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Chronic Health Conditions: Federal Strategy Needed to Coordinate Diet-Related Efforts

GAO-21-593 Published: Aug 17, 2021. Publicly Released: Sep 16, 2021.
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Fast Facts

Chronic health conditions (like heart disease, diabetes, cancer, and obesity) are costly and deadly—causing over half of U.S. deaths in 2018. They also exacerbated the pandemic: Americans with such conditions were 12 times more likely to die after contracting COVID, according to the CDC.

Yet chronic conditions are largely preventable with a healthy diet and other behaviors like exercise. The federal government leads 200 different efforts, spread across 21 agencies, to improve Americans' diets. But agency efforts are fragmented and there are gaps in key scientific research, including for children. A strategy for working together could help.

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What GAO Found

According to the latest federal data available, selected chronic health conditions linked to diet are prevalent, deadly, and costly. These diet-related conditions include cardiovascular diseases (heart disease and stroke), cancer, diabetes, and obesity. For example, 2018 federal data show:

Prevalence. Forty-two percent of adults had obesity—or approximately 100 million U.S. adults.

Mortality. Cardiovascular diseases, cancer, and diabetes accounted for half of all annual deaths in the U.S. (about 1.5 million deaths). People living in southern states, men, and Black Americans had disproportionately higher mortality rates than those living in other regions, women, and other races.

Cost. Government spending, including Medicare and Medicaid, to treat cardiovascular disease, cancer, and diabetes accounted for 54 percent of the $383.6 billion in health care spending to treat these conditions.

The increase in certain diet-related conditions over time indicates further potential threats to Americans' health. For example, the prevalence of obesity among adults was 19 percent higher in 2018 than in 2009.

GAO identified 200 federal efforts related to diet—fragmented across 21 agencies—for reducing Americans' risk of chronic health conditions. The efforts fall into four categories (see table).

Federal Agencies' Efforts to Address Diet as a Factor of Chronic Health Conditions


Number of efforts

Examples of activities

Total efforts





Collect and monitor data, conduct or fund studies, review research to develop guidelines on healthy eating

Education and clinical services


Inform program beneficiaries, counsel health care patients, inform the public with mass communication

Food assistance and access


Provide food or assistance in purchasing food, improve community access to healthy food

Regulatory action


Issue requirements or recommendations for food producers, manufacturers, and retailers

Source: GAO analysis of agency information. | GAO-21-593

Note: Effort numbers do not add up to 200 because some efforts fall into multiple categories.

Agencies have taken some actions to coordinate, such as by establishing interagency groups. However, they have not effectively managed fragmentation of diet-related efforts or the potential for overlap and duplication. Such fragmentation has impacted the agencies' ability to achieve certain outcomes. For example, according to agency officials and nonfederal stakeholders, agencies have not fully addressed important gaps in scientific knowledge where research is sparse, including on healthy diets for infants and young children. A federal strategy for diet-related efforts could provide sustained leadership and result in improved, cost-effective outcomes for reducing Americans' risk of diet-related chronic health conditions.

Why GAO Did This Study

Many chronic health conditions are preventable, yet they are leading causes of death and disability in the United States. In addition, people with certain chronic health conditions are more likely to be hospitalized or die from COVID-19 than people without them. Poor diet is one prominent risk factor for chronic health conditions, alongside tobacco use, physical inactivity, and others. Numerous federal agencies have a role in addressing diet and its link to chronic health conditions.

GAO was asked to review diet-related chronic health conditions and federal efforts to address them. This report examines (1) federal data on prevalence, mortality, and costs of selected diet-related chronic health conditions; (2) federal diet-related efforts to reduce Americans' risk of chronic health conditions; and (3) the extent to which federal agencies have coordinated their efforts. GAO selected conditions with established scientific links to diet. GAO then analyzed federal data on prevalence, mortality, and health care spending; reviewed agency documents; interviewed officials from 21 federal agencies with a role in diet, as well as nonfederal stakeholders; and compared agency actions with selected leading practices for collaboration, which GAO has identified in prior work.


Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans' risk of chronic health conditions.

Matter for Congressional Consideration

Matter Status Comments
Congress should consider identifying and directing a federal entity to lead the development and implementation of a federal strategy to coordinate diet-related efforts that aim to reduce Americans' risk of chronic health conditions. The strategy could incorporate elements from the 2011 National Prevention Strategy and should address outcomes and accountability, resources, and leadership. (Matter for Consideration 1)
Open – Partially Addressed
The White House sponsored a conference on Hunger, Nutrition, and Health on September 28, 2022. In advance of that event, the White House released a national strategy aimed at ending hunger in America and increasing healthy eating and physical activity by 2030. However, we do not believe the White House strategy satisfies our matter because it does not contain the necessary information about outcomes and accountability, resources, and leadership. In particular, without designated leadership, it may be difficult to sustain the strategy over time. Therefore, as of March 2024, the matter remains open.

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