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Over the past century, essential nutrient deficiencies have dramatically decreased, many infectious diseases have been conquered, and the majority of the U.S. population can now anticipate a long and productive life. However, as infectious disease rates have dropped, the rates of noncommunicable diseases—specifically, chronic diet-related diseases—have risen, due in part to changes in lifestyle behaviors. A history of poor eating and physical activity patterns have a cumulative effect and have contributed to significant nutrition- and physical activity-related health challenges that now face the U.S. population. About half of all American adults—117 million individuals—have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. These include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers, and poor bone health. More than two-thirds of adults and nearly one-third of children and youth are overweight or obese. These high rates of overweight and obesity and chronic disease have persisted for more than two decades and come not only with increased health risks, but also at high cost. In 2008, the medical costs associated with obesity were estimated to be $147 billion. In 2012, the total estimated cost of diagnosed diabetes was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity.[1]

Table I-1 describes the high rates of nutrition- and physical activity-related chronic diseases and their related risk factors. These diseases affect all ages—children, adolescents, adults, and older adults—though rates vary by several factors, including race/ethnicity, income status, and body weight status.

Table I-1. Facts About Nutrition- and Physical Activity-Related Health Conditions in the United States

Health Condition Facts

Overweight and Obesity

  • For more than 25 years, more than half of the adult population has been overweight or obese.
  • Obesity is most prevalent in those ages 40 years and older and in African American adults, and is least prevalent in adults with highest incomes.
  • Since the early 2000s, abdominal obesitya has been present in about half of U.S. adults of all ages. Prevalence is higher with increasing age and varies by sex and race/ethnicity.
  • In 2009-2012, 65% of adult females and 73% of adult males were overweight or obese.
  • In 2009-2012, nearly one in three youth ages 2 to 19 years were overweight or obese.

Cardiovascular Disease (CVD) and Risk Factors:

  • Coronary heart disease
  • Stroke
  • Hypertension
  • High total blood cholesterol
  • In 2010, CVD affected about 84 million men and women ages 20 years and older (35% of the population).
  • In 2007-2010, about 50% of adults who were normal weight, and nearly three-fourths of those who were overweight or obese, had at least one cardiometabolic risk factor (i.e., high blood pressure, abnormal blood lipids, smoking, or diabetes).
  • Rates of hypertension, abnormal blood lipid profiles, and diabetes are higher in adults with abdominal obesity.
  • In 2009-2012, almost 56% of adults ages 18 years and older had either prehypertension (27%) or hypertension (29%).b
  • In 2009-2012, rates of hypertension among adults were highest in African Americans (41%) and in adults ages 65 years and older (69%).
  • In 2009-2012, 10% of children ages 8 to 17 years had either borderline hypertension (8%) or hypertension (2%).c
  • In 2009-2012, 100 million adults ages 20 years or older (53%) had total cholesterol levels ≥200 mg/dL; almost 31 million had levels ≥240 mg/dL.
  • In 2011-2012, 8% of children ages 8 to 17 years had total cholesterol levels ≥200 mg/dL.


  • In 2012, the prevalence of diabetes (type 1 plus type 2) was 14% for men and 11% for women ages 20 years and older (more than 90% of total diabetes in adults is type 2).
  • Among children with type 2 diabetes, about 80% were obese.


  • Breast cancer
  • Colorectal cancer
  • Breast cancer is the third leading cause of cancer death in the United States.
  • In 2012, an estimated 3 million women had a history of breast cancer.
  • Colorectal cancer is the second leading cause of cancer death in the United States.
  • In 2012, an estimated 1.2 million adult men and women had a history of colorectal cancer.

