[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1888 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 1888

   To provide for a grants program to develop and enhance integrated 
     nutrition and physical activity curricula in medical schools.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 26, 2019

Mr. Ryan (for himself 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 and physical activity curricula in medical schools.

    Be it enacted by the Senate and House of Representatives 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 spending was about 
        $8,915 per resident and accounted for 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. Cardiovascular disease cost American's $555 
        billion in 2016 alone.
            (3) It is estimated that health care costs for chronic 
        disease treatment account for over 75 percent of national 
        health expenditures.
            (4) In March 2003, a report from the World Health 
        Organization 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) In 2015, 102.7 million people in the United States had 
        at least one form of cardiovascular disease. 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 
        2035, costs related to cardiovascular disease will triple to 
        around $1.1 trillion. 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 29 million Americans have diabetes. 
        Another 86 million adults 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. 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 Americans 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 cancer were $102.8 billion and that number is expected 
        to rise to $172 billion by 2020. More than 33 percent of 
        cancers are diet related and could be prevented with a 
        healthful diet.
            (10) Eating is a complex social phenomenon influenced by 
        family, social networks, culture, socioeconomic and educational 
        status. An interprofessional approach to nutrition education 
        for clinicians may not necessarily overcome these forces but 
        may help the health professions team, including physicians and 
        non-physicians, identify effective strategies for nutrition 
        counseling and management.
            (11) Physicians are an important source of information and 
        motivation for patients' health behavior. Multiple studies have 
        shown that physician counseling on weight loss increases the 
        likelihood that patients will attempt weight loss, increase 
        physical 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 benefits of lifestyle 
        changes through lifestyle changes such as diet and physical 
        activity.

SEC. 3. GRANTS PROGRAM TO DEVELOP OR ENHANCE INTEGRATED NUTRITION 
              CURRICULA IN MEDICAL SCHOOLS.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and Services 
Administration and in conjunction with the National Institutes of 
Health National Heart, Lung, and Blood Institute, shall establish a 
competitive 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 and physical activity curriculum 
        described in paragraph (2) for the medical school.
            (2) Integrated nutrition curriculum.--For purposes of 
        paragraph (1), an integrated nutrition and physical activity 
        curriculum--
                    (A) shall be designed based on the best possible 
                evidence to improve communication and provider 
                preparedness in the prevention, management, and, as 
                possible, reversal of obesity, cardiovascular disease, 
                diabetes, and cancer; and
                    (B) shall, to the greatest extent practicable, 
                address such additional topics, including nutrition 
                across the life cycle of individuals who are members of 
                at-risk populations, physical activity training and 
                programs for such individuals, food insecurity among 
                such individuals, and malnutrition among such 
                individuals.
    (c) Eligibility.--To be eligible to receive a grant under this 
section, an eligible entity shall--
            (1) be a medical school in the United States that is 
        accredited by the Liaison Committee on Medical Education and 
        Residency Program Accreditation Council for Graduate Education 
        or by the American Osteopathic Association Commission on 
        Osteopathic College Accreditation; and
            (2) submit an application to the Secretary, in accordance 
        with such time, form, and manner and containing such 
        information as specified by the Secretary, including--
                    (A) a description of how the medical school intends 
                to implement the integrated nutrition and physical 
                activity curriculum described in subsection (b)(2); and
                    (B) a description of benchmarks to measure the 
                success of the implementation of such curriculum.
    (d) Administrative Provisions.--
            (1) Duration of program.--A grant awarded to a medical 
        school under this section shall be for a three-year period, 
        beginning on the date of the establishment of the grants 
        program under subsection (a).
            (2) Limitations.--
                    (A) Grant amounts.--A grant awarded to a medical 
                school under this section may not exceed $500,000.
                    (B) One grant per school.--A medical school shall 
                not be eligible for more than one grant under this 
                section and may not renew such a grant.
            (3) Priority.--In awarding grants, the Secretary shall give 
        priority to medical schools--
                    (A) that submit applications under subsection 
                (c)(1) that describe an integrated nutrition and 
                physical activity curriculum that will be implemented 
                through the use of such a grant--
                            (i) that is coordinated with a residency 
                        program; or
                            (ii) provides that students of such school 
                        should receive at least 25 hours of nutrition 
                        education; or
                    (B) that, for purposes of carrying out such 
                curriculum through the use of such a grant, partner 
                with education programs for both physicians and non-
                physician health professionals.
    (e) Reports.--
            (1) Periodic reports during grants program.--
                    (A) In general.--For each school year ending during 
                the duration of the grants program under this section, 
                the Secretary shall submit to Congress a report on the 
                grants program.
                    (B) Report elements.--Each such report shall 
                include--
                            (i) the findings and conclusions of the 
                        Secretary with respect to the integration of 
                        nutrition and physical activity curriculum into 
                        the curriculum of the medical schools receiving 
                        a grant under the grants program;
                            (ii) an assessment of the benefits of the 
                        grants program for--
                                    (I) establishing best practices for 
                                providers to advise patients in the 
                                clinical setting;
                                    (II) providing greater nutrition 
                                and physical activity awareness to 
                                physicians and other health 
                                professionals and patients of such 
                                physicians and professionals; and
                                    (III) improving healthfulness of 
                                patients' diets and improving patient 
                                health outcomes; and
                            (iii) suggestions on how to promote the 
                        integration of nutrition curriculum in medical 
                        schools around the United States.
            (2) Final report.--Not later than 180 days after the last 
        day of the grants program under this section, the Secretary 
        shall submit to Congress a report detailing the recommendations 
        of the Secretary as to any benefits or barriers of integrating 
        nutrition and physical activity curriculum at both the medical 
        school and residency levels.
    (f) Funding.--No additional funds are authorized to carry out the 
requirements of this section. The Secretary shall carry out such 
requirements by using, from amounts otherwise authorized or 
appropriated, up to $5,000,000 for each of fiscal years 2019 through 
2021.
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