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| The Acting Assistant Secretary
for Health chaired the third review of progress on Healthy People 2000 objectives for
nutrition. As the co-lead agencies for this priority area, the Food and Drug
Administration and the National Institutes of Health led a discussion that focused on
overweight prevalence and consumption of fruits and vegetables, with an emphasis on
children and adolescents. A summary of the review of these and other selected nutrition
objectives follows: |
| 2.3
2.3 The
prevalence of overweight has increased since 1980 for nearly all age, ethnic and gender
groups. From a 1976-80 baseline of 24 percent, overweight prevalence in adult males 20-74
years of age (body mass index [BMI]³27.8) increased to 34 percent, according to data for
1988-94. Overweight prevalence for adult females (BMI³27.3) increased from the baseline
of 27 percent to 37 percent in the same period. The year 2000 target is 20 percent for
both groups. Data for 1988-94 showed that 24 percent of adolescents aged 12-19 were
overweight (using BMI cutoffs based on modified age- and gender-specific 85th percentile
values of the 1976-80 National Health and Nutrition Examination Survey), an increase from
the base-line of 15 percent. While there are no year 2000 objectives for reducing
overweight in children, data show that overweight in girls aged 4-5 (using sex- and
age-specific 95th percentile of weight for stature based on NCHS/CDC growth charts)
increased from 7.6 percent in 1976-80 to 11.2 percent in 1988-94. For boys in that age
group, the increase was from 4.4 to 5 percent. Among children aged 6-11, overweight (using
sex- and age-specific 95th percentile of BMI based on the National Health Examination
Survey II) increased from 7.6 percent in 1976-80 to 13.6 percent in 1988-94. 2.5 2.5 Data for 1994-96 indicate that people 2 years of
age and over received on average 33 percent of their total caloric intake from fat and 11
percent from saturated fat. In the baseline period of 1989-91, the proportions were 34
percent and 12 percent, respectively. Thus, there is some progress toward the year 2000
targets: 30 percent for fat and 10 percent for saturated fat. In 1994-96, 33 percent of
people age 2 and over met the goal for fat intake (baseline: 22 percent) and 35 percent
met the goal for intake of saturated fat (baseline: 21 percent), which is progress toward
the 50 percent target.
2.6 2.6 In 1994-96, the population aged 2 and
over consumed an average of 4.6 daily servings of fruits and vegetables, an increase from
the 1989-91 baseline of 4.1. Those aged 2-19 consumed an average of 4.0 daily servings
(baseline: 3.6) and those aged 20 years and over consumed an aver-age of 4.9 daily
servings (baseline: 4.3). The year 2000 target for all groups is 5 servings. The
proportion of the population aged 2 and over that met the Dietary Guide-lines for
Americans recommendation of 5 or more servings daily has increased from 29 percent in
the baseline period 1989-91 to 36 percent in 1994-96. The age group 2-19 years showed an
increase from 20 percent to 26 percent over this time span. The increase for those aged 20
and over was from 32 percent at baseline to 40 per-cent in 1994-96. The target for all
groups is 50 percent.
2.19 2.19 There has been an increase from 60
percent in 1990 to 69 per-cent in 1994 in the proportion of States that require nutrition
education in grades K-12, moving toward the year 2000 target of 75 percent.
2.20 2.20 In 1995, 18 percent of work-sites
with 50 or more employees offered nutrition or cholesterol education programs and 14
per-cent offered weight management programs. The year 2000 target is for 50 percent of
these worksites to provide such programs.
