I 117th CONGRESS 2d Session H. R. 8964 IN THE HOUSE OF REPRESENTATIVES September 22, 2022 Mr. Grijalva (for himself and Mr. McGovern ) 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 2022 or the EAT for Health Act of 2022 . 2. Findings Congress finds the following: (1) According to 2019 National Health Expenditure Account data, the growth in total national healthcare expenditures in 2019 reached $3.8 trillion, or $11,582 per person. (2) According to the Center for Disease Control and Prevention (CDC) around 90 percent of annual health expenditures are for people with chronic and mental health conditions. (3) According to the CDC most people in the United States don’t eat a healthy diet and consume too much sodium, saturated fat, and sugar, increasing their risk of chronic diseases. Fewer than 1 in 10 adolescents and adults eat enough fruits or vegetables. (4) According to National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes. (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) According to NCCDPHP eating healthy helps prevent, delay, and manage heart disease, type 2 diabetes, and other chronic diseases. (5) According to the CDC, heart disease is the leading cause of death for American adults. Approximately 659,000 American adults die each year from cardiovascular disease. Coronary heart disease alone costs American taxpayers $363 billion each year. (7) Research has shown that following a healthful diet, including a plant-based diet, can not only reduce symptoms related to cardiovascular disease but can also actually reverse damage done to the arteries. (8) According to the Journal of the American Medical Association, two-thirds of adults in the United States are currently overweight, and half of those overweight individuals are obese. One in three children are overweight, and one-fifth of children are obese. The United States spends about $147 to $210 billion a year on obesity related diseases, including type 2 diabetes, hypertension, heart disease, and arthritis. (9) An estimated 34.2 million people in the United States have diabetes. Another 88 million American adults have prediabetes. The Centers for Disease Control and Prevention predicts that one in three children born in 2000 will develop diabetes at some point in their lives. Total direct estimated costs of diagnosed diabetes increased from $188 billion in 2012 to $237 billion in 2017. (10) A consensus statement endorsed by American Association of Clinical Endocrinology, supported by the Academy of Nutrition and Dietetics, and co-sponsored by the Endocrine Society reports that plant-based diets and other nutrition interventions aid type 2 diabetes remission. (11) According to the American Cancer Society, there will be an estimated 1,918,030 new cancer cases diagnosed and 609,360 cancer deaths in the United States in 2022. That is equivalent to about 1,670 deaths per day and accounts for nearly 1 of every 4 deaths. The National Cancer Institute estimates that cancer-related direct medical costs in the U.S. were $183 billion in 2015 and are projected to increase to $246 billion by 2030, a 34% increase based only on population growth and aging. (12) According to a 2008 survey published in Journal of the American College of Nutrition, physicians felt inadequately trained to provide proper nutrition advice. Ninety-four percent felt nutrition counseling should be included during primary care visits, but only 14 percent felt adequately trained to provide such counseling. (13) A 1985 National Academy of Sciences report recommended that all medical schools require at least 25 contact hours of nutrition education. According to a 2009 national survey of medical colleges published in Academic Medicine, only 38 percent of medical schools met these minimum standards by requiring 25 hours of nutrition education as part of their general curricula in 2004. By 2010, that number had shrunk to 27 percent. (14) According to the Journal of Nutrition in Clinical Practice in 2010, more than half of graduating medical students felt their nutrition education was insufficient. (15) Recognizing the importance of nutrition, Healthy People 2030—the Federal Government’s framework for a healthier Nation—includes a goal (NWS–05) to increase the proportion of health care visits by adults with obesity that include counseling or education related to nutrition, weight loss, or physical activity. According to Healthy People 2030, only 24.8 percent of physician office visits included counseling about nutrition or diet in 2016. (16) According to Mission: Readiness, obesity disqualifies 31 percent of youth from serving if they so choose. (17) According to the Journal of American Health Promotion, the military spends well over $1 billion a year to treat weight-related health problems such as heart disease and diabetes through its TRICARE health insurance for active duty personnel, reservists, retirees and their families. (18) According to the Department of Health and Human Services, racial and ethnic minority groups experience higher rates of chronic health conditions, including diabetes, hypertension, obesity, heart disease, and cancer when compared to their White counterparts due to Social Determinants of Health, including lack of access to nutritious food. 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 continuing education courses relating to nutrition (as described in subsection (c)). (b) Biannual reports Not later than 18 months after the date of the enactment of this Act 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 encouraged 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 encourage 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 completed continuing education courses relating to nutrition (as described in subsection (c)). (c) Continuing education relating to nutrition For purposes of subsections (a) and (b), continuing education courses relating to nutrition shall include at least content on the role of nutrition, in the prevention, management, and, as possible, reversal of obesity, cardiovascular disease, diabetes, or cancer. (d) Definitions For purposes of this Act: (1) Continuing education The term continuing education is defined as courses that meet requirements for Continuing Medical Education (CME) or Continuing Education (CE) by medical or nurse practitioner professional organizations or certified accrediting bodies. (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 health professional The term primary care health professional means a physician or nurse practitioner who furnishes primary care services. (5) 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.