Specific Strategies

Goal 1

Increase the awareness of overweight and obesity as a major public health threat.

  • Objective 1a

    Increase the perception that overweight and obesity are significant public health risks by a wide array of stakeholders including the healthcare community and the general public.

  • Objective 1b

    Increase the proportion of persons who know the health risks (hypertension, dyslipidemia, insulin resistance, etc.) and diseases (i.e., diabetes, cardiovascular disease, cancer, arthritis, asthma, disability) associated with overweight and obesity.

    • Use formative evaluation targeting high-risk populations to identify barriers to recognition of overweight/obesity as a significant personal health risk.
    • Use social marketing to develop culturally-appropriate messages tailored to specific high-risk populations and low-income groups to increase knowledge, attitudes, beliefs and change perceptions.
    • Develop a coordinated statewide media campaign targeting high-risk populations who experience health disparities.
    • Work with the healthcare industry to increase the proportion of health care providers, health maintenance organizations, and health insurance companies who present and discuss the health risks associated with overweight and obesity in sensitive, culturally-appropriate language to their patients.
  • Objective 1c

    Increase the proportion of persons aware of the economic impact (i.e., increased healthcare and insurance costs, increased absenteeism) associated with overweight, obesity and obesity-related diseases.

  • Objective 1d

    Increase the proportion of persons who know the environmental, socioeconomic and personal factors (poor nutrition, physical inactivity) that contribute to obesity.

Goal 2

Increase early recognition of overweight and/or excessive weight gain.

  • Objective 2a

    Increase the proportion of healthcare providers who routinely monitor, track and inform patients and/or parents of weight gain or growth:

    • For adults, using Body Mass Index (BMI) to screen for overweight
    • For children, aged 2-18 years, using gender-specific BMI-for-age-percentiles
    • For infants, aged 0-2 years using gender-specific weight-for-height percentiles
    • For pregnant women, using weight gain charts based on a woman's pre-pregnancy BMI
    • Increase knowledge and use of BMI as a screening tool by medical providers to improve identification of children who are overweight and adults who are overweight or obese.
    • Identify barriers to implementation of practice recommendations and policies to support obesity prevention and control.
    • Collaborate with the insurers, and other medical professional organizations, managed care programs and healthcare systems to provide incentives for maintaining healthy body weight
    • Increase the number of healthcare organizations that include screening and obesity preventive services in routine clinical practice and quality assessment measures.
  • Objective 2b

    Increase the proportion of adults who know their own weight status (based on BMI) and their children's weight status (based on gender-specific BMI-for-age percentile).

    • Work with healthcare providers to increase the use of evidence-based counseling and guidance to patients and parents about promoting a healthy weight and preventing overweight and obesity by healthy eating and physical activity.
    • Collaborate with professional, medical and allied health organizations and community leaders to develop culturally-sensitive methods of discussing weight status and weight-related issues, especially with high-risk population groups
    • Increase understanding and use of BMI by the general population
    • Use formative evaluation to assess the needs of high-risk populations in understanding "healthy weight" and the use of BMI to define weight status.
  • Objective 2c

    Increase the proportion of schools that collect accurate height and weight measurements (required by New York State Education Department at school entrance and in grades 1, 3, 7 and 10), calculate BMI, and communicate pupils' weight status (based on BMI percentile) to the Department of Health.

    • Collaborate with the NY State Education Department and the NYC Education Department, local school districts and other stakeholders to develop a system to collect students' height and weight and gender-specific BMI-for-age percentile and report findings to the DOH for monitoring and program planning purposes.
    • Involve school health services and school physical education departments in childhood obesity prevention efforts.
  • Objective 2d

    Increase the proportion of [pregnant women] who gain the optimal recommended amount of weight [as defined by Institute of Medicine (IOM) Guidelines] based on a woman's pre-pregnant weight during their pregnancies (HP 2010, 16-12).

    • Collaborate with medical and other healthcare providers who use BMI to guide recommended weight gain during pregnancy using IOM guidelines.
    • Work with Medicaid and other healthcare providers to increase the use of counseling regarding nutrition, physical activity and appropriate weight gain during pregnancy.
    • Increase patient, provider and public awareness of the importance of appropriate weight gain during pregnancy, based on IOM guidelines.
    • Increase opportunities for women to be physically active during pregnancy, e.g. by encouraging community organizations and health clubs to offer physical activities for pregnant women.

