|
|
|
National Data Source
|
National Health and Nutrition
Examination Survey (NHANES), CDC, NCHS.
|
|
State Data Source
|
Behavioral Risk Factor
Surveillance System (BRFSS), CDC, NCCDPHP. (See Comments.)
|
|
Healthy People 2000 Objective
|
Not applicable.
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
42 (1988–94).
|
|
Numerator
|
Number of persons aged 20 years
and older with a BMI equal to or greater than 18.5 and less than 25.0.
|
|
Denominator
|
Number of persons in the survey
population aged 20 years and older.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual, beginning with 1999 data.
|
|
Comments
|
The NHANES obtains measured
weights and heights without shoes. BMI is calculated by dividing weight in
kilograms by the square of height in meters.
|
|
The selection of a BMI cut-point
to establish the healthy weight range is based on the relationship of
overweight or obesity to disease or death. A BMI of less than 25 has been
accepted by numerous groups as the upper limit of the healthy weight range,
because more disease occurs in most populations at or above this cut-point.1,
2, 3, 4 The lower cut-point for the healthy weight range (BMI of
18.5) was selected to be consistent with national and international
recommendations.1, 3, 4
|
|
Data are age adjusted to the 2000
standard population. Age-adjusted percents are weighted sums of age-specific
percents. For a discussion of age adjustment, see Part A, section 5.
|
|
State-level data on self-reported
heights and weights are collected annually in BRFSS for adults aged 18 years
and older. This data source enables States to estimate the proportion of the
population that reports heights and weights in the healthy range and to track
trends, although the method of measurement (through telephone interview)
differs from the national measures. Body weight prevalence estimates derived
from self-reported heights and weights tend to be lower than those derived
from measured height and weight.
|
|
See Part C for a description of
NHANES and Appendix A for focus area contact information.
|
|
|
|
National Data Source
|
National Health and Nutrition
Examination Survey (NHANES), CDC, NCHS.
|
|
State Data Source
|
Behavioral Risk Factor
Surveillance System (BRFSS), CDC, NCCDPHP. (See Comments.)
|
|
Healthy People 2000 Objective
|
Adapted from 2.3 (Nutrition) (also
1.2, 15.10, 17.12).
|
|
Leading Health Indicator
|
Overweight and Obesity.
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
23 (1988–94).
|
|
Numerator
|
Number of persons aged 20 years
and older with a BMI at or above 30.0.
|
|
Denominator
|
Number of persons in the survey population
aged 20 years and older.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual, beginning with 1999 data.
|
|
Comments
|
NHANES obtains measured weights
and heights without shoes. BMI is calculated by dividing weight in kilograms
by the square of height in meters.
|
|
BMI will be used as a proxy for
overweight and obesity in adults until a better measure of body fat is
developed. In 1997, a Consultation on Obesity convened by the World Health
Organization recommended standardizing the classification of overweight and
obesity.5 Overweight was defined as a BMI of 25.0 or
greater and obesity was defined as a BMI of 30.0 or greater. Further
classification of obesity was made as follows: 30.0-34.9 was defined as Class I obesity, 35.0-39.9 as Class
II, and 40.0 or greater as Class III.
|
|
The Expert Panel on the
Identification, Evaluation, and Treatment of Overweight and Obesity in
Adults, convened by NIH, recently adopted general concepts of the World
Health Organization classification system1, 5 and it has
now been endorsed by more than 50 professional medical societies, consumer
groups, and government agencies. For this objective, therefore, a BMI cutoff
point of 30.0 was chosen for adults aged 20 years and older. Since 1960,
essentially all of the increased prevalence of overweight and obesity in
adults in the United States has occurred at a BMI greater than or equal to
30.0.1, 5, 6
|
|
Data are age adjusted to the 2000 standard population. Age-adjusted
percents are weighted sums of age-specific percents. For a discussion of age
adjustment, see Part A, section 5.
|
|
State-level data on self-reported
heights and weights are collected annually in BRFSS for adults, but are not
comparable to the national statistics. These data enable States to estimate
the proportion of the population that reports heights and weights in the
obese range and to track trends, although the method of measurement (through
telephone interview) differs from the national measures. Body weight
prevalence estimates derived from self-reported heights and weights tend to
be lower than those derived from measured height and weight.
|
|
This objective differs from
Healthy People 2000 objective 2.3 (Nutrition), which defined overweight as a
BMI greater than or equal to 27.8 for men and 27.3 for women. The values used
for Healthy People 2000 corresponded with the gender-specific 85th percentile
of the 1976–80 NHANES II reference population 20 to 29 years of age and were
not age adjusted.
|
|
This objective is one of the
measures used to track the Overweight and Obesity Leading Health Indicator.
