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Opportunity Arises As New Report Says Produce Consumption Falls Short Of Recommendations

The Centers for Disease Control and Prevention are out with a report titled, State-Specific Trends in Fruit and Vegetable Consumption Among Adults — United States, 2000-2009.

The media is picking up on it, with pieces such as Most Americans Skip Fruits and Vegetables:

Fruit and vegetable consumption increased significantly in only one state during the past decade, as all 50 states and the District of Columbia continued to fall far short of recommended daily intake, according to a study from the CDC.

Only Idaho had a significant increase in the percentage of residents who consumed at least two servings of fruit and at least three servings of vegetables daily from 2000 to 2009. However, the absolute increases were small — 27.9% to 32.9% for fruits and 24.7% to 27.8% for vegetables.

At the opposite end of the consumption spectrum, 10 states had small but statistically significant decreases in the proportion of residents who consumed the recommended number of servings of fruit and vegetables, investigators reported in the Sept. 10 issue of Morbidity and Mortality Weekly Report.

Overall, only about a third of American adults ate at least two servings of vegetables daily in 2009, and about a fourth consumed at least three servings of vegetables a day.

“The findings in this report indicate that 2009 overall and state-specific estimates of the proportions of U.S. adults consuming fruit two or more times per day or vegetables three or more times per day were far short of the targets set by Healthy People 2010,” Kirsten A. Grimm, MPH, and co-investigators wrote in the discussion of their findings.

“Furthermore, trends in fruit and vegetable consumption during the past decade were relatively flat. The prevalence of fruit and vegetable consumption varied by demographic characteristics and body mass index; nonetheless, neither the fruit nor vegetable consumption target was met by any of the subgroups analyzed.”

The Healthy People 2010 campaign builds on an initiative begun in 1979 by the Office of the Surgeon General to promote preventive care and healthy lifestyle behaviors. Among other objectives, Healthy People 2010 established targets of 75% for the proportion of Americans ages 2 or older who consumed two or more servings of fruit and 50% for consumption of three or more servings of vegetables every day.

To examine states’ progress toward the goals, investigators analyzed data from the Behavioral Risk Factor Surveillance System. The analysis covered trends from 2000 through 2009.

For the fruit goal of two or more servings a day, the data showed that in 2009:

  • 32.5% of Americans met the goal
  • That proportion decreased from 34.4% in 2000
  • Four states had small increases in progress toward the fruit goal
  • 12 states had rates of 35% to 45% for the fruit goal

Oklahoma had the fewest residents who met the goal (18.1%)

The District of Columbia and California had the highest on-target fruit consumption (40.2% and 40.1%, respectively)

For the vegetable-consumption goal of three or more servings a day, in 2009:

  • 26.3% of American met the goal
  • That proportion was virtually unchanged from 26.7% in 2000
  • 11 states had slight increases in progress toward the goal
  • No state had 35% or more of residents who met the goal
  • South Dakota had the fewest residents who met the goal (19.6%)
  • Tennessee had the highest on-target vegetable consumption (33.0%)

The proper produce industry attitude toward such a report reminds us of the old joke about two shoe salespeople sent to visit some tribe never touched by civilization. One salesperson sent back a note. “I’m coming home. There is no market here. Nobody wears shoes.” The other salesperson confronted with the same circumstances sent back a note: “I’m staying. Send samples. Big market opportunity. Nobody has shoes.”

So we can be optimistic and say that the abysmally low consumption numbers represents a big opportunity for the industry… and a big opportunity to improve public health.

This is especially so because in all probability this study overstates consumption. It is based entirely on self-reporting in phone interviews, and the social pressure to eat healthy probably leads people to lie about eating less Cheetos and more produce.

Still we found a bit troubling the big conclusions of the study:

What is already known on this topic?

Fruit and vegetable consumption, although beneficial to health, has historically been lower than national recommendations.

What is added by this report?

Estimates of fruit and vegetable consumption among U.S. adults were far short of Healthy People 2010 targets, and trends in fruit and vegetable consumption over the past decade were relatively flat; no state has met the Healthy People 2010 targets.

What are the implications for public health practice?

To meet national targets for fruit and vegetable consumption, intensified, multisector (e.g., agriculture, business, food industry, and health care) and multisetting (e.g., worksite, school, child care, and community) approaches are necessary to improve access, availability, and affordability of fruits and vegetables.

Although the first two points are unobjectionable and grow out of the research, the third is really pure conjecture. There is nothing in the study to indicate that any of those approaches will result in meeting the national targets for fruit and vegetable consumption.

Other than the fact that those over 65 are closer to the goal than others — so as the population ages we will probably move closer to the goal without doing anything — the only other variable that we can actually change is that people who are college graduates come closer to the goal than people with less education. Of course we have no idea from the study whether that is because college graduates are more intelligent, are better able to absorb information, are more disciplined at following recommendations and requirements or what. So we don’t even know if sending everyone to college would do any good.

The obvious question raised by this report is whether the money going to the Produce for Better Health Foundation is achieving anything. It is difficult to say. Would consumption have been less if PBH hadn’t existed the last decade?

Last year the industry had a substantial debate on the possibility of a national mandatory generic marketing program. In the end, the finding was not so much that more promotion couldn’t grow the industry; the consensus was that ease of entry on many products was such that it would be difficult for the producers to get an adequate return on investment as they often would be developing a market for someone else to seize.

This means that efforts at increasing consumption, which is a public health concern, will have to be funded publicly if they are to be funded at all.

Perhaps an excellent point to make before Congress if you are attending United’s excellent Washington Public Policy Conference.

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