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Nutrition and Physical Activity

Helping People Choose Healthy Eating And Active Living
At A Glance 2011

Cover of Nutrition and Physical Activity At A Glance 2011

Nutrition and Physical Activity: Foundations for Health

Healthy eating and regular physical activity can prevent injury, disability, and early death from many chronic conditions, including obesity, heart disease, stroke, some cancers, diabetes, depression, and osteoporosis. They also can help people maintain healthy weight. Unfortunately, few Americans make healthy food choices on a regular basis, and many do not get enough physical activity to receive health benefits.

According to the 2009 Behavioral Risk Factor Surveillance System, 67.5% of U.S. adults aged 18 years or older do not eat fruit at least 2 times a day, and 73.7% do not eat vegetables at least 3 times a day. The 2008 National Health Interview Survey found that 36.2% of adults report no leisure-time physical activity and 81.8% do not meet current federal guidelines for physical activity and muscle strengthening. Results from the 2009 Youth Risk Behavior Surveillance System found that 81.6% of adolescents do not meet current guidelines for aerobic physical activity. Physical inactivity is estimated to cost the United States about $75 billion in medical costs each year.

Barriers to Healthy Lifestyles

Some Americans, including those with disabilities, experience more barriers in their pursuit of healthy lifestyles than others. For example, the quality and accessibility of a community's food and physical activity environment affects the health of its residents. People who live in neighborhoods in which more residents have low incomes or are members of racial or ethnic minority groups often have poor access to healthy foods and few places for safe physical activity. Such conditions contribute to significant health disparities related to obesity. Increasing access to healthier food options and safe places to be physically active are important strategies for reducing health disparities and improving population-level health outcomes.

Public health officials and policy makers have begun to recognize that public health initiatives that focus on changing policies and environmental factors at federal, state, and local levels can help to remove the barriers that prevent people from making healthy lifestyle choices.

CDC Supports Healthy Nutrition and Physical Activity

CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO) is a national leader in helping to identify and implement policy, system, and environmental approaches that improve food, breastfeeding, and physical activity environments and support healthy eating and active living. As part of these efforts, CDC has identified the following target areas for improving nutrition and promoting active living:

  • Increase consumption of fruits and vegetables.
  • Increase physical activity.
  • Increase breastfeeding initiation, duration, and exclusivity.
  • Decrease consumption of sugar drinks.
  • Decrease consumption of energy-dense foods, which are high in calories.

States in Action

CDC funds all U.S. states and territories to develop and implement programs to promote healthy eating and increase physical activity through two state-based cooperative agreements. The State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (NPAO) funds 25 states to address obesity and other chronic diseases through statewide efforts coordinated with multiple partners. The program's primary focus is to improve the places where Americans live, work, learn, and play through policy and environmental supports that address the target areas for improving nutrition and promoting active living.

The Communities Putting Prevention to Work (CPPW) State and Territory Initiative is a 2-year cooperative agreement designed to promote health and prevent chronic disease through sustained policy, system, and environmental strategies at the state level. DNPAO will provide program and evaluation assistance to all 50 states and 8 U.S. territories to use the MAPPS (Media, Access, Point of decision information, Price, and Social support/services strategies) intervention model for this initiative through Spring 2012.

CDC is making progress toward improving eating and physical activity behaviors through these innovative initiatives. More information on these programs can be found online at

Technical Assistance and Training

CDC staff members provide technical assistance, training, and opportunities for collaboration to state and community grantees, partners, and researchers in several ways. Examples include one-on-one sessions, site visits, webinars, teleconferences, and training symposiums. CDC also develops tool kits, data reports, case studies, and assessment tools and puts them on the DNPAO Web site. For example, CDC provides information about and technical assistance on the benefits of using Health Impact Assessments to evaluate the potential health effects of a project or policy and make recommendations on how to increase positive health outcomes.

Research and Evaluation

CDC supports research and evaluation projects that can be used to identify promising policy and environmental strategies to improve population-level health that are aligned with the target areas associated with healthy nutrition and active living.

The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) is made up of 15 funded and unfunded Prevention Research Centers (PRCs) and is coordinated by the Harvard University PRC. NOPREN researchers describe, assess, and study the effectiveness of policies designed to increase access to healthier foods and drinks in a variety of settings. (See for more information.)

The Physical Activity Policy Research Network (PAPRN) is a group of 17 funded and unfunded PRCs led by the PRC at Washington University in St. Louis. PAPRN researchers conduct research on and evaluate the effectiveness of policies and resources that are designed to promote and support physical activity at state and local levels. (See for more information.)