See Appendix H for a complete list.
|
|
See Part C for a description of
NHANES and Appendix A for focus area contact information.
|
|
19-3a. Children
aged 6 to 11 years.
|
|
National Data Source
|
National Health and Nutrition
Examination Survey (NHANES), CDC, NCHS.
|
|
State Data Source
|
Not identified.
|
|
Healthy People 2000 Objective
|
Adapted from 2.3 (Nutrition) (also
1.2, 15.10, 17.12).
|
|
Measure
|
Percent.
|
|
Baseline
|
11 (1988–94).
|
|
Numerator
|
Number of children aged 6 to 11
years with a BMI at or above the gender- and age-specific 95th percentile
from the CDC Growth Charts: United States.
|
|
Denominator
|
Number of children in the survey
population aged 6 to 11 years.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual, beginning with 1999 data.
|
|
Comments
|
The NHANES obtains measured
weights and heights without shoes. BMI is calculated by dividing weight in
kilograms by the square of height in meters.
|
|
BMI will be used as a proxy for
overweight and obesity in children and adolescents until a better measure is
developed.7 There is a prepubertal increase in subcutaneous
fat that is lost during adolescence in boys, while in girls fat deposition
continues. There also is a differential increase in muscle (or lean body
mass) by gender during puberty. Thus, without measures of sexual maturity,
measures of body fat and body weight are equally difficult to interpret in
preadolescents and adolescents.
|
|
In 2000, the 1977 NCHS Growth
Charts were revised to consider additional large, nationally representative
samples of children aged 2 to 20 years from the 1976–80 NHANES and the
1988–94 NHANES and to provide BMI for age in lieu of weight for age.8
When extrapolated to age 20 years, the gender- and age-specific 95th
percentile of BMI from the Revised CDC Growth Charts approximates a BMI of
30. Thus, the 95th percentiles of BMI for children aged 6 to 11 years and for
adolescents aged 12 to 19 years were chosen to estimate the prevalence of
overweight and obesity for this objective. The CDC Growth Charts can be found
on the Internet at http://www.cdc.gov/growthcharts.
|
|
In addition to the revised
measure, this objective differs from Healthy People 2000 objective 2.3, which
did not track overweight in children aged 6 to 11 years.
|
|
See Part C for a description of
NHANES and Appendix A for focus area contact information.
|
|
19-3b. Adolescents
aged 12 to 19 years.
|
|
National Data Source
|
National Health and Nutrition
Examination Survey (NHANES), CDC, NCHS.
|
|
State Data Source
|
Not identified.
|
|
Healthy People 2000 Objective
|
Adapted from 2.3 (Nutrition) (also
1.2, 15.10, 17.12).
|
|
Measure
|
Percent.
|
|
Baseline
|
11 (1988–94).
|
|
Numerator
|
Number of adolescents aged 12 to
19 years with a BMI at or above the gender- and age-specific 95th percentile
from the CDC Growth Charts: United States.
|
|
Denominator
|
Number of adolescents in the
survey population aged 12 to 19 years.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual, beginning with 1999 data.
|
|
Comments
|
State-level data on self-reported
heights and weights are collected biennially in the Youth Risk Behavior
Surveillance System (YRBSS) for adolescents in grades 9 through 12. This data
source enables States to estimate the proportion of this population that
reports heights and weights in the overweight and obese ranges and to track
trends, although the methods of measurement differ from the national measure.
Body weight prevalence estimates derived from self-reported heights and
weights tend to be lower than those derived from measured height and weight.
|
|
See Comments provided with
objective 19-3a for more information on the methods of calculation.
|
|
This objective differs from
Healthy People 2000 objective 2.3, which defined overweight for adolescents
based on modified age- and gender-specific 85th percentile values of the
1976–80 NHANES II. For adolescents, overweight was defined as a BMI equal to
or greater than 23.0 for males aged 12 to 14 years, 24.3 for males aged 15 to
17 years, 25.8 for males aged 18 to 19 years, 23.4 for females aged 12 to 14
years, 24.8 for females aged 15 to 17 years, and 25.7 for females aged 18 to
19 years.
|
|
See Part C for a description of NHANES
and Appendix A for focus area contact information.
|
|
19-3c. Children
and adolescents aged 6 to 19 years.
|
|
National Data Source
|
National Health and Nutrition
Examination Survey (NHANES), CDC, NCHS.
|
|
State Data Source
|
Not identified.
|
|
Healthy People 2000 Objective
|
Adapted from 2.3 (Nutrition) (also
1.2, 15.10, 17.12).
