Approximately 30 percent of the edible food produced in the United States is wasted and a significant portion of this waste occurs at the consumer level. Despite food's essential role as a source of nutrients and energy and its emotional and cultural importance, U.S. consumers waste an estimated average of 1 pound of food per person per day at home and in places where they buy and consume food away from home. Many factors contribute to this waste?consumers behaviors are shaped not only by individual and interpersonal factors but also by influences within the food system, such as policies, food marketing and the media. Some food waste is unavoidable, and there is substantial variation in how food waste and its impacts are defined and measured. But there is no doubt that the consequences of food waste are severe: the wasting of food is costly to consumers, depletes natural resources, and degrades the environment. In addition, at a time when the COVID-19 pandemic has severely strained the U.S. economy and sharply increased food insecurity, it is predicted that food waste will worsen in the short term because of both supply chain disruptions and the closures of food businesses that affect the way people eat and the types of food they can afford. A National Strategy to Reduce Food Waste at the Consumer Level identifies strategies for changing consumer behavior, considering interactions and feedbacks within the food system. It explores the reasons food is wasted in the United States, including the characteristics of the complex systems through which food is produced, marketed, and sold, as well as the many other interconnected influences on consumers' conscious and unconscious choices about purchasing, preparing, consuming, storing, and discarding food. This report presents a strategy for addressing the challenge of reducing food waste at the consumer level from a holistic, systems perspective. Table of Contents Front Matter Summary 1 Introduction 2 Understanding Food Waste, Consumers, and the U.S. Food Environment 3 Drivers of Food Waste at the Consumer Level and Implications for Intervention Design 4 Interventions to Reduce Food Waste at the Consumer Level 5 Strategy for Reducing Food Waste at the Consumer Level 6 A Research Agenda for Improving Interventions to Reduce Food Waste and Their Implementation Appendix A: Public Session Agendas Appendix B: Literature Search Approach Appendix C: Additional Information on Food Waste Appendix D: Interventions to Reduce Food Waste at the Consumer Level: Examples from the Literature Appendix E: Research on Behavioral Change from Other Domains Appendix F: Committee Member Biographical Sketches Appendix G: Glossary

Older adults are a growing demographic group in the United States, and a range of physical, social, financial, and cultural factors affect their nutritional status. Metabolic and physiologic changes that accompany normal aging modify the nutritional requirements of older adults. An examination of evidence is needed to better understand how nutritional status is associated with aging and risk of mortality or chronic disease among older adults. Underpinning many, if not most, nutritional problems in older adults is socioeconomic status. Therefore, understanding access challenges to healthy food, including geographic, financial, and transportation barriers, also is needed to better understand how to meet the nutritional needs of older adults. On October 28-29, 2015, the Food and Nutrition Board convened a workshop, Meeting the Dietary Needs of Older Adults, in Washington, DC. Participants examined factors in the physical, social, and cultural environment that affect the ability of older adults to meet their daily dietary needs. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Background 2 Emerging Insights (Physiological) 3 Emerging Insights (Ecological) 4 National Programs Addressing Dietary Needs of the Older Population 5 Role of Community and the Food Sector 6 Potential Research Priorities and Gaps Appendix A: Workshop Agenda Appendix B: Acronyms Appendix C: Speaker Biosketches Appendix D: Planning Committee Biosketches

The U.S. food system provides many benefits, not the least of which is a safe, nutritious and consistent food supply. However, the same system also creates significant environmental, public health, and other costs that generally are not recognized and not accounted for in the retail price of food. These include greenhouse gas (GHG) emissions, soil erosion, air pollution, and their environmental consequences, the transfer of antibiotic resistance from food animals to human, and other human health outcomes, including foodborne illnesses and chronic disease. Some external costs which are also known as externalities are accounted for in ways that do not involve increasing the price of food. But many are not. They are borne involuntarily by society at large. A better understanding of external costs would help decision makers at all stages of the life cycle to expand the benefits of the U.S. food system even further. The Institute of Medicine (IOM) and the National Research Council (NRC) with support from the U.S. Centers for Disease Control and Prevention (CDC) convened a public workshop on April 23-23, 2012, to explore the external costs of food, methodologies for quantifying those costs, and the limitations of the methodologies. The workshop was intended to be an information-gathering activity only. Given the complexity of the issues and the broad areas of expertise involved, workshop presentations and discussions represent only a small portion of the current knowledge and are by no means comprehensive. The focus was on the environmental and health impacts of food, using externalities as a basis for discussion and animal products as a case study. The intention was not to quantify costs or benefits, but rather to lay the groundwork for doing so. A major goal of the workshop was to identify information sources and methodologies required to recognize and estimate the costs and benefits of environmental and public health consequences associated with the U.S. food system. It was anticipated that the workshop would provide the basis for a follow-up consensus study of the subject and that a central task of the consensus study will be to develop a framework for a full-scale accounting of the environmental and public health effects for all food products of the U.S. food system. Exploring Health and Environmental Costs of Food: Workshop Summary provides the basis for a follow-up planning discussion involving members of the IOM Food and Nutrition Board and the NRC Board on Agriculture and Natural Resources and others to develop the scope and areas of expertise needed for a larger-scale, consensus study of the subject. Table of Contents Front Matter 1 Introduction 2 The Economics of Food Prices 3 Understanding Measures and Strategies 4 Examining Social and Ecological Costs and Benefits 5 Attaching Value to Costs and Benefits 6 Exploring Costs and Benefits 7 Reflecting on the Path Forward Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Workshop Attendees Appendix D: Abbreviations and Acronyms

Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease. A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk. Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse-that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality. Table of Contents Front Matter Summary 1 Introduction 2 Approach to Evidence Review 3 Sodium Intake and Intermediate Markers for Health Outcomes 4 Sodium Intake and Health Outcomes 5 Findings and Conclusions Appendix A: Acronyms and Abbreviations Appendix B: Committee Member Biographical Sketches Appendix C: Open Session Agendas Appendix D: Biomarkers Figure Appendix E: Literature Search Strategy Appendix F: Presentation of Results - Evidence Tables

Traumatic brain injury (TBI) accounts for up to one-third of combat-related injuries in Iraq and Afghanistan, according to some estimates. TBI is also a major problem among civilians, especially those who engage in certain sports. At the request of the Department of Defense, the IOM examined the potential role of nutrition in the treatment of and resilience against TBI. Table of Contents Front Matter Summary Part I: Background 1 Introduction 2 Nutrition in Clinical Practice Guidelines for Traumatic Brain Injury 3 Understanding Pathophysiological Changes Part II: Nutrition and TBI 4 Approach for Selecting Nutritional Interventions: Mechanistic Targets 5 Acquiring Resilience to TBI Prior to Injury 6 Energy and Protein Needs During Early Feeding Following Traumatic Brain Injury 7 Antioxidants 8 Branched-Chain Amino Acids 9 Choline 10 Creatine 11 Ketogenic Diet 12 Magnesium 13 Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) 14 Polyphenols 15 Vitamin D 16 Zinc Part III: Recommendations 17 Summary of Recommendations Appendixes Appendix A: Agenda Appendix B: Evidence-Based Guidelines for Traumatic Brain Injury Appendix C: Workshop Speakers' Papers Appendix D: Glossary Appendix E: Acronyms Appendix F: Committee Member Biographical Sketches

Recent outbreaks of illnesses traced to contaminated sprouts and lettuce illustrate the holes that exist in the system for monitoring problems and preventing foodborne diseases. Although it is not solely responsible for ensuring the safety of the nation's food supply, the U.S. Food and Drug Administration (FDA) oversees monitoring and intervention for 80 percent of the food supply. The U.S. Food and Drug Administration's abilities to discover potential threats to food safety and prevent outbreaks of foodborne illness are hampered by impediments to efficient use of its limited resources and a piecemeal approach to gathering and using information on risks. Enhancing Food Safety: The Role of the Food and Drug Administration, a new book from the Institute of Medicine and the National Research Council, responds to a congressional request for recommendations on how to close gaps in FDA's food safety systems. Enhancing Food Safety begins with a brief review of the Food Protection Plan (FPP), FDA's food safety philosophy developed in 2007. The lack of sufficient detail and specific strategies in the FPP renders it ineffectual. The book stresses the need for FPP to evolve and be supported by the type of strategic planning described in these pages. It also explores the development and implementation of a stronger, more effective food safety system built on a risk-based approach to food safety management. Conclusions and recommendations include adopting a risk-based decision-making approach to food safety; creating a data surveillance and research infrastructure; integrating federal, state, and local government food safety programs; enhancing efficiency of inspections; and more. Although food safety is the responsibility of everyone, from producers to consumers, the FDA and other regulatory agencies have an essential role. In many instances, the FDA must carry out this responsibility against a backdrop of multiple stakeholder interests, inadequate resources, and competing priorities. Of interest to the food production industry, consumer advocacy groups, health care professionals, and others, Enhancing Food Safety provides the FDA and Congress with a course of action that will enable the agency to become more efficient and effective in carrying out its food safety mission in a rapidly changing world. Table of Contents Front Matter Summary Part I: Setting the Stage for Understanding and Improving the U.S. Food and Drug Administration's Role in the Food Safety System 1 Introduction 2 The Food Safety System: Context and Current Status Part II: Toward a Stronger and More Effective Food Safety System 3 Adopting a Risk-Based Decision-Making Approach to Food Safety 4 Sharing the Responsibility for a Risk-Based System: Models of Governance and Oversight Part III: Implementation of the New Food Safety System 5 Creating an Integrated Information Infrastructure for a Risk-Based Food Safety System 6 Creating a Research Infrastructure for a Risk-Based Food Safety System 7 Integrating Federal, State, and Local Government Food Safety Programs 8 Enhancing the Efficiency of Inspections 9 Improving Food Safety and Risk Communication 10 Modernizing Legislation to Enhance the U.S. Food Safety System 11 Achieving the Vision of an Efficient Risk-Based Food Safety System Appendix A: Workshop Agendas Appendix B: Past Recommendations About the U.S. Food and Drug Administration's Food Safety Program Appendix C: Food Safety Systems in the United States and Other Countries Appendix D: The U.S. Food and Drug Administration's Food Defense Program Appendix E: The U.S. Food and Drug Administration and Imported Food Safety Appendix F: Food Safety Research at Intramural and Extramural U.S. Food and Drug Administration Research Centers, by Topic Appendix G: U.S. Food and Drug Administration Food Protection Plan Appendix H: Glossary Appendix I: Acronyms and Abbreviations Appendix J: Committee Member Biographical Sketches

Physical fitness affects our ability to function and be active. At poor levels, it is associated with such health outcomes as diabetes and cardiovascular disease. Physical fitness testing in American youth was established on a large scale in the 1950s with an early focus on performance-related fitness that gradually gave way to an emphasis on health-related fitness. Using appropriately selected measures to collected fitness data in youth will advance our understanding of how fitness among youth translates into better health. In Fitness Measures and Health Outcomes in Youth, the IOM assesses the relationship between youth fitness test items and health outcomes, recommends the best fitness test items, provides guidance for interpreting fitness scores, and provides an agenda for needed research. The report concludes that selected cardiorespiratory endurance, musculoskeletal fitness, and body composition measures should be in fitness surveys and in schools. Collecting fitness data nationally and in schools helps with setting and achieving fitness goals and priorities for public health at an individual and national level.