Monitoring Behaviors and Their Policy and Environmental Supports

Since 2007, CDC has published the State Indicator Reports, which track healthy nutrition and active living behaviors at state levels, as well as the policy and environmental supports that promote these behaviors.

The State Indicator Report on Physical Activity, 2010 provides information on physical activity behaviors and policy and environmental supports in each state. The report's 17 indicators measure each state's progress toward meeting national objectives for healthy behaviors for youth and adults. They also measure the states' progress toward increasing access to places for physical activity; enhancing supports for physical activity in schools and child care settings; supporting urban design, land use, and transportation policies; and developing a public health workforce to promote physical activity. (See

The State Indicator Report on Fruits and Vegetables, 2009 provides information on fruit and vegetable consumption and policy and environmental supports for the nation and within each state. It also provides information about the availability of healthier food retail in communities; the availability of healthier foods and nutrition services in schools; and the existence of food system supports, such as the coordinated efforts of food policy councils. (See

The Breastfeeding Report Card—United States, 2010 shows how breastfeeding is being protected, promoted, and supported in each state. The nine policy and environmental indicators measure elements that support or promote breastfeeding, as well as outcome indicators of breastfeeding rates. Each indicator is measured in every state, which allows for easy state-by-state comparisons. (See

Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey that collects data on policy and environmental supports related to maternity care in U.S. hospitals. Research has shown that birth facilities that implement evidence-based maternity care practices can help mothers successfully initiate and continue breastfeeding. However, survey results show that birth facilities in most states are not providing maternity care that is fully supportive of breastfeeding. Although 75% of infants were initially breastfed in 2007, only 43% were still breastfeeding at age 6 months, and only 13% of those infants were exclusively breastfed. (See

Turning Research Findings into Practice

CDC routinely translates and shares evidence from research to help public health practitioners and policy makers improve the health of communities throughout the country. In the area of nutrition and physical activity, CDC has developed guidance documents on how to apply policy, system, and environmental approaches to address the target areas identified by CDC. For example, The CDC Guide to Breastfeeding Interventions shows states and local communities how to choose the strategies that best meet their needs. (See for more information.)

The Center of Excellence for Training and Research Translation works to bridge the gap between research and public health practice in the areas of nutrition, physical activity, and obesity. CDC funds the center and cosponsors an annual training for state program coordinators on policy, system, and environmental approaches. The center's Web site includes online training modules, information about interventions that have been shown to be effective, and tools to help practitioners implement evidence-based interventions in their communities. (See

Breastfeeding Gives Babies a Healthy Start

Breastfeeding supports the growth and development of babies and protects the health of babies and mothers. This protection increases with more months of breastfeeding and is strongest when babies receive no foods or liquids other than breast milk for the first 6 months of life. In 2005, CDC released The CDC Guide to Breastfeeding Interventions to provide guidance and information on interventions that support breastfeeding mothers, their babies, and their families in several areas, including hospitals and work sites. This guide is currently being updated.

Partnerships Help CDC Impact Public Health

The National Fruit & Vegetable Alliance is a partnership headed by CDC and the Produce for Better Health Foundation and includes representatives from federal public health and agriculture agencies, national nonprofit public health organizations, and produce trade associations. Its goal is to increase consumption of fruits and vegetables to improve the public's health. CDC supports the alliance's work by providing technical assistance and training to fruit and vegetable nutrition coordinators in the states.

TheNational Physical Activity Plan is designed to encourage all Americans to improve their health by being active at levels recommended by the 2008 Physical Activity Guidelines for Americans ( CDC is a partner in the public-private collaboration that developed this comprehensive national plan, and the agency continues to support comprehensive efforts to increase physical activity throughout the U.S. population. (See

The CDC/WHO Collaborating Center for Physical Activity and Health partners with the World Health Organization, Pan American Health Organization, World Bank, International Union for Health Promotion and Education, American College of Sports Medicine, and other groups. These organizations work together to (1) build capacity, provide training, promote partnerships; (2) establish and maintain surveillance and evaluation systems for physical activity; and (3) develop and implement policies, strategies, programs, and guidelines to increase physical activity worldwide. (See for more information.)

CDC's International Micronutrient and Malnutrition Prevention and Control (IMMPaCt) Program works with global partners to eliminate vitamin and mineral deficiencies, which can cause health problems such as blindness and birth defects throughout the world. These efforts include ensuring high-quality assessments of vitamin and mineral status in specific populations, increasing the effectiveness of micronutrient interventions, and increasing the fortification of
staple foods and condiments in countries throughout the world. (See for more information.)

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