,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #afcd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #bj1 #bjag,mr4   
,grijalva 7= himself1 ,mr4 ,g>am5di1    
,ms4 ,jackson ,lee1 ,ms4 ,roybal-,all>d1
 & ,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 ( #bjag or ! ,,eat =     
,heal? ,act ( #bjag4  #b4 ,f9d+s        
,congress f9ds ! foll[+3  7#a7 ,accord+ 
to #bjac national heal? exp5diture data1
 ,unit$ ,/ates heal? c>e sp5d+ increas$ 
#c4f p]c5t to rea* #b4i trillion1 or    
#i1bee p] p]son1 & acc\nt$ = #ag4d p]c5t

 ( ,gross ,dome/ic ,product 7,,gdp74    
7#b7 ,accord+ to ! ,in/itute ( ,m$ic9e1 
9 #bjab e/imates ( heal? c>e co/s       
attribut$ ov] #ge p]c5t ( national heal?
 exp5ditures to treatm5t = *ronic       
diseases4  7#c7 ,a ,m>* #bjjc report f !
 ,_w ,heal? ,organization conclud$ diet 
0 a major cause ( *ronic diseases4  7#d7
 ,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#e7       
,accord+ to ! ,c5t]s = ,disease ,control
 & ,prev5tion1 9 #bjac he>t disease 0 ! 
lead+ cause ( dea? = ,am]ican adults4   
,approximately #fjj1jjj ,am]ican adults 
die ea* ye> f c>diovascul> disease4     
,coron>y he>t disease alone co/s        
,am]ican taxpay]s #ajh4i billion ea*    
ye>4  7#f7 ,rese>* has %[n t foll[+ a   
heal?ful diet c n only r$uce symptoms   
relat$ to c>diovascul> disease b c also 
actually rev]se damage done to !        
art]ies4  7#g7 ,accord+ to ! ,j\rnal ( !
 ,am]ican ,m$ical ,association1         

two-?irds ( adults 9 ! ,unit$ ,/ates are
 curr5tly ov]weight1 & half ( ^?        
ov]weight individuals are obese4 ,"o 9  
?ree *ildr5 are ov]weight1 & "o-fif? (  
*ildr5 are obese4 ,! ,unit$ ,/ates sp5ds
 ab\t #adg to #baj billion a ye> on     
obesity relat$ diseases1 includ+ type #b
 diabetes1 hyp]t5sion1 he>t disease1 &  
ar?ritis4  7#h7 ,an e/imat$ #bi4a       
million p 9 ! ,unit$ ,/ates h diabetes4 
,ano!r #hf million ,am]ican adults h    
pr$iabetes4 ,! ,c5t]s = ,disease        
,control & ,prev5tion pr$icts 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  7#i7     
,accord+ to ! ,am]ican ,canc] ,society1 
!re w be an e/imat$ #a1feh1cgj new canc]
 cases diagnos$ & #ehi1dcj canc] dea?s 9
 ! ,unit$ ,/ates 9 #bjae4 ,t is         
equival5t to ab\t #a1fbj dea?s p] day & 
acc\nts = ne>ly #a ( e #d dea?s4 ,!     
,ag5cy = ,heal?c>e ,rese>* & ,quality   

7,,ahrq7 e/imates t ! direct m$ical co/s
 = canc] 9 ! ,unit$ ,/ates 9 #bjaa 7    
#hh4g billion4  7#aj7 ,accord+ to !     
,j\rnal ( ! ,am]ican ,college (         
,nutrition1 9 #bjjh physicians felt     
inadequately tra9$ to provide prop]     
nutrition advice4 ,n9ety-f\r p]c5t felt 
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#aa7 ,a #aihe ,national      
,academy ( ,sci5ces report recomm5d$ t  
all m$ical s*ools require at lea/ #be   
contact h\rs ( nutrition education4     
,accord+ to a #bjji national survey (   
m$ical colleges publi%$ 9 ,academic     
,m$ic9e1 only #ch p]c5t ( m$ical s*ools 
met ^! m9imum /&>ds by requir+ #be h\rs 
( nutrition education z "p ( _! g5]al   
curricula 9 #bjjd4 ,by #bjaj1 t numb] _h
 %runk to #bg p]c5t4 ,9 addition1 #cj   
p]c5t ( ,unit$ ,/ates m$ical s*ools     
requir$ a d$icat$ nutrition c\rse 9     
#bjjd4 ,mo/ rec5tly1 only #be p]c5t (   
su* s*ools requir$ su* a c\rse 9 #bjaj4 