|
|
Leading Health Indicator
|
Overweight and Obesity.
|
|
Measure
|
Percent.
|
|
Baseline
|
11 (1988–94).
|
|
Numerator
|
Number of children and adolescents
aged 6 to 19 years with a BMI at or above the gender- and age-specific 95th
percentile from the CDC Growth Charts: United States.
|
|
Denominator
|
Number of children and adolescents
in the survey population aged 6 to 19 years.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual, beginning with 1999 data.
|
|
Comments
|
See Comments provided with
objective 19-3a for more information on methods of calculation and see
objective 19-3b for more information on State-level data.
|
|
This objective differs from
Healthy People 2000 objective 2.3, which defined overweight for adolescents
based on modified age- and gender-specific 85th percentile values of the
1976–80 NHANES II. For adolescents, overweight was defined as a BMI equal to
or greater than 23.0 for males aged 12 to 14 years, 24.3 for males aged 15 to
17 years, 25.8 for males aged 18 to 19 years, 23.4 for females aged 12 to 14
years, 24.8 for females aged 15 to 17 years, and 25.7 for females aged 18 to
19 years.
|
|
This objective is one of the
measures used to track the Overweight and Obesity Leading Health Indicator.
See Appendix H for a complete list.
|
|
See Part C for a description of
NHANES and Appendix A for focus area contact information.
|
|
|
|
National Data Source
|
Pediatric Nutrition Surveillance
System (PedNSS), CDC, NCCDPHP.
|
|
State Data Source
|
Pediatric Nutrition Surveillance
System (PedNSS), CDC, NCCDPHP.
|
|
Healthy People 2000 Objective
|
2.4 (Nutrition).
|
|
Measure
|
Percent.
|
|
Baseline
|
8 (1997) (preliminary) (selected
sites—see Comments).
|
|
Numerator
|
Number of low-income children
under age 5 years who are below the 5th percentile of height for age.
|
|
Denominator
|
Number of low-income children
under age 5 years.
|
|
Population Targeted
|
Selected sites—see Comments.
|
|
Questions Used To Obtain the
National Data
|
Not applicable.
|
|
Expected Periodicity
|
Annual.
|
|
Comments
|
For the preliminary baseline
estimates, growth retardation is defined as height for age below the 5th
percentile in the age-gender-appropriate reference population using the 1977
NCHS Growth Charts (that is, data from the Fels Research Institute and the
1971–74 NHANES).9
|
|
The 1997 baseline estimates were
obtained from PedNSS, which collects annual data from participating States on
growth retardation among low-income children. These data are collected from
low-income, high-risk infants and children who participate in publicly funded
health, nutrition, and food assistance programs such as WIC; the Early
Periodic Screening, Diagnosis, and Treatment program; and clinics funded by
Maternal and Child Health Program Block Grants.
|
|
In 1997, 44 States, the District of Columbia, and five Tribal
governments provided data for tracking growth retardation nationally. Data
can also be analyzed at clinic, county, and State levels. Estimates from
PedNSS are not based on a nationally representative sample. Participation in
publicly funded programs in a State can vary from year to year and can be affected
by fluctuating resources. Further, the number of participating States and
Tribal governments in PedNSS has varied from year to year. The fluctuations
in the scope of surveillance can affect the representation and comparability
of estimates.
|
|
The final
national estimates used to track this objective will differ from Healthy
People 2000 objective 2.4 because they will be based on the revised CDC
Growth Charts and not the 1977 NCHS Growth Charts.
|
|
See Appendix A for focus area
contact information.
|
|
|
|
National Data Source
|
Continuing Survey of Food Intakes
by Individuals (CSFII), USDA, ARS.
|
|
State Data
Sources
|
Behavioral Risk Factor
Surveillance System (BRFSS), CDC, NCCDPHP and Youth Risk Factor Surveillance
System (YRBSS), CDC, NCCDPDP. (See Comments.)
|
|
Healthy People 2000 Objective
|
Adapted from 2.6 (Nutrition) (also
16.8).
