Survey Finds Americans Lack Basic Nutrition Information
A Report from the Physicians Committee for Responsible Medicine
A surprising number of Americans lack the most basic nutrition information, according to a new national survey of more than 1,000 adults conducted by ORC International on behalf of the Physicians Committee for Responsible Medicine (PCRM). Ten questions were posed to 1,015 adults, revealing gaps in America’s nutrition knowledge, including these five surprises:
| Five Nutrition Information Gaps
||Only 7 percent were aware that an egg has more cholesterol than a Big Mac.
||Only 7 percent of individuals in households with children ages 13 to 17 knew that skim milk and Coca-Cola have about the same number of calories.
||Only 18 percent knew that 70 percent of the calories in cheese come from fat.
||Only 22 percent were aware that beans, broccoli, and milk are all high in calcium.
||Only 36 percent realized that fish and beef have the same amount of fiber. There is no fiber in animal products.
Nutrition-related diseases kill millions of Americans every year, and a major cause of these epidemics is that many consumers do not know enough about the role that foods play in health. About two-thirds of adults and one-third of children and adolescents are overweight. Obesity raises the risk of many leading causes of death, including heart disease, cancer, and diabetes, according to the Centers for Disease Control and Prevention (CDC). More than 25 million children and adults in the United States have diabetes. Heart disease is the leading cause of death for both men and women.
To assess the public’s current knowledge of nutrition issues, PCRM commissioned ORC International to conduct random telephone surveys of the U.S. adult public in February of 2012. The company polled 1,015 adults using a random digit dial sample of both landline and cell phone numbers, yielding a margin of error of +/- 3 percent. Interviews were weighted by age, sex, geographic region, race, and education to ensure an accurate representation of the total adult (18 years of age and older) population.
Results and Discussion
Following are the 10 survey questions and key findings.
1. Which one of the following is true?
a. Skim milk has far more calories than Coca-Cola.
b. Skim milk has far fewer calories than Coca-Cola.
c. Skim milk has about the same calories as Coca-Cola.
Only 19 percent of respondents answered this question correctly. Ounce for ounce, colas and skim milk have about the same number of calories. Whole milk has about 50 percent more calories and 2 percent milk has approximately one-third more calories than cola.
Just 7 percent of households with children ages 13 to 17 and 18 percent of households with children younger than 13 gave a correct answer. Reduced-fat milk is the seventh leading source of calories among Americans ages 2 to 18 years old, and whole milk is 12th, according to the 2010 Dietary Guidelines for Americans.
2. Which one of the following is true?
a. Cheese has far more cholesterol than steak.
b. Cheese has far less cholesterol than steak.
c. Cheese has about the same amount of cholesterol as steak.
Thirty-nine percent of respondents gave the correct answer, which is that cheese has about the same amount of cholesterol as steak. One ounce of mozzarella cheese has 22 milligrams of cholesterol. That’s about the same amount as a porterhouse steak, ounce for ounce. An ounce of cheddar has 30 milligrams, an ounce of Monterey Jack has 25 milligrams, and an ounce of Swiss has 26 milligrams.
Thirty-four percent of survey participants ages 18 to 34 and 38 percent of households with children answered this correctly. The CDC says that 20 percent of adolescents ages 12 to 19 have at least one abnormal lipid level (LDL cholesterol, HDL cholesterol, or triglycerides).
3. What percentage of calories in typical cheeses is from fat?
a. 20 percent
b. 40 percent
c. 50 percent
d. 70 percent
Fewer than one in five of respondents correctly answered this question. About 70 percent of the calories in cheese come from fat, most of which is saturated (“bad”) fat. Cheese is the leading source of saturated fat in the American diet. Americans eat more than 33 pounds of cheese per person per year—three times more than they did in 1970. The 2010 Dietary Guidelines for Americans recommend that less than 10 percent of calories should come from saturated fat. The Guidelines also note that lowering calories from saturated fat to 7 percent can further reduce the risk of cardiovascular disease.
4. What part of your body is more likely to get cancer if you eat hot dogs and bacon frequently?
Just 30 percent of respondents gave the correct answer—the colon or large intestine—to this open-ended question. Among the 70 percent of respondents who answered incorrectly, answers included stomach, small intestine, and throat/esophagus.
Consuming processed meats increases the risk of colorectal cancer, according to a large number of studies, including the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A recent study from the Harvard School of Public Health found that a daily serving of processed meats—a category that includes hot dogs, sausages, and bacon—increases the risk of premature death by 20 percent.
Women were more likely than men to give a correct answer to this question. The Center for Disease Control and Prevention’s latest statistics show that more men than women die from colorectal cancer.
Only 20 percent of 18 to 34 year olds knew the correct answer to this question—less than any other age group. Annual colorectal cancer incidence rates recently increased more than 2 percent per year among those younger than 50 years old, according to a new study in the Archives of Internal Medicine.
More white than Hispanic respondents gave a correct answer. Colorectal cancer is the second most common cancer among Hispanic men and women. It is the third most common cancer among white and black men and women.
