Most people know fruits and veggies are healthier choices than chips and cookies, and yet most Americans aren't applying that common knowledge to their lives. Nonetheless, some may be catching on, a new report suggests.

Thefindings, published in September 2019 in theJournal of the American Medical Association, analyzed 44,000 American adults eating habits from 1999 to 2016. Researchers found that refined carbohydrate intake fell by 3 percent, but low-quality carbs, including white bread, white potatoes, and processed snack foods like crackers and cakes, still accounted for about 42 percent of the typical Americans daily calories. Healthy high-quality carbs that come from vegetables, fruits, and whole grains, including brown rice, whole-wheat bread, and whole-wheat pasta, made up only 9 percent of calories consumed.

Im not at all surprised by these findings. We need to make some fundamental changes if we hope to fix our current diet, says David L. Katz, MD, MPH, founder and president of the True Health Initiative, who is based in Derby, Connecticut, and was not involved in this research. The simple fact is our culture does nothing to make eating well easy to understand, or to make healthy food choices the readily available default.

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Authors used information gathered from a nationally representative group of people ages 20 and older from nine National Health and Nutrition Examination Survey (NHANES) cycles. Using information on race, gender, age, education, and family income, researchers sought to identify whether they could identify any trends in segments of the population.

To evaluate individual diets, researchers relied on people to self-report what they ate in a 24-hour period. They used a multiple-pass method, which means after the respondents made an initial list of what they remembered eating, the interviewers probed for forgotten foods and gathered details of foods they consumed.

They categorized foods accordingly:

Authors assessed the quality of a persons diet using the Healthy Eating Index (HEI)from 2015. The U.S. Department of Agriculture (USDA) developed the HEI in 1995 as a way to measure how well Americans are following dietary recommendations. Scored from 0 to 100 (with 100 being a perfect diet), its composed of 13 components that incorporate different food groups and key recommendations, and the USDA has periodically updated it when guidelines have changed.

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Over the 18-year study, researchers observed the following trends:

Authors also noted trends in different populations:

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The results show that Americans are still consuming too many calories from low-quality carbohydrates, and more than the recommended amounts of added sugars and saturated fat, saysShilpa Bhupathiraju, PhD, co-senior author of the study, who is a research scientist at the Harvard T.H. Chan School of Public Health and also with Harvard Medical School and Brigham and Womens Hospital in Boston. Our study gives us insights into where we can improve our diets, where we can make further gains to optimize diet quality, and which subgroups to target so that we can eliminate disparities in healthy eating, Dr.Bhupathiraju says.

The popularity of the ketogenic and paleo diets could help explain why carbs went down slightly and saturated fat intake remained high, says Ariana Cucuzza, RD, at the Center for Functional Medicine at Cleveland Clinic in Ohio, who was not involved in the study. A Mediterranean diet would have higher polyunsaturated fats, which are the healthy fats, she says.

Self-reported recall of diet is a limitation of the study, which is a shortcoming that the authors point out, says Cucuzza. It can be hard to remember everything that you eat you can have a bite or two here or a snack there that you forget to include, she says.

Right now, much of the food supply (like low-quality carbs) in the United States are manipulated to be addictive, says Dr. Katz. Theres a lot of profit for some companies to keep the status quo when it comes to our current diet, but it comes at a massive health cost to the American public, he says.

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Making the grade with your food choices doesnt have to be complicated. Bhupathiraju offers a few tips to get you started:

If you really want to get an idea of what youre eating, write it in a food diary or record it in an app in real time, she says. Tracking what you eat with a food diary or app can help you see where you need to improve, says Cucuzza.

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Americans' Diet Is Improving, But They're Still Overdoing It on Unhealthy Carbs and Fat - Everyday Health