1. Focus Area 19: Nutrition and Overweight Progress Review Edward J. Sondik National Center for Health Statistics April 3, 2008

2. Nutrition and Overweight Diet is associated with  heart disease  stroke  some cancers  type 2 diabetes  overweight and obesity  osteoporosis Diet-related conditions contribute to  reduced quality of life  premature death  substantial medical costs  lost productivity

3. 19-3.Overweight or obesity in children and adolescents 19-5. Fruit consumption 19-6. Vegetable consumption 19-7. Grain product consumption 19-10.Total sodium intake 19-11.Total calcium intake Improving Getting worse Little or no progress* Highlighted Objectives *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

4. Child and Adolescent Overweight 1988-94 2003-06 2010 Target: 5% Decrease desired Note: I= 95% confidence interval. Overweight is defined for ages 6-19 years as BMI ≥ gender- and age- specific 95th percentile from the 2000 CDC Growth Charts for the United States. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-3c Total White Black Mexican Female Male American Percent 40 30 20 10 0

5. Child and Adolescent Overweight 1988-94 2003-06 2010 Target: 5% Decrease desired * Statistically unreliable. ** Baseline data are for 1991-94. Note: I= 95% confidence interval. Overweight is defined for ages 6-19 years as BMI ≥ gender- and age- specific 95th percentile from the 2000 CDC Growth Charts for the United States. Higher income is defined as > 130 % poverty threshold, and lower as ≤ 130%. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-3c Total Higher Lower With Without Income Disabilities** Percent * 40 30 20 10 0

6. 1963-67 1971-74 1976-80 1988-1994 2003-06 1966-70 1999-2002 Percent 2010 Target: 5% Decrease desired *Data for 1966-70 are for adolescents 12-17 years of age. Note: Overweight is defined as BMI ≥ gender- and age-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-3a, b 1963-65 1971-74 1976-80 1988-1994 2003-06 1966-70* 1999-2002 Child and Adolescent Overweight Male 12-19 Male 6-11 Female 12-19 Female 6-11 40 30 20 10 0

7. 2003 2005 Prevalence of Adolescent Overweight Note: Data are for high school students in grade 9 – 12. Overweight is defined as ≥ 95th percentile for body mass index, by age and sex, on the basis of reference data, based on self-reported weight and height. Source: Youth Risk Behavior Survey, NCCDPHP, CDC.

8. 2010 Target: 15% Decrease desired 1988-942003-06 Percent Obj. 19-2 60 40 20 0 White Black Female Male Note: I = 95% confidence interval. Data are for ages 20 years and over, and age adjusted to the 2000 standard population. Obesity is defined as BMI ≥ 30.0. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Adult Obesity Mexican American White Black Mexican American

9. Trends in Adult Obesity 1960-62 1976-80 1988-94 2003-06 1971-74 1999-2002 Note: Data are for ages 20 years and over, and age adjusted to the 2000 standard population. Obesity is defined as BMI ≥ 30.0. Source: National Health Examination Survey, National Health and Nutrition Examination Surveys I, II, III and National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-2 Trends in Adult Obesity 2010 Target: 15 Decrease desired Female Male Total Percent 60 40 20 0

10. Percent Fruits: 2+ servings Vegetables Grains 75 50 25 0 Fruits, Vegetables and Grains Consumption, 2003-04 Objs. 19-5, 19-6 & 19-7 * Statistically unreliable. Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. One serving has been calculated as two- thirds of a standard serving for all children age 2-3. The categories black and white includes persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Increase desired Total White Black Mexican American 3+ Servings 6+ Servings

11. Percent Fruits: 2+ servings Vegetables: 3+ servings Grains: 6+ servings * ** 75 50 25 0 2010 Target Fruits, Vegetables and Grains Consumption, 2003-04 Objs. 19-5, 19-6 & 19-7 * Statistically unreliable. Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. One serving has been calculated as two- thirds of a standard serving for all children age 2-3. The categories black and white includes persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Increase desired Total White Black Mexican American With 1/3 Dark Green/Orange With 3+ Whole Grain

