I 113th CONGRESS 2d Session H. R. 4378 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. Short title This Act may be cited as the Education and Training for Health Act of 2014 or the EAT for Health Act of 2014 . 2. Findings Congress finds the following: (1) In 2012, United States health care spending was approximately $8,233 per resident and accounted for 17.6 percent of the Nation’s gross domestic product. This is among the highest of all industrialized 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 treatment 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. (6) Approximately 81.1 million American adults in the United States have at least one form of cardiovascular disease. Approximately 2,300 American adults in the United States 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 will triple to around $818 billion. (7) Research has shown that following a healthful diet can not only reduce symptoms related to cardiovascular disease but also actually reverse damage done to the arteries. (8) Two-thirds of adults in the United States are currently overweight, and half of those overweight 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 lives. Total estimated costs of diagnosed diabetes have increased 41 percent, to $245 billion in 2012 from $174 billion in 2007. Research shows that reducing fat in the diet can reverse the symptoms of type 2 diabetes, not just manage the symptoms. (10) Cancer kills approximately 570,000 Americans each year, accounting for one in four deaths. More than 1.5 million new cancer cases are diagnosed 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 included during primary care visits, but only 14 percent felt adequately trained to provide such counseling. (12) A 1985 National Academy of Sciences report 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 nutrition education as part of their general curricula. By 2010, that number had shrunk to 27 percent. (13) In 2004, 30 percent of United States medical 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. 3. Department of Health and Human Services guidelines, and Federal agencies annual reports, relating to certain primary care Federal health professionals completing continuing medical 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 employed full-time for such agencies have at least 6 credits of continuing medical education courses relating to nutrition (as described in subsection (c)). (b) Annual reports For 2016 and each subsequent year, the head of each Federal agency that employs full-time primary care health professionals shall submit to Congress a report attesting, in a form and manner specified 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 percentage 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 primary care services. (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 primary 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 services furnished by a nurse practitioner as would otherwise be included if furnished by a physician.