Goal 3

Improve management (medical and non-medical) of people who are overweight or obese and those with obesity-related diseases.

  • Objective 3a

    Increase the proportion of people appropriately counseled by medical and allied healthcare providers about achieving and maintaining a healthy weight.

    • Develop training programs for medical and allied health professionals to improve their knowledge and counseling skills related to nutrition, physical activity, and other life behaviors related to obesity prevention.
    • Increase medical and allied healthcare provider awareness of critical (i.e., high risk) periods during the lifecycle for excessive weight gain and the development of overweight or obesity (i.e., pregnancy, infancy, early childhood, adolescence).
    • Develop culturally-sensitive messages specifically targeted to individuals during each critical period.
    • Reduce disparities in obesity-related diseases by income, sex, race/ethnicity and educational attainment.
  • Objective 3b

    Improve management of obesity-related diseases.

    • Work with professional medical organizations to identify and disseminate best practices in identifying, monitoring, and optimizing treatment of obesity-associated risk factors in provider settings.
    • Increase availability of chronic disease self-management programs in community settings.
  • Objective 3c

    Reduce barriers that impede medical and allied healthcare professionals from managing (providing behavioral, nutritional, medical and surgical treatment) individuals who are overweight or obese.

    • Work with insurers and employers to identify, prioritize and evaluate insurance coverage by public and private payers for behavioral, nutritional, medical and surgical treatment of overweight and obesity.

Goal 4

Increase initiation, exclusivity and duration of breastfeeding during infancy.

  • Objective 4a

    Increase the proportion of mothers who exclusively breastfeed their babies in early postpartum to 75% and at 6 months to 50%, and increase the proportion of mothers who breastfeed at one year of age to 25% (HP 2010, 16-19).

    • See Figures 14, 15, and 16
    • Increase promotion and support for breastfeeding as the "normal" and preferred method of feeding infants.
  • Objective 4b

    Reduce racial/ethnic, income, and age disparities in breastfeeding rates.

    • Increase access by local agency staff of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Prenatal Care Assistance Program (PCAP) staff to breastfeeding education through innovative techniques such as distance learning, teleconferences, website development, and the expansion of peer counselor training programs.
    • Identify barriers to breastfeeding among participants enrolled in the WIC, Food Stamp Nutrition Education Program (FSNEP) and related food and nutrition programs in the community.
  • Objective 4c

    Increase the proportion of medical and allied healthcare providers who counsel women about breastfeeding during prenatal period, at the time of delivery and postpartum and who provide lactation support services.

    • Improve continuing education about breastfeeding to physicians, midwives, nurses, and dietitians.
    • Increase training opportunities for certified lactation specialists.
  • Objective 4d

    Increase protection, promotion and support for breastfeeding by mothers in the workplace.

    • Collaborate with employers, the NYS Business Council, Chambers of Commerce, the Retail Council of NYS, the National Federation of Independent Businesses (NFIB) and other business groups to identify barriers and develop incentives to support maternity leave and to promote breastfeeding in the workplace.
    • Work with employers to expand the use of "NYS Best Practices for Breastfeeding Promotion in Workplace."
    • Work with urban development planners to facilitate placement of daycare centers at and near worksites.

Goal 5

Improve lifelong healthy eating.

  • Objective 5a

    Increase awareness and knowledge about healthy eating.

    • Increase the proportion of persons counseled about the benefits of eating healthy and using food appropriately.
    • Use social marketing strategies to increase the knowledge and awareness of the benefits of healthy food choices that are culturally-appropriate and tailored to specific populations, particularly low-income groups, minorities and those at increased risk of obesity.
    • Work with schools to enhance health curricula to address nutrition and energy balance with a behavioral skill focus.
    • Collaborate with schools of medicine, nursing, allied health and nutrition to improve nutrition education and health-promoting behavioral counseling skills taught to students and professionals.
    • Increase the proportion of parents counseled about optimal nutrition and feeding of children beginning in infancy.
    • Increase the awareness of availability of locally-grown fruits and vegetables through the Pride of New York generic advertising program, the Farm-to-School program, farmers' markets, and the Department of Agriculture and Markets' Farm Fresh Guide.
  • Objective 5b

    Increase the proportion of persons who balance caloric intake with energy expenditure to achieve and maintain a healthy weight.

