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

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

19-3.Overweight or obesity in children and adolescents Fruit consumption Vegetable consumption Grain product consumption Total sodium intake 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.

Child and Adolescent Overweight 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 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

Child and Adolescent Overweight Target: 5% Decrease desired * Statistically unreliable. ** Baseline data are for 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 *

Percent 2010 Target: 5% Decrease desired *Data for are for adolescents 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 * Child and Adolescent Overweight Male Male 6-11 Female Female

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.

2010 Target: 15% Decrease desired Percent Obj 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 ≥ Respondents were asked to select only one race prior to 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

Trends in Adult Obesity Note: Data are for ages 20 years and over, and age adjusted to the 2000 standard population. Obesity is defined as BMI ≥ Source: National Health Examination Survey, National Health and Nutrition Examination Surveys I, II, III and National Health and Nutrition Examination Survey, NCHS, CDC. Obj Trends in Adult Obesity 2010 Target: 15 Decrease desired Female Male Total Percent

Percent Fruits: 2+ servings Vegetables Grains Fruits, Vegetables and Grains Consumption, 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

Percent Fruits: 2+ servings Vegetables: 3+ servings Grains: 6+ servings * ** Target Fruits, Vegetables and Grains Consumption, 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

Obj 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 % Target 33% dark green or orange vegetables

Children 2-19 yearsAdults 20 years and over Target 50% whole grain Proportion of Grain Servings Obj 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%

Percent Target: 65% Increase desired Total Usual Sodium Intake Objs 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 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, From Supplements 0% Mexican American

Percent Increase desired * Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate, ** 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 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, ** Total Usual Potassium Intake From Supplements 0.6% Total White Black Mexican American 100% of Adequate Intake* or More

Percent * Institute of Medicine, National Academies, Food and Nutrition Board, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, 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 Total Female Male Total Usual Calcium Intake Increase desired 2010 Target: % of Adequate Intake* or More

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

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

Moved Toward Target Total calcium intake 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 years Anemia in low-income pregnant females in 3rd trimester Diet and nutrition counseling Progress Toward 2010 Targets Little or No Progress* 19-4.Growth retardation among low-income children 19-5.Fruit consumption Vegetable consumption 19-7.Grain product consumption 19-8.Percent calories from saturated fat Total sodium intake 19-12a.Iron deficiency, 1–2 years No Data Iron deficiency in pregnant females Baseline Only Worksite counseling Deleted at Midcourse Review Meals and snacks at school *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

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

Progress review data and slides can be found on the web at: hphome.htm hphome.htm