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Physical
Activity and Good Nutrition:
Essential Elements for Good Health
Source: McGinnis JM, Foege WH. Actual causes of death in the United States.
JAMA 1993; 270:2207–12. (1990 data).
Note: The percentages used in the figure are composite approximations derived
from published scientific studies that attributed death to these causes.
“Americans of
all ages are heavier than ever before. This trend, along with the aging of the
nation’s population, is increasing the risk for heart attack and stroke.
Improving the health of Americans through physical activity and good nutrition
must become a national priority.”
Martha N. Hill, RN, PhD
Past President, American Heart Association
Physical Activity
and Good Nutrition
Every year, chronic
diseases claim the lives of more than one and a half million Americans. These
diseases account for 7 of every 10 deaths in the United States each year and
for more than 60% of total medical care expenditures. In addition, the
prolonged illness and disability associated with many chronic diseases result
in decreased quality of life for millions of Americans.
Much of the chronic disease
burden is preventable. To a certain degree, the major chronic disease killers—cardiovascular
disease, cancer, and diabetes—are an extension of what people do, or what
they do not do, as they go about the business of daily living. The actual
underlying contributors to much of the chronic disease burden are a limited
number of health-damaging behaviors practiced by people every day for much of
their lives.
Physical inactivity and
unhealthy eating are risk behaviors that have a critical impact on health.
Together, they are responsible for at least 300,000 preventable deaths each
year. Only tobacco use causes more preventable deaths in the United States.
Promoting regular physical
activity and healthy eating and creating an environment that supports these
behaviors are essential to reducing the burden of chronic diseases. Chronic
diseases do not have to be an inevitable consequence of aging. People who live
healthfully and avoid the behaviors that increase their risk for chronic
diseases can expect to have healthier, longer lives.
Lack of Physical Activity Among Americans Despite Proven Benefits
Regular physical activity
provides short-term benefits and reduces long-term risks for disability and
premature death. Moreover, physical activity need not be strenuous to be
beneficial; men and women of all ages benefit from moderate physical activity,
such as 30 minutes of brisk walking five or more times a week. Regular
physical activity substantially reduces the risk of dying of coronary heart
disease, the nation’s leading cause of death, and decreases the risk for
colon cancer, diabetes, and high blood pressure. Regular physical activity
also helps to control weight; contributes to the development and maintenance
of healthy bones, muscles, and joints; and reduces symptoms of anxiety and
depression. For many people with arthritis, physical activity helps to relieve
pain and maintain joint mobility.
Despite the proven benefits
of being physically active, more than 60% of American adults do not engage in
levels of physical activity necessary to provide health benefits. More than
one-fourth are not active at all in their leisure time. Activity decreases
with age and is less common among women than men and among those with lower
income and less education.
Insufficient physical
activity is not limited to adults. Information gathered through CDC’s Youth
Risk Behavior Surveillance System indicates that more than a third of young
people aged 12–21 years do not regularly engage in vigorous physical
activity. Daily participation in high school physical education classes
dropped from 42% in 1991 to 27% in 1997.
Healthy Eating Is
Critical to Healthy Living
We now know that good
nutrition lowers a person’s risk for many chronic diseases, including
coronary heart disease, stroke, some types of cancer, diabetes, and
osteoporosis.
Americans are slowly
changing their eating patterns toward healthier diets. However, a considerable
gap remains between recommended dietary patterns and what Americans actually
eat. Information from CDC’s Behavioral Risk Factor Surveillance System
indicates that only 27% of women and 19% of men eat the recommended five or
more servings of fruits and vegetables each day. Although the amounts of total
fat, saturated fatty acids, and cholesterol that Americans consume have
decreased, they remain above recommended levels for a large proportion of the
population. Between 20% and 30% of the nation’s adults are at least 30
pounds overweight, and more than 3 million women weigh at least 100 pounds
more than their recommended body weight.