    • Work with partners to implement a sustained, targeted, community-wide information campaign for individuals and families to change knowledge, attitudes, and beliefs about the importance of balancing caloric intake with energy expenditure.
    • Work with local and state policymakers to develop and implement guidelines and policies to ensure that foods and beverages available in schools and/or childcare settings are consistent with nutritional guidelines, and support the goal of preventing excess energy intake among students, and helping students achieve energy balance at a healthy weight.
  • Objective 5c

    Increase the proportion of persons aged 2 years and older who meet dietary recommendations for calcium [by increasing consumption of low-fat or fat-free milk or dairy products] (HP 2010, 19-11).

  • Objective 5d

    Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables (HP 2010, 19-6), and at least 2 servings per day of fruits (HP 2010, 19-5).

    • See Figures 17 and 18
  • Objective 5e

    Increase the proportion of children and adolescents whose intake of meals and snacks at [childcare centers,] schools, [and after-school programs] contributes to good overall dietary quality (HP 2010, 19-15).

    • Collaborate to enhance or adopt the Food Guide Pyramid to better convey how foods/portions should be distributed.
    • Use social marketing strategies to increase awareness and knowledge of U.S. Dietary Guidelines.
  • Objective 5f

    Increase food security among [NYS] households and, in so doing, reduce hunger (HP 2010, 19-18).

    • Conduct outreach and enrollment campaigns to increase the number and percentage of eligible households, children, adults and elderly that participate in federal and state food and nutrition programs including WIC, food stamps and Farmers' Market Nutrition Programs.
    • Collaborate with statewide non-profit organizations to identify and reduce barriers to federal and state food and nutrition program participation.
    • Increase the amounts of fruits and vegetables procured by food banks for distribution to emergency food providers such as food pantries and soup kitchens.

Goal 6

Increase lifelong physical activity.

  • Objective 6a

    Increase the proportion of adolescents and adults aware of current physical activity guidelines and recommendations.

    • Develop a media health promotion campaign emphasizing increasing physical activity to prevent or reduce overweight and obesity.
    • Collaborate with medical, allied health, educational and community partners to raise awareness and improve dissemination of physical activity guidelines and recommendations.
    • Increase the proportion of persons appropriately counseled by medical and allied healthcare professionals and educators about physical activity or exercise (HP 2010, 1-3a).
    • Increase the number (proportion) of healthcare providers who use effective methods to encourage patients to increase physical activity levels (HP 2010, 7-7).
  • Objective 6b

    Increase the proportion of adults aged 18 and older who meet current recommendations for physical activity, specifically:

    • Reduce to at most 20 percent the proportion of adults aged 18 and older who engage in no leisure-time physical activity (HP 2010, 22- 1) (See Figure 19).
    • Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day (HP 2010, 22-2), and/or vigorous physical activity for at least 20 minutes per day (HP 2010, 22-3).
    • See Figure 20
  • Objective 6c

    Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs (HP 2010, 22-13).

    • Work with the NYS Business Council, Chambers of Commerce, insurance payers, health care plans, Wellness Councils of America, the Retail Council of NYS, National Federation of Independent Businesses (NFIB), and other business organizations, partners and policymakers to develop ways to affect environmental and policy changes in work sites to increase opportunities for work site wellness.
    • Develop best strategies, e.g., training partners such as occupational nurses, Chambers of Commerce, and others to provide technical assistance to employers to expand worksite exercise and wellness programs for all types of employers.
  • Objective 6d

    Increase the proportion of [children and] adolescents [aged 2-18] years who engage in moderate physical activity for at least [60] minutes per day on five or more of the previous seven days (HP 2010, 22-6; NASPE).

    • Work with community youth organizations to develop ways to increase the number and variety of physical activity programs provided before or after school by these organizations.
    • Enhance school health curricula to devote adequate attention to physical activity with a behavioral skills focus.
  • Objective 6e

    Increase the proportion of schools that comply with NYS Department of Education physical education regulations.

    • Identify barriers to complying with regulations.
  • Objective 6f

    Increase the proportion of [children and] adolescents who spend at least 50% of school physical education class time being physically active (HP 2010, 22-10).

    • Provide training and technical assistance to increase the activity level of physical education curriculum.
    • See Figure 21
  • Objective 6g

    Increase the proportion of [NYS's] public and non-public schools that require daily physical education classes for all students (HP 2010, 22-8).

