,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dcgh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #b1 #bjad ,mr4 
,grijalva 7= himself & ,mr4 ,ryan (     
,ohio7 introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to require !      
,secret>y ( ,heal? & ,human ,s]vices to 
issue to ,f$]al ag5cies guidel9es =     
develop+ proc$ures & requirem5ts relat+ 
to c]ta9 prim>y c>e ,f$]al heal?        
pr(essionals complet+ cont9u+ m$ical    
education on nutrition & to require     
,f$]al ag5cies to submit annual reports 
relat+ to su* guidel9es1 & = o!r        
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,education & ,tra9+ =      
,heal? ,act ( #bjad or ! ,,eat = ,heal? 
,act ( #bjad4  #b4 ,f9d+s ,congress f9ds
 ! foll[+3  7#a7 ,9 #bjab1 ,unit$ ,/ates
 heal? c>e sp5d+ 0 approximately #h1bcc 
p] resid5t & acc\nt$ = #ag4f p]c5t ( !  
,nation's gross dome/ic product4 ,?is is
 among ! highe/ ( all indu/rializ$      
c\ntries4  7#b7 ,exp5ditures 9 ! ,unit$ 

,/ates on heal? c>e surpass$ #b4f       
trillion 9 #bjaa1 m ?an ?ree times !    
#gad billion sp5t 9 #aiij1 & ov] eight  
times ! #bec billion sp5t 9 #aihj4  7#c7
 ,e/imates ( heal? c>e co/s attribute   
ov] #ge p]c5t ( national heal?          
exp5ditures to treatm5t = *ronic        
diseases4  7#d7 ,a ,m>* #bjjc report f !
 ,_w ,heal? ,organization conclud$ diet 
0 a major cause ( *ronic diseases4  7#e7
 ,sev5 out ( #aj dea?s among p 9 !      
,unit$ ,/ates ea* ye> are f *ronic      
diseases su* z c>diovascul> disease1    
obesity1 diabetes1 & canc]4  7#f7       
,approximately #ha4a million ,am]ican   
adults 9 ! ,unit$ ,/ates h at lea/ "o =m
 ( c>diovascul> disease4 ,approximately 
#b1cjj ,am]ican adults 9 ! ,unit$ ,/ates
 die e day f c>diovascul> disease4 ,9   
#bjaj1 c>diovascul> disease co/ ,am]ican
 taxpay]s #ahi4d billion4 ,! ,am]ican   
,he>t ,association e/imates t1 by #bjcj1
 direct co/s relat$ to c>diovascul>     
disease w triple to ar\nd #hah billion4 
7#g7 ,rese>* has %[n t foll[+ a heal?ful

 diet c n only r$uce symptoms relat$ to 
c>diovascul> disease b also actually    
rev]se damage done to ! art]ies4  7#h7  
,two-?irds ( adults 9 ! ,unit$ ,/ates   
are curr5tly ov]weight1 & half ( ^?     
ov]weight individuals are obese4 ,"o 9  
?ree *ildr5 are n[ ov]weight1 & "o-fif? 
( *ildr5 are obese4 ,9 #bjjh1 direct    
m$ical co/s associat$ ) obesity total$  
#adg billion4  7#i7 ,an e/imat$ #be4h   
million p 9 ! ,unit$ ,/ates h diabetes4 
,ano!r #gi million ,am]ican adults 9 !  
,unit$ ,/ates h pr$iabetes4 ,! ,c5t]s = 
,disease ,control & ,prev5tion pr$ict t 
"o 9 ?ree *ildr5 born 9 #bjjj w develop 
diabetes at "s po9t 9 _! lives4 ,total  
e/imat$ co/s ( diagnos$ diabetes h      
increas$ #da p]c5t1 to #bde billion 9   
#bjab f #agd billion 9 #bjjg4 ,rese>*   
%[s t r$uc+ fat 9 ! diet c rev]se !     
symptoms ( type #b diabetes1 n j manage 
! symptoms4  7#aj7 ,canc] kills         
approximately #egj1jjj ,am]icans ea*    
ye>1 acc\nt+ = "o 9 f\r dea?s4 ,m ?an   
#a4e million new canc] cases are        

