by Marion Nestle
May 23 2023

U.S. Nutrition Monitoring System is at Grave Risk

Here’s one of the most important—and alarming—papers I’ve seen in a long time.

Critical data at the crossroads: the National Health and Nutrition Examination Survey [NHANES] faces growing challenges

In summary, NHANES is at crossroads. Its many past successes are impressive, given the ambition of its goals and the complex nature of the data it has been designed to collect. However, the effect of years of inflation on the survey’s stagnant budget has undercut activities to meet the future, and the potentially game-changing nature of newer challenges cannot be avoided. A NASEM study to set the stage for the future of NHANES—that is, to provide an actionable framework—is a critical and prudent step forward. Certainly, maintaining the status quo and failing to adapt to emerging challenges cannot be an option for a survey vital to the nation’s health.

The National Nutrition Monitoring and Related Research Act of 1990 established a system for tracking diet and health in the United States.  Its passage was a long time coming and a terrific step forward.

The Act legally established the National Nutrition Monitoring and Related Research Program and numerous activities including development and implementation of a Ten-Year Comprehensive Plan and formation of the Interagency Board for Nutrition Monitoring and Related Research. Both requirements serve as the basis for planning and coordinating the activities of 22 Federal agencies that either conduct nutrition monitoring surveys and surveillance activities or are major users of nutrition monitoring data.

It set up the data collection system for What We Eat in America and the National Health and Nutrition Examination Survey (NHANES), Originally, the surveys were done by separate agencies, but they are now integrated under the CDC. 

It’s hard to overstate their importance.  Here’s a short list of how what the data are used for:

Everything we know about diet and health—and trends—in the U.S. comes from these surveys.

The report makes it clear that:

  • The CDC has been letting the surveys slide.
  • They are badly underfunded.
  • Nobody is paying attention to them.
  • They are not able to collect the data they need.
  • They are not being revised or modernized to collect new kinds of data.
  • They do not have champions in the public or in government.

I remember what it took to get the 1990 act: concerted efforts from advocacy groups and government nutrition personnel, and a series of reports over a ten-year period.  

Do we need to go through all that again?  It sure looks that way.

The paper calls for a deep investigation of the nutrition monitoring system.

the single most effective action at this time would be an overall and integrated examination of NHANES in the context of its future. Without a well-informed and defined set of goals and recommendations, there cannot be meaningful progress. Such a study would need to not only carry the gravitas of diverse experts with experience and knowledge related to health surveys and to health and nutrition data collection but also provide an independent and consensus-driven report.

That seems like a bare minimum.  Let’s get to it right away.