    • See Figure 22
  • Objective 6h

    Increase the number/proportion of trips made by walking, bicycling [and other means of self-propulsion (e.g., wheelchairs, rollerblading)] (HP 2010, 22-14 & 22-15).

    • Provide training and technical assistance to local pedestrian groups.

Goal 7

Decrease exposure to television and other recreational screen time.

  • Objective 7a

    Increase awareness and knowledge of recommendations to limit television viewing and other recreational screen time.

    • Work with medical and allied healthcare providers, educators and others to develop efficient ways to counsel individuals, families, and other caregivers about limiting television viewing and other recreational screen time (videos, computer or video games, internet, etc.) to no more than 1-2 hours per day (for persons two years and older) and discourage any viewing by children under two years. (American Academy of Pediatrics Guideline).
    • Conduct a social marketing campaign to reduce television viewing.
      • Educate the public, specifically targeting boards of education, teachers, parents and pediatricians, about the health benefits of reducing television viewing.
      • Inform teachers, parents, and childcare workers of their significance as role models in reducing television viewing among children.
  • Objective 7b

    Increase the proportion of [children,] adolescents, [and adults] who view television [and other recreational screen time] no more than two hours per day (HP 2010, 22-11; AAP).

    • Work with schools and preschools to implement TV and media reduction curricula such as Student Media and Awareness for the Reduction of Television-viewing (SMART) and Fit by 5 to reduce use of television and other recreational screen time in schools, aftercare/beforecare programs and childcare settings.
    • Work with schools and communities to increase participation in "National TV Turn-off Week" campaigns.
    • Enhance health curricula to include reducing sedentary behaviors, specifically targeting television and other recreational screen use, and include a behavioral skills focus.
    • See Figure 23
  • Objective 7c

    Increase media literacy.

    • Work with schools to increase the use of school-based media literacy programs.
    • Develop training programs for educators and healthcare providers to implement media literacy programs in other settings.
  • Objective 7d

    Decrease exposure by children and youth to advertisement for products associated with increased risk of obesity.

    • Work with the advertising industry to develop marketing and advertising guidelines for high calorie, low nutrient foods and beverages to minimize the risk of obesity in children and youth.
    • Work to restrict commercials for high calorie, low-nutrient foods on school television programs.
    • Develop, implement, and enforce school policies to create schools that are advertising-free to the greatest possible extent.

Goal 8

Increase policy and environmental supports for physical activity and healthy eating, including breastfeeding.

  • Objective 8a

    Increase the number/proportion of institutional and environmental policies that promote energy balance.

    • Improve understanding and use of nutrition and food labeling.
    • Increase the proportion of restaurants that offer healthy menu options with appropriately-sized portions and caloric content and general nutritional information available at point-of-purchase.
  • Objective 8b

    Increase the proportion of childcare centers, schools and worksites that have 1) assessed, 2) developed plans, 3) implemented and 4) evaluated changes to their nutrition and physical activity environments.

    • Assess policies and change following NYS legislation encouraging "School District Child Nutrition Advisory Committees."
    • Assess nutrition, physical activity and other wellness policies and change following federal legislation requiring wellness policies (for schools participating in federal school meals program). (effective July 2006)
    • Develop and disseminate model nutrition and physical activity guidelines and policies for schools.
    • Increase the work site supports for healthy eating, use of NYS Guidelines for Healthy Meetings, and support of farmers' markets and Community Supported Agriculture (CSA).
    • Partner with organizations such as the Statewide Center for Healthy Schools, Childcare Coordinating Councils and the After-School Corporation to provide training and technical assistance in assessing and improving the nutrition environments in schools, childcare centers, and after-school programs.
    • Collaborate with schools to ensure that all school meals meet the Dietary Guidelines for Americans.
    • Develop community evaluation tools to measure the availability of opportunities for physical activity and healthful eating.
  • Objective 8c

    Increase the availability and accessibility of affordable, healthy foods and beverages.

    • Collaborate with local produce growers and community organizations to increase the availability and affordability of fruits and vegetables in school, childcare, and after-school settings through promotion of farm-to-school and similar initiatives.
    • Collaborate with the Child and Adult Care Food Program (CACFP), Child Care Health Promotion Specialists, Child Care Coordinating Councils and other resources to improve the food and nutrition environments of child care centers.
    • Work with local communities and neighborhoods, retail marketing associations, retailers, economic development agencies and the NYS Department of Agriculture and Markets to improve access to: supermarkets, farmers' markets, community gardens, urban farmstands, and local markets that provide affordable fresh fruits, vegetables and low-fat dairy products.
    • Support the expansion of wireless electronic benefits transfer (EBT) machines and other mechanisms that enable farmers' markets to serve Food Stamp Program participants with high-quality fruits and vegetables.
  • Objective 8d

    Increase the availability and accessibility of affordable places to be physically active.