Like adults, many young
people in the United States make poor eating choices. More than 84% of young
people eat too much fat, and less than 30% eat the recommended number of
servings of fruits and vegetables each day. Nearly 25% of young people aged 6–17
years are considered overweight. The percentage of young people who are
seriously overweight has more than doubled in the last 30 years.
People who are overweight are
at increased risk for heart disease, high blood pressure, diabetes, and possibly
cancer. Being overweight also worsens the disabilities associated with
arthritis. In 1995, the total economic cost of obesity in the United States was
$99.2 billion.
CDC’s National
Leadership
In 1996, CDC released the
landmark Physical Activity and Health: A Report of the Surgeon General.
This report brings together, for the first time, what has been learned about
physical activity and health from decades of research. Among its major
findings are that physical activity need not be strenuous to produce health
benefits and that inactive people can improve their health by becoming
moderately active on a regular basis. The important public health implications
of these findings compel CDC, as the nation’s prevention agency, to ensure
that the promotion of physical activity is accorded the same degree of
attention and commitment given to other important public health measures.
Getting the Message Out
To ensure that key research
findings reach those whom they will benefit, CDC has collaborated with its
public health partners to design and launch an award-winning national health
communications campaign, “Physical Activity: It’s Everywhere You Go.”
The campaign is designed to emphasize the positive, satisfying, and social
aspects of physical activity and to help busy adults find convenient,
practical ways to fit activity into their everyday schedules. An important
component is a marketing kit that provides health professionals and
communities with easy-to-use tools designed to get people moving. These tools
include ready-to-use print materials, radio and television public service
announcements (including a spot starring Olympic gold medal speed skater Dan
Jansen), and information about how to work with the media and communities to
promote physical activity.
CDC collaborates with the
National Cancer Institute (NCI) to disseminate information on healthy eating
and physical activity. CDC and NCI have partnered with state health
departments to promote the national 5-A-Day program in supermarkets, farmers
markets, schools, worksites, WIC programs, and communities and through the
media.
Capitalizing on a Unique
Opportunity to Improve Women’s Health
CDC’s National Breast and
Cervical Cancer Early Detection Program has provided women in low-income
groups with life-saving screening for these two cancers. Active in every
state, this program offers an established, community-based framework that
provides a novel opportunity to address other high-priority health problems
among women.
Through this program, CDC
enables three states—Arizona, Massachusetts, and North Carolina—to direct
additional funding to screen women for factors that significantly increase
their risk for cardiovascular disease, the leading cause of death among women.
In this demonstration project, called WISEWOMAN, a portion of the women who
are screened for breast and cervical cancer are also assessed for sedentary
lifestyle, obesity, elevated cholesterol, high blood pressure, and smoking.
Since WISEWOMAN’s
inception in 1995, more than 4,000 low-income and uninsured women aged 50
years and older have been screened and received counseling, education,
referral, and follow-up services. More than 50% of the women screened have
been found to have either elevated cholesterol or high blood pressure, and
more than 60% are overweight. Within one year, women enrolled in the WISEWOMAN
project in one state had significantly lowered their cholesterol level,
increased their physical activity level, and raised their fruit and vegetable
intake.
Women are often diagnosed
with cardiovascular disease in its advanced stages, when treatment is less
effective. The WISEWOMAN project identifies and addresses risky health
behaviors among women early, thus helping women reduce their risk of
cardio-vascular disease. In addition, the project is providing valuable
insights into the feasibility and benefits of making comprehensive, integrated
preventive services available to women in low-income groups in all states.
Expanding the Knowledge
Base
CDC conducts research to
strengthen and expand the scientific basis for the role of physical activity
and nutrition in health.
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A recent CDC analysis
of data from the Bogalusa, Louisiana, heart study has shown that the
prevalence of overweight and obesity among children and young adults
increased more than threefold from 1973 to 1994. Furthermore, these trends
appear to be accelerating. Because overweight in early life tends to be
associated with chronic diseases in adulthood, these findings emphasize
the importance of preventing obesity in children.
