1. 1. Dietary Guidelinesfor AmericansU.S. Department of AgricultureU.S. Department of Health and Human Serviceswww.dietaryguidelines.gov
2. 2. This publication may be viewed and downloaded from the Internet at www.dietaryguidelines.gov.Suggested citation: U.S. Department of Agriculture and U.S. Department of Health and HumanServices. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. GovernmentPrinting Office, December 2010.The U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) prohibitdiscrimination in all their programs and activities on the basis of race, color, national origin, age,disability and, where applicable, sex, marital status, familial status, parental status, religion,sexual orientation, genetic information, political beliefs, reprisal, or because all or part of anindividuals income is derived from any public assistance program. (Not all prohibited bases applyto all programs.) Persons with disabilities who require alternative means for communicationof program information (Braille, large print, audiotape, etc.) should contact USDAs TARGETCenter at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA,Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410,or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA and HHS are equal opportunityproviders and employers.December 2010
3. 3. Message froM the secretariesWe are pleased to present the Dietary Guidelines for Americans, 2010. Based on the most recentscientific evidence review, this document provides information and advice for choosing ahealthy eating patternnamely, one that focuses on nutrient-dense foods and beverages, andthat contributes to achieving and maintaining a healthy weight. Such a healthy eating patternalso embodies food safety principles to avoid foodborne illness.The 2010 Dietary Guidelines are intended to be used in developing educational materials andaiding policymakers in designing and carrying out nutrition-related programs, including Federalnutrition assistance and education programs. The Dietary Guidelines also serve as the basisfor nutrition messages and consumer materials developed by nutrition educators and healthprofessionals for the general public and specific audiences, such as children.This document is based on the recommendations put forward by the 2010 Dietary GuidelinesAdvisory Committee. The Committee was composed of scientific experts who reviewed andanalyzed the most current information on diet and health and incorporated it into a scientific,evidence-based report. We want to thank them and the other public and private professionalswho assisted in developing this document for their hard work and dedication.Our knowledge about nutrition, the food and physical activity environment, and healthcontinues to grow, reflecting an evolving body of evidence. It is clear that healthy eatingpatterns and regular physical activity are essential for normal growth and development and forreducing risk of chronic disease. The goal of the Dietary Guidelines is to put this knowledgeto work by facilitating and promoting healthy eating and physical activity choices, with theultimate purpose of improving the health of all Americans ages 2 years and older.We are releasing the seventh edition of the Dietary Guidelines at a time of rising concern aboutthe health of the American population. Americans are experiencing an epidemic of overweightand obesity. Poor diet and physical inactivity also are linked to major causes of illness anddeath. To correct these problems, many Americans must make significant changes in theireating habits and lifestyles. This document recognizes that all sectors of society, includingindividuals and families, educators and health professionals, communities, organizations,businesses, and policymakers, contribute to the food and physical activity environments inwhich people live. We all have a role to play in reshaping our environment so that healthychoices are easy and accessible for all.Today, more than ever, consumers need sound advice to make informed food and activitydecisions. The 2010 Dietary Guidelines will help Americans choose a nutritious diet withintheir calorie needs. We believe that following the recommendations in the Dietary Guidelineswill assist many Americans to live longer, healthier, and more active lives.Thomas J. VilsackKathleen SebeliusSecretary of Agriculture Secretary of Health and Human ServicesDIETARY GUIDELINES FOR AMERICANS, 2010 i
4. 4. acknowledgMents The U.S. Department of Agriculture and the U.S. Department of Health and Human Services acknowledge the work of the 2010 Dietary Guidelines Advisory Committee whose recommendations formed the basis for this edition of the Dietary Guidelines for Americans. dietary guidelines advisory committee Members Linda Van Horn, PhD, RD, LD; Naomi K. Fukagawa, MD, PhD; Cheryl Achterberg, PhD; Lawrence J. Appel, MD, MPH; Roger A. Clemens, DrPH; Miriam E. Nelson, PhD; Sharon (Shelly) M. Nickols-Richardson, PhD, RD; Thomas A. Pearson, MD, PhD, MPH; Rafael Prez- Escamilla, PhD; F. Xavier Pi-Sunyer, MD, MPH; Eric B. Rimm, ScD; Joanne L. Slavin, PhD, RD; Christine L. Williams, MD, MPH. The Departments also acknowledge the work of the departmental scientists, staff, and policy officials responsible for the production of this document. Policy officials USDA: Kevin W. Concannon; Rajen S. Anand, DVM, PhD; Robert C. Post, PhD, MEd, MSc. HHS: Howard K. Koh, MD, MPH; Penelope Slade-Sawyer, PT, MSW, RADM, USPHS. Policy document writing staff Carole A. Davis, MS; Kathryn Y. McMurry, MS; Patricia Britten, PhD, MS; Eve V. Essery, PhD; Kellie M. OConnell, PhD, RD; Paula R. Trumbo, PhD; Rachel R. Hayes, MPH, RD; Colette I. Rihane, MS, RD; Julie E. Obbagy, PhD, RD; Patricia M. Guenther, PhD, RD; Jan Barrett Adams, MS, MBA, RD; Shelley Maniscalco, MPH, RD; Donna Johnson-Bailey, MPH, RD; Anne Brown Rodgers, Scientific Writer/Editor. Policy document reviewers/technical assistance Jackie Haven, MS, RD; Joanne Spahn, MS, RD; Shanthy Bowman, PhD; Holly H. McPeak, MS; Shirley Blakely, PhD, RD; Kristin L. Koegel, MBA, RD; Kevin Kuczynski, MS, RD; Kristina Davis, MS, MPH; Jane Fleming; David Herring, MS; Linda Cleveland, MS, RD. The Departments would like to acknowledge the important role of those who provided input and public comments throughout this process. Finally, the Departments acknowledge the contributions of numerous other internal departmental and external scientists and staff who contributed to the production of this document, including the members of the Independent Scientific Review Panel, who peer reviewed the recommendations of the document to ensure they were based on the preponderance of the scientific evidence.ii DIETARY GUIDELINES FOR AMERICANS, 2010
5. 5. DIETARY GUIDELINES FOR AMERICANS, 2010 iii
6. 6. contents executive summary.................................................................................................. viii chapter 1 introduction.................................................................................................1 Developing the Dietary Guidelines for Americans, 2010 ............................................................2 A Roadmap to the Dietary Guidelines for Americans, 2010 ......................................................4 Sources of Information.......................................................................................................... 5 Importance of the Dietary Guidelines for Health Promotion and Disease Prevention .......5 Uses of the Dietary Guidelines for Americans, 2010....................................................................6 Development of Educational Materials and Communications................................... 6 Development of Nutrition-Related Programs.................................................................. 6 Development of Authoritative Statements...................................................................... 7 chapter 2 Balancing calories to Manage weight...................................................... 8 Key Recommendations .................................................................................................................. 9 An Epidemic of Overweight and Obesity.................................................................................. 9 Contributing to the Epidemic: An Obesogenic Environment ............................................. 10 Current Dietary Intake .................................................................................................................. 11 Calorie Balance: Food and Beverage Intake .............................................................................13Understanding Calorie Needs ............................................................................................13Carbohydrate, Protein, Fat, and Alcohol ......................................................................... 