Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress or that were assessed in alternative ways. Progress is illustrated in the Progress Quotient bar chart (see Figure 19-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Data to measure progress toward the 2010 targets were available for the following objectives and subobjectives: healthy weight in adults (19-1), obesity in adults (19-2), overweight or obesity in children and adolescents (19-3a, b, and c), growth retardation in children (19-4), iron deficiency in young children aged 1 to 2 years (19-12a) and females of childbearing years (19-12c), anemia in low-income pregnant females (19-13), nutrition counseling for medical conditions (19-17), and food security (19-18).

Objectives that met or exceeded their targets. No objectives in this focus area met or exceeded their targets.

Objectives that moved toward their targets. Food security (19-18) was the only objective that moved toward its target for which the change was statistically significant. "Food security" is defined as household members having access at all times to enough food for an active, healthy life.⁶ This objective aims to increase food security among U.S. households from a baseline of 88 percent in 1995 to a target of 94 percent in 2010.

In 2003, 89 percent of American households were food secure throughout the entire year. The typical food-secure household in the United States spent 34 percent more on food than did the typical food-insecure household of the same size and household composition.⁶ Just over half of the food-insecure households reported previous-month participation in one or more of the three largest Federal food assistance programs—National School Lunch Program; Food Stamp Program; and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Of the three subobjectives for iron deficiency in young children and in females of childbearing age (19-12), only one moved toward its target: children aged 1 to 2 years (19-12a). The prevalence of iron deficiency moved toward the target of 5 percent, from 9 percent in 1988–94 to 7 percent in 1999–2000.

Objectives that demonstrated no change. Growth retardation among children under age 5 years in low-income families (19-4) showed no movement toward or away from its target. This objective remained static at 6 percent through 2003, with the target at 4 percent. Optimal nutrition is important to reducing the growth retardation among low-income children.

Objectives that moved away from their targets. The data for three Healthy People 2010 objectives on the weight status of adults and youth showed a trend away from the 2010 targets.⁷ During the survey periods from 1988–94 to 1999–2002, the age-adjusted proportion of adults aged 20 years and older at a healthy weight (19-1) decreased from 42 percent to 33 percent, while the proportion of adults who were obese (19-2) increased from 23 percent to 30 percent. The targets for 19-1 and 19-2 are 60 percent and 15 percent, respectively. Between 1988–94 and 1999–2002, the prevalence of overweight and obesity among children and adolescents aged 6 to 19 years (19-3c) increased from 11 percent to 16 percent, moving away from the target of 5 percent. Identical trends were observed among children aged 6 to 11 years (19-3a) and adolescents aged 12 to 19 years (19-3b).

The challenges in addressing the increase in overweight and obesity are many. Food is abundant, portion sizes have increased, and society has become increasingly sedentary.^{4, 8} Because the contributing factors to overweight and obesity are complex―including genetic, metabolic, behavioral, environmental, cultural, and socioeconomic components―reversing the epidemic will take concerted action by all sectors of society. A supportive environment with accessible and affordable healthy food choices and opportunities for regular physical activity can facilitate individual behavior change.⁴ In addition, for obese adults, even modest weight loss (for example, 10 pounds) has health benefits.²

Promoting healthy weight is a principal component of the HealthierUS initiative and the Steps to a HealthierUS (Steps) initiative.⁹ A centerpiece of Steps is the 5-year cooperative agreement programs between the Federal Government and States, cities, and Tribal entities. These groups receive funds to implement prevention efforts to reduce the burden of disease attributable to obesity, diabetes, heart disease, stroke, and asthma. Another cooperative effort is a memorandum of understanding (MOU) between the U.S. Departments of Education, Agriculture (USDA), and HHS. The MOU establishes a framework for the departments to work together to encourage youth to adopt healthy eating and physical activity.¹⁰ These initiatives are a sampling of the collaboration among agencies and the public-private sector directed at reversing the overweight and obesity epidemic.

