Eat your vegetables. Everyone has heard it, from a mom, a teacher or a commercial.

Yet, years after a concerted effort to boost consumption of healthful foods, Americans eat the same paltry amounts that they did in 1985, when the government first recommended two servings of fruit and three servings of vegetables daily.

The bad eating habits cross all socioeconomic levels. Researchers say those with higher incomes might eat out frequently and consume more fried foods than salads, and those with lower incomes could find fresh produce too pricey at their corner market.

Public health professionals are developing new ways to teach proper nutrition and lower the cost, but if they can't, they say, the consequences for the nation's already hobbled health could be dire. Two-thirds of adults are overweight or obese, and their fat is contributing to life-threatening ailments that include heart disease, cancer, strokes and diabetes.

All of this is disheartening to health experts who are coming to realize that America's bad habits are the nation's most challenging public health problem. Those habits have many roots: the hectic pace of modern life, unavailability of healthful food because of cost or location, the relentless marketing of ever-larger meals with high fat and sugar content, and the seductive taste and smell of fatty favorites such as french fries and burgers.

The bottom line: Americans are struggling with a dangerously stubborn addiction to unhealthful foods.

"I try and go for the apple or pear, but believe me, I'd rather have the cookie," said Brentt Naylor, a 33-year-old Baltimore resident who not only shops at the hyper-health-conscious Whole Foods, but belongs to a community program that allows him a weekly bounty of locally grown produce. "You really have to set aside time to make vegetables tasty. It's taste and time."

Catherine Fine, a 34-year-old Whole Foods shopper, said it was long hours at work that drove her to the vending machine despite all the healthful food she has at home. And then there was Bryan Rupert, a 20-year-old ordering a pizza for dinner recently from a South Baltimore shop. He said he wouldn't know what to do with vegetables if he bought them, which he doesn't.

Despite regular gym visits, he said, mac-'n'-cheese was a typical meal. And in an attempt to bulk up not too long ago, he ate two McDonald's double cheeseburgers a day for two and a half months and gained 15 pounds.

"I know it wasn't the right way," said Rupert, who does try to eat a piece of fruit a day. "I'm not going to let myself become a fat pig. I'll change my diet first."

Stymied researchers

Researchers are confounded by people like Rupert who cling to their old ways. They had expected at least a slight increase in fruit and vegetable consumption over time, said Sarah Stark Casagrande, an author of a study of the subject from 1988 to 1994 and 1999 to 2002. The results were published in April's American Journal of Preventive Medicine.

But only 11 percent of the people studied met U.S. Department of Agriculture guidelines for eating fruits and vegetables during both periods, said Casagrande, a pre-doctoral student in the Johns Hopkins Bloomberg School of Public Health.

Black men were the least likely to eat enough; those with higher incomes and more education were the most likely. Still, half the participants did not consume any fruit, and a quarter ate no vegetables.

(Guidelines were changed in 2005 to boost requirements and to account for variations in people's level of activity, but the authors didn't think the situation had improved.)

The study pointed to some of the same problems Naylor and the other Baltimore shoppers found: taste and convenience. It also blamed cost, large restaurant portions, advertising and confusing food guidelines.

The results, the report said, "should alarm public health officials. ... The implications of a diet low in fruits and vegetables are extensive."

The study was not the only one to report such news. Another recent study that examined price as a barrier to healthy eating also sounded alarms.

The report in the November Journal of the American Dietetic Association said that when produce was available in poorer neighborhoods, the cost was lower in some cases. But to meet the new federal guidelines, the average family of four would have to spend between 43 percent and 70 percent of its food budget on produce.

Obesity and health

That's a problem that requires public policy changes, the report said. "There is a need to educate consumers about the importance of increasing their consumption of fruits and vegetables, yet these ... programs must consider the trade-offs required for families to purchase more fruits and vegetables."

The cheapest food today does tend to be the most unhealthful, so it's not a coincidence that low-income areas tend to have higher rates of obesity and chronic diseases, researchers say.

In Maryland, between 20 percent and 24 percent of the residents are obese. The worst states, including Texas and Mississippi, have obesity rates above 30 percent. The most recent study conducted by the Centers for Disease control and Prevention, released last week, said that 34 percent of U.S. adults were obese in 2006.