14 Does Macronutrient Proportion Make a Difference for Body Weight?Individual Foods and Beverages and Body Weight .......................................................15Placing Individual Food Choices Into an Overall Eating Pattern ................................16 Calorie Balance: Physical Activity ..............................................................................................17 Principles for Promoting Calorie Balance and Weight Management ...............................17 Improving Public Health Through Diet and Physical Activity .............................................19 chapter 3 foods and food components to reduce .................................................20 Key Recommendations .................................................................................................................21 Supporting the Recommendations ............................................................................................21 Sodium......................................................................................................................................21 Fats ...........................................................................................................................................24Saturated Fatty AcidsTrans Fatty AcidsCholesterol Calories From Solid Fats and Added Sugars ..................................................................27Solid FatsAdded SugarsWhy Solid Fats and Added Sugars Are a Particular Concern Refined Grains .......................................................................................................................29 Alcohol ....................................................................................................................................30 Chapter Summary .........................................................................................................................32iv DIETARY GUIDELINES FOR AMERICANS, 2010
7. 7. chapter 4 foods and nutrients to increase............................................................. 33Key Recommendations ................................................................................................................34Recommendations for Specific Population Groups .....................................................34Supporting the Recommendations ...........................................................................................35Vegetables and Fruits ..........................................................................................................35Grains.......................................................................................................................................36 Whole GrainsMilk and Milk Products .......................................................................................................38Protein Foods .........................................................................................................................38 SeafoodOils ...........................................................................................................................................39Nutrients of Concern .......................................................................................................... 40 Potassium Dietary Fiber Calcium Vitamin D Additional Nutrients of Concern for Specific GroupsChapter Summary .........................................................................................................................42chapter 5 Building healthy eating Patterns............................................................43Key Recommendations ................................................................................................................43Research Informs Us about Healthy Eating Patterns .......................................................... 44 Research on Dietary Approaches to Stop Hypertension (DASH) .......................... 44 Research on Mediterranean-Style Eating Patterns ..................................................... 44 Research on Vegetarian Eating Patterns.........................................................................45 Common Elements of the Healthy Eating Patterns Examined..................................45Principles for Achieving a Healthy Eating Pattern ............................................................... 46 Focus on Nutrient-Dense Foods ...................................................................................... 46 Remember that Beverages Count.....................................................................................47 Follow Food Safety Principles ........................................................................................... 48 Consider the Role of Supplements and Fortified Foods..............................................49Putting the Principles for a Healthy Eating Pattern Into Action ....................................... 50 USDA Food Patterns ........................................................................................................... 50 Vegetarian Adaptations of the USDA Food Patterns ..................................................52 DASH Eating Plan .................................................................................................................53Chapter Summary .........................................................................................................................53chapter 6 helping americans Make healthy choices ............................................ 55A Call to Action .............................................................................................................................57Ensure that All Americans Have Access to Nutritious Foods and Opportunities for Physical Activity ............................................................................57Facilitate Individual Behavior Change Through Environmental Strategies ............58Set the Stage for Lifelong Healthy Eating, Physical Activity, and Weight Management Behaviors...........................................................................58Chapter Summary .........................................................................................................................59Resource List ..................................................................................................................................59DIETARY GUIDELINES FOR AMERICANS, 2010 v
8. 8. appendicesappendix 1 Guidance for Specific Population Groups...................................................61 appendix 2 Key Consumer Behaviors and Potential Strategies for Professionals to Use in Implementing the 2010 Dietary Guidelines..........................62 appendix 3 Food Safety Principles and Guidance for Consumers ............................69 appendix 4 Using the Food Label to Track Calories, Nutrients, and Ingredients.....73appendix 5 Nutritional Goals for Age-Gender Groups, Based on Dietary Reference Intakes and Dietary Guidelines Recommendations.....................76appendix 6 Estimated Calorie Needs per Day by Age, Gender, andPhysical Activity Level (Detailed) .......................................................................................78appendix 7 USDA Food Patterns.......................................................................................79 appendix 8 Lacto-Ovo Vegetarian Adaptation of the USDA Food Patterns...........81appendix 9 Vegan Adaptation of the USDA Food Patterns .......................................82 appendix 10 The DASH Eating Plan at Various Calorie Levels..................................83appendix 11 Estimated EPA and DHA and Mercury Content in 4 Ounces of Selected Seafood Varieties...............................................................................................85appendix 12 Selected Food Sources Ranked by Amounts of Potassium and Calories per Standard Food Portion............................................................................87 appendix 13 Selected Food Sources Ranked by Amounts of Dietary Fiber and Calories per Standard Food Portion .................................................................88appendix 14 Selected Food Sources Ranked by Amounts of Calcium and Calories per Standard Food Portion............................................................................89 appendix 15 Selected Food Sources Ranked by Amounts of Vitamin D and Calories per Standard Food Portion........................................................................... 90 appendix 16 Glossary of Terms ..........................................................................................91vi DIETARY GUIDELINES FOR AMERICANS, 2010