2.21 In 1992, the percentages of primary
care providers who provided nutrition assessment and counseling and/or referral to 81-100
percent of patients were as follows: pediatricians— 53 percent; nurse
practitioners— 46 percent; obstetricians/gynecologists—15 percent;
internists—36 percent; family physicians— 19 percent. The percentages who
formulated a diet/nutrition plan for 81-100 percent of patients who needed it were as
follows: pediatricians— 31 percent; nurse practitioners—31 percent;
obstetricians/ gynecologists—19 percent; internists—33 percent;
family-California physicians—24 percent. The year 2000 target for each category and
specialty is 75 percent.. In 1992, the percentages of primary
care providers who provided nutrition assessment and counseling and/or referral to 81-100
percent of patients were as follows: pediatricians— 53 percent; nurse
practitioners— 46 percent; obstetricians/gynecologists—15 percent;
internists—36 percent; family physicians— 19 percent. The percentages who
formulated a diet/nutrition plan for 81-100 percent of patients who needed it were as
follows: pediatricians— 31 percent; nurse practitioners—31 percent;
obstetricians/ gynecologists—19 percent; internists—33 percent;
family-California physicians—24 percent. The year 2000 target for each category and
specialty is 75 percent.. |
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H I G H L I G H T S
- Increasing Body Mass Index (BMI) carries increased risks of
heart disease, diabetes and other chronic diseases in all populations, although there is
some variation in absolute risk among different ethnic groups.
- The increase since 1980 in the prevalence of obesity in
young children and youth is most probably associated with declining rates of participation
in sports and other forms of physical activity. Only one state, Illinois, requires daily
physical education in grades K-12.
- A comprehensive school health program in Denver has had
notable success in improving health and fitness levels of Hispanic children from lower
socioeconomic families. The key is an integrated approach to enhancing both sound
nutritional behavior and physical activity levels.
- Research on the mechanisms that control food intake and
energy balance is increasing the understanding of the roles that genetic, behavioral, and
physiological factors play in the development of obesity.
- Research on identifying the genetic susceptibility to
obesity is advancing and should make possible the future identification of individuals who
are particularly susceptible to becoming overweight.
- The 5-A-Day for Better Health Program is a multi-level
(national, state, and local) nutrition education program and public-private partnership
that encourages the daily intake of at least 5 servings of healthful fruits and
vegetables. Data from California suggest that nutrition education must be continued over
time to achieve lasting success; when suspended, consumption of fruits and vegetables
drops.
- Not all vegetable products consumed are low in fat. The U.S.
Department of Agriculture’s Continuing Survey of Food Intakes by Individuals found
that one-third of vegetable servings consumed by persons 2-19 years of age in 1994-96 were
fried potatoes.
- Fruit and vegetable consumption varies by meal and day of
the week. It is higher on Mondays and Tuesdays, lower on Fridays and Saturdays. Eating
away from home also influences consumption.
F O L L O W- U P
- Forge stronger partnerships among Federal, state, local and
private agencies that conduct programs to promote healthier eating habits as part of a
healthy lifestyle.
- Emphasize the close linkage between diet and physical
activity in health promotion messages. Ensure the consistency of positive, reinforcing
messages to the public on nutrition, allowing for varying emphases depending on the
particular population group targeted.
- Explore the feasibility of a Surgeon General’s Report
on obesity.
- Investigate ways to enhance funding to initiate, sustain,
and broaden efforts to promote fruit and vegetable consumption and other healthful
behaviors, especially at the state and community levels.
- When setting agendas for research on changing dietary
behavior, explore behavioral and social intervention strategies based on lifestyles.
- Encourage the Department of Education to promote greater
emphasis on public school programs in nutrition and physical activity.
- Seek ways to integrate and leverage funding for programs to
promote healthful behaviors after school as well as in school.
- Achieve greater integration of current food consumption
surveys with a view to increasing the compatibility of data sets.
- Develop consistent measures in federal reporting on
nutritional status, including those reported in strategic plans and budget documents
developed under the Government Performance and Results Act.
- Continue to advance preparations for the fifth edition of
the Dietary Guidelines for Americans, to be issued jointly by HHS and USDA in 2000.
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P A R T I C I P A N T S
Agency for Healthcare Research and Quality (AHRQ)
California Department of Health Services
Centers for Disease Control and Prevention
Food and Drug Administration
Health Resources and Services Administration
M.D. Anderson Cancer Center (University of Texas)
National Institutes of Health
Office of Disease Prevention and Health Promotion
Office of Minority Health
Pan American Health Organization
President’s Council on Physical Fitness and Sports
Produce for Better Health Foundation
Substance Abuse and Mental Health Services Administration
U.S. Department of Agriculture
University of Colorado
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