For the subobjective that addresses iron deficiency in nonpregnant females aged 12 to 49 years (19-12c), the prevalence increased from 11 percent to 12 percent, moving away from the target of 7 percent. In addition, the prevalence of anemia among low-income pregnant females in the third trimester (19-13) increased from 29 percent in 1996 to 30 percent in 2003, moving away from the target of 20 percent. For females of childbearing age, iron deficiency may be prevented by screening, appropriate treatment, and dietary counseling. Dietary counseling includes encouraging the consumption of foods that are good sources of iron (for example, red meat, spinach, and iron-fortified breakfast cereals) and foods with an enhancer of iron absorption such as vitamin C. The WIC program is an important and wide-reaching Federal initiative to reduce iron deficiency and anemia. The initiative offers nutrition counseling and iron-rich foods to low-income pregnant, post partum, and breastfeeding women and to infants and children at nutritional risk.¹¹

Nutrition counseling for medical conditions (19-17) moved away from its target. This objective aims to increase the proportion of physician office visits made by patients with a diagnosis of cardiovascular disease, diabetes, or hyperlipidemia that include ordering or providing dietary counseling to 75 percent by 2010. From 1997 to 2000, the proportion declined from 42 percent to 40 percent.

Objectives that could not be assessed or were assessed in alternative ways. Nine objectives and one subobjective did not have available data at the midcourse review. Some had other measurements that were useful in assessing progress.

No data were available to assess reducing the prevalence of iron deficiency among children aged 3 to 4 years (19-12b) or increasing the proportion of worksites that offer nutrition or weight management classes or counseling (19-16). However, data sources have been identified, and these objectives are anticipated to have data to assess progress by the end of the decade.

Seven objectives are aimed at encouraging healthful eating patterns. They address fruit, vegetable, and grain product intake (19-5, 19-6, and 19-7), saturated and total fat intake (19-8 and 19-9), and total sodium and calcium intake (19-10 and 19-11). Data were not available to provide updated estimates on the proportion of the population that meets intake recommendations for these objectives but will be available for final review. The assessment of progress in relation to the targets was not possible for this report because a second day of diet recall data on survey respondents was not available from the most recent national dietary intake survey, the 1999–2002 NHANES.

However, 1-day diet recall data were available from the baseline data sources and the 1999–2000 NHANES, and were used to estimate average intakes of fruits, vegetables, whole grains, total and saturated fats, and sodium (but not calcium). These data provide useful information on trends in food and nutrient consumption but are not included in Figure 19-1, because they do not represent the same measurement used to create the initial baselines.

Objective 19-5 aims to increase the proportion of the population aged 2 years and older who consume at least two daily servings of fruit. The average intake by persons aged 2 years and older remained the same from 1994–96 to 1999–2002 (1.6 servings). Progress was also not apparent for two objectives: to increase Americans' consumption of total vegetables with at least one-third being dark green or orange (19-6) and to increase consumption of total grain products with at least three being whole grain (19-7). During this same time period, average vegetable consumption for people aged 2 years and older declined from 3.4 to 3.2, with no noted change in the daily consumption of dark green or orange vegetables (0.3 servings). Average total grain product consumption, originally at 6.8 servings per day, also did not change. Whole grain consumption decreased from 1.0 to 0.8 servings per day.

Increasing consumption of fruits, vegetables, and whole grains in the United States presents a range of challenges. For example, consumers weigh attributes such as taste, convenience, availability, price, and perceived health benefits.^{12, 13} The 2005 Dietary Guidelines for Americans (Dietary Guidelines)² provides a basis for renewed efforts to promote daily consumption of whole grains and of a variety of fruits and vegetables.² One framework for such efforts is the 5 A Day for Better Health Program, a large-scale partnership between the fruit and vegetable industry and the Federal Government to identify and implement strategies to increase fruit and vegetable consumption.¹⁴

The data suggested that little or no progress was achieved in decreasing the Nation's consumption of saturated fat (19-8) or total fat (19-9). Between 1988–94 and 1999–2002, the average intake for persons aged 2 years and older remained at 33 percent of calories for total fat and at 11 percent of calories for saturated fat. The Dietary Guidelines recommends total fat intake as a percentage of calories between 30 percent and 35 percent for children aged 2 to 3 years, 25 percent and 35 percent for children and adolescents aged 4 to 18 years, and 20 percent and 35 percent for adults.² The Dietary Guidelines also recommends that Americans 2 years of age and older consume less than 10 percent of calories from saturated fat while keeping trans fatty acid consumption as low as possible. Processed foods and oils provide most of the trans fats in the diet.²

For the objective aimed at decreasing total sodium intake (19-10), 1999–2000 data suggested that average intake by persons 2 years of age and older remains well above the Dietary Guidelines' recommendation to consume less than 2,300 milligrams daily.² Most of Americans' sodium intake comes from salt added by manufacturers to processed and prepackaged foods rather than from the natural salt content of foods or salt shakers used at the table or in cooking.² With respect to objectives 19-8, 19-9, and 19-10, consumers need access to information about the fat (including saturated fat and trans fat) and sodium content of the foods they eat, both at home and away from home.

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