9. 9. list of tables table 2-1 Obesity in AmericaThen and Now ............................................................... 10 table 2-2 Top 25 Sources of Calories Among Americans Ages2 Years and Older, NHANES 20052006..........................................................................12table 2-3 Estimated Calorie Needs per Day by Age, Gender,and Physical Activity Level.................................................................................................... 14table 2-4 Recommended Macronutrient Proportions by Age....................................15 table 2-5 2008 Physical Activity Guidelines ..................................................................18 table 5-1 Eating Pattern Comparison: Usual U.S. Intake, Mediterranean,DASH, and USDA Food Patterns, Average Daily Intake at or Adjusted to a2,000 Calorie Level..................................................................................................................51table 5-2 USDA Food PatternsFood Groups and Subgroups .................................52 table 5-3 Average Daily Amounts in the Protein Foods Group in the USDA FoodPattern at the 2,000 Calorie Level and its Vegetarian Adaptations ..........................53list of figures figure 3-1 Estimated Mean Daily Sodium Intake, by AgeGender Group, NHANES 20052006 ..............................................................................................22figure 3-2 Sources of Sodium in the Diets of the U.S. PopulationAges 2 Years and Older, NHANES 20052006..............................................................22 figure 3-3 Fatty Acid Profiles of Common Fats and Oils.............................................25 figure 3-4 Sources of Saturated Fat in the Diets of the U.S. PopulationAges 2 Years and Older, NHANES 20052006..............................................................26 figure 3-5 Sources of Solid Fats in the Diets of the U.S. PopulationAges 2 Years and Older, NHANES 20032004..............................................................28 figure 3-6 Sources of Added Sugars in the Diets of the U.S.Population Ages 2 Years and Older, NHANES 20052006.........................................29 figure 3-7 Sources of Refined Grains in the Diets of the U.S.Population Ages 2 Years and Older, NHANES 20032004.........................................30 figure 4-1 Three Ways to Make at Least Half of Total Grains Whole Grains.........37figure 5-1 How Do Typical American Diets Compare to RecommendedIntake Levels or Limits?......................................................................................................... 46figure 5-2 Examples of the Calories in Food Choices that are not in Nutrient- Dense Forms and the Calories in Nutrient-Dense Forms of these Foods.................47figure 6-1 A Social-Ecological Framework for Nutrition andPhysical Activity Decisions...................................................................................................56DIETARY GUIDELINES FOR AMERICANS, 2010 vii
10. 10. Executive Summary Eating and physical activity patterns that are focused Dietary Guidelines recommendations traditionally on consuming fewer calories, making informed foodhave been intended for healthy Americans ages choices, and being physically active can help people 2 years and older. However, Dietary Guidelines for attain and maintain a healthy weight, reduce their Americans, 2010 is being released at a time of rising risk of chronic disease, and promote overall health. concern about the health of the American popula- The Dietary Guidelines for Americans, 2010 exempli-tion. Poor diet and physical inactivity are the most fies these strategies through recommendations that important factors contributing to an epidemic of accommodate the food preferences, cultural tradi-overweight and obesity affecting men, women, and tions, and customs of the many and diverse groupschildren in all segments of our society. Even in the who live in the United States. absence of overweight, poor diet and physical inactiv-ity are associated with major causes of morbidity By law (Public Law 101-445, Title III, 7 U.S.C. 5301 and mortality in the United States. Therefore, the et seq.), Dietary Guidelines for Americans is reviewed,Dietary Guidelines for Americans, 2010 is intended for updated if necessary, and published every 5 years. Americans ages 2 years and older, including those at The U.S. Department of Agriculture (USDA) andincreased risk of chronic disease. the U.S. Department of Health and Human Services (HHS) jointly create each edition. Dietary GuidelinesDietary Guidelines for Americans, 2010 also recognizes for Americans, 2010 is based on the Report of thethat in recent years nearly 15 percent of American Dietary Guidelines Advisory Committee on the Dietary households have been unable to acquire adequate Guidelines for Americans, 2010 and consideration offood to meet their needs.1 This dietary guidance Federal agency and public comments.can help them maximize the nutritional content of 1. Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household food security in the United States, 2009. Washington (DC): U.S. Department of Agriculture, Economic Research Service. 2010 Nov. Economic Research Report No. ERR-108. Available from http://www.ers.usda.gov/publications/err108.viii DIETARY GUIDELINES FOR AMERICANS, 2010
11. 11. their meals. Many other Americans consume lessA basic premise of the Dietary Guidelines is thatthan optimal intake of certain nutrients even thoughnutrient needs should be met primarily throughthey have adequate resources for a healthy diet. This consuming foods. In certain cases, fortified foods anddietary guidance and nutrition information can help dietary supplements may be useful in providing onethem choose a healthy, nutritionally adequate diet. or more nutrients that otherwise might be consumedin less than recommended amounts. Two eatingThe intent of the Dietary Guidelines is to summarizepatterns that embody the Dietary Guidelines are theand synthesize knowledge about individual nutri-USDA Food Patterns and their vegetarian adapta-ents and food components into an interrelated set tions and the DASH (Dietary Approaches to Stopof recommendations for healthy eating that can be Hypertension) Eating Plan.adopted by the public. Taken together, the DietaryGuidelines recommendations encompass two over-A healthy eating pattern needs not only to promotearching concepts: health and help to decrease the risk of chronicdiseases, but it also should prevent foodborne illness. Maintain calorie balance over time to achieve andFour basic food safety principles (Clean, Separate,sustain a healthy weight. People who are mostCook, and Chill) work together to reduce the risk ofsuccessful at achieving and maintaining a healthyfoodborne illnesses. In addition, some foods (such asweight do so through continued attention to con-milks, cheeses, and juices that have not been pas-suming only enough calories from foods and bever-teurized, and undercooked animal foods) pose highages to meet their needs and by being physicallyrisk for foodborne illness and should be avoided.active. To curb the obesity epidemic and improvetheir health, many Americans must decrease theThe information in the Dietary Guidelines for Americanscalories they consume and increase the caloriesis used in developing educational materials andthey expend through physical activity.aiding policymakers in designing and carrying out focus on consuming nutrient-dense foods and nutrition-related programs, including Federal food,beverages. Americans currently consume toonutrition education, and information programs. Inmuch sodium and too many calories from solid fats,addition, the Dietary Guidelines for Americans has theadded sugars, and refined grains.2 These replacepotential to offer authoritative statements as providednutrient-dense foods and beverages and make for in the Food and Drug Administration Modernizationit difficult for people to achieve recommendedAct (FDAMA).nutrient intake while controlling calorie and sodiumintake. A healthy eating pattern limits intake of The following are the Dietary Guidelines for Americans,sodium, solid fats, added sugars, and refined grains2010 Key Recommendations, listed by the chapterand emphasizes nutrient-dense foods and bever-in which they are discussed in detail. These Keyagesvegetables, fruits, whole grains, fat-free Recommendations are the most important in termsor low-fat milk and milk products,3 seafood, lean of their implications for improving public health.4 Tomeats and poultry, eggs, beans and peas, and nuts get the full benefit, individuals should carry out theand seeds.Dietary Guidelines recommendations in their entiretyas part of an overall healthy eating pattern.2. Added sugars: Caloric sweeteners that are added to foods during processing, preparation, or consumed separately. Solid fats: Fats with a high content ofsaturated and/or trans fatty acids, which are usually solid at room temperature. Refined grains: Grains and grain products missing the bran, germ, and/orendosperm; any grain product that is not a whole grain.3. Milk and milk products also can be referred to as dairy products.4. Information on the type and strength of evidence supporting the Dietary Guidelines recommendations can be found at http://www.nutritionevidencelibrary.gov. DIETARY GUIDELINES FOR AMERICANS, 2010ix
