I 

113TH CONGRESS 

2D SESSION H. R. 4427 

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

curricula in medical schools. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 8, 2014 

Mr. RYAN of Ohio (for himself, Mr. CASSIDY, 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 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. 

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

9 chronic disease treatment account for over 75 per10 cent of national health expenditures. 

11 (4) The last major report from the World 

12 Health Organization in March 2003 concluded diet 

13 was a major factor in the cause of chronic diseases. 

14 (5) Seven out of 10 deaths among Americans 

15 each year are from chronic diseases. Heart disease, 

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

17 linked to dietary and lifestyle choices—account for 

18 more than 50 percent of all deaths each year. 

19 (6) About 81.1 million people in the United 

20 States have at least one form of cardiovascular dis21 ease. Approximately 2,300 Americans die every day 

22 from cardiovascular disease. In 2010, cardiovascular 

23 disease cost American taxpayers $189.4 billion. The 

24 American Heart Association estimates that, by 

25 2030, direct costs related to cardiovascular disease 


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1 will triple to around $818 billion. Research has 

2 shown that following a healthful diet can not only 

3 reduce symptoms related to heart disease but also 

4 reverse the damage done to the arteries. 

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

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

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

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

9 $190 billion on obesity-related health care costs. 

10 (8) An estimated 25.8 million Americans have 

11 diabetes. Another 79 million adults have prediabetes. 

12 The Centers for Disease Control and Prevention pre13 dict that one in three children born in 2000 will de14 velop diabetes at some point in their lives. Diabetes 

15 cost the government $116 billion in 2007. Research 

16 has shown that nutrition therapy is a key component 

17 of diabetes management and can improve clinical 

18 outcomes. 

19 (9) Cancer kills approximately 570,000 Ameri20 cans each year, accounting for one in every four 

21 deaths. More than 1.5 million new cancer cases are 

22 diagnosed annually. In 2010, the direct costs of can23 cer were $102.8 billion and that number is expected 

24 to rise to $172 billion by 2020. More than 33 perVerDate Mar 15 2010 02:29 Apr 12, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4427.IH H4427

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1 cent of cancers are diet related and could be pre2 vented with a healthful diet. 

3 (10) Eating is a complex social phenomenon in4 fluenced by family, social networks, culture, socio5 economic and educational status. An interprofes6 sional approach to nutrition education for clinicians 

7 may not necessarily overcome these forces but may 

8 help the health professions team identify effective 

9 strategies for nutrition counseling and management. 

10 (11) Physicians are an important source of in11 formation and motivation for patients’ health behav12 ior. Multiple studies have shown that physician 

13 counseling on weight loss increases the likelihood 

14 that patients will attempt weight loss, increase phys15 ical activity, improve diet, and lose weight. 

16 (12) Leading medical bodies recommend that 

17 physicians address diet with overweight patients. 

18 Guidelines from leading medical bodies such as the 

19 National Institutes of Health, the American Heart 

20 Association, the American College of Cardiology, and 

21 the Obesity Society recommend that physicians 

22 counsel overweight and obese patients on the bene23 fits of lifestyle changes through lifestyle changes 

24 such as diet and physical activity. 


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1 SEC. 3. GRANTS PROGRAM TO DEVELOP OR ENHANCE IN2 TEGRATED NUTRITION CURRICULA IN MED3 ICAL SCHOOLS. 

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

5 Human Services, acting through the Administrator of the 

6 Health Resources and Services Administration and in con7 junction with the National Institutes of Health National 

8 Heart, Lung, and Blood Institute, shall establish a com9 petitive grants program under which the Secretary may 

10 award grants to medical schools in the United States for 

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

12 (b) USE OF GRANT FUNDS.— 

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

14 grant under this section shall use the grant to create 

15 new or expand existing integrated nutrition cur16 riculum described in paragraph (2) for the medical 

17 school. 

18 (2) INTEGRATED NUTRITION CURRICULUM.— 

19 For purposes of paragraph (1), an integrated nutri20 tion curriculum— 

21 (A) shall be designed based on the best 

22 possible evidence to improve communication and 

23 provider preparedness in the prevention, man24 agement, and, as possible, reversal of obesity, 

25 cardiovascular disease, diabetes, and cancer; 

26 and 


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1 (B) shall, to the greatest extent prac2 ticable, address such additional topics, including 

3 nutrition across the life cycle of individuals who 

4 are members of at-risk populations, food insecu5 rity among such individuals, and malnutrition 

6 among such individuals. 

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

8 under this section, an eligible entity shall— 

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

10 that is accredited by the Liaison Committee on Med11 ical Education and Residency Program Accreditation 

12 Council for Graduate Education or by the American 

13 Osteopathic Association Commission on Osteopathic 

14 College Accreditation; and 

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

16 accordance with such time, form, and manner and 

17 containing such information as specified by the Sec18 retary, including— 

19 (A) a description of how the medical school 

20 intends to implement the integrated nutrition 

21 curriculum described in subsection (b)(2); and 

22 (B) a description of benchmarks to meas23 ure the success of the implementation of such 

24 curriculum. 

25 (d) ADMINISTRATIVE PROVISIONS.— 


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

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

3 three-year period, beginning on the date of the es4 tablishment of the grants program under subsection 

5 (a). 

6 (2) LIMITATIONS.— 

7 (A) GRANT AMOUNTS.—A grant awarded 

8 to a medical school under this section may not 

9 exceed $500,000. 

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

11 school shall not be eligible for more than one 

12 grant under this section and may not renew 

13 such a grant. 

14 (3) PRIORITY.—In awarding grants, the Sec15 retary shall give priority to medical schools— 

16 (A) that submit applications under sub17 section (c)(1) that describe an integrated nutri18 tion curriculum that will be implemented 

19 through the use of such a grant— 

20 (i) that is coordinated with a resi21 dency program; or 

22 (ii) provides that students of such 

23 school should receive at least 25 hours of 

24 nutrition education; or 


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

2 curriculum through the use of such a grant, 

3 partner with education programs for health pro4 fessionals other than physicians. 

5 (e) REPORTS.— 

6 (1) PERIODIC REPORTS DURING GRANTS PRO7 GRAM.— 

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

9 ending during the duration of the grants pro10 gram under this section, the Secretary shall 

11 submit to Congress a report on the grants pro12 gram. 

13 (B) REPORT ELEMENTS.—Each such re14 port shall include— 

15 (i) the findings and conclusions of the 

16 Secretary with respect to the integration of 

17 nutrition curriculum into the curriculum of 

18 the medical schools receiving a grant under 

19 the grants program; and 

20 (ii) an assessment of the benefits of 

21 the grants program for— 

22 (I) establishing best practices for 

23 providers to advise patients in the 

24 clinical setting; 


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1 (II) providing greater nutrition 

2 awareness to physicians and other 

3 health professionals and patients of 

4 such physicians and professionals; and 

5 (III) improving healthfulness of 

6 patients’ diets and improving patient 

7 health outcomes. 

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

9 after the last day of the grants program under this 

10 section, the Secretary shall submit to Congress a re11 port detailing the recommendations of the Secretary 

12 as to any benefits or barriers of integrating nutrition 

13 curriculum at both the medical school and residency 

14 levels. 

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

16 carry out the requirements of this section. The Secretary 

17 shall carry out such requirements by using, from amounts 

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

19 for each of fiscal years 2015 through 2017. 

Æ 


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