    • Increase the number of facilities or places for physical activity (e.g., parks, playgrounds, gyms, community centers, schools, etc.) open for community use.
    • Increase the availability and use of community recreational facilities and other places for physical activity by individuals across the lifespan including those with disabilities.
    • Revise comprehensive plans, zoning and subdivision ordinances, and other planning practices to increase availability and accessibility of opportunities for physical activities in new developments.
  • Objective 8d

    Increase advocacy and public support for initiatives, policies and legislation that eliminate barriers to healthy food choices and physically active lifestyles.

    • Support capital improvement projects that increase opportunities for physical activity in existing areas.
    • Support building local schools within walking and bicycling distance of the neighborhoods they serve.
    • Improve street, sidewalk, and street-crossing safety of routes to school.
    • Work with local and state government to change transportation policies and practices to promote safe non-motorized transportation (Guide to Community Preventive Services GCPS).
    • Change state and local land use policies and practices to promote more bicycle and pedestrian friendly communities (GCPS).

Goal 9

Increase and maintain effective public health responses to the obesity epidemic in NYS.

  • Objective 9a

    Increase availability, accessibility and sustainability of support and financial resources for overweight/obesity prevention activities.

    • Leverage additional resources for obesity prevention programs and research efforts through grants and other sources.
  • Objective 9b

    Strengthen statewide, regional and local infrastructure to promote coordination among partners across the state and within each region.

  • Objective 9c

    Enhance communication and collaboration among the overweight/obesity prevention program, community partners and statewide stakeholders.

Goal 10

Expand surveillance and program evaluation to prevent overweight and obesity.

  • Objective 10a

    Analyze, synthesize and disseminate existing data related to overweight, obesity, obesity-related diseases, nutrition, physical activity, television viewing, breastfeeding, food insecurity and related issues to monitor progress toward achieving program goals.

    • Assess the utility of existing data systems for population-based surveillance of obesity-related indicators, risk factors and outcomes including data sources from partners outside the Department of Health.
    • Routinely analyze reports of prevalence and trends from existing surveillance and other relevant data systems.
    • Report on the health and economic burden of obesity in New York State.
  • Objective 10b

    Summarize and disseminate science-based best practices for the prevention of overweight and obesity on an ongoing basis.

    • Ensure timely access and dissemination of surveillance findings to meet the information needs of obesity prevention stakeholders.
    • Apply the results of research to improve program effectiveness.
  • Objective 10c

    Enhance, expand and strengthen surveillance to ensure that information is available across the population and within defined geographic areas.

    • Expand routine collection of data pertaining to breastfeeding, perinatal weight gain, and television viewing.
    • Identify gaps in surveillance information and develop strategies and resources to conduct surveillance across the population and within defined geographic areas.
    • Modify and integrate existing surveillance and other data systems to measure and report on obesity-related indicators.
    • Develop a statewide school-based monitoring system to assess the prevalence of childhood obesity.
  • Objective 10d

    Develop and implement data collection systems to evaluate the impact of the overweight and obesity prevention program.

    • Utilize formative evaluation to assess design needs and program implementation needs.
    • Develop and validate policy and environmental indicators of overweight and obesity prevention.
    • Develop a Community Check tool to be used at the local level to measure environmental and policy supports for physical activity and to guide local action.
  • Objective 10e

    Evaluate the design, implementation and effectiveness of interventions to reduce overweight and obesity and to improve health outcomes.

    • Develop strategies for formative process, impact and outcome evaluation for the obesity prevention program.
    • Collaborate with New York State academic institutions, local health departments, and community organizations to conduct, evaluate and incorporate new research to support the obesity prevention program.
    • Work with CDC sponsors to develop and report relevant obesity program performance measures.
  • Objective 10f

    Increase the number and diversity of obesity prevention programs across age, gender, educational levels, income levels and racial/ethnic groups that are being evaluated.

    • Identify high-risk populations and target specifically tailored interventions to those groups.
    • Provide technical assistance to obesity program partners and coalitions to conduct local level program evaluation.