12. 12. Balancing calories toManage weight Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. Key Control total calorie intake to manage body weight. For people who are overweight or Recommendations obese, this will mean consuming fewer calories from foods and beverages. Increase physical activity and reduce time spent in sedentary behaviors. Maintain appropriate calorie balance during each stage of lifechildhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.foods and foodcoMPonents to reduce Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults. Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars. Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium. If alcohol is consumed, it should be consumed in moderationup to one drink per day for women and two drinks per day for menand only by adults of legal drinking age.55. See Chapter 3, Foods and Food Components to Reduce, for additional recommendations on alcohol consumption and specific population groups. Thereare many circumstances when people should not drink alcohol.x DIETARY GUIDELINES FOR AMERICANS, 2010
13. 13. foods and nutrients to increaseIndividuals should meet the followingRecommendations for specific population groupsrecommendations as part of a healthy eatingWomen capable of becoming pregnant7pattern while staying within their calorie needs. Choose foods that supply heme iron, which is Increase vegetable and fruit intake.more readily absorbed by the body, additional iron Eat a variety of vegetables, especially dark-green sources, and enhancers of iron absorption such asand red and orange vegetables and beans and peas. vitamin C-rich foods. Consume at least half of all grains as whole Consume 400 micrograms (mcg) per day ofgrains. Increase whole-grain intake by replacingsynthetic folic acid (from fortified foods and/orrefined grains with whole grains. supplements) in addition to food forms of folatefrom a varied diet.8 Increase intake of fat-free or low-fat milk andmilk products, such as milk, yogurt, cheese, or Women who are pregnant or breastfeeding7fortified soy beverages.6 Choose a variety of protein foods, which include Consume 8 to 12 ounces of seafood per weekseafood, lean meat and poultry, eggs, beans and from a variety of seafood types.peas, soy products, and unsalted nuts and seeds. Due to their high methyl mercury content, limit Increase the amount and variety of seafood white (albacore) tuna to 6 ounces per week andconsumed by choosing seafood in place of some do not eat the following four types of fish: tilefish,meat and poultry. shark, swordfish, and king mackerel. Replace protein foods that are higher in solid If pregnant, take an iron supplement, asfats with choices that are lower in solid fats andrecommended by an obstetrician or other healthcalories and/or are sources of oils.care provider. Use oils to replace solid fats where possible. Individuals ages 50 years and older Choose foods that provide more potassium,dietary fiber, calcium, and vitamin D, which are Consume foods fortified with vitamin B12, suchnutrients of concern in American diets. These as fortified cereals, or dietary supplements.foods include vegetables, fruits, whole grains,and milk and milk products.Building healthy eating Patterns Select an eating pattern that meets nutrient needs over time at an appropriate calorie level. Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern. Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses.6. Fortified soy beverages have been marketed as soymilk, a product name consumers could see in supermarkets and consumer materials. However,FDAs regulations do not contain provisions for the use of the term soymilk. Therefore, in this document, the term fortified soy beverage includes productsthat may be marketed as soymilk.7. Includes adolescent girls.8. Folic acid is the synthetic form of the nutrient; whereas, folate is the form found naturally in foods.DIETARY GUIDELINES FOR AMERICANS, 2010xi
14. 14. Chapter 1 IntroductionIn 1980, the U.S. Department of Agriculture (USDA)The recommendations contained in the Dietaryand the U.S. Department of Health and Human Guidelines for Americans traditionally have beenServices (HHS) released the first edition of Nutritionintended for healthy Americans ages 2 years andand Your Health: Dietary Guidelines for Americans. Theseolder. However, Dietary Guidelines for Americans, 2010Dietary Guidelines were different from previous dietary is being released at a time of rising concern aboutguidance in that they reflected emerging scientific the health of the American population. Its recom-evidence about diet and health and expanded the mendations accommodate the reality that a largetraditional focus on nutrient adequacy to also addresspercentage of Americans are overweight or obesethe impact of diet on chronic disease.and/or at risk of various chronic diseases. Therefore,the Dietary Guidelines for Americans, 2010 is intendedSubsequent editions of the Dietary Guidelines for for Americans ages 2 years and older, includingAmericans have been remarkably consistent inthose who are at increased risk of chronic disease.their recommendations about the components of ahealth-promoting diet, but they also have changed Poor diet and physical inactivity are the most impor-in some significant ways to reflect an evolving bodytant factors contributing to an epidemic of overweightof evidence about nutrition, the food and physicaland obesity in this country. The most recent dataactivity environment, and health. The ultimate goal indicate that 72 percent of men and 64 percent ofof the Dietary Guidelines for Americans is to improve women are overweight or obese, with about one-thirdthe health of our Nations current and future genera- of adults being obese.9 Even in the absence of over-tions by facilitating and promoting healthy eatingweight, poor diet and physical inactivity are associ-and physical activity choices so that these behaviors ated with major causes of morbidity and mortality.become the norm among all individuals.These include cardiovascular disease, hypertension,9. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among U.S. adults, 1999-2008. JAMA. 2010;303(3):235-241.1 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One
15. 15. type 2 diabetes, osteoporosis, and some types ofto create each edition of the Dietary Guidelines forcancer. Some racial and ethnic population groupsAmericans is a joint effort of the USDA and HHS andare disproportionately affected by the high rates ofhas evolved to include three stages.overweight, obesity, and associated chronic diseases.These diet and health associations make a focus In the first stage, an external scientific Dietaryon improved nutrition and physical activity choices Guidelines Advisory Committee (DGAC) isever more urgent. These associations also provide appointed to conduct an analysis of new scientificimportant opportunities to reduce health disparitiesinformation on diet and health and to prepare athrough dietary and physical activity changes.report summarizing its findings. The Committeesanalysis is the primary resource for the twoDietary Guidelines for Americans also recognizes that Departments in developing the Dietary Guidelinesin recent years nearly 15 percent of American house-for Americans. The 2010 DGAC used a systematicholds have been unable to acquire adequate food evidence-based review methodology involving ato meet their needs because of insufficient money web-based electronic system to facilitate its reviewor other resources for food.10 This dietary guidanceof the scientific literature and address approximatelycan help them maximize the nutritional content of 130 scientific questions. The methodological rigortheir meals within their resource constraints. Many of each study included in the analysis was assessed,other Americans consume less than optimal intakeand the body of evidence supporting each questionof certain nutrients, even though they have adequatewas summarized, synthesized, and graded