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Americans Are Still Eating Too Much Added Sugar, Fat

Posted on by Dr. Francis Collins

Foods with refined grains and sugar
Credit: iStock/happy_lark

Most of us know one of the best health moves we can make is to skip the junk food and eat a nutritious, well-balanced diet. But how are we doing at putting that knowledge into action? Not so great, according to a new analysis that reveals Americans continue to get more than 50 percent of their calories from low-quality carbohydrates and artery-clogging saturated fat.

In their analysis of the eating habits of nearly 44,000 adults over 16 years, NIH-funded researchers attributed much of our nation’s poor dietary showing to its ongoing love affair with heavily processed fast foods and snacks. But there were a few bright spots. The analysis also found that, compared to just a few decades ago, Americans are eating more foods with less added sugar, as well as more whole grains (e.g., brown rice, quinoa, rolled oats), plant proteins (e.g., nuts, beans), and sources of healthy fats (e.g., olive oil).

Over the last 20-plus years, research has generated new ideas about eating a proper diet. In the United States, the revised thinking led to the 2015-2020 Dietary Guidelines for Americans. They recommend eating more fruits, vegetables, whole grains, and other nutrient-dense foods, while limiting foods containing added sugars, saturated fats, and salt.

In the report published in JAMA, a team of researchers wanted to see how Americans are doing at following the new guidelines. The team was led by Shilpa Bhupathiraju, Harvard T. H. Chan School of Public Health, Boston, and Fang Fang Zhang, Tufts University, Boston.

To get the answer, the researchers looked to the National Health and Nutrition Examination Survey (NHANES). The survey includes a nationally representative sample of U.S. adults, age 20 or older, who had answered questions about their food and beverage intake over a 24-hour period at least once during nine annual survey cycles between 1999-2000 and 2015-2016.

The researchers assessed the overall quality of the American diet using the Healthy Eating Index-2015 (HEI-2015), which measures adherence to the 2015-2020 Dietary Guidelines. The HEI-2015 scores range from 0 to 100, with the latter number being a perfect, A-plus score. The analysis showed the American diet barely inching up over the last two decades from a final score of 55.7 to 57.7.

That, of course, is still far from a passing grade. Some of the common mistakes identified:

• Refined grains, starchy vegetables, and added sugars still account for 42 percent of the average American’s daily calories.
• Whole grains and fruits provide just 9 percent of daily calories.
• Saturated fat consumption remains above 10 percent of daily calories, as many Americans continue to eat more red and processed meat.

Looking on the bright side, the data do indicate more Americans are starting to lean toward the right choices. They are getting slightly more of their calories from healthier whole grains and a little less from added sugar. Americans are also now looking a little more to whole grains, nuts, and beans as a protein source. It’s important to note, though, these small gains weren’t seen in lower income groups or older adults.

The bottom line is most Americans still have an awfully long way to go to shape up their diets. The question is: how to get there? There are plenty of good choices that can help to turn things around, from reading food labels and limiting calories or portion sizes to exercising and finding healthy recipes that suit your palate.

Meanwhile, nutrition research is poised for a renaissance. Tremendous progress is being made in studying the microbial communities, or microbiomes, helping to digest our foods. The same is true for studies of energy metabolism, genetic variation influencing our dietary preferences, and the effects of aging.

This is an optimum time to enhance the science and evidence base for human nutrition. That may result in some updating of the scoring system for the nation’s dietary report card. But it will be up to all of us to figure out how to ace it.


[1] Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016. Shan Z, Rehm CD, Rogers G, Ruan M, Wang DD, Hu FB, Mozaffarian D, Zhang FF, Bhupathiraju SN. JAMA. 2019 Sep 24;322(12):1178-1187.


