About the ENRICH Act

The Physicians Committee
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Legislative Focus

About the ENRICH Act

The Expanding Nutrition’s Role in Curricula and Healthcare (ENRICH) Act (H.R. 1411) is a bipartisan bill sponsored by Rep. Tim Ryan (D-Ohio) and Rep. Pat Tiberi (R-Ohio).

Important things to keep in mind:

  • This bill does not require any new money.
  • Integrating nutrition and physical activity education into curricula means offering nutrition and physical activity education throughout medical school, residency programs, and in conjunction with other health education programs, and can also mean offering additional opportunities such as CME and seminars.

Questions and Answers

1. Why does this bill combine nutrition and physical activity education in medical schools?

Expert recommendations on the prevention and mitigation of chronic health conditions such as cardiovascular disease and type 2 diabetes focus on the two most important lifestyle factors that contribute to disease: diet and exercise. Health care providers are ill-equipped to counsel and educate patients at risk or living with chronic health conditions despite the burgeoning need. Medical schools recognize the deficiency in education but have not prioritized funding or integrating nutrition and physical activity education. The ENRICH Act will update and align medical school curricula with these expert recommendations so that all health care providers—no matter the specialty—will become competent in nutrition and physical activity science and will increase counseling and referrals to registered dietitians, nutritionists, and sports medicine and fitness professionals.

2. Do increasing nutrition and physical activity awareness and education among health care providers really work?
    
Many studies support health improvements after nutrition and physical activity counseling. A study in JAMA Internal Medicine shows patients who receive an extra 5.5 minutes in primary care visits to talk about nutrition lose 5 pounds, lower saturated fat intake, and improve LDL cholesterol levels. For exercise, in one study, physical activity among patients increased after receiving physician advice.  

3. What are medical schools currently doing about nutrition education?
 
Despite the fact that medical school students want more nutrition education, the amount of nutrition education is very low and actually declining. A 1985 National Academy of Sciences (NAS) report recommended that all medical schools require at least 25 contact hours of nutrition education. In 2004, only 38 percent of medical schools met these minimum standards by requiring 25 hours of nutrition education as part of their general curricula. By 2010, that number shrunk to 27 percent. In 2004, 30 percent of U.S. medical schools required a dedicated nutrition course. In 2010, only 25 percent of U.S. medical schools required such a course.
    
4. What are medical schools currently doing about physical activity education?
 
Although 92 percent of medical school deans regard physical activity education as important, only 13 percent of medical schools report having a core course or required curriculum on physical activity (2002 latest data available).
    
5. Why aren’t more medical schools offering nutrition and physical activity education?
 
Despite both being an important crosscutting issue for all specialties and chronic diseases, medical schools are only starting to consider lifestyle factors as an important part of improving the health and well-being of patients. Many of them see cost as a barrier, despite how little integration can cost and, once integrated, how little it costs to sustain.

6. Why would ENRICH grants be administered by the Health Resources and Services Administration (HRSA)?
 
HRSA will coordinate with the NIH’s National Heart, Lung, and Blood Institute (NHLBI) in the development of the ENRICH grant program, since the NHLBI had previously funded a similar grant program for medical schools under the Nutrition Academic Award program.
 
HRSA is under the Department of Health and Human Services (HHS) and works to strengthen the health care workforce, build healthy communities, and improve health equity. HRSA supports the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery. To this end, HRSA is positioned to oversee grants to medical schools to increase nutrition and physical activity education among training health care professionals.
 
7. What is the precedent for this bill?
 
There is no dedicated funding to increase nutrition and physical activity education for health care professionals in medical schools and residency programs. However, one grant program that focused on nutrition education called the Nutrition Academic Award (NAA), funded primarily by the NIH National Heart, Lung, and Blood Institute (NHLBI), provided more than $15 million to 21 of the 126 existing medical institutions ($150,000 per school) to integrate nutrition education into medical school curricula from 1998 to 2005, showed positive results.
 
The ENRICH Act would fund at least 30 medical schools and will further build on initiatives like the NAA that sustained and increased nutrition education and awareness among training physicians but would include physical activity education. The NAA is considered by many experts to be a successful federal intervention. Some of the results are:
 

  • Medical students in NAA schools viewed their nutrition education as more adequate than in non-NAA schools (about half of NAA students versus about one-third of non-NAA students), and this increased over the length of the program.
  • More than 50 percent of NAA schools show consistent inclusion of nutrition in their curricula.
  • More than 25 non-NAA schools increased nutrition in their curricula because of NAA efforts.
  • More than 10,000 medical students were affected by the collective NAA efforts.

8. What is the cost of integration into medical school curricula?
    
While the NAA gave $150,000 per school to integrate nutrition, the costs of integration into curricula may be much lower and schools have been able to maintain the courses. The ENRICH Act would fund $15 million in grants. Using the NAA as example, at $150,000 per school the ENRICH grant program could fund more than 30 medical schools.

9. What are some examples of integration?
 
Integration means offering nutrition and physical activity education as an integral part of the school’s curriculum and throughout the student’s tenure in medical school and residency:

  • Offering a lifestyle course that focuses on nutrition and physical activity
  • Integrating into existing courses for all specialties
  • Integrating into clerkships and outpatient electives
  • Providing CME, workshops, lectures, and seminars
  • Offering research electives
  • Residency programs includes rotation in nutrition and physical activity

10.  Will schools be able to maintain integrated curricula after ENRICH no longer funds them?
    
More than 50 percent of NAA schools still show consistent inclusion of nutrition in their curriculum.

11.  How is this bill funded?
 

This bill does not specify how it will be funded but that, if enacted, it would be funded from existing funds from HHS. Therefore, it does not require any new money.