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Through CDC’s
Prevention Research Centers network, CDC and the National Institutes of
Health are collaboratively developing better methods to measure physical
activity levels. The research focuses on African American, American
Indian, Hispanic, and low-income white women older than age 40. This
research will improve CDC’s ability to target and evaluate health
promotion efforts among these high-risk populations.
Reaching Young People
Through Schools
Lifelong health-related
habits, including physical activity and eating patterns, are often established
in childhood. Because ingrained behaviors are difficult to change as people
grow older, public health measures need to reach young people early, before
health-damaging behaviors are adopted.
Schools provide an ideal
opportunity to make an enormous, positive impact on the health of the nation.
To reach the more than 50 million young people in schools across the country,
CDC has established a nationwide framework for coordinated health education in
schools. As part of this effort, simple, easily referenced guidelines have
been developed to assist educators and others in promoting lifelong physical
activity and healthy eating among young people. Developed by CDC in
collaboration with a variety of national health and education organizations,
these guidelines are the first of their kind and are being used in schools and
communities across the nation.
With fiscal year 1999
funding of about $9.9 million, CDC is directly assisting 15 states in
providing coordinated health education in schools. Such education provides
young people with the information and skills needed to make positive health
behavior choices. Inactivity and unhealthy diets, together with tobacco use,
are among the critical risk behaviors being addressed.
CDC is developing several
instruments to assist schools in promoting healthy eating and physical
activity. These include a self-assessment and program-planning tool. CDC is
also collaborating with the American Medical Association and pediatric and
family practice physicians to determine the extent to which these physicians
are counseling their young patients on the importance of physical activity and
healthy eating.
Future Directions
Although much remains to be
learned about the role of physical activity and nutrition in health, a wealth
of research makes it clear that in the United States today, inactivity and
poor nutrition are responsible for many unnecessary deaths, illnesses, and
disabilities associated with chronic diseases.
Physical activity and good
nutrition play critical roles in promoting and maintaining health and in
reducing the risk for chronic diseases, and it is vitally important to get
this message out to the American people. However, communicating the message
alone is not enough. If people are to adopt and maintain healthy behaviors,
such changes must be supported by programs and policies and by the
environments in which they live.
Life expectancy for
Americans has risen from 45 years at the turn of the century to 75 years
today. Research has indicated that only 5 years of this 30-year gain can be
attributed to curative medicine; the remaining 25 years represent advances in
public health, through improved housing, sanitation, and immunization. Just as
societal-level changes were necessary to address the ravages of disease
earlier in this century, far-reaching environmental, social, and policy
changes are needed now to address the major health threats of our time.
Twentieth-century
innovations in transportation, food processing, and food availability have
displaced the regular physical activity and the lower-fat, higher-fiber diets
that used to be a natural part of everyday life. Collective action is required
at the federal, state, and local levels to create or modify programs,
policies, and practices that encourage and facilitate healthy living. CDC
considers it a priority that people be afforded opportunities to pursue and
maintain good health through such avenues as safe walking and cycling trails;
low-fat, high-fruit-and-vegetable menu selections in restaurants, schools, and
worksite cafeterias; and physical activity programs in schools, worksites, and
community gathering places.
CDC, in collaboration with
its public health partners at the national, state, and local levels, will
pursue changes to the community environment that encourage healthy lifestyles.
In addition, CDC is striving to expand health communications to promote the
benefits of physical activity and good nutrition through worksites, schools,
and health care settings. Although the messages are relatively simple,
promoting, implementing, and reinforcing these messages to change individual,
family, and community behaviors throughout the country are a key public health
challenge for the coming century. The health of our nation depends on our
successful response to this challenge.
For more
information:
Centers for Disease Control
and Prevention,
National Center for Chronic Disease Prevention and Health Promotion
Mail Stop K–46,
4770 Buford Highway NE,
Atlanta GA 30341-3717,
Telephone (770) 488-5820; Fax (770) 488-5473.
ccdinfo@cdc.gov
http://www.cdc.gov/nccdphp
U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Public Health Service
Centers for Disease Control and Prevention
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