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 con-
tinuing 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 guide-
lines, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Education and Train-
ing for Health Act of 2014’’ or the ‘‘EAT for Health Act 
of 2014’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In 2012, United States health care spend-
ing was approximately $8,233 per resident and ac-
counted for 17.6 percent of the Nation’s gross do-
mestic product. This is among the highest of all in-
dustrialized countries. 
(2) Expenditures in the United States on health 
care surpassed $2.6 trillion in 2011, more than 
three times the $714 billion spent in 1990, and over 
eight times the $253 billion spent in 1980. 
(3) Estimates of health care costs attribute over 
75 percent of national health expenditures to treat-
ment for chronic diseases. 
(4) A March 2003 report from the World 
Health Organization concluded diet was a major 
cause of chronic diseases. 
(5) Seven out of 10 deaths among people in the 
United States each year are from chronic diseases 
such as cardiovascular disease, obesity, diabetes, and 
cancer. 
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(6) Approximately 81.1 million American adults 
in the United States have at least one form of car-
diovascular disease. Approximately 2,300 American 
adults in the United States die every day from car-
diovascular disease. In 2010, cardiovascular disease 
cost American taxpayers $189.4 billion. The Amer-
ican Heart Association estimates that, by 2030, di-
rect costs related to cardiovascular disease will triple 
to around $818 billion. 
(7) Research has shown that following a health-
ful diet can not only reduce symptoms related to 
cardiovascular disease but also actually reverse dam-
age done to the arteries. 
(8) Two-thirds of adults in the United States 
are currently overweight, and half of those over-
weight individuals are obese. One in three children 
are now overweight, and one-fifth of children are 
obese. In 2008, direct medical costs associated with 
obesity totaled $147 billion. 
(9) An estimated 25.8 million people in the 
United States have diabetes. Another 79 million 
American adults in the United States have 
prediabetes. The Centers for Disease Control and 
Prevention predict that one in three children born in 
2000 will develop diabetes at some point in their 
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lives. Total estimated costs of diagnosed diabetes 
have increased 41 percent, to $245 billion in 2012 
from $174 billion in 2007. Research shows that re-
ducing fat in the diet can reverse the symptoms of 
type 2 diabetes, not just ‘‘manage’’ the symptoms. 
(10) Cancer kills approximately 570,000 Ameri-
cans each year, accounting for one in four deaths. 
More than 1.5 million new cancer cases are diag-
nosed annually. In 2010, the direct costs of cancer 
were $102.8 billion. Estimates expect that number 
to rise to $172 billion by 2020. 
(11) According to the Journal of the American 
College of Nutrition, physicians feel inadequately 
trained to provide proper nutrition advice. Ninety- 
four percent feel nutrition counseling should be in-
cluded during primary care visits, but only 14 per-
cent felt adequately trained to provide such coun-
seling. 
(12) A 1985 National Academy of Sciences re-
port recommended that all medical schools require at 
least 25 contact hours of nutrition education. In 
2004, only 38 percent of medical schools met these 
minimum standards by requiring 25 hours of nutri-
tion education as part of their general curricula. By 
2010, that number had shrunk to 27 percent. 
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(13) In 2004, 30 percent of United States med-
ical schools required a dedicated nutrition course. In 
2010, only 25 percent of such schools required such 
a course. 
(14) According to a 2009 national survey of 
medical colleges published in Academic Medicine, 
more than half of graduating medical students feel 
their nutrition education is insufficient. 
SEC. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
GUIDELINES, AND FEDERAL AGENCIES AN-
NUAL REPORTS, RELATING TO CERTAIN PRI-
MARY 
CARE 
FEDERAL 
HEALTH 
PROFES-
SIONALS COMPLETING CONTINUING MED-
ICAL EDUCATION ON NUTRITION. 
(a) GUIDELINES.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall issue guidelines to Federal 
agencies for developing procedures and requirements to 
ensure that every primary care health professional em-
ployed full-time for such agencies have at least 6 credits 
of continuing medical education courses relating to nutri-
tion (as described in subsection (c)). 
(b) ANNUAL REPORTS.—For 2016 and each subse-
quent year, the head of each Federal agency that employs 
full-time primary care health professionals shall submit to 
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Congress a report attesting, in a form and manner speci-
fied by the Secretary of Health and Human Services, to 
the extent to which the agency has adopted and enforced 
the guidelines issued under subsection (a) with respect to 
such professionals employed by such agency during any 
portion of the previous year. If the agency, with respect 
to such previous year, did not fully adopt and enforce such 
guidelines with respect to such professionals, the head of 
the agency shall include in the report for the year the per-
centage of such professionals employed by such agency to 
furnish primary care services who during such previous 
year completed 6 credits of continuing medical education 
courses relating to nutrition (as described in subsection 
(c)). 
(c) CONTINUING MEDICAL EDUCATION RELATING TO 
NUTRITION.—For purposes of subsections (a) and (b), 
continuing medical education courses relating to nutrition 
shall include at least courses on the role of nutrition in 
the prevention, management, and, as possible, reversal of 
obesity, cardiovascular disease, diabetes, and cancer. 
(d) DEFINITIONS.—For purposes of this Act: 
(1) PRIMARY CARE HEALTH PROFESSIONAL.— 
The term ‘‘primary care health professional’’ means 
a physician or nurse practitioner who furnishes pri-
mary care services. 
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(2) NURSE PRACTITIONER.—The term ‘‘nurse 
practitioner’’ has the meaning given such term in 
section 1861(aa)(5) of the Social Security Act (42 
U.S.C. 1395x(aa)(5)). 
(3) PHYSICIAN.—The term ‘‘physician’’ has the 
meaning given such term in section 1861(r)(1) of 
the Social Security Act (42 U.S.C. 1395x(r)(1)). 
(4) PRIMARY CARE SERVICES.—The term ‘‘pri-
mary care services’’ has the meaning given such 
term in section 1842(i)(4) of the Social Security Act 
(42 U.S.C. 1395u(i)(4)), but shall include such serv-
ices furnished by a nurse practitioner as would oth-
erwise be included if furnished by a physician. 
Æ 
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