Nutrition and Weight Status

Goal

Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights.

Overview

The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities.

The goal of promoting healthful diets and healthy weight encompasses increasing household food security and eliminating hunger.

Americans with a healthful diet:

• Consume a variety of nutrient-dense foods within and across the food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources.
• Limit the intake of saturated and trans fats, cholesterol, added sugars, sodium (salt), and alcohol.
• Limit caloric intake to meet caloric needs.1

All Americans should avoid unhealthy weight gain, and those whose weight is too high may also need to lose weight.2

Why Are Nutrition and Weight Status Important?

Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions,1 including:

• Overweight and obesity
• Malnutrition
• Iron-deficiency anemia
• Heart disease
• High blood pressure
• Dyslipidemia (poor lipid profiles)
• Type 2 diabetes
• Osteoporosis
• Oral disease
• Constipation
• Diverticular disease
• Some cancers

Individuals who are at a healthy weight are less likely to:

• Develop chronic disease risk factors, such as high blood pressure and dyslipidemia.
• Develop chronic diseases, such as type 2 diabetes, heart disease, osteoarthritis, and some cancers.
• Experience complications during pregnancy.
• Die at an earlier age.2, 3, 4, 5

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Understanding Nutrition and Weight Status

Diet

Diet reflects the variety of foods and beverages consumed over time and in settings such as worksites, schools, restaurants, and the home. Interventions to support a healthier diet can help ensure that:

• Individuals have the knowledge and skills to make healthier choices.
• Healthier options are available and affordable.

Social Determinants of Diet

Demographic characteristics of those with a more healthful diet vary with the nutrient or food studied. However, most Americans need to improve some aspect of their diet.6, 7

Social factors thought to influence diet include:

• Knowledge and attitudes
• Skills
• Social support
• Societal and cultural norms
• Food and agricultural policies
• Food assistance programs
• Economic price systems8

Physical Determinants of Diet

Access to and availability of healthier foods can help people follow healthful diets. For example, better access to retail venues that sell healthier options may have a positive impact on a person’s diet; these venues may be less available in low-income or rural neighborhoods.9

The places where people eat appear to influence their diet. For example, foods eaten away from home often have more calories and are of lower nutritional quality than foods prepared at home.10

Marketing also influences people’s—particularly children’s—food choices.11

Weight

Because weight is influenced by energy (calories) consumed and expended, interventions to improve weight can support changes in diet or physical activity. They can help change individuals’ knowledge and skills, reduce exposure to foods low in nutritional value and high in calories, or increase opportunities for physical activity.3, 12, 13 Interventions can help prevent unhealthy weight gain or facilitate weight loss among obese people. They can be delivered in multiple settings, including health care settings,2, 14, 15, 16 worksites,17 or schools.12, 18, 19

Social and Physical Determinants of Weight

The social and physical factors affecting diet and physical activity (see Physical Activity topic area) may also have an impact on weight.

Obesity is a problem throughout the population. However, among adults, the prevalence is highest for middle-aged people and for non-Hispanic black and Mexican American women.20 Among children and adolescents, the prevalence of obesity is highest among older and Mexican American children and non-Hispanic black girls.21 The association of income with obesity varies by age, gender, and race/ethnicity.22

Emerging Issues in Nutrition and Weight Status

As new and innovative policy and environmental interventions to support diet and physical activity are implemented, it will be important to identify which are most effective. A better understanding of how to prevent unhealthy weight gain is also needed.

References

1US Department of Health and Human Services and US Department of Agriculture (USDA). Dietary guidelines for Americans, 2005. 6th ed. Washington: US Government Printing Office, 2005 Jan.

2National Institutes of Health (NIH); National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Bethesda, MD: NIH; 1998.

3World Health Organization (WHO). Obesity: Preventing and managing the global epidemic. Geneva: WHO; 1999.

4Dietz WH. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics. 1998;101:518-24.

5Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes. 1999;23:S2-S11.

6US Department of Agriculture (USDA), Center for Nutrition Policy and Promotion. Diet quality of low-income and higher-income Americans in 2003–04 as measured by the Healthy Eating Index, 2005. Nutrition Insight, 2008 December, no. 42.

7Healthy People 2010 midcourse review [Internet]. Washington: Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 2007. Available from: http://www.healthypeople.gov/2010/Data/midcourse/html/focusareas/FA19ProgressHP.htm

8Story M, Kaphingst KM, Robinson-O’Brien R, et al. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.

9Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the US. Am J Prev Med. 2009 Jan;36(1):74-81.

10Guthrie JF, Lin BH, Frazao E. Role of food prepared away from home in the American diet, 1977–78 versus 1994–96: Changes and consequences. J Nutr Educ Behav. 2002 May–Jun;34(3):140-50.

11Institute of Medicine. Food marketing to children and youth. McGinnis JM, Gootman J, Kraak VI, editors. Washington: National Academies Press; 2006.

12Institute of Medicine. Preventing childhood obesity: Health in the balance. Koplan JP, Liverman CT, Kraak VI, editors. Washington: National Academies Press; 2005.

13US Department of Health and Human Services (HHS), Public Health Service, Office of the Surgeon General. The Surgeon General’s vision for a healthy and fit nation. Rockville, MD: HHS, 2010 Jan.

14US Preventive Services Task Force. Screening for obesity in adults: Recommendations and rationale. Ann Intern Med. 2003 Dec 2;139(11):930-2.

15US Preventive Services Task Force, Barton M. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics. 2010 Feb;125(2):361-7.

16Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics. 2007 Dec;120(suppl 4):S164-92.

17Anderson LM, Quinn TA, Glanz K, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. Am J Prev Med. 2009 Oct;37(4):340-57. Review. Erratum in: Am J Prev Med. 2010 Jul;39(1):104.

18Summerbell CD, Waters E, Edmunds LD, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001871. Review.

19Wechsler H, McKenna ML, Lee SM, et al. The role of schools in preventing childhood obesity. State Educ Standard. 2004 Dec;5:4-12.

20Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010 Jan 20;303(3):235-41.

21Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010 Jan 20;303(3):242-9.

22Ogden CL, Yanovski SZ, Carroll MD, et al. The epidemiology of obesity. Gastroenterology. 2007 May;132(6):2087-102. Review.

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