufficient. 

7 (13) Recognizing the importance of nutrition, 

8 Healthy People 2020—the Federal Government’s 

9 framework for a healthier Nation—includes a goal 

10 (NWS–6) to increase the proportion of physician of11 fice visits that include counseling or education re12 lated to nutrition or weight. According to Healthy 

13 People 2020, only 13.8 percent of physician office 

14 visits included counseling about nutrition or diet 

15 (2010 latest year available). 

16 (14) According to Mission: Readiness, one in 

17 four Americans cannot serve in the military due to 

18 weight. For those serving, the military discharged 

19 4,300 active-duty personnel due to weight problems 

20 in 2012. 

21 (15) According to the Journal of American 

22 Health Promotion, the military spends well over $1 

23 billion a year to treat weight-related health problems 

24 such as heart disease and diabetes through its 


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1 TRICARE health insurance for active duty per2 sonnel, reservists, retirees and their families. 

3 (16) According to the Centers for Disease Con4 trol and Prevention, American Indian or Alaska Na5 tive adults are 60 percent more likely to be obese 

6 and over twice as likely as to have diabetes com7 pared to White adults. 

8 (17) According to the Centers for Disease Con9 trol and Prevention, American Indian or Alaska Na10 tive adults have the highest rate of diabetes among 

11 all minority groups at 15.9 percent. 

12 SEC. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

13 GUIDELINES, AND FEDERAL AGENCIES AN14 NUAL REPORTS, RELATING TO CERTAIN PRI15 MARY CARE FEDERAL HEALTH PROFES16 SIONALS COMPLETING CONTINUING MED17 ICAL EDUCATION ON NUTRITION. 

18 (a) GUIDELINES.—Not later than 180 days after the 

19 date of the enactment of this Act, the Secretary of Health 

20 and Human Services shall issue guidelines to Federal 

21 agencies for developing procedures and requirements to 

22 ensure that every primary care health professional em23 ployed full-time for such agencies have continuing edu24 cation courses relating to nutrition (as described in sub25 section (c)). 


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1 (b) BIANNUAL REPORTS.—Not later than 18 months 

2 after the date of the enactment of this Act and each subse3 quent year, the head of each Federal agency that employs 

4 full-time primary care health professionals shall submit to 

5 Congress a report attesting, in a form and manner speci6 fied by the Secretary of Health and Human Services, to 

7 the extent to which the agency has adopted and encour8 aged the guidelines issued under subsection (a) with re9 spect to such professionals employed by such agency dur10 ing any portion of the previous year. If the agency, with 

11 respect to such previous year, did not fully adopt and en12 courage such guidelines with respect to such professionals, 

13 the head of the agency shall include in the report for the 

14 year the percentage of such professionals employed by 

15 such agency to furnish primary care services who com16 pleted continuing education courses relating to nutrition 

17 (as described in subsection (c)). 

18 (c) CONTINUING EDUCATION RELATING TO NUTRI19 TION.—For purposes of subsections (a) and (b), con20 tinuing education courses relating to nutrition shall in21 clude at least content on the role of nutrition in the pre22 vention, management, and, as possible, reversal of obesity, 

23 cardiovascular disease, diabetes, or cancer. 

24 (d) DEFINITIONS.—For purposes of this Act: 


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1 (1) CONTINUING EDUCATION.—The term ‘‘con2 tinuing education’’ is defined as courses that meet 

3 requirements for Continuing Medical Education 

4 (CME) or Continuing Education (CE) by medical or 

5 nurse practitioner professional organizations or cer6 tified accrediting bodies. 

7 (2) NURSE PRACTITIONER.—The term ‘‘nurse 

8 practitioner’’ has the meaning given such term in 

9 section 1861(aa)(5) of the Social Security Act (42 

10 U.S.C. 1395x(aa)(5)). 

11 (3) PHYSICIAN.—The term ‘‘physician’’ has the 

12 meaning given such term in section 1861(r)(1) of 

13 the Social Security Act (42 U.S.C. 1395x(r)(1)). 

14 (4) PRIMARY CARE HEALTH PROFESSIONAL.— 

15 The term ‘‘primary care health professional’’ means 

16 a physician or nurse practitioner who furnishes pri17 mary care services. 

18 (5) PRIMARY CARE SERVICES.—The term ‘‘pri19 mary care services’’ has the meaning given such 

20 term in section 1842(i)(4) of the Social Security Act 

21 (42 U.S.C. 1395u(i)(4)), but shall include such serv22 ices furnished by a nurse practitioner as would oth23 erwise be included if furnished by a physician. 

Æ 


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