Bone Health

  • A higher percent of women are affected by osteoporosis (15%) and low bone mass (51%) than men (about 4% and 35%, respectively).
  • In 2005-2010, approximately 10 million (10%) adults ages 50 years and older had osteoporosis and 43 million (44%) had low bone mass.

a Abdominal obesity, as measured by waist circumference, is defined as a waist circumference of >102 centimeters in men and >88 centimeters in women.

b For adults, prehypertension was defined as a systolic blood pressure of 120-139 mm mercury (Hg) or diastolic blood pressure of 80-89 mm Hg among those who were not currently being treated for hypertension. Hypertension was defined as systolic blood pressure (SBP) >140 mm Hg, diastolic blood pressure (DBP) >90 mm Hg, or taking antihypertensive medication.

c For children, borderline hypertension was defined as systolic or diastolic blood pressure at the 90th percentile or higher but lower than the 95th percentile or as blood pressure levels of 120/80 mm Hg or higher (but less than the 95th percentile). Hypertension was defined as a systolic or diastolic blood pressure at the 95th percentile or higher.

d The types of cancer included here are not a complete list of all diet- and physical activity-related cancers.

Concurrent with these diet-related health problems persisting at high levels, trends in food intake over time show that, at the population level, Americans are not consuming healthy eating patterns. For example, the prevalence of overweight and obesity has risen and remained high for the past 25 years, while Healthy Eating Index (HEI) scores, a measure of how food choices align with the Dietary Guidelines, have remained low (Figure I-1). Similarly, physical activity levels have remained low over time (Figure I-2). The continued high rates of overweight and obesity and low levels of progress toward meeting Dietary Guidelines recommendations highlight the need to improve dietary and physical activity education and behaviors across the U.S. population. Progress in reversing these trends will require comprehensive and coordinated strategies, built on the Dietary Guidelines as the scientific foundation, that can be maintained over time. The Dietary Guidelines is an important part of a complex and multifaceted solution to promoting health and helping to reduce the risk of chronic disease.

Figure I-1. Adherence of the U.S. Population Ages 2 Years and Older to the 2010 Dietary Guidelines, as Measured by Average Total Healthy Eating Index-2010 (HEI-2010) Scores

Figure I-1 line chart - chart description provided below
Read text description of Figure I-1

Figure I-1 is a line chart indicating changes over time in adherence of the U.S. population ages 2 years and older to the 2010 Dietary Guidelines. Adherence is measured using Healthy Eating Index-2010 (HEI-2010) scores for each 2-year NHANES cycle from 1999–00 to 2009–10.

HEI-2010 Total Score has been increasing slightly from 1999–00 to 2009–10, with values as follows:
1999–2000: 49.1;
2001–2002: 51.9;
2003–2004; 51.4;
2005–2006: 54.1;
2007–2008: 55.1;
2009–2010: 57.8.

Data Source: Analyses of What We Eat in America, National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 through 2009-2010.

Note: HEI-2010 total scores are out of 100 possible points. A score of 100 indicates that recommendations on average were met or exceeded. A higher total score indicates a higher quality diet.

Figure I-2. Percentage of Adults Meeting the Physical Activity Guidelines (Aerobic and Muscle-Strengthening Recommendations)

Figure I-2 bar chart - chart description provided below
Read text description of Figure I-2

Figure I-2 is a bar graph indicating the percentage of adults meeting the Physical Activity Guidelines Aerobic and Muscle-Strengthening recommendations, in 2008 and 2013. Figures are provided for all adults, males, females, and various age brackets, with bars for 2008 and 2013.

From 2008 to 2013, the total percent of adults meeting the Physical Activity Guidelines increased from 18% to 21%. Males increased from 22% to 25%; females increased from 15% to 17%.

Age 18 to 24 increased from 26% to 31%;
age 22 to 44 increased from 21% to 24%;
age 45 to 54 increased from 18% to 20%;
age 55 to 64 increased from 14% to 15%;
age 65 to 74 increased from 11% to 14%;
age 75 to 84 decreased from 9% to 8%;
age 85 and older increased from 0% to 4%.

Data Source: Analyses of the National Health Interview Survey, 2008 and 2013.

Healthy People 2020 PA-2.4. Increase the proportion of adults who meet the objectives for aerobic physical activity and for muscle-strengthening activity. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, June 3, 2015. Available at:


[1] For more information, see: Centers for Disease Control and Prevention (CDC). Chronic Disease Overview. August 26, 2015. Available at Accessed November 3, 2015.