by theresources for a healthy diet. This dietary guidance Committee (this work is publicly available at http://and nutrition information can help them choose awww.nutritionevidencelibrary.gov). The DGAC usedhealthy, nutritionally adequate diet. data analyses, food pattern modeling analyses,12 andreviews of other evidence-based reports to addressChildren are a particularly important focus of thean additional 50 questions.Dietary Guidelines for Americans because of thegrowing body of evidence documenting the vital role The DGAC report presents a thorough review of keythat optimal nutrition plays throughout the lifespan. nutrition, physical activity, and health issues, includ-Today, too many children are consuming diets with ing those related to energy balance and weight man-too many calories and not enough nutrients and areagement; nutrient adequacy; fatty acids and cho-not getting enough physical activity. Approximately lesterol; protein; carbohydrates; sodium, potassium,32 percent of children and adolescents ages 2 toand water; alcohol; and food safety and technology.19 years are overweight or obese, with 17 percent Following its completion in June 2010, the DGACof children being obese.11 In addition, risk factorsreport was made available to the public and Federalfor adult chronic diseases are increasingly found inagencies for comment. For more information aboutyounger ages. Eating patterns established in child- the process and the Committees review, see thehood often track into later life, making early inter- Report of the Dietary Guidelines Advisory Committee onvention on adopting healthy nutrition and physicalthe Dietary Guidelines for Americans, 2010 at http://activity behaviors a priority.www.dietaryguidelines.gov.During the second stage, the Departments developdeveloPing the Dietarythe policy document, Dietary Guidelines for Americans.GuiDelines for americans, 2010The audiences for this document include policymak-ers, nutrition educators, nutritionists, and healthBecause of their focus on health promotion andcare providers. Similar to previous editions, the 2010disease risk reduction, the Dietary Guidelines form edition of Dietary Guidelines for Americans is based onthe basis for nutrition policy in Federal food, educa-the Advisory Committees report and a considerationtion, and information programs. By law (Public Lawof public and Federal agency comments. The Dietary101-445, Title III, 7 U.S.C. 5301 et seq.), the Dietary Guidelines science-based recommendations are usedGuidelines for Americans is reviewed, updated iffor program and policy development. In the third andnecessary, and published every 5 years. The process final stage, the two Departments develop messages10. Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household food security in the United States, 2009. Washington (DC): U.S. Department ofAgriculture, Economic Research Service. 2010 Nov. Economic Research Report No. ERR-108. Available from http://www.ers.usda.gov/publications/err108.11. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007-2008. JAMA.2010;303(3):242-249.12. Food pattern modeling analyses are conducted to determine the hypothetical impact on nutrients in and adequacy of food patterns when specificmodifications to the patterns are made. DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One 2
16. 16. the heavy toll of diet-related chronic diseases cardiovascular disease diabetes 81.1 million Americans37 percent of the Nearly 24 million peoplealmost 11 percent of populationhave cardiovascular disease.13the populationages 20 years and older have Major risk factors include high levels of blooddiabetes.17 The vast majority of cases are type cholesterol and other lipids, type 2 diabetes, 2 diabetes, which is heavily influenced by diet hypertension (high blood pressure), metabolicand physical activity. syndrome, overweight and obesity, physical About 78 million Americans35 percent of inactivity, and tobacco use.the U.S. adult population ages 20 years or 16 percent of the U.S. adult population has high olderhave pre-diabetes.18 Pre-diabetes (also total blood cholesterol.14 called impaired glucose tolerance or impairedfasting glucose) means that blood glucose hypertensionlevels are higher than normal, but not high 74.5 million Americans34 percent of U.S.enough to be called diabetes. adultshave hypertension.15cancer Hypertension is a major risk factor for heart Almost one in two men and womenapproxi- disease, stroke, congestive heart failure, andmately 41 percent of the populationwill be kidney disease.diagnosed with cancer during their lifetime.19 Dietary factors that increase blood pressure Dietary factors are associated with risk of include excessive sodium and insufficientsome types of cancer, including breast (post- potassium intake, overweight and obesity, andmenopausal), endometrial, colon, kidney, excess alcohol consumption.mouth, pharynx, larynx, and esophagus. 36 percent of American adults haveosteoporosis prehypertensionblood pressure numbers One out of every two women and one in four that are higher than normal, but not yet in themen ages 50 years and older will have an hypertension range.16osteoporosis-related fracture in their lifetime.20 About 85 to 90 percent of adult bone mass isacquired by the age of 18 in girls and the ageof 20 in boys.21 Adequate nutrition and regularparticipation in physical activity are importantfactors in achieving and maintaining optimalbone mass.13. American Heart Association. Heart Disease and Stroke Statistics, 2010 Update At-A-Glance. http://www.americanheart.org/downloadable/heart/1265665152970DS-3241%20HeartStrokeUpdate_2010.pdf.14. Centers for Disease Control and Prevention. Cholesterol Facts. http://www.cdc.gov/cholesterol/facts.htm.15. American Heart Association. Heart Disease and Stroke Statistics, 2010 Update. Table 6-1. http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192667.16. Egan BM, Zhao Y, Axon RN. U.S. trends in prevalence, awareness, treatment, and control of hypertension, 19882008. JAMA. 2010;303(20):2043-2050.17. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2007. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf.18. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2007. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Estimatesprojected to U.S. population in 2009.19. National Cancer Institute. Surveillance Epidemiology and End Results (SEER) Stat Fact Sheets: All Sites. http://seer.cancer.gov/statfacts/html/all.html.20. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). NIH Osteoporosis and Related Bone Diseases National ResourceCenter. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/default.asp#h.21. National Osteoporosis Foundation. Fast Facts. http://www.nof.org/node.40.3 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One
17. 17. and materials communicating the Dietary Guidelines chapter 4: foods and nutrients to increaseto the general public.focuses on the nutritious foods that are recom-mended for nutrient adequacy, disease prevention,and overall good health. These include vegetables;a roadMaP to the Dietaryfruits; whole grains; fat-free or low-fat milk andGuiDelines for americans, 2010milk products;22 protein foods, including seafood,lean meat and poultry, eggs, beans and peas, soyDietary Guidelines for Americans, 2010 consists of sixproducts, and unsalted nuts and seeds; and oils.chapters. This first chapter introduces the docu- Additionally, nutrients of public health concern,ment and provides information on background and including potassium, dietary fiber, calcium, andpurpose. The next five chapters correspond to major vitamin D, are discussed.themes that emerged from the 2010 DGACs review chapter 5: Building healthy eating Patterns showsof the evidence, and Chapters 2 through 5 providehow the recommendations and principles describedrecommendations with supporting evidence andin earlier chapters can be combined into a healthyexplanations. These recommendations are basedoverall eating pattern. The USDA Food Patterns andon a preponderance of the scientific evidence forDASH Eating Plan are healthy eating patterns thatnutritional factors that are important for promot-provide flexible templates allowing all Americans toing health and lowering risk of diet-related chronicstay within their calorie limits, meet their nutrientdisease. Quantitative recommendations always referneeds, and reduce chronic disease risk.to individual intake or amount rather than populationaverage intake, unless otherwise noted. chapter 6: helping americans Make healthychoices discusses two critically important facts.Although divided into chapters that focus on particu- The first is that the current food and physicallar aspects