Abstract
Despite the well-documented health benefits of eating 5+ fruits and vegetables, few Americans do it. Convenience, eating out, and changes in the traditional family meal make eating 5 to 9 fruits and vegetables a day challenging. At the same time, obesity and its related chronic diseases are increasing to epidemic proportions. The environment presents both causes and possible solutions for the high prevalence of obesity. 5-A-Day provides simple, positive concepts with positive health benefits. Environmental/policy research interventions that promote 5-A-Day in work sites and supermarkets show promise as effective strategies to support health and to prevent obesity.
THE NATIONAL 5-A-Day for Better Health Program (5-A-Day) aims to increase Americans' consumption of fruits and vegetables to 5 to 9 servings a day so as to promote good health and reduce the risk of chronic disease. In its first decade, 5-A-Day built strong national public-private partnerships and was successful in increasing the public's knowledge about the importance of eating 5+ fruits and vegetables for better health, with knowledge levels rising from 8% in 1991 to 20% in 1997.1-3 The program had limited success in increasing consumption of fruits and vegetables however,1,4,5 and in 2002 a national eating trends survey found that only 20% of Americans consume the recommended 5+ servings (french fries and potato chips are not included). Conversely, the survey estimated that 66% of Americans eat fewer than 4 servings a day.6 Despite the well-documented health benefits of eating the recommended amounts of fruits and vegetables, few Americans do it.
Why is there a gap between what many Americans know they should eat for better health and what they actually do eat? Two of the reasons are the increasing desire for convenience and the decline of the traditional family meal. According to the 2002 national survey, almost half of Americans consider convenience the most important factor in determining the foods they eat.6 One way to make meals easier at home is to prepare fewer dishes and the dish most often dropped is the side dish, or the dish of seasonal vegetables.6 Also as Americans seek convenience they eat more meals away from home, giving them fewer opportunities to select fruits and vegetables.
Despite the dismal picture, 3 groups of Americans, on average, eat the recommended 5+ servings a day: teenage boys, men aged 45 years and older, and women 55+ years. Teenage boys get their 5-A-Day because they generally need and consume more calories. Older adults tend to eat fruits and vegetables more frequently, and also to eat more traditional meals at home.6
As health practitioners, our challenge is to make the "eat more fruits and vegetables" message so compelling that others become motivated to follow suit. We must also improve environments so that they will support the behavior changes needed to prevent obesity and related chronic diseases. The 5-A-Day Program offers a simple positive concept with positive health benefits. Yet this simple concept is difficult to turn into dietary action.
Changing the behavior of adults is more difficult than establishing healthy eating behaviors in the very young, but 2 recent national campaigns may offer insights into how to change adults. In 2003, the National Cancer Institute (NCI), a partner in the National 5-A-Day Program, initiated a high-level media campaign targeting African American men called "Shoot for 9" and the Produce for Better Health Foundation (PBH; Wilmington, Del), another national partner, produced the 5-A-Day the Color Way campaign. The latter campaign, which is directed to retailers, uses color to guide consumers in selecting 5 to 9 fruits and vegetables a day. Evaluation of these 2 campaigns will provide valuable information about effective strategies for changing consumer fruit and vegetable eating patterns and purchasing practices.
This article explores using 5-A-Day as a strategy to achieve environmental change for the promotion of good health and possibly to prevent obesity and manage weight. It highlights environmental approaches that affect purchasing and consumption of fruits and vegetables at work sites and in grocery stores, and it discusses implications for practitioners.