In the 19th session in the second series of assessments of
Healthy People 2010, Assistant Secretary for Health Joxel Garcia
chaired a Progress Review on Nutrition and Overweight. He was assisted by staff
of the co-lead Agencies for this Healthy People 2010 focus area, the
Food and Drug Administration (FDA) and the National Institutes of Health (NIH).
Also participating in the review were representatives from other Agencies and
offices within the U.S. Department of Health and Human Services (HHS) and from
the U.S. Department of Agriculture, the U.S. Department of Defense, the U.S.
Department of Education, and the Federal Trade Commission. ADM Garcia opened
the meeting by stating that ensuring good nutrition and controlling the trend
toward overweight were critical to the well-being of the Nation. Not only the
health and life expectancy of the people, but also the productivity of the
country, are affected. ADM Garcia stressed the importance of the situation with
the statement that we, as adults, may be the first generation that will be
burying our children if we do not reverse the increasing prevalence of
overweight and obesity.
The complete November 2000 text for the Nutrition and
Overweight focus area of Healthy People 2010 is available online at
www.healthypeople.gov/document/html/volume2/19nutrition.htm.
Revisions to the focus area chapter that were made after the January 2005
Midcourse Review are available at www.healthypeople.gov/data/midcourse/html/focusareas/fa19toc.htm.
For comparison with the current state of the focus area, the report on the
first-round Progress Review (held on January 21, 2004) is archived at
www.healthypeople.gov/data/2010prog/focus19/2004fa19.htm.
The meeting agenda, tabulated data for all focus area objectives, charts, and
other materials used in the Progress Review can be found at a companion site
maintained by the Centers for Disease Control and Prevention's (CDC's) National
Center for Health Statistics (NCHS): www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa19-nutrition2.htm.
That site has a link to wonder.cdc.gov/data2010,
which provides access to detailed definitions for the objectives in all 28
Healthy People 2010 focus areas and periodic updates to their
data.
Data Trends
In his overview of data for the focus area, NCHS Director
Edward Sondik first focused on the increasing prevalence of overweight and
obesity in children and adolescents. According to national data from the period
20032006, the proportion of young people aged 6-19 years who were
overweight or obese was 17 percent. This is an increase from 11 percent in the
period 19881994. Dr. Sondik also noted that improved State-level data
collection on the prevalence of child and adolescent overweight and obesity is
in place. He emphasized the importance of taking advantage of the window of
opportunity to establish healthful behaviors in youth that could then be
continued over their lifetime as adults. Other serious health problems
associated with diet include heart disease, stroke, some cancers, type 2
diabetes, and osteoporosis. Diet-related conditions can contribute to reduced
quality of life, premature death, substantial medical costs, and lost
productivity. Of the 19 objectives and subobjectives remaining in the focus
area after the Healthy People 2010 Midcourse Review for which there
are data to assess progress, only 2calcium intake and food
securityhave made significant progress toward their targets. Seven show
little or no progress, and 8 have moved away from their targets. Two other
objectives either have only baseline data or are without data. Dr. Sondik noted
that all objectives related to overweight and obesity are moving away from
their targets. A more detailed examination of some of the objectives in the
focus area follows.
(Obj. 19-1): The age-adjusted proportion
of adults aged 20 years and older whose weight is in the healthy range was 32
percent in the period 20032006, a decrease from 42 percent in the period
19881994. The 2010 target is 60 percent. Healthy weight is defined in
terms of a body mass index (BMI) of between 18.5 and 24.9. This downward trend
in healthy weight carries across all demographic groups for whom data were
collected, including Mexican American, non-Hispanic black, and non-Hispanic
white. The trend also prevails across genders and income levels.
(Obj. 19-2): The age-adjusted
proportion of adults aged 20 years and older who are obesethat is, have a
BMI of 30 or abovewas 33 percent in 20032006. The 19881994
baseline was 23 percent, and the target is 15 percent. Increases in this
proportion were evident in all racial and ethnic groups for whom data were
collected, including Mexican American (rising from 29 percent to 35 percent
over that period), non-Hispanic blacks (from 30 percent to 45 percent), and
non-Hispanic white (from 22 percent to 32 percent). Gender differences were
most apparent for Mexican Americans42 percent of females were obese,
compared with 29 percent of malesand non-Hispanic blacks53 percent
of females were obese, compared with 35 percent of males.
(Objs. 19-3a, -3b, -3c): Overweight
and obesity in children aged 6 to 11 years increased from 11 percent in
19881994 to 17 percent in 20032006. In adolescents aged 12 to 19
years, the increase over the same period was from 11 percent to 18 percent. The
target for both children and adolescents is 5 percent. The proportion of
children and adolescents who are overweight or obese increased for all racial
and ethnic groups surveyedfrom 15 to 22 percent among Mexican Americans,
from 14 to 22 percent among non-Hispanic blacks, and from 10 to 15 percent
among non-Hispanic whites.