of eating patterns, Dietary Guidelines foractivity environment is influential in the nutritionAmericans provides integrated recommendations for and activity choices that people makefor betterhealth. To get the full benefit, individuals should carry and for worse. The second is that all elements ofout these recommendations in their entirety as part society, including individuals and families, com-of an overall healthy eating pattern: munities, business and industry, and various levelsof government, have a positive and productive role chapter 2: Balancing calories to Manageto play in the movement to make America healthy.weight explains the concept of calorie balance,The chapter suggests a number of ways that thesedescribes some of the environmental factorsplayers can work together to improve the Nationsthat have contributed to the current epidemic ofnutrition and physical activity.overweight and obesity, and discusses diet andphysical activity principles that can be used toIn addition to these chapters, Dietary Guidelines forhelp Americans achieve calorie balance.Americans, 2010 provides resources that can be used chapter 3: foods and food components to in developing policies, programs, and educationalreduce focuses on several dietary componentsmaterials. These include Guidance for Specificthat Americans generally consume in excessPopulation Groups (Appendix 1), Key Consumercompared to recommendations. These includeBehaviors and Potential Strategies for Professionalssodium, solid fats (major sources of saturated fats to Use in Implementing the 2010 Dietary Guidelinesand trans fats), cholesterol, added sugars, refined (Appendix 2), Food Safety Principles and Guidancegrains, and for some Americans, alcohol. Thefor Consumers (Appendix 3), and Using the Foodchapter explains that reducing foods and bever- Label to Track Calories, Nutrients, and Ingredientsages that contain relatively high amounts of these(Appendix 4). These resources complement existingdietary components and replacing them with foodsFederal websites that provide nutrition informationand beverages that provide substantial amounts of and guidance, such as www.healthfinder.gov,nutrients and relatively few calories would improve www.nutrition.gov, www.mypyramid.gov, andthe health of Americans.www.dietaryguidelines.gov.22. Milk and milk products also can be referred to as dairy products.DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One 4
18. 18. Finally, the document has additional appendices key terMs to know containing nutritional goals for age-gender groupsbased on the Dietary Reference Intakes and theDietary Guidelines recommendations (Appendix 5),estimated calorie needs per day by age, gender, and Several terms are used throughout Dietaryphysical activity level (Appendix 6), the USDA Food Guidelines for Americans, 2010 and are essentialPatterns and DASH Eating Plan (Appendices 710), to understanding the principles and recommen-tables that support individual chapters (Appendices dations discussed:1115), and a glossary of terms (Appendix 16). calorie balance. The balance between calories consumed in foods and beverages and calories sources of information expended through physical activity and meta- For more information about the articles and reports bolic processes. used to inform the development of the DietaryGuidelines for Americans, readers are directed to the eating pattern. The combination of foodsReport of the Dietary Guidelines Advisory Committee and beverages that constitute an individualson the Dietary Guidelines for Americans, 2010 and the complete dietary intake over time.related Nutrition Evidence Library website (http:// nutrient dense. Nutrient-dense foods and www.nutritionevidencelibrary.gov). Unless other- beverages provide vitamins, minerals, andwise noted, usual nutrient, food group, and selected other substances that may have positive health dietary component intakes by Americans are drawn effects with relatively few calories. The term from analyses conducted by the National Cancer nutrient dense indicates that the nutrientsInstitute (NCI),23 a component of HHSs National and other beneficial substances in a food have Institutes of Health, and by USDAs Agricultural not been diluted by the addition of calories Research Service (ARS),24 using standard meth- from added solid fats, added sugars, or addedodologies and data from the National Health and refined starches, or by the solid fats naturally Nutrition Examination Survey (NHANES). Additional present in the food. Nutrient-dense foods andreferences are provided throughout this document, beverages are lean or low in solid fats, and where appropriate. minimize or exclude added solid fats, sugars, starches, and sodium. Ideally, they also are in forms that retain naturally occurring com-iMPortance of the dietary ponents, such as dietary fiber. All vegetables,guidelines for health ProMotion fruits, whole grains, seafood, eggs, beans and and disease Prevention peas, unsalted nuts and seeds, fat-free and low-fat milk and milk products, and lean meats A growing body of scientific evidence demonstrates and poultrywhen prepared without adding that the dietary and physical activity recommenda- solid fats or sugarsare nutrient-dense foods. tions described in the Dietary Guidelines for Americans For most Americans, meeting nutrient needs may help people attain and maintain a healthy within their calorie needs is an important goalweight, reduce the risk of chronic disease, and for health. Eating recommended amounts frompromote overall health. These recommendations each food group in nutrient-dense forms is the accommodate the varied food preferences, cultural best approach to achieving this goal and build-traditions, and customs of the many and diverse ing a healthy eating pattern.groups who live in the United States.A basic premise of the Dietary Guidelines is thatnutrient needs should be met primarily throughconsuming foods. Foods provide an array of nutri-ents and other components that are thought tohave beneficial effects on health. Americans shouldaim to consume a diet that achieves the Institute23. National Cancer Institute (NCI). Usual dietary intakes: food intakes, U.S. population, 20012004. Risk Factor Monitoring and Methods. http://riskfactor.cancer.gov/diet/usualintakes/pop/#results. Updated January 15, 2009. Accessed April 10, 2010.24. Agricultural Research Service (ARS). Nutrient intakes from food: mean amounts consumed per individual, one day, 20052006. Food Surveys ResearchGroup, ARS, U.S. Department of Agriculture. www.ars.usda.gov/ba/bhnrc/fsrg. 2008. Accessed April 10, 2010.5 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One
19. 19. of Medicines most recent Dietary ReferenceIntakes (DRIs), which consider the individuals lifedescriBing the strength ofstage, gender, and activity level. In some cases, the evidencefortified foods and dietary supplements may beuseful in providing one or more nutrients thatotherwise may be consumed in less than recom- Throughout this document, the Dietary Guide-mended amounts. Another important premise lines note the strength of evidence supportingof the Dietary Guidelines is that foods should be its recommendations:prepared and handled in a way that reduces riskstrong evidence reflects consistent, convinc-of foodborne illness. All of these issues are dis-ing findings derived from studies with robustcussed in detail in the remainder of this documentmethodology relevant to the populationand its appendices.of interest.Moderate evidence reflects somewhat lessuses of the Dietary GuiDelinesevidence or less consistent evidence. The bodyfor americans, 2010 of evidence may include studies of weakerdesign and/or some inconsistency in results.As with previous editions, Dietary Guidelines for The studies may be susceptible to some bias,Americans, 2010 forms the basis for nutrition but not enough to invalidate the results, or thepolicy in Federal food, nutrition, education, and body of evidence may not be as generalizable toinformation programs. This policy document hasthe population of interest.several specific uses.limited evidence reflects either a small numberof studies, studies of weak design, and/ordevelopment of educational materials andinconsistent results.communicationsThe information in this edition of Dietary Guidelines For more information about evaluating thefor Americans is used in developing nutrition educa-strength of evidence, go to http://www.tion and communication messages and materials.nutritionevidencelibrary.gov.For example, Federal dietary guidance publicationsare required by law to be consistent with theDietary Guidelines.When appropriate, specific statements in Dietarycauses the other. Often, several