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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanding Nutrition’s 
Role in Curricula and Healthcare Act’’ or the ‘‘ENRICH 
Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In 2012, United States health care spend-
ing was about $8,915 per resident and accounted for 
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17.2 percent of the Nation’s gross domestic product, 
which is among the highest of all industrialized 
countries. 
(2) Expenditures in the United States on health 
care surpassed $2.3 trillion in 2008, more than 
three times the $714 billion spent in 1990, and over 
eight times the $253 billion spent in 1980. 
(3) It is estimated that health care costs for 
chronic disease treatment account for over 75 per-
cent of national health expenditures. 
(4) The last major report from the World 
Health Organization in March 2003 concluded diet 
was a major factor in the cause of chronic diseases. 
(5) Seven out of 10 deaths among Americans 
each year are from chronic diseases. Heart disease, 
cancer, and stroke—each of which has been strongly 
linked to dietary and lifestyle choices—account for 
more than 50 percent of all deaths each year. 
(6) About 81.1 million people in the United 
States have at least one form of cardiovascular dis-
ease. Approximately 2,300 Americans die every day 
from cardiovascular disease. In 2010, cardiovascular 
disease cost American taxpayers $189.4 billion. The 
American Heart Association estimates that, by 
2030, direct costs related to cardiovascular disease 
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will triple to around $818 billion. Research has 
shown that following a healthful diet can not only 
reduce symptoms related to heart disease but also 
reverse the damage done to the arteries. 
(7) Two-thirds of the American population is 
currently overweight, half of whom are obese. One in 
three children is now overweight, and one-fifth of 
children are obese. In 2008, the United States spent 
$190 billion on obesity-related health care costs. 
(8) An estimated 25.8 million Americans have 
diabetes. Another 79 million adults have prediabetes. 
The Centers for Disease Control and Prevention pre-
dict that one in three children born in 2000 will de-
velop diabetes at some point in their lives. Diabetes 
cost the government $116 billion in 2007. Research 
has shown that nutrition therapy is a key component 
of diabetes management and can improve clinical 
outcomes. 
(9) Cancer kills approximately 570,000 Ameri-
cans each year, accounting for one in every four 
deaths. More than 1.5 million new cancer cases are 
diagnosed annually. In 2010, the direct costs of can-
cer were $102.8 billion and that number is expected 
to rise to $172 billion by 2020. More than 33 per-
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cent of cancers are diet related and could be pre-
vented with a healthful diet. 
(10) Eating is a complex social phenomenon in-
fluenced by family, social networks, culture, socio-
economic and educational status. An interprofes-
sional approach to nutrition education for clinicians 
may not necessarily overcome these forces but may 
help the health professions team identify effective 
strategies for nutrition counseling and management. 
(11) Physicians are an important source of in-
formation and motivation for patients’ health behav-
ior. Multiple studies have shown that physician 
counseling on weight loss increases the likelihood 
that patients will attempt weight loss, increase phys-
ical activity, improve diet, and lose weight. 
(12) Leading medical bodies recommend that 
physicians address diet with overweight patients. 
Guidelines from leading medical bodies such as the 
National Institutes of Health, the American Heart 
Association, the American College of Cardiology, and 
the Obesity Society recommend that physicians 
counsel overweight and obese patients on the bene-
fits of lifestyle changes through lifestyle changes 
such as diet and physical activity. 
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SEC. 3. GRANTS PROGRAM TO DEVELOP OR ENHANCE IN-
TEGRATED NUTRITION CURRICULA IN MED-
ICAL SCHOOLS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration and in con-
junction with the National Institutes of Health National 
Heart, Lung, and Blood Institute, shall establish a com-
petitive grants program under which the Secretary may 
award grants to medical schools in the United States for 
the purpose described in subsection (b)(1). 
(b) USE OF GRANT FUNDS.— 
(1) IN GENERAL.—A medical school receiving a 
grant under this section shall use the grant to create 
new or expand existing integrated nutrition cur-
riculum described in paragraph (2) for the medical 
school. 
(2) INTEGRATED
NUTRITION
CURRICULUM.— 
For purposes of paragraph (1), an integrated nutri-
tion curriculum— 
(A) shall be designed based on the best 
possible evidence to improve communication and 
provider preparedness in the prevention, man-
agement, and, as possible, reversal of obesity, 
cardiovascular disease, diabetes, and cancer; 
and 
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