12. Obj. 19-6 Notes: Excludes pregnant or lactating women and breast-fed children. One serving has been calculated as two-thirds of a standard serving for all children age 2-3. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Tomatoes 22% Other vegetables 39% Legumes 6% Potatoes 23% 11% Children 2-19 yearsAdults 20 years and over Tomatoes 27% Other vegetables 28% Legumes 6% Potatoes 31% Dark green or orange vegetables Proportion of Vegetable Servings 2003-04 7% Target 33% dark green or orange vegetables

13. Children 2-19 yearsAdults 20 years and over Target 50% whole grain Proportion of Grain Servings 2003-04 Obj. 19-7 Notes: Excludes pregnant or lactating women and breast-fed children. One serving has been calculated as two-thirds of a standard serving for all children age 2-3. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Other grains 93% Whole grain 7% Other grains 90% 10%

14. Percent 1988-94 2003-04 2010 Target: 65% 75 50 25 0 Increase desired Total Usual Sodium Intake Objs. 19-10 Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. Total sodium intake is from food, supplements, tap water and salt added at table. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. 2,400mg of Sodium or Less Total White Black From Food 94.2% Added at Table 5.2% From Tap Water 0.6% Sources of Sodium Intake Ages 2 and over, 2003-04 From Supplements 0% Mexican American

15. Percent 1988-94 2003-04 10 5 0 Increase desired * Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate, 2004. ** Statistically unreliable. Note: I = 95% confidence interval. Data are for 2 years and over excluding pregnant or lactating women and breast-fed children, and are age adjusted to the 2000 standard population. Total potassium intake is from food and supplements. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. From Food 99.4% Sources of Potassium Intake Ages 2 and over, 2003-04 ** Total Usual Potassium Intake From Supplements 0.6% Total White Black Mexican American 100% of Adequate Intake* or More

16. 75 50 25 0 Percent * Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, 1997. Note: I = 95% confidence interval. Data exclude pregnant or lactating women and breast-fed children. Data for total are for 2 years and over, and age adjusted to the 2000 standard population. Total calcium intake is from food, supplements and antacids. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-11 Total Female Male Total Usual Calcium Intake 2-1112-1920-3940-5960+ Increase desired 2010 Target: 74 100% of Adequate Intake* or More

17. Females 51 and overMales 51 and over Obj. 19-11 Source: National Health and Nutrition Examination Survey, NCHS, CDC. From Supplements From Antacids Sources of Calcium Intake, 2003-04 From Food 66% 32% 2% 15% From Food 83% 3%

18. Weight status objectives for children, adolescents and adults moved away from their targets. Fruit, vegetable and grain objectives, total usual sodium intake showed little or no progress. Total usual calcium intake moved toward the target. The weight status and diets of Americans remain an important public health and economic concern. Summary

19. Moved Toward Target 19-11.Total calcium intake 19-18.Food security Target Met No Objective Moved Away from Target 19-1.Healthy weight in adults 19-2.Obesity in adults 19-3.Overweight or obesity, 6-19 years 19-9.Percent calories from total fat 19-12b.Iron deficiency, 3-4 years 19-12c.Iron deficiency, non-pregnant females 12-49 years 19-13.Anemia in low-income pregnant females in 3rd trimester 19-17.Diet and nutrition counseling Progress Toward 2010 Targets Little or No Progress* 19-4.Growth retardation among low-income children 19-5.Fruit consumption 19-6. Vegetable consumption 19-7.Grain product consumption 19-8.Percent calories from saturated fat 19-10.Total sodium intake 19-12a.Iron deficiency, 1–2 years No Data 19-14.Iron deficiency in pregnant females Baseline Only 19-16.Worksite counseling Deleted at Midcourse Review 19-15.Meals and snacks at school *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

20. Nancy Crane, FDA Sarah Cusick, NCCDPHP/CDC Kevin Dodd, NCI/NIH Joseph Goldman, ARS/USDA Van Hubbard, DNRC/NIH Clifford Johnson, NCHS/CDC Margaret McDowell, NCHS/CDC Kathryn McMurry, ODPHP Alanna Moshfegh, ARS/USDA Mark Nord, ERS/USDA Barbara Schneeman, FDA Bettylou Sherry, NCCDPHP/CDC Pamela Starke-Reed, DNRC/NIH Jean Williams, NCHS/CDC Data Contributors and Federal Interagency Work Group Acknowledgements

21. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/ hphome.htm http://www.cdc.gov/nchs/ hphome.htm