different factorsGuidelines for Americans, 2010 indicate the strengthmay contribute to an outcome. In some cases,of the evidence (e.g., strong, moderate, or limited)scientific conclusions are based on relationshipsrelated to the topic as summarized by the 2010or associations because studies examining causeDietary Guidelines Advisory Committee. Theand effect are not available. When developingstrength of evidence is provided so that users areeducation materials, the relationship of associatedinformed about how much evidence is available factors should be carefully worded so that causa-and how consistent the evidence is for a particular tion is not suggested.statement or recommendation. This information isuseful for educators when developing programs and development of nutrition-related programstools. Statements supported by strong or moderate The Dietary Guidelines aid policymakers in design-evidence can and should be emphasized in educa- ing and implementing nutrition-related programs.tional materials over those with limited evidence.For example, the Federal Government uses theDietary Guidelines in developing nutrition assis-When considering the evidence that supports a tance programs such as the National Child Nutritionrecommendation, it is important to recognize thePrograms and the Elderly Nutrition Program. Thedifference between association and causation. Two Dietary Guidelines also provide the foundation forfactors may be associated; however, this associa- the Healthy People national health promotion andtion does not mean that one factor necessarilydisease prevention objectives related to nutrition,DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One 6
20. 20. which set measurable targets for achievement over should be phrased in a manner that enables consum-a decade. ers to understand the claim in the context of the totaldaily diet. FDAMA upholds the significant scientificdevelopment of authoritative statements agreement standard for authorized health claims. ByThe Dietary Guidelines for Americans, 2010 has thelaw, this standard is based on the totality of publiclypotential to offer authoritative statements as a basisavailable scientific evidence. Therefore, for FDAMAfor health and nutrient content claims, as provided for purposes, statements based on, for example, evidencein the Food and Drug Administration Modernization that is moderate, limited, inconsistent, emerging, orAct (FDAMA). Potential authoritative statements growing, are not authoritative statements.7 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter One
21. 21. Chapter 2Balancing Caloriesto Manage WeightAchieving and sustaining appropriate body weightMaintaining a healthy body weight and preventingacross the lifespan is vital to maintaining good health excess weight gain throughout the lifespan are highlyand quality of life. Many behavioral, environmental,preferable to losing weight after weight gain. Once aand genetic factors have been shown to affect a per-person becomes obese, reducing body weight backsons body weight. Calorie balance over time is the key to a healthy range requires significant effort overto weight management. Calorie balance refers to the a span of time, even years. People who are mostrelationship between calories consumed from foods successful at losing weight and keeping it off do soand beverages and calories expended in normal bodythrough continued attention to calorie balance.functions (i.e., metabolic processes) and throughphysical activity. People cannot control the calories The current high rates of overweight and obesityexpended in metabolic processes, but they can among virtually all subgroups of the population incontrol what they eat and drink, as well as how manythe United States demonstrate that many Americanscalories they use in physical activity. are in calorie imbalancethat is, they consume morecalories than they expend. To curb the obesity epi-Calories consumed must equal calories expendeddemic and improve their health, Americans need tofor a person to maintain the same body weight.make significant effortsConsuming more calories than expended will result to decrease the total for More inforMationin weight gain. Conversely, consuming fewer caloriesnumber of calories theySee chapter 5 for discus-than expended will result in weight loss. This can be consume from foods sion of healthy eatingachieved over time by eating fewer calories, beingand beverages andpatterns that meet nutrientmore physically active, or, best of all, a combinationincrease calorie expen-needs within calorie limits.of the two. diture through physical DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Two 8
22. 22. activity. Achieving these goals will require Americans an ePideMic of overweightto select a healthy eating pattern that includes and oBesitynutrient-dense foods and beverages they enjoy, meetsnutrient requirements, and stays within calorie needs. The prevalence of overweight and obesity in theIn addition, Americans can choose from a variety ofUnited States is dramatically higher now than it wasstrategies to increase physical activity.a few decades ago. This is true for all age groups, including children, adolescents, and adults. OneKey Recommendations of the largest changes has been an increase in the number of Americans in the obese category. As shown in Table 2-1, the prevalence of obesity hasPrevent and/or reduce overweight and doubled and in some cases tripled between theobesity through improved eating and1970s and 2008.physical activity behaviors. The high prevalence of overweight and obesityControl total calorie intake to manage bodyacross the population is of concern becauseweight. For people who are overweightindividuals who are overweight or obese have anor obese, this will mean consuming fewer increased risk of many health problems. Type 2 diabetes,calories from foods and beverages. heart disease, and certain types of cancer are among the conditions most often associated with obesity. Ultimately,Increase physical activity and reduce time obesity can increase the risk of premature death.spent in sedentary behaviors. These increased health risks are not limited to adults.Maintain appropriate calorie balance duringWeight-associated diseases and conditions that wereeach stage of lifechildhood, adolescence, once diagnosed primarily in adults are now observedadulthood, pregnancy and breastfeeding,in children and adolescents with excess body fat. Forand older age. example, cardiovascular disease risk factors, such as high blood cholesterol and hypertension, and type 2overweight and oBese: what do they Mean?Body weight status can be categorized as underweight, healthy weight, overweight, or obese. Body massindex (BMI) is a useful tool that can be used to estimate an individuals body weight status. BMI is ameasure of weight in kilograms (kg) relative to height in meters (m) squared. The terms overweight andobese describe ranges of weight that are greater than what is considered healthy for a given height, whileunderweight describes a weight that is lower than what is considered healthy for a given height. Thesecategories are a guide, and some people at a healthy weight also may have weight-responsive health condi-tions. Because children and adolescents are growing, their BMI is plotted on growth charts25 for sex and age.The percentile indicates the relative position of the childs BMI among children of the same sex and age.categorychildren and adolescents (BMi for age Percentile range)adults (BMi)underweight Less than the 5th percentileLess than 18.5 kg/m2Healthy weight 5th percentile to less than the 85th percentile18.5 to 24.9 kg/m2overweight 85th percentile to less than the 95th percentile25.0 to 29.9 kg/m2obese Equal to or greater than the 95th percentile 30.0 kg/m2 or greaterAdult BMI can be calculated at http://www.nhlbisupport.com/bmi/. A child and adolescent BMIcalculator is available at http://apps.nccd.cdc.gov/dnpabmi/.25. Growth charts are available at http://www.cdc.gov/growthcharts.9 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Two