Eat Right (National Heart, Lung, and Blood Institute/NIH)

Dietary Fats (MedlinePlus, National Library of Medicine/NIH)

ChooseMyPlate (U.S. Department of Agriculture)

Healthy Eating Index (Department of Agriculture)

NIH Nutrition Research Task Force (National Institute of Diabetes and Digestive and Kidney Disease/NIH)

Dietary Guidelines for Americans (U.S. Department of Health and Human Services)

Shilpa Bhupathiraju (Harvard T. H. Chan School of Public Health, Boston)

Fang Fang Zhang (Tufts University, Boston)

NIH Support: National Institute on Minority Health and Health Disparities; National Institute of Diabetes and Digestive and Kidney Diseases


  • Pamea H. Daugavietis says:

    We could reduce the growing cost of health care by making better choices about the foods we eat, and feel better, live longer, more productive and happier lives, as well!!!!

    • Dan A says:

      At the same time Pamea…. all the big money fast food chains, restaurant chains, and even the FDA/USDA have NOT stepped up to the challenge of promoting healthy food and nutritional information. Many well educated people make those wise choices; the unfortunate reality is that the very large vast majority of Americans are not well educated and completely misinformed by advertisers and irresponsible corporate greed. The USDA has only a very small fraction of the advertising budget that the powerhouse fast food chains have. . .

    • Ian L says:

      We could also stop buying personal cars which, aside from a lack of exercise, would make pretty much all of the boilerplate explanations for American obesity* easier to deal with and yet this proven correlation only briefly appears and then disappears in the conversation every couple of years for some reason ( Nevermind! I’m sure diet, exercise and a better food pyramid will solve things; we just need to use our willpower!

      *: Fast-food, buying too much food (harder to do when you have to carry it), eating too much at restaurants (not nearly as fun when have to walk/bike home or to the subway), debt, and underfunded healthier public transportation.

  • keith botts says:

    If you want people to use this advice, make it easy to use. There is no way to download it so it can be read from hard-copy later. Put a .pdf button out there, conveniently located and BIG ENOUGH us geezers can see it and print it.

    • Moderator says:

      Thanks for your comment. It is possible to print a hard copy. On the homepage, place your cursor on the “More” box in the post, which is to the right of Twitter icon. As the cursor hovers over the box, a dropdown menu will appear with several options, including the print icon. Click on the icon, and you can print from there.

      • keith botts says:

        Thanks and that works to print directly, but I want to download a copy for later so I don’t have to store paper everywhere.



  • simo says:

    Americans and everyone around the world should eat more fruits, vegetables, whole grains and other nutrient-rich foods while reducing foods containing added sugars, saturated fats and salt . . .

  • Betty C. Jung says:

    Hello, maybe you can weigh in on:
    “There’s no need to eat less red or processed meat, group says, prompting criticism. Medical groups call the research recommendations “a major disservice to public health.”

  • hpk says:

    Processed meat is very dangerous for health same like GMOs Food.Both are very dangerous for health and environment.these thing ruin our life very badly.Please take them seriously

  • Abdel moneim says:

    If United States Government want to build healthy Nation, I would say FDA must strictly deal with all bakeries who make (Bread) that not to add a single Gram of sugar to the wheat flour so the Bread must be just (Wheat and Yeast) with little amount of salt. If you notice, the Bread in market made by this method is very high in price. To bring its price down for everyone, FDA must interfere and regulate such industries.

  • thomasr says:

    Thanks NIH Director’s blog for keeping up my head with very extended information for GOOD RESULTS.

  • A. Ambrose says:

    Not sure that 44,000 out of 329,000,000 Americans (just barely over 13%) is a large enough sample group to discuss “most Americans” or comment on the eating habits of Americans. (And what about all those “other” people who are not Americans living in the USA? – Oh, yes, that’s another story.) Numbers can be crunched any number of ways, depending on who is doing the crunching and the pre-determined agendas, anyway.

  • A. says:

    Awesome write-up. I’m a normal visitor of your blog and appreciate you taking the time to maintain the nice site. I will be a frequent visitor for a really long time

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