Sixty percent of adults the United States are now living with one or more chronic diseases, including cancer, cardiovascular disease, and type 2 diabetes. That’s 150 million people—not counting millions of children and young adults—whose daily lives are disrupted by poor health. These chronic conditions are the leading causes of death and disability, and they’re also the leading drivers of the $3.5 trillion we spend on health care each year.
I’m not quick to call something a “crisis,” but the current trajectory of population health renders possible a future in which the vast majority of us are simply too sick to thrive. If we don’t make some changes, that future may come sooner than we think.
Luckily, we’re far from exhausting our options. One of the most powerful pathways to better health is through better nutrition. A recent study estimated that nearly half of all deaths from heart disease, stroke, and type 2 diabetes in the US could be attributed to poor diets. This and other research suggest that there is vast untapped potential to improve our health and wellbeing with the food we put on our plates.
That’s why, in a new report, we examined just how many lives might be saved and medical costs might be spared if adults in the US made key dietary changes to eat less processed meat, less added sugar, and more fruits and vegetables. We looked at these changes through the lens of the Dietary Guidelines for Americans, the leading set of science-based dietary recommendations in the US, currently in the process of being updated. The results make an overwhelming case for the federal government to take a fresh look at its food policy.
A menu with multi-billion dollar benefits
Our analysis considered three separate kinds of food and their respective relationships to common chronic diseases: processed meat and colorectal cancer, sugar-sweetened beverages and type 2 diabetes, and fruits and vegetables and cardiovascular disease. (For more on our research methods, including topic selection, tables and figures, and references, see the full report online.)
When it comes to processed meat (a category that includes foods like bacon, deli meat, hot dogs and sausage), there is strong evidence linking consumption to higher risk of colorectal cancer. Colorectal cancer is the third most commonly diagnosed cancer in the US, and although overall rates are declining, there has been an alarming increase in colorectal cancer among younger populations—which researchers believe may be partially related to diet. Experts have found that each additional 50 grams of processed meat (equal to two to four pieces of deli meat or bacon, or about one hot dog) eaten daily increases the risk of colorectal cancer by 16 to 18 percent. As a result, most leading agencies—with one notable exception—recommend that people consume little to no processed meat. That exception, of course, is in the US Dietary Guidelines. Despite overwhelming scientific consensus, industry groups have successfully prevented federal agencies from issuing a limit on processed meat.
So what would it look like if adults in the US were following the science on processed meat, consuming the equivalent of no more than one hot dog every two weeks? According to our analysis, this might have saved nearly 3,900 lives and $1.5 billion in medical costs due to colorectal cancer in 2018, with an additional $1 billion recouped in productivity costs.
Adults and kids alike are getting too much added sugar in their diets. And a lot of it comes in the form of sugar-sweetened beverages, including fruit drinks, soft drinks, sports drinks, and sweetened coffee and tea. Sugar-sweetened beverages make up almost half of all the added sugars consumed in the US, accounting for nearly 150 calories eaten by the average person each day. To put that into context, that means the average eight-year-old is getting one out of every 10 calories from sugar-sweetened beverages. And an ever-growing body of research shows that added sugar intake is harmful to our health in many ways—including increasing our risk of developing type 2 diabetes. Studies show that the risk of type 2 diabetes, a metabolic disorder affecting close to 30 million people in the US, increases by between 13 and 21 percent for each additional serving of sugar-sweetened beverages each day. And while the 2015-2020 Dietary Guidelines took a major step forward in recommending that we limit added sugar to less than 10 percent of total calories, research suggests that an even lower limit would provide greater protection against chronic disease.
What would it mean for our health if our diets were in better alignment with the science on added sugar? Our analysis found that, if adults in the US who drink sugar-sweetened beverages were consuming one fewer serving each day, this would have saved nearly 19,000 lives and decreased medical costs by $16 billion in 2018 from type 2 diabetes, and an additional $6 billion recouped in productivity costs.
Fruits and vegetables
Most of us are accustomed to hearing about the virtues of eating a variety of fruits and vegetables, but we might be surprised to learn just how good they are for us. A strong body of research shows that eating more fruits and vegetables can protect us against cardiovascular disease—the leading cause of death for both men and women. Cardiovascular disease, which includes heart disease, high blood pressure, and stroke, is responsible for one in three deaths, or more than 800,000 deaths annually, in the US. The Dietary Guidelines have consistently recommended that adults and children in the US eat more fruits and vegetables. And—with equal consistency—we have fallen short. People may face any number of challenges to eating healthfully, from cost to convenience to culture, and for many populations, including low-income communities and people of color, these challenges are amplified by systemic barriers that can make foods like fruits and vegetables much harder to come by. This points to an urgent need for more than just the best science-based guidelines, but also for a coordinated strategy that will allow the federal government to implement them and the general public to apply them.
If the guidelines were implemented to their fullest—if the healthy choice could be the healthy choice the easy choice when it comes to fruits and vegetables—what would it mean for our health? Our analysis found that, if adults in the US were able to meet recommendations for fruit and vegetable intake, this could have saved almost 110,000 deaths and more than $32 billion in medical costs, with an additional $20 billion in recouped productivity costs, in 2018.
Delivering on the Dietary Guidelines
Though there are notable cases in which food companies have managed to influence the guidelines via Congress or agency secretaries, these have proven to be the exception, not the rule. By and large, the Dietary Guidelines is consistently undergirded by high-quality scientific evidence and expertise, and its content has changed relatively little over the last 35 years: recommendations typically call on us to consume more fruit, vegetables, and whole grains; to limit foods that contain high amounts of sugar or sodium; and to develop healthy eating habits based on moderation and variety.
That being said, the Trump administration has ushered in a new era. With a particularly friendly attitude toward industry and a demonstrated distaste for science and scientific expertise, it may prove more challenging under such an administration to protect the current scientific process for developing the guidelines. As the scientific advisory committee meets throughout the course of the next year to review current evidence, we are encouraging the public to get involved and hold the administration accountable. (Right now, and through early 2020, the best way to do that is to submit a public comment—check our website later this month for a helpful how-to guide.)
On the road to making a healthy diet accessible to everyone, the Dietary Guidelines will continue to be an invaluable tool for health professionals, federal nutrition program operators, and many families. But we are far from reaching our destination.
The bottom line is this: if it is important to ensure the guidelines are evidence-based, it is essential to recognize that even evidence-based guidelines are only as effective as their implementation. As the development of the 2020-2025 Dietary Guidelines is underway, the federal government should be making a renewed commitment to public health by developing a strategy that will allow the benefits of a healthy diet to be realized by all communities, particularly those most vulnerable to the effects of chronic disease. With adequate resources supporting scientific recommendations, we could begin to deliver the full potential of the Dietary Guidelines.