TABLE 4-1 Top 10 Leading Causes of Death in the United States: All Ages, 2007


Deaths per 100,000 Population

Heart disease






Chronic lower respiratory disease


Unintentional injuries (accidents)


Alzheimer’s disease




Influenza and pneumonia


Nephritis, nephrotic syndrome and nephrosis





during this time, but the increased rates of those classified as obese, and the shift of those classified as healthy to overweight status has resulted in Americans weighing much more than they did in the 1960s (NCHS, 2010). Childhood obesity, defined as a BMI at or above the sex- and age-specific 95th percentile BMI cut points from the 2000 CDC Growth Charts, has also recently leveled off after several decades of increase, again at record high levels. These alarming trends have given rise to a major, national public health campaign to reduce obesity rates over the next decade. Obesity and overweight increase the risk for premature death and a host of co-morbidities. Co-morbidities include coronary heart disease (CHD) and stroke, type 2 diabetes, metabolic syndrome, certain types of cancer, sleep apnea, osteoarthritis, gallbladder disease, fatty liver disease, and pregnancy complications.2 In 2006 three of the most prevalent co-morbidities, heart disease, stroke, and diabetes, together accounted for approximately 34 percent of age-related deaths (NCHS, 2010). Additionally, in a prospectively studied cohort of U.S. adults, Calle et al. (2003) estimated that 14 percent and 20 percent of cancer deaths among men and women, respectively, were due to overweight and obesity. It has been estimated that $169 billion in annual medical savings could potentially be saved if overweight and obesity problems were eliminated in the United States, and even modest caloric reductions (100 calories per day) across the population could save as much as $58 billion in medical costs (Dall et al., 2009).

Overweight and obesity are the result of excess calorie intake or inadequate energy expenditure or both. While total daily caloric expenditure is difficult to quantify because of limited national surveillance, the increase in caloric consumption has been well documented (DGAC, 2010). According to the loss-adjusted USDA food availability data, daily per capita intake increased by 617 calories between 1970 and 2008 (DGAC, 2010). The three largest contributors to the increased calorie intake were added fats and oils (34 percent); flour and cereal products (31 percent); and caloric sweeteners (9 percent) (DGAC, 2010). Caloric sweeteners, or added sugars, include all refined sugars, corn sweeteners, honey, and edible syrups.

In the 2005 Dietary Guidelines for Americans (HHS/USDA, 2005b), a new concept regarding excess, nonessential calories was introduced. The term was “discretionary calorie allowance” or the balance of calories remaining in a person’s energy allowance after accounting for those consumed when meeting recommended nutrient intakes through healthful foods. Only a relatively small number of discretionary calories remain to be consumed as high-energy, low-nutrient foods (i.e., foods high in added sugars, fats, or alcohol) or as additional high-nutrient foods in excess of the levels needed for a healthy diet (e.g., additional fruit and vegetables or whole grains). For example, a person consuming 1,600 calories per day would have 130 discretionary calories, while a person consuming 2,000 calories a day would have 265. A high intake of added sugars or fat has the potential to contribute to overconsumption of discretionary calories by Americans. Because the concept of discretionary calories has been difficult to translate into meaningful consumer education (DGAC, 2010), the 2010 Dietary Guidelines Advisory Committee (DGAC) referred to the non-essential or extra calories coming from solid fats (i.e., saturated and trans


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