7#ab7 ,accord+ to ! ,j\rnal ( ,nutrition
 9 ,cl9ical ,practice 9 #bjaj1 m ?an    
half ( graduat+ m$ical /ud5ts felt _!   
nutrition education 0 insuffici5t4      
7#ac7 ,recogniz+ ! importance (         
nutrition1 ,heal?y ,p #bjbj--! ,f$]al   
,gov]nm5t's framework = a heal?i]       
,nation--includes a goal 7,,nws-#f7 to  
increase ! proportion ( physician (fice 
visits t include c\nsel+ or education   
relat$ to nutrition or weight4 ,accord+ 
to ,heal?y ,p #bjbj1 only #ac4h p]c5t ( 
physician (fice visits includ$ c\nsel+  
ab\t nutrition or diet 7#bjaj late/ ye> 
available74  7#ad7 ,accord+ to ,mission3
 ,read9ess1 "o 9 f\r ,am]icans _c s]ve 9
 ! milit>y due to weight4 ,= ^? s]v+1 ! 
milit>y dis*>g$ #d1cjj active-duty      
p]sonnel due to weight problems 9 #bjab4
  7#ae7 ,accord+ to ! ,j\rnal ( ,am]ican
 ,heal? ,promotion1 ! milit>y sp5ds well
 ov] #a billion a ye> to treat          
weight-relat$ heal? problems su* z he>t 
disease & diabetes ?r\gh its ,,tric>e   
heal? insurance = active duty p]sonnel1 

res]vi/s1 retirees & _! families4  7#af7
 ,accord+ to ! ,c5t]s = ,disease        
,control & ,prev5tion1 ,am]ican ,indian 
or ,alaska ,native adults are #fj p]c5t 
m likely to be obese & ov] twice z      
likely z to h diabetes comp>$ to ,:ite  
adults4  7#ag7 ,accord+ to ! ,c5t]s =   
,disease ,control & ,prev5tion1 ,am]ican
 ,indian or ,alaska ,native adults h !  
highe/ rate ( diabetes among all m9ority
 gr\ps at #ae4i p]c5t4  #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 cont9u+         
education c\rses relat+ to nutrition 7z 
describ$ 9 subsection 7c774  7b7        

,biannual reports ,n lat] ?an #ah mon?s 
aft] ! date ( ! enactm5t ( ?is ,act &   
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$ & enc\rag$ ! 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 & enc\rage 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 complet$ cont9u+ education c\rses    
relat+ to nutrition 7z describ$ 9       
subsection 7c774  7c7 ,cont9u+ education
 relat+ to nutrition ,= purposes (      
subsections 7a7 & 7b71 cont9u+ education
 c\rses relat+ to nutrition %all include
 at lea/ cont5t on ! role ( nutrition 9 

! prev5tion1 managem5t1 &1 z possible1  
rev]sal ( obesity1 c>diovascul> disease1
 diabetes1 or canc]4  7d7 ,def9itions ,=
 purposes ( ?is ,act3 7#a7 ,cont9u+     
education ,! t]m cont9u+ education is   
def9$ z c\rses t meet requirem5ts =     
,cont9u+ ,m$ical ,education 7,,cme7 or  
,cont9u+ ,education 7,,ce7 by m$ical or 
nurse practition] pr(essional           
organizations or c]tifi$ accr$it+       
bodies4  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 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#e7 ,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