Related to this issue, we asked the survey team to pose an extra question during the survey:
The ‘colon’ is another name for what part of the body?
a. Small intestine
b. Large intestine
e. Don’t know
Fifty-nine percent of respondents knew (or guessed) the correct answer to this multiple choice question. The colon is the large intestine. More white than black respondents gave a correct answer. African-Americans have the highest incidence and mortality rates for colorectal cancer in the United States. A new American College of Physicians guidance statement recommends physicians should screen for colorectal cancer in high-risk adults starting at the age of 40.
Fifty-one percent of 18 to 34 year olds gave the correct answer. Fifty-eight percent of households with children ages 13 and younger gave the correct answer to this question.
5. Women who regularly eat soy products, such as soymilk or tofu, have:
a. Less cancer risk, compared with women who avoid soy products
b. More cancer risk, compared with women who avoid soy products
c. About the same cancer risk, compared with women who avoid soy products
Overall, 41 percent of survey participants gave a correct answer, with 44 percent of women answering correctly. Women who regularly eat soy products have less cancer risk, compared with women who avoid soy products. Women previously diagnosed with cancer tend to have better survival rates when soy is included in their diets.
Studies show that women who include soy products, such as edamame, tofu, tempeh, miso, and soy milk, in their diets are less likely to develop breast cancer, compared with other women.
6. Would you say salmon is:
a. Free of cholesterol
b. Low in fat
c. All of these
d. None of these
Only about 20 percent of respondents gave a correct answer, which is “none of these.” Salmon, like all animals, contain cholesterol. Salmon are also very fatty fish and provide a range of calories from fat. Farmed Atlantic salmon, for example, derives more than half of its calories from fat.
Among the five age groups, 18 to 34 year olds least often answered this question correctly. More white and Hispanic than black respondents gave a correct answer. African-Americans have a higher risk of heart disease than Caucasians.
7. Which one of these is true?
a. An egg has more cholesterol than a Big Mac.
b. An egg has less cholesterol than a Big Mac.
c. An egg has about the same amount of cholesterol as a Big Mac.
Overall, only 7 percent of respondents knew the correct answer. An egg has more cholesterol than a Big Mac. One egg has about 212 milligrams of cholesterol, and a Big Mac has 79 milligrams. It’s not necessary to consume any cholesterol, and healthful diets contain little or none.
Just 7 percent of women gave a correct answer. More women than men have high cholesterol in the United States. More black and Hispanic than white respondents gave a correct answer. Non-Hispanic white persons have a significantly higher prevalence of high cholesterol compared with non-Hispanic black and Mexican-American persons, according to the CDC.
8. Which of the following foods are high in calcium?
d. All of these
e. None of these
Only 22 percent of respondents chose the correct answer. Beans, broccoli, and milk are all high in calcium. Although milk has calcium, beans and greens are excellent sources of the nutrient. Greens contain calcium that is 50 to 60 percent absorbable by your body. Calcium in milk is only 32 percent absorbable.
Twenty-one percent of households with children and 25 percent of women picked the correct answer. Twenty-nine percent of 45 to 54 year olds, 28 percent of 55 to 64 year olds, and 27 percent of those older than 65 answered correctly. Age groups of particular concern for bone fractures due to low calcium intake from food include children ages 9 years and older, adolescent girls, adult women, and adults ages 51 years and older, according to the 2010 Dietary Guidelines for Americans.
The results, favoring an understanding of the calcium in dairy products, rather than in vegetables and legumes, suggest an effect of dairy industry publicity over time.
9. Which one of these is true?
a. Fish has more fiber than beef.
b. Fish has less fiber than beef.
c. Fish and beef have the same amount of fiber.
Only 36 percent of respondents knew that fish and beef have the same amount of fiber. There is no fiber in animal products of any sort. Fiber is in beans, vegetables, fruits, and whole grains.
Higher fiber intake is associated with significantly lower risk of premature death, according to a study published in the Archives of Internal Medicine in 2011. Researchers examined diet records from 219,213 people who were part of the NIH (National Institutes of Health)-AARP Diet and Health Study, finding that those who ate the most fiber had lower risks of death from cardiovascular disease and infectious and respiratory diseases, compared with participants who ate the least. Additionally, men who ate the most fiber also had a lower risk of cancer death, compared with men who consumed the least, while women with the highest fiber intake showed a nonstatistically significant lower risk of death from cancer.
Thirty-seven percent of survey participants ages 45 to 54, 37 percent ages 55 to 64, and 31 percent 65 or older answered correctly. Incidence and death rates for colorectal cancer increase with age. Overall, 90 percent of new cases and 94 percent of deaths occur in individuals 50 and older, according to the American Cancer Society. High-fiber diets may help prevent colon cancer, according to results from the Polyp Prevention Trial.
10. Which of the following has the most calories per ounce?
a. Roasted chicken breast without skin
b. Regular soda
c. Cooked white rice
Only 14 percent of the survey sample gave the correct answer, which is that roasted chicken breast without skin has the most calories per ounce. Chicken is the fourth highest contributor of calories among Americans ages 2 years and older, according to the 2010 Dietary Guidelines for Americans. The percentage of fat from roasted, skinless chicken breasts is about the same as some cuts of beef, contributing to its high calorie content. The estimated U.S. per capita consumption of chicken in 2011-2012 is 84 pounds.
Fourteen percent of 18-34 year olds answered this question correctly. This same age group eats chicken the most often—seven times per two-week period—according to a survey by the National Chicken Council.