Eduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Center for Health Metrics and Evaluation, and Kim Stitzel, M.S., R.D., Senior Vice President, Center for Health Metrics and Evaluation
Eat your fruits and vegetables. The public health community and our mothers have been making this simple recommendation for people to improve their health for decades, and it’s just as true today.
Another truth about fruits and vegetables is less encouraging: Americans still aren’t eating nearly enough of them.
The Centers for Disease Control and Prevention (CDC) recently reported that only 12.2 percent of adults meet the daily fruit intake recommendation and just 9.3 percent meet the vegetable recommendation.
The CDC’s 2018 State Indicator Report on Fruits and Vegetables also provides data for each of the 50 states on 10 indicators of fruit and vegetable access and production. The indicators are related to improving fruit and vegetable access for individuals and families, improving fruit and vegetable access for children, and food system support for fruits and vegetables.
Among the key findings was that only 10 states have adopted a food service guidelines policy to ensure that healthy foods are sold or served in government-owned or government-controlled facilities such as worksites, state agencies (which includes state health departments) and parks and recreation centers. (The AHA’s Healthy Community Food and Beverage Toolkit is such a guideline.)
On the other hand, 47 states and Washington, D.C., have adopted state-level farm-to-school or farm-to-early care and education policies to increase student access to locally grown foods. Another positive finding was that 32 states have an active food policy council. These councils convene diverse food system stakeholders to collectively address issues such as accessibility and distribution of healthy foods, and can focus specifically on availability and affordability of fruits and vegetables.
The case for fruits and vegetables
There is no shortage of data showing the health-promoting power of produce. Higher fruit and vegetable intakes might even benefit the health of our economy and our planet, according to the “triple bottom line” perspective. This boils down to at least 39,900 avoided deaths, 2.2 million fewer illnesses, 400 million tons of avoided greenhouse gas emissions and more than $7.6 billion per year in healthcare savings in the United States alone.
Recommended fruit and vegetable consumption contributes to ideal cardiovascular health by providing essential nutrients and by helping to reduce cholesterol, lower blood pressure, and maintain a healthy weight. The AHA defines ideal cardiovascular health as not having heart disease and maintaining optimal levels (without drug treatment) of the Life’s Simple 7 metrics – not smoking, eating a healthy dietary pattern (including at least 4½ cups of fruits and vegetables daily), getting enough physical activity and maintaining a healthy body weight and healthy levels of blood pressure, cholesterol and blood glucose.
An ongoing problem
The CDC’s report revives a longtime public health question: How do we get people to eat more fruits and vegetables?
In 2017 the CDC released a different report examining disparities in state-specific adult fruit and vegetable consumption. It was based on the 2015 Behavioral Risk Factor Surveillance System, an annual telephone survey administered by the CDC’s National Center for Health Statistics (NCHS) to collect data on health and health risk behaviors related to chronic disease.
The survey found that fruit and vegetable consumption varied by state and was lower among men, young adults and adults with greater poverty. The lowest levels were in West Virginia, with 7.3 percent of adults meeting fruit intake recommendations and 5.8 meeting vegetable intake recommendations. The highest percentage of adults meeting intake recommendations was in Washington, D.C. for fruits (15.5 percent) and in Colorado for vegetables (11.6 percent).
In 2011 the CDC published strategies to promote increased fruit and vegetable consumption, based on data from the National Health and Nutrition Examination Survey (NHANES). This surveillance program administered by NCHS combines data from interviews, physical examinations and diagnostic tests to assess the health and nutritional status of U. S. adults and children. It found no significant change in overall fruit and vegetable intake among adults between 1999 and 2012. Increases noted in whole fruit intake were highest among those with higher income, and consumption of vegetables was higher for those with higher socioeconomic status.
The big takeaway
The CDC reports collectively serve as an important reminder that Americans are not consuming enough fruits and vegetables. They are a call to action to make these foods more affordable and accessible, especially in communities that are hit hardest by heart disease, stroke and their associated risk factors.
Moving toward a diet that includes at least 4½ cups of fruits and vegetables per day – while reducing consumption of red meats, refined grains, sodium, added sugars and sugar-sweetened beverages – can deliver benefits to our health, the health of our economy and the health of our planet.