I 

113TH CONGRESS 

2D SESSION H. R. 4378 

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 

APRIL 2, 2014 

Mr. GRIJALVA (for himself 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 2014’’ or the ‘‘EAT for Health Act 

4 of 2014’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) In 2012, United States health care spend8 ing was approximately $8,233 per resident and ac9 counted for 17.6 percent of the Nation’s gross do10 mestic product. This is among the highest of all in11 dustrialized countries. 

12 (2) Expenditures in the United States on health 

13 care surpassed $2.6 trillion in 2011, more than 

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

15 eight times the $253 billion spent in 1980. 

16 (3) Estimates of health care costs attribute over 

17 75 percent of national health expenditures to treat18 ment for chronic diseases. 

19 (4) A March 2003 report from the World 

20 Health Organization concluded diet was a major 

21 cause of chronic diseases. 

22 (5) Seven out of 10 deaths among people in the 

23 United States each year are from chronic diseases 

24 such as cardiovascular disease, obesity, diabetes, and 

25 cancer. 


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1 (6) Approximately 81.1 million American adults 

2 in the United States have at least one form of car3 diovascular disease. Approximately 2,300 American 

4 adults in the United States die every day from car5 diovascular disease. In 2010, cardiovascular disease 

6 cost American taxpayers $189.4 billion. The Amer7 ican Heart Association estimates that, by 2030, di8 rect costs related to cardiovascular disease will triple 

9 to around $818 billion. 

10 (7) Research has shown that following a health11 ful diet can not only reduce symptoms related to 

12 cardiovascular disease but also actually reverse dam13 age done to the arteries. 

14 (8) Two-thirds of adults in the United States 

15 are currently overweight, and half of those over16 weight individuals are obese. One in three children 

17 are now overweight, and one-fifth of children are 

18 obese. In 2008, direct medical costs associated with 

19 obesity totaled $147 billion. 

20 (9) An estimated 25.8 million people in the 

21 United States have diabetes. Another 79 million 

22 American adults in the United States have 

23 prediabetes. The Centers for Disease Control and 

24 Prevention predict that one in three children born in 

25 2000 will develop diabetes at some point in their 


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1 lives. Total estimated costs of diagnosed diabetes 

2 have increased 41 percent, to $245 billion in 2012 

3 from $174 billion in 2007. Research shows that re4 ducing fat in the diet can reverse the symptoms of 

5 type 2 diabetes, not just ‘‘manage’’ the symptoms. 

6 (10) Cancer kills approximately 570,000 Ameri7 cans each year, accounting for one in four deaths. 

8 More than 1.5 million new cancer cases are diag9 nosed annually. In 2010, the direct costs of cancer 

10 were $102.8 billion. Estimates expect that number 

11 to rise to $172 billion by 2020. 

12 (11) According to the Journal of the American 

13 College of Nutrition, physicians feel inadequately 

14 trained to provide proper nutrition advice. Ninety15 four percent feel nutrition counseling should be in16 cluded during primary care visits, but only 14 per17 cent felt adequately trained to provide such coun18 seling. 

19 (12) A 1985 National Academy of Sciences re20 port recommended that all medical schools require at 

21 least 25 contact hours of nutrition education. In 

22 2004, only 38 percent of medical schools met these 

23 minimum standards by requiring 25 hours of nutri24 tion education as part of their general curricula. By 

25 2010, that number had shrunk to 27 percent. 


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1 (13) In 2004, 30 percent of United States med2 ical schools required a dedicated nutrition course. In 

3 2010, only 25 percent of such schools required such 

4 a course. 

5 (14) According to a 2009 national survey of 

6 medical colleges published in Academic Medicine, 

7 more than half of graduating medical students feel 

8 their nutrition education is insufficient. 

9 SEC. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

10 GUIDELINES, AND FEDERAL AGENCIES AN11 NUAL REPORTS, RELATING TO CERTAIN PRI12 MARY CARE FEDERAL HEALTH PROFES13 SIONALS COMPLETING CONTINUING MED14 ICAL EDUCATION ON NUTRITION. 

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

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

17 and Human Services shall issue guidelines to Federal 

18 agencies for developing procedures and requirements to 

19 ensure that every primary care health professional em20 ployed full-time for such agencies have at least 6 credits 

21 of continuing medical education courses relating to nutri22 tion (as described in subsection (c)). 

23 (b) ANNUAL REPORTS.—For 2016 and each subse24 quent year, the head of each Federal agency that employs 

25 full-time primary care health professionals shall submit to 


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1 Congress a report attesting, in a form and manner speci2 fied by the Secretary of Health and Human Services, to 

3 the extent to which the agency has adopted and enforced 

4 the guidelines issued under subsection (a) with respect to 

5 such professionals employed by such agency during any 

6 portion of the previous year. If the agency, with respect 

7 to such previous year, did not fully adopt and enforce such 

8 guidelines with respect to such professionals, the head of 

9 the agency shall include in the report for the year the per10 centage of such professionals employed by such agency to 

11 furnish primary care services who during such previous 

12 year completed 6 credits of continuing medical education 

13 courses relating to nutrition (as described in subsection 

14 (c)). 

15 (c) CONTINUING MEDICAL EDUCATION RELATING TO

16 NUTRITION.—For purposes of subsections (a) and (b), 

17 continuing medical education courses relating to nutrition 

18 shall include at least courses on the role of nutrition in 

19 the prevention, management, and, as possible, reversal of 

20 obesity, cardiovascular disease, diabetes, and cancer. 

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

22 (1) PRIMARY CARE HEALTH PROFESSIONAL.— 

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

24 a physician or nurse practitioner who furnishes pri25 mary care services. 


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

2 practitioner’’ has the meaning given such term in 

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

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

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

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

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

8 (4) PRIMARY CARE SERVICES.—The term ‘‘pri9 mary care services’’ has the meaning given such 

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

11 (42 U.S.C. 1395u(i)(4)), but shall include such serv12 ices furnished by a nurse practitioner as would oth13 erwise be included if furnished by a physician. 

Æ 


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