People are considered obese when they have a high level of body fat, usually presented in terms of a person's body mass index, calculated using a person's height and weight. For example, a woman who is 5 feet 2 inches tall and weighs 164 pounds has a BMI of 30 and is considered obese. A calculator is available on the CDC Web site, www.cdc.gov.

Those who eat right and maintain proper weight are less likely to develop chronic diseases such as diabetes, some kinds of cancer and heart disease, the CDC says.

Nutrients in fruits and vegetables include fiber to reduce coronary artery disease, folate to reduce brain defects in babies, potassium to maintain healthy blood pressure, vitamin A for eye and skin health and vitamin C to help wounds heal and to keep teeth and gums healthy.

New solutions

To get the nation's attention - and change what appear to be deep-seated eating habits - a new public health initiative has been launched by a group sponsored by the government, the CDC and other health organizations and producers, called the Produce for Better Health Foundation. The group's educational program will be called "Fruits & Veggies - More Matters."

Its Web site, www.fruitsandveg giesmorematters.org, offers cooking tips and recipes. And the group plans to pass information through schools and product packaging at stores.

Elizabeth Pivonka, president and chief executive of the foundation, said the new campaign should be fully up and running by the end of 2008 and will make more of an emotional appeal.

It's an appeal largely to mothers. It's not a guilt trip, but a gentle reminder to feed their families more fruits and vegetables, she said. And that includes canned, frozen, dried and juiced forms. Beans and tomato sauce are in, but french fries are out.

Congress is considering an expansion of a pilot program that introduced free healthful snacks in 107 elementary and secondary schools in 2002.

So far, the $6 million program has successfully pushed students to try new foods, said Joanne Guthrie, assistant deputy director of the U.S. Department of Agriculture's Economic Research Service, which studied the effort.

Other programs

Also under congressional consideration is a pilot program that would offer bonuses to food stamp recipients to offset the cost of fruits and vegetables.

Guthrie's service had looked at ways to use the far-reaching food stamp program - serving one in 12 Americans at a cost of $32.8 billion - to improve food choices. It concluded that bonuses that specifically lower the price of fruits and vegetables by 20 percent could raise consumption from none to 2.2 cups per day.

Another national initiative aimed at lower-income shoppers, the Healthy Stores Project, encourages groceries to carry more healthful foods. Program officials also work with shop owners to educate customers.

The project, launched by an associate professor at the Johns Hopkins Bloomberg School of Public Health, is running in a handful of cities. A pilot program began in Baltimore in 2004 with a Stop, Shop and Save market. It has now spread to 16 stores in East and West Baltimore.

The group says there is a lot of need for grocers in the city, which lost 15 percent of its supermarkets between 2000 and 2002. Residents have had to get groceries at corner stores and drugstores, which don't always have fresh produce.

Joel Gittelsohn, the professor and program founder, said it has received positive reviews from store owners and customers.

There are plans to take the program citywide in 2008.

meredith.cohn@baltsun.com

PROPER NUTRITION

What nutrients do and which fruits and vegetables contain them:

FIBER

What it does: among other benefits, reduces risk of coronary heart disease

Found in: black and navy beans, soybeans and chickpeas

FOLATE

What it does: could reduce a woman's risk of having a child with a brain or spinal cord defect

Found in: cooked spinach, asparagus and black-eyed peas

POTASSIUM

What it does: could help maintain healthy blood pressure

Found in: sweet and white potatoes, cooked greens and carrots and prune juice

VITAMIN A

What it does: keeps eyes and skin healthy and protects against infection

Found in: carrots, spinach, cantaloupe, red peppers and cabbage

VITAMIN C

What it does: helps heal cuts and wounds, keeps teeth and gums healthy

Found in: red and green peppers, strawberries, cantaloupe, broccoli, oranges and Brussels sprouts

[Source: Fruits & Veggies - More Matters]

By the numbers

Getting fatter

Percentage of adults ages 20-74 obese:

1988-1994 22.9%

1999-2000 30.5%

2005-2006 34.0%

(Source: U.S. Centers for Disease Control and Prevention)

Getting enough fruits and vegetables

Percentage of adults over 18 years old who met federal dietary guidelines from 1999-2002:

Fruits 28.4%

Vegetables (excluding french fries) 27.4%

(Source: American Journal of Preventive Medicine)