diagnos$ annually4 ,9 #bjaj1 ! direct   
co/s ( canc] 7 #ajb4h billion4 ,e/imates
 expect t numb] to rise to #agb billion 
by #bjbj4  7#aa7 ,accord+ to ! ,j\rnal (
 ! ,am]ican ,college ( ,nutrition1      
physicians feel inadequately tra9$ to   
provide prop] nutrition advice4         
,n9ety-f\r p]c5t feel nutrition c\nsel+ 
%\ld be includ$ dur+ prim>y c>e visits1 
b only #ad p]c5t felt adequately tra9$  
to provide su* c\nsel+4  7#ab7 ,a #aihe 
,national ,academy ( ,sci5ces report    
recomm5d$ t all m$ical s*ools require at
 lea/ #be contact h\rs ( nutrition      
education4 ,9 #bjjd1 only #ch p]c5t (   
m$ical s*ools met ^! m9imum /&>ds by    
requir+ #be h\rs ( nutrition education z
 "p ( _! g5]al curricula4 ,by #bjaj1 t  
numb] _h %runk to #bg p]c5t4  7#ac7 ,9  
#bjjd1 #cj p]c5t ( ,unit$ ,/ates m$ical 
s*ools requir$ a d$icat$ nutrition      
c\rse4 ,9 #bjaj1 only #be p]c5t ( su*   
s*ools requir$ su* a c\rse4  7#ad7      
,accord+ to a #bjji national survey (   
m$ical colleges publi%$ 9 ,academic     

,m$ic9e1 m ?an half ( graduat+ m$ical   
/ud5ts feel _! nutrition education is   
insuffici5t4  #c4 ,dep>tm5t ( ,heal? &  
,human ,s]vices guidel9es1 & ,f$]al     
ag5cies annual reports1 relat+ to c]ta9 
prim>y c>e ,f$]al heal? pr(essionals    
complet+ cont9u+ m$ical education on    
nutrition  7a7 ,guidel9es ,n lat] ?an   
#ahj days aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,secret>y ( ,heal? & ,human    
,s]vices %all issue guidel9es to ,f$]al 
ag5cies = develop+ proc$ures &          
requirem5ts to ensure t e prim>y c>e    
heal? pr(essional employ$ full-"t = su* 
ag5cies h at lea/ #f cr$its ( cont9u+   
m$ical education c\rses relat+ to       
nutrition 7z describ$ 9 subsection 7c774
  7b7 ,annual reports ,= #bjaf & ea*    
subsequ5t ye>1 ! head ( ea* ,f$]al ag5cy
 t employs full-"t prim>y c>e heal?     
pr(essionals %all submit to ,congress a 
report atte/+1 9 a =m & mann] specifi$  
by ! ,secret>y ( ,heal? & ,human        
,s]vices1 to ! ext5t to :i* ! ag5cy has 
adopt$ & en=c$ ! guidel9es issu$ "u     

subsection 7a7 ) respect to su*         
pr(essionals employ$ by su* ag5cy dur+  
any portion ( ! previ\s ye>4 ,if !      
ag5cy1 ) respect to su* previ\s ye>1 did
 n fully adopt & en=ce su* guidel9es )  
respect to su* pr(essionals1 ! head ( ! 
ag5cy %all include 9 ! report = ! ye> ! 
p]c5tage ( su* pr(essionals employ$ by  
su* ag5cy to furni% prim>y c>e s]vices  
:o dur+ su* previ\s ye> complet$ #f     
cr$its ( cont9u+ m$ical education c\rses
 relat+ to nutrition 7z describ$ 9      
subsection 7c774  7c7 ,cont9u+ m$ical   
education relat+ to nutrition ,=        
purposes ( subsections 7a7 & 7b71       
cont9u+ m$ical education c\rses relat+  
to nutrition %all include at lea/ c\rses
 on ! role ( nutrition 9 ! prev5tion1   
managem5t1 &1 z possible1 rev]sal (     
obesity1 c>diovascul> disease1 diabetes1
 & canc]4  7d7 ,def9itions ,= purposes (
 ?is ,act3  7#a7 ,prim>y c>e heal?      
pr(essional ,! t]m prim>y c>e heal?     
pr(essional means a physician or nurse  
practition] :o furni%es prim>y c>e      

s]vices4  7#b7 ,nurse practition] ,! t]m
 nurse practition] has ! mean+ giv5 su* 
t]m 9 section #ahfa7;aa77#e7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciex7aa77#e774  7#c7 ,physician ,! t]m
 physician has ! mean+ giv5 su* t]m 9   
section #ahfa7r77#a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciex7r77#a774  7#d7 ,prim>y c>e       
s]vices ,! t]m prim>y c>e s]vices has ! 
mean+ giv5 su* t]m 9 section            
#ahdb7;i77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieu7i77#d771 b %all  
include su* s]vices furni%$ by a nurse  
practition] z w\ld o!rwise be includ$ if
 furni%$ by a physician4