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
28 (1994–96).
|
|
Numerator
|
Number of persons aged 2 years and
older who report consuming two or more servings of fruit daily (based on a
2-day average).
|
|
Denominator
|
Number of persons in the survey
population aged 2 years and older.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
From the 1994–96 Continuing Survey of Food Intakes by Individuals:
|
|
|
The 1994–96 CSFII included the collection of 2
nonconsecutive days of dietary data through in-person 24-hour recalls.10
Each respondent was asked to recall the kinds and amounts of foods eaten at
home and away from home during the previous day. Amounts of foods reported in
household measures were then converted to gram amounts.
|
|
Expected Periodicity
|
Annual.
|
|
Comments
|
The definitions for fruit and for
serving sizes were derived from the 1995 Dietary Guidelines,11 the Food Guide Pyramid
(http://www.usda.gov/cnpp;pyramid2.htm), and related documentation, and
estimates were calculated using the USDA Pyramid Servings Database. The
intakes of fruit servings were modified for children aged 2 to 3 years. The
modification was accomplished by multiplying their daily servings intake by
1.5, equivalent to estimating that their requirement is two-thirds that of
persons over age 3 years. Fruit ingredients from mixtures are included in the
total, and fractions of servings are counted.12
|
|
Pregnant or lactating women and breast-fed children are excluded from
the numerator and denominator.
|
|
Data are age adjusted to the 2000
standard population. Age-adjusted percents are weighted sums of age-specific
percents. For a discussion of age adjustment, see Part A, section 5.
|
|
State-level data on fruit and
vegetable consumption are collected biennially by BRFSS for persons 18 years
and older and YRBSS for adolescents in grades 9 through 12. No State-level
data for younger children are available from these surveillance systems. These
data enable States to track (1) the proportion of the population that
consumes five or more servings of fruits and vegetables daily, (2) mean
intakes and trends in consumption, and (3) consumption of selected fruit and
vegetable items. However, the food items and dietary data collection methods
used in these surveillance systems differ from those used by CSFII to track
Healthy People 2010 objective 19-5.
|
|
This objective differs from
Healthy People 2000 objective 2.6, which only tracked the proportion of the
population that consumed five or more daily servings of fruits and vegetables
and the mean number of servings consumed, with a few exclusions of fruit andvegetable products. Also, Healthy People 2000 estimates were not age
adjusted.
|
|
See Part C for a description of
CSFII and Appendix A for focus area contact information.
|
|
|
|
National Data Source
|
Continuing Survey of Food Intakes
by Individuals (CSFII), USDA, ARS.
|
|
State Data Sources
|
Behavioral Risk Factor
Surveillance System (BRFSS), CDC, NCCDPHP and Youth Risk Behavior
Surveillance System (YRBSS), CDC, NCCDPHP. (See Comments.)
|
|
Healthy People 2000 Objective
|
Adapted from 2.6 (Nutrition) (also
16.8).
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
3 (1994–96).
|
|
Numerator
|
Number of persons who report
consuming three or more servings of vegetables daily, of which at least
one-third are dark green or orange vegetables (based on a 2-day average).
|
|
Denominator
|
Number of persons in the survey
population aged 2 years and older.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
See Questions Used To Obtain the
National Data provided with objective 19-5.
|
|
Expected Periodicity
|
Annual.
|
|
Comments
|
The definitions for dark green and
orange vegetables and for serving sizes were derived from the 1995 Dietary Guidelines
(http://www.health.gov/dietaryguidelines),11 the Food Guide Pyramid
(http://www.usda.gov/cnpp/pyramid2.htm), and related documentation, and
estimates were calculated using the USDA Pyramid Servings Database. The goal
of one-third of servings from dark green or orange vegetables was based on an
assessment of the variety of vegetable consumption needed to obtain nutrient
adequacy in the development of the
Food Guide Pyramid. The intakes of vegetable servings were modified
for children aged 2 to 3 years. The modification was accomplished by
multiplying their daily servings intake by 1.5, equivalent to estimating that
their requirement is two-thirds that of persons over age 3 years. Vegetable
ingredients from mixtures are included in the total, and fractions of
servings are counted.12
|
|
Pregnant or lactating women and breast-fed children are excluded from
the numerator and denominator.
|
|
Two component measures will also
be tracked: (1) age-adjusted percent of persons that report consuming three
or more servings of vegetables daily (based on a 2-day average), and (2)
age-adjusted percent of persons that report consuming at least one-third of
their vegetables as dark green or orange vegetables (based on a 2-day
average).
|
|
Data are age adjusted to the 2000
standard population. Age-adjusted percents are weighted sums of age-specific
percents. For a discussion of age adjustment, see Part A, section 5.
|
|
State-level data on fruit and
vegetable consumption are collected biennially by BRFSS for persons 18 years
and older and YRBSS for adolescents in grades 9 through 12. No State-level
data for younger children are available from these surveillance systems.
