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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

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

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

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.