23. 23. taBle 2-1. obesity in america ...then and now obesity thenobesity now In the early 1970s, the prevalence of obesity was 5% forIn 20072008, the prevalence of obesity reached 10% children ages 2 to 5 years, 4% for children ages 6 to 11for children ages 2 to 5 years, 20% for children ages 6 to years, and 6% for adolescents ages 12 to 19 years.11 years, and 18% for adolescents ages 12 to 19 years. In the late 1970s, 15% of adults were obese.In 2008, 34% of adults were obese. In the early 1990s, zero States had an adult obesityIn 2008, 32 States had an adult obesity prevalence rate of prevalence rate of more than 25%. more than 25%. Sources: Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among U.S. adults, 19992008. JAMA. 2010;303(3):235-241. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among U.S. children and adolescents, 19992000. JAMA. 2002;288(4):1728-1732. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 20072008. JAMA. 2010;303(3):242-249. Centers for Disease Control and Prevention. U.S. Obesity Trends. Available at: http://www.cdc.gov/obesity/data/trends.html. Accessed August 12, 2010. [Note: State prevalence data based on self-report.]diabetes are now increasing in children and ado- Maintaining a healthy weight also is importantlescents. The adverse effects also tend to persist for certain subgroups of the population, includingthrough the lifespan, as children and adolescentswomen who are capable of becoming pregnant,who are overweight and obese are at substantiallypregnant women, and older adults.increased risk of being overweight and obese as Women are encouraged to achieve and maintainadults and developing weight-related chronic a healthy weight before becoming pregnant. Thisdiseases later in life. Primary prevention of obesity, may reduce a womans risk of complications duringespecially in childhood, is an important strategy for pregnancy, increase the chances of a healthy infantcombating and reversing the obesity epidemic. birth weight, and improve the long-term health of both mother and infant.All Americanschildren, adolescents, adults, andolder adultsare encouraged to strive to achieve Pregnant women are encouraged to gain weightand maintain a healthy body weight. Adults who within the 2009 Institute of Medicine (IOM)are obese should make changes in their eating andgestational weight gain guidelines.26 Maternalphysical activity behaviors to prevent additionalweight gain during pregnancy outside the recom-weight gain and promote weight loss. Adults who aremended range is associated with increased risks foroverweight should not gain additional weight, andmaternal and child health.most, particularly those with cardiovascular disease Adults ages 65 years and older who are overweightrisk factors, should make changes to their eating and are encouraged to not gain additional weight.physical activity behaviors to lose weight. Children Among older adults who are obese, particularlyand adolescents are encouraged to maintain calorie those with cardiovascular disease risk factors,balance to support normal growth and development intentional weight loss can be beneficial and resultwithout promoting excess weight gain. Children and in improved quality of life and reduced risk ofadolescents who are overweight or obese should chronic diseases and associated disabilities.change their eating and physical activity behaviors sothat their BMI-for-age percentile does not increaseover time. Further, a health care provider should be contriButing to the ePideMic:consulted to determine appropriate weight manage- an oBesogenic environMentment for the child or adolescent. Families, schools,and communities play important roles in supporting The overall environment in which many Americanschanges in eating and physical activity behaviors for now live, work, learn, and play has contributedchildren and adolescents. to the obesity epidemic. Ultimately, individuals26. Institute of Medicine (IOM) and National Research Council (NRC). Weight gain during pregnancy: reexamining the guidelines. Washington (DC):The National Academies Press; 2009. DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Two10
24. 24. choose the type and amount of food they eat andlifestyle. For example, the lack of sidewalks or parks how physically active they are. However, choices and concerns for safety when outdoors can reduce are often limited by what is available in a persons the ability of individuals to be physically active. environment, including stores, restaurants, schools, Also, over the past several decades, transporta- and worksites. Environment affects both sides of tion and technological advances have meant that the calorie balance equationit can promote over-people now expend fewer calories to perform tasks consumption of calories and discourage physicalof everyday life. Consequently, many people today activity and calorie expenditure.need to make a special effort to be physically activeduring leisure time to meet physical activity needs. The food supply has changed dramatically over theUnfortunately, levels of leisure-time physical activity past 40 years. Foods available for consumption are low. Approximately one-third of American adults increased in all major food categories from 1970 toreport that they participate in leisure-time physical 2008. Average daily calories available per person in activity on a regular basis, one-third participate in the marketplace increased approximately 600 calo-some leisure-time physical activity, and one-third are ries,27 with the greatest increases in the availability of considered inactive.30 Participation in physical activ- added fats and oils, grains, milk and milk products,28 ity also declines with age. For example, in national and caloric sweeteners. Many portion sizes offered surveys using physical activity monitors, 42 percent of for sale also have increased. Research has shown children ages 6 to 11 years participate in 60 minutes that when larger portion sizes are served, peopleof physical activity each day, whereas only 8 percent tend to consume more calories. In addition, strong of adolescents achieve evidence shows that portion size is associated withthis goal.31 Less than 5for More inforMation body weight, such that being served and consumingpercent of adults par-See chapter 6 for a discus- smaller portions is associated with weight loss. ticipate in 30 minutession of changes to the foodof physical activity each and physical activity envi-ronment involving families, Studies examining the relationship between the foodday, with slightly morepeers, and the community environment and BMI have found that communitiesmeeting the recom-that can help Americans with a larger number of fast food or quick-service mended weekly goal of achieve calorie balance. restaurants tend to have higher BMIs. Since theat least 150 minutes. 1970s, the number of fast food restaurants has more than doubled. Further, the proportion of daily calorie intake from foods eaten away from home current dietary intake has increased,29 and evidence shows that children, adolescents, and adults who eat out, particularly at The current dietary intake of Americans has fast food restaurants, are at increased risk of weight contributed to the obesity epidemic. Many children gain, overweight, and obesity. The strongest associa-and adults have a usual calorie intake that exceeds tion between fast food consumption and obesity istheir daily needs, and they are not physically active when one or more fast food meals are consumed perenough to compensate for these intakes. The com- week. As a result of the changing food environment,bination sets them on a track to gain weight. On the individuals need to deliberately make food choices,basis of national survey data, the average calorie both at home and away from home, that are nutrient intake among women and men older than age 19 dense, low in calories, and appropriate in portion size. years are estimated to be 1,785 and 2,640 caloriesper day, respectively. While these estimates do not On the other side of the calorie balance equation, appear to be excessive, the numbers are difficult to many Americans spend most of their waking hoursinterpret because survey respondents, especially engaged in sedentary behaviors, making it difficult forindividuals who are overweight or obese, often them to expend enough calories to maintain calorie underreport dietary intake. Well-controlled studies balance. Many home, school, work, and communitysuggest that the actual number of calories consumed environments do not facilitate a physically active may be higher than these estimates. 27. Adjusted for spoilage and other waste. ERS Food Availability (Per Capita) Data System. http://www.ers.usda.gov/Data/FoodConsumption/. Accessed August 12, 2010. 28. Milk and milk products also can be referred to as dairy products. 29. Stewart H, Blisard N, Jolliffe D. Lets eat out: Americans weigh taste, convenience, and nutrition. U.S. Department of Agriculture, Economic Research Service; 2006. Economic Information Bulletin No. 19. http:/ /www.ers.usda.gov/publications/eib19/eib19.pdf. 30. Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital Health Stat. 2009;10(242):1-157. 31. Troiano RP, Berrigan D, Dodd KW, Msse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181188.11 DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Two