These data enable States to track (1) the proportion of the population that
consumes five or more servings of fruits and vegetables daily, (2) mean
intakes and trends in consumption, and (3) consumption of selected fruit and
vegetable items. However, the food items and dietary data collection methods
used in these surveillance systems differ from those used by CSFII to track
Healthy People 2010 objective 19-6.
|
|
The objective differs from Healthy
People 2000 objective 2.6, which tracked only the proportion of the
population that consumed five or more servings daily of fruits and vegetables
and the mean number of servings consumed, with a few exclusions of fruit and
vegetable products. Also, Healthy People 2000 estimates were not age
adjusted.
|
|
See Part C for a description of
CSFII and Appendix A for focus area contact information.
|
|
|
|
National Data Source
|
Continuing Survey of Food Intakes
by Individuals (CSFII), USDA, ARS.
|
|
State Data Source
|
Not identified.
|
|
Healthy People 2000 Objective
|
Adapted from 2.6 (Nutrition) (also
16.8).
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
7 (1994–96).
|
|
Numerator
|
Number of persons aged 2 years and
older who report consuming six or more servings of grain products per day,
including three or more servings of whole-grain products (based on 2-day
average).
|
|
Denominator
|
Number of persons in the survey
population aged 2 years and older.
|
|
Population Targeted
|
U.S.
civilian, noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
See Questions Used To Obtain the National Data provided with
objective 19-5.
|
|
Expected Periodicity
|
Annual.
|
|
Comments
|
The definitions for grain products
and for serving sizes were derived from the 1995 Dietary Guidelines
(http://www.health.gov/dietaryguidelines),11 the
Food Guide Pyramid
(http://www.usda.gov/cnpp/pyramid2.htm), and related documentation. Estimates
were calculated using the USDA Pyramid Servings Database, which provided data
on total and whole grain consumption.12, 13
|
|
The goal of three servings from
whole-grain products was based on an assessment of the variety of grain
product consumption needed to obtain nutrient adequacy in the development of the Food Guide Pyramid. The intakes
of grain servings were modified for children aged 2 to 3 years. The
modification was accomplished by multiplying their daily servings intake by
1.5, equivalent to estimating that their requirement is two-thirds that of
persons over age 3 years. Grain ingredients from mixtures are included in the
total, and fractions of servings are counted.
|
|
Pregnant or lactating women and
breast-fed children are excluded from the numerator and denominator.
|
|
Two component measures will also
be tracked: (1) age-adjusted percent of persons who consumed six or more
servings of grain products per day (based on 2-day average), and (2)
age-adjusted percent of persons who consumed three or more servings of
whole-grain products (based on 2-day average).
|
|
Data are age adjusted to the 2000
standard population. Age-adjusted percents are weighted sums of age-specific
percents. For a discussion of age adjustment, see Part A, section 5.
|
|
This objective differs from
Healthy People 2000 objective 2.6, which tracked the proportion of the
population who consumed six or more servings of grain products daily and the
mean number of servings consumed, with no exclusions. Also,
Healthy People 2000 estimates were not age adjusted.
|
|
See Part C for a description of
CSFII and Appendix A for focus area contact information.
|
|
|
|
National Data Source
|
Continuing Survey of Food Intakes
by Individuals (CSFII), USDA, ARS.
|
|
State Data Source
|
Not identified.
|
|
Healthy People 2000 Objective
|
Adapted from 2.5 (Nutrition) (also
15.9 and 16.7).
|
|
Measure
|
Percent (age adjusted—see
Comments).
|
|
Baseline
|
33 (1994–96).
|
|
Numerator
|
Number of persons aged 2 years and
older who report consuming less than or equal to 30 percent of calories from
total fat (based on 2-day average).
|
|
Denominator
|
Number of persons in the survey
population aged 2 years and older.
|
|
Population Targeted
|
U.S. civilian,
noninstitutionalized population.
|
|
Questions Used To Obtain the
National Data
|
See Questions Used To Obtain the
National Data provided with objective 19-8.
|
|
Expected Periodicity
|
Annual.
|
|
Comments
|
This objective tracks the
proportion of the population that meets recommendations for total fat
consumption in the 2000 Dietary
Guidelines for Americans.4Additional
tracking of fat intake expressed in grams may also help in interpreting how
much progress has been made, because a decrease in fat intake as a percent of
calories may not reflect a decrease in grams of fat if, for example,
carbohydrate intake has increased.
|
|
Pregnant or lactating women and
breast-fed children are excluded from the numerator and denominator.
|
|
Data are age adjusted to the 2000
standard population. Age-adjusted percents are weighted sums of age-specific
percents. For a discussion of age adjustment, see Part A, section 5.
|
|
This objective differs from
Healthy People 2000 objective 2.5, which tracked the mean fat intake of
population groups and the proportion of the population who consumed 30
percent or fewer calories from fat; the tracking data were not age adjusted.
|
|
See Part C for a description of
CSFII and Appendix A for focus area contact information.
|