(Objs. 19-5, 19-6, 19-7): The
proportion of people aged 2 years and older (age-adjusted) who ate at least two
servings of fruit per day increased slightly from 19941996 (39 percent)
to 20032004 (40 percent). The target is 75 percent. In 20032004,
the proportion of the population that met the Healthy People 2010
criteria for vegetable intakeat least three daily servings with at least
one-third being dark green or orangewas the same as in 19941996, 4
percent. The target is 50 percent. In 20032004, dark green or orange
vegetables represented about 7 percent of the total vegetable consumption by
children and adolescents aged 2 to 19 years. For adults, the proportion was 11
percent in 20032004. Current dietary guidance recommends that Americans
consume at least half their grains from whole grain. The proportion of people
who ate at least six daily servings of grain products with at least three being
whole grains was 3 percent in 20032004, a decrease from 4 percent in
19941996. In 20032004, whole grains represented 7 percent of total
grain product intake by children and adolescents and 10 percent of total grain
product intake by adults. The target is 50 percent.
(Obj. 19-10): The age-adjusted
proportion of people meeting the Healthy People 2010 criterion for
total daily sodium intake, i.e., 2,400 mg or less, was 13 percent in
20032004, compared with 15 percent in 19881994. The target is 65
percent.
(Obj. 19-11): Total calcium intake is
one objective for which the data show improvement. The age-adjusted proportion
of people whose total calcium intake was at or above 100 percent of the
Institute of Medicine (IOM) adequate intake (AI) values was 42 percent in
20032004, compared with 31 percent in 19881994. The target is 74
percent.
Key Challenges and Current Strategies
Representatives from FDA and NIH made presentations on the
principal themes of the Progress Review, which centered on focus area
objectives that aim to promote healthy weights among children and adolescents
and healthy eating among all Americans. The presenters were Stephen Sundlof,
Director, Center for Food Safety and Applied Nutrition (CFSAN)/FDA, and Raynard
Kington, Deputy Director, NIH. Their statements and Progress Review briefing
materials prepared by an interagency workgroup identified a number of barriers
to achieving the objectives, as well as activities under way to meet these
challenges, including the following.
Barriers
-
Surveys such as What We Eat in America (WWEIA)/National
Health and Nutrition Examination Survey (NHANES) play a crucial role in
tracking the progress of objectives in this focus area. However, the increasing
cost of conducting the WWEIA/NHANES survey has challenged its capability to
continue in this tracking role. Modifications in methodologies and technologies
present other tracking challenges. Furthermore, national data from WWEIA/NHANES
are not meant to be representative of the States and local communities, and
State and local data are not always comparable to national data.
-
"Away from home" foodsfull meals and single
ready-to-eat items purchased at restaurants, prepared-food counters at grocery
stores, institutional foodservice settings, and other outletsplay an
important role in the increasing prevalence of overweight and obesity. Healthy
eating is a challenge at restaurants that offer a limited choice of healthful
foods.
-
Many factors influence development of inappropriate
weight gain, and not all factors contribute equally for all people. It is
important, therefore, to understand which factors are more important for which
individuals and for population groups.
-
In the Dietary Guidelines for Americans, 2005,
it is estimated that about 75 percent of the salt content in food comes from
salt added by manufacturers. Data from 20032004 showed that salt use at
the table contributed a small but not inconsequential amount to the total, with
very little sodium being contributed by tap water or dietary supplements.
-
Getting people to sustain the necessary behavioral
changes to maintain lifelong weight management can be extremely
difficult.
-
Although individuals who have calcium intakes at or
above the IOM AI values have a low probability of inadequacy, a limitation of
these reference values is that they cannot be used to assess the proportion of
a population who have inadequate intakes.
-
Besides limiting daily sodium intake, another dietary
measure to lower blood pressure is to consume a diet rich in potassium.
However, data from 20032004 showed that few Americans had intakes above
the AI values established by the IOM.
-
Federal nutrition assistance programs designed to
improve access to healthful foods for low-income families are not uniformly
aligned with the Dietary Guidelines for Americans, 2005.
-
Although States and local communities have the authority
to set standards for all foods and beverages sold in schools outside of school
meal programs, as in vending machines, for example, many jurisdictions have not
taken action.
