I 

116TH CONGRESS 

1ST SESSION H. R. 1888 

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 26, 2019 

Mr. RYAN (for himself and Mr. GRIJALVA) 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: 

9 (1) In 2012, United States health care spend10 ing was about $8,915 per resident and accounted for 


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1 17.2 percent of the Nation’s gross domestic product, 

2 which is among the highest of all industrialized 

3 countries. 

4 (2) Expenditures in the United States on health 

5 care surpassed $2.3 trillion in 2008, more than 

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

7 eight times the $253 billion spent in 1980. Cardio8 vascular disease cost American’s $555 billion in 

9 2016 alone. 

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

11 chronic disease treatment account for over 75 per12 cent of national health expenditures. 

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

14 Health Organization concluded diet was a major fac15 tor in the cause of chronic diseases. 

16 (5) Seven out of 10 deaths among Americans 

17 each year are from chronic diseases. Heart disease, 

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

19 linked to dietary and lifestyle choices—account for 

20 more than 50 percent of all deaths each year. 

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

22 States had at least one form of cardiovascular dis23 ease. Approximately 2,300 Americans die every day 

24 from cardiovascular disease. In 2010, cardiovascular 

25 disease cost American taxpayers $189.4 billion. The 


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1 American Heart Association estimates that, by 

2 2035, costs related to cardiovascular disease will tri3 ple to around $1.1 trillion. Research has shown that 

4 following a healthful diet can not only reduce symp5 toms related to heart disease but also reverse the 

6 damage done to the arteries. 

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

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

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

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

11 $190 billion on obesity-related health care costs. 

12 (8) An estimated 29 million Americans have di13 abetes. Another 86 million adults have prediabetes. 

14 The Centers for Disease Control and Prevention pre15 dict that one in three children born in 2000 will de16 velop diabetes at some point in their lives. Diabetes 

17 cost the government $116 billion in 2007. Research 

18 has shown that nutrition therapy is a key component 

19 of diabetes management and can improve clinical 

20 outcomes. 

21 (9) Cancer kills approximately 570,000 Ameri22 cans each year, accounting for one in every four 

23 deaths. More than 1.5 million new cancer cases are 

24 diagnosed annually. In 2010, the direct costs of can25 cer were $102.8 billion and that number is expected 


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1 to rise to $172 billion by 2020. More than 33 per2 cent of cancers are diet related and could be pre3 vented with a healthful diet. 

4 (10) Eating is a complex social phenomenon in5 fluenced by family, social networks, culture, socio6 economic and educational status. An interprofes7 sional approach to nutrition education for clinicians 

8 may not necessarily overcome these forces but may 

9 help the health professions team, including physi10 cians and non-physicians, identify effective strategies 

11 for nutrition counseling and management. 

12 (11) Physicians are an important source of in13 formation and motivation for patients’ health behav14 ior. Multiple studies have shown that physician 

15 counseling on weight loss increases the likelihood 

16 that patients will attempt weight loss, increase phys17 ical activity, improve diet, and lose weight. 

18 (12) Leading medical bodies recommend that 

19 physicians address diet with overweight patients. 

20 Guidelines from leading medical bodies such as the 

21 National Institutes of Health, the American Heart 

22 Association, the American College of Cardiology, and 

23 the Obesity Society recommend that physicians 

24 counsel overweight and obese patients on the beneVerDate Sep 11 2014 21:50 Apr 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1888.IH H1888

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1 fits of lifestyle changes through lifestyle changes 

2 such as diet and physical activity. 

3 SEC. 3. GRANTS PROGRAM TO DEVELOP OR ENHANCE IN4 TEGRATED NUTRITION CURRICULA IN MED5 ICAL SCHOOLS. 

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

7 Human Services, acting through the Administrator of the 

8 Health Resources and Services Administration and in con9 junction with the National Institutes of Health National 

10 Heart, Lung, and Blood Institute, shall establish a com11 petitive grants program under which the Secretary may 

12 award grants to medical schools in the United States for 

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

14 (b) USE OF GRANT FUNDS.— 

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

16 grant under this section shall use the grant to create 

17 new or expand existing integrated nutrition and 

18 physical activity curriculum described in paragraph 

19 (2) for the medical school. 

20 (2) INTEGRATED NUTRITION CURRICULUM.— 

21 For purposes of paragraph (1), an integrated nutri22 tion and physical activity curriculum— 

23 (A) shall be designed based on the best 

24 possible evidence to improve communication and 

25 provider preparedness in the prevention, manVerDate Sep 11 2014 21:50 Apr 06, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1888.IH H1888

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1 agement, and, as possible, reversal of obesity, 

2 cardiovascular disease, diabetes, and cancer; 

3 and 

4 (B) shall, to the greatest extent prac5 ticable, address such additional topics, including 

6 nutrition across the life cycle of individuals who 

7 are members of at-risk populations, physical ac8 tivity training and programs for such individ9 uals, food insecurity among such individuals, 

10 and malnutrition among such individuals. 

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

12 under this section, an eligible entity shall— 

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

14 that is accredited by the Liaison Committee on Med15 ical Education and Residency Program Accreditation 

16 Council for Graduate Education or by the American 

17 Osteopathic Association Commission on Osteopathic 

18 College Accreditation; and 

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

20 accordance with such time, form, and manner and 

21 containing such information as specified by the Sec22 retary, including— 

23 (A) a description of how the medical school 

24 intends to implement the integrated nutrition 


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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 


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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 


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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. 


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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 2019 through 2021. 

Æ 


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