,i #aaeth ,,congress #ast ,session ,h4 ,r4 #adac ,,in ,,the ,,house ,,of ,,representatives ,march #g1 #bjag,mr4 ,ryan of ,ohio 7for himself1 ,mr4 ,tiberi1 ,mr4 ,mc,govern1 ,mr4 ,blumenauer1 and ,ms4 ,pingree7 introduced the following bill2 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 schools4 #a4 ,short title ,this ,act may be cited as the ,expanding ,nutrition's ,role in ,curricula and ,healthcare ,act or the ,,enrich ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,in #bjab1 ,united ,states health care spending was about #h1iae per resident and accounted for #ag4b percent of the ,nation's gross domestic product1 which is among the highest of all industrialized countries4 7#b7 ,expenditures in the ,united ,states on health care surpassed #b4c trillion in #bjjh1 more than three times the #gad billion spent in #aiij1 and over eight times the #bec billion spent in #aihj4 ,cardiovascular disease cost ,american's #eee billion in #bjaf alone4 7#c7 ,it is estimated that health care costs for chronic disease treatment account for over #ge percent of national health expenditures4 7#d7 ,in ,march #bjjc1 a report from the ,world ,health ,organization concluded diet was a major factor in the cause of chronic diseases4 7#e7 ,seven out of #aj deaths among ,americans each year are from chronic diseases4 ,heart disease1 cancer1 and stroke--each of which has been strongly linked to dietary and lifestyle choices--account for more than #ej percent of all deaths each year4 7#f7 ,in #bjae1 #ajb4g million people in the ,united ,states had at least one form of cardiovascular disease4 ,approximately #b1cjj ,americans die every day from cardiovascular disease4 ,in #bjaj1 cardiovascular disease cost ,american taxpayers #ahi4d billion4 ,the ,american ,heart ,association estimates that1 by #bjce1 costs related to cardiovascular disease will triple to around #a4a trillion4 ,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 arteries4 7#g7 ,two-thirds of the ,american population is currently overweight1 half of whom are obese4 ,one in three children is now overweight1 and one-fifth of children are obese4 ,in #bjjh1 the ,united ,states spent #aij billion on obesity-related health care costs4 7#h7 ,an estimated #bi million ,americans have diabetes4 ,another #hf million adults have prediabetes4 ,the ,centers for ,disease ,control and ,prevention predict that one in three children born in #bjjj will develop diabetes at some point in their lives4 ,diabetes cost the government #aaf billion in #bjjg4 ,research has shown that nutrition therapy is a key component of diabetes management and can improve clinical outcomes4 7#i7 ,cancer kills approximately #egj1jjj ,americans each year1 accounting for one in every four deaths4 ,more than #a4e million new cancer cases are diagnosed annually4 ,in #bjaj1 the direct costs of cancer were #ajb4h billion and that number is expected to rise to #agb billion by #bjbj4 ,more than #cc percent of cancers are diet related and could be prevented with a healthful diet4 7#aj7 ,eating is a complex social phenomenon influenced by family1 social networks1 culture1 socioeconomic and educational status4 ,an interprofessional approach to nutrition education for clinicians may not necessarily overcome these forces but may help the health professions team1 including physicians and non-physicians1 identify effective strategies for nutrition counseling and management4 7#aa7 ,physicians are an important source of information and motivation for patients' health behavior4 ,multiple studies have shown that physician counseling on weight loss increases the likelihood that patients will attempt weight loss1 increase physical activity1 improve diet1 and lose weight4 7#ab7 ,leading medical bodies recommend that physicians address diet with overweight patients4 ,guidelines from leading medical bodies such as the ,national ,institutes of ,health1 the ,american ,heart ,association1 the ,american ,college of ,cardiology1 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 activity4 #c4 ,grants program to develop or enhance integrated nutrition curricula in medical schools 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in conjunction with the ,national ,institutes of ,health ,national ,heart1 ,lung1 and ,blood ,institute1 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 7b77#a74 7b7 ,use of grant funds 7#a7 ,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 7#b7 for the medical school4 7#b7 ,integrated nutrition curriculum ,for purposes of paragraph 7#a71 an integrated nutrition and physical activity curriculum-- 7,a7 shall be designed based on the best possible evidence to improve communication and provider preparedness in the prevention1 management1 and1 as possible1 reversal of obesity1 cardiovascular disease1 diabetes1 and cancer2 and 7,b7 shall1 to the greatest extent practicable1 address such additional topics1 including nutrition across the life cycle of individuals who are members of at-risk populations1 physical activity training and programs for such individuals1 food insecurity among such individuals1 and malnutrition among such individuals4 7c7 ,eligibility ,to be eligible to receive a grant under this section1 an eligible entity shall-- 7#a7 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 ,accreditation2 and 7#b7 submit an application to the ,secretary1 in accordance with such time1 form1 and manner and containing such information as specified by the ,secretary1 including-- 7,a7 a description of how the medical school intends to implement the integrated nutrition and physical activity curriculum described in subsection 7b77#b72 and 7,b7 a description of benchmarks to measure the success of the implementation of such curriculum4 7d7 ,administrative provisions 7#a7 ,duration of ,program ,a grant awarded to a medical school under this section shall be for a three-year period1 beginning on the date of the establishment of the grants program under subsection 7a74 7#b7 ,limitations 7,a7 ,grant amounts ,a grant awarded to a medical school under this section may not exceed #ejj1jjj4 7,b7 ,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 grant4 7#c7 ,priority ,in awarding grants1 the ,secretary shall give priority to medical schools-- 7,a7 that submit applications under subsection 7c77#a7 that describe an integrated nutrition and physical activity curriculum that will be implemented through the use of such a grant-- 7i7 that is coordinated with a residency program2 or 7ii7 provides that students of such school should receive at least #be hours of nutrition education2 or 7,b7 that1 for purposes of carrying out such curriculum through the use of such a grant1 partner with education programs for both physicians and non-physician health professionals4 7e7 ,reports 7#a7 ,periodic reports during grants program 7,a7 ,in general ,for each school year ending during the duration of the grants program under this section1 the ,secretary shall submit to ,congress a report on the grants program4 7,b7 ,report ,elements ,each such report shall include-- 7i7 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 program2 7ii7 an assessment of the benefits of the grants program for-- 7,i7 establishing best practices for providers to advise patients in the clinical setting2 7,,ii7 providing greater nutrition and physical activity awareness to physicians and other health professionals and patients of such physicians and professionals2 and 7,,iii7 improving healthfulness of patients' diets and improving patient health outcomes2 and 7iii7 suggestions on how to promote the integration of nutrition curriculum in medical schools around the ,united ,states4 7#b7 ,final ,report ,not later than #ahj days after the last day of the grants program under this section1 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 levels4 7f7 ,funding ,no additional funds are authorized to carry out the requirements of this section4 ,the ,secretary shall carry out such requirements by using1 from amounts otherwise authorized or appropriated1 up to #e1jjj1jjj for each of fiscal years #bjah through #bjbj4