Activities and Outcomes
-
The Dietary Guidelines for Americans, 2000
document was updated in 2005, and the focus continues to be on helping
Americans manage weight and reduce their risk for chronic diseases. The
guidelines encourage consumption of a variety of fruits and vegetables, whole
grains, and calcium-rich foods, while staying within the limits of daily
calorie needs. The value of exercise also is stressed. These guidelines are one
example of the importance of interagency collaboration in establishing dietary
recommendations and monitoring the Nation's progress in their implementation.
The HHS Childhood Overweight and Obesity Prevention Council is another example
of such collaboration.
-
The Nutrition Facts label on packaged foods is another
important tool in helping consumers construct healthful diets. FDA is seeking
ways to improve the label's information about nutrients, calories, and serving
size. The Agency has updated nutrition information for the voluntary labeling
of raw fruits, vegetables, and seafood.
-
FDA is involved in collaborative efforts to promote
healthy weights and eating among youth. Spot the Block is a partnership with
the Cartoon Network that aims to increase use and understanding of the
nutrition facts label. The Power of Choice is an afterschool program
developed in collaboration with U.S. Department of Agriculture's (USDA's) Food
and Nutrition Service. Both programs are directed at "tweens" (i.e., children
and adolescents aged 9 to 13 years). FDA also has partnered with the National
Science Teachers Association to provide teachers with training and tools to
help children use the Nutrition Facts label.
-
USDA has contracted with the IOM to provide
recommendations to update the meal patterns and nutrition requirements for both
the National School Lunch Program and the School Breakfast Program. In December
2007, USDA also published an interim final rule revising the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC) food
packages to increase access and availability of fruits, vegetables, and whole
grains and decrease provision of higher fat dairy products to low-income
families and children.
-
NIH supports a variety of research studiesbasic,
clinical, and translationalon various aspects of nutrition and
overweight. Studies endeavor to increase understanding of biologic pathways
that control appetite and energy use, genetic factors that predispose people to
weight gain, and behavioral and environmental factors that can contribute to
weight problems.
-
The Dietary Approaches to Stop Hypertension (DASH) study
showed that a healthy eating plan can reduce the risk for developing high blood
pressure and can lower elevated blood pressure. The DASH eating plan is a model
diet within the Dietary Guidelines for Americans, 2005 and is a
program initiated through support from NIH.
-
NIH's National Heart, Lung, and Blood Institute,
National Institute of Diabetes and Digestive and Kidney Diseases, National
Institute of Child Health and Human Development, and National Cancer Institute
collaborated on the We Can! (Ways to Enhance Children's Activity and
Nutrition) initiative in 2005. We Can! is a national,
community-based education and outreach program designed to help prevent
childhood obesity.
-
NIH has established a strategic plan to coordinate and
enhance development of new obesity research efforts among NIH Institutes,
Centers, and Offices.
-
Effecting behavioral change is considered integral to
the mission of NIH, which supports research on emerging bio-behavioral science
and on problem behaviors that fall within the scope of individual Institutes.
NIH research in the area of behavior change includes the Health Maintenance
Consortium, a 5-year study begun in 2003 that intends to increase understanding
of long-term maintenance of behavior change. Also included is the Science of
Behavior Change, a roadmap pilot study set to begin in 2008 that is intended to
establish the groundwork for a unified science of behavior change.
Approaches for Consideration
Participants in the Progress Review made the following
suggestions for public health professionals and policymakers to consider as
steps to enable further progress toward achieving the objectives for Nutrition
and Overweight:
-
Support and strengthen NHANES and other data monitoring
activities with dedicated Federal funding.
-
Increase public awareness of overweight and obesity at
the individual and population levels.
-
Place greater emphasis on the importance of scientific
understanding to the achievement of sustained behavioral change and long-term
lifestyle modification.
-
Improve communications with the public to convey the
message that there are recommended actions that can be effective in weight
management.
-
Integrate efforts of multiple public-private sector
partners to address nutrition and overweight as Healthy People 2020
begins, and include nontraditional partners in these activities.
-
Use emerging technologies, such as interactive
videogaming technology, to direct efforts at youth and other targeted
audiences.
-
Support and strengthen efforts to identify and share
weight control and reduction interventions that work.
-
Make a special effort to address high-risk populations
and health disparities in childhood obesity through additional mechanisms to
provide community support programs and community participation in research
efforts.
-
Provide greater support for school health and physical
education programs.
-
Use Federal nutrition assistance programs to increase
access to and availability of fruits, vegetables, and whole grains and decrease
provision of higher fat dairy products to low-income families and
children.
-
Support efforts to change the way foods are marketed to
children and to improve the nutritional profile of those foods.
Contacts for information about Healthy
People 2010 focus area 19Nutrition and Overweight:
|
[Signed July 1, 2008] Donald Wright, M.D.,
M.P.H. Principal Deputy Assistant Secretary for Health
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