Focus Area 1: Reduce Obesity in Children and Adults

Defining the Problem

Childhood and adult overweight and obesity have reached epidemic proportions in New York State (NYS) and across the nation. Nationally, 17 percent of American children and adolescents aged 2-19 years are obese, and obesity prevalence among adults exceeds 35 percent.4,5 In NYS, 24.6 percent of adults are obese and another 35.6 percent are overweight, affecting an estimated 8.5 million.6 Overweight and obesity affect 40 percent of New York City (NYC) public school students ages 6-12 years7 and 32 percent of students in the rest of the state.8 Among children ages 2-4 years, living in low-income families who participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in NYS, 31.5 percent are overweight or obese.9

Obesity and overweight are the second leading cause of preventable death in the United States (US) and may soon overtake tobacco as the leading cause of death.10 By the year 2050, obesity is predicted to shorten life expectancy in the US by two to five years.11

Obesity is a significant risk factor for many chronic diseases and conditions, which reduce the quality of life, including type-2 diabetes, asthma, high blood pressure and high cholesterol. Increasingly, these conditions are being seen in children and adolescents.12

New York ranks second highest among states for medical expenditures attributable to obesity. Expenditures totaled $11.1 billion (in 2009 dollars); $4 billion financed by Medicaid and $2.7 billion financed by Medicare.13 Preventing and controlling obesity has the potential to save hundreds of millions of dollars annually. Failing to win the battle against obesity will mean premature death and disability for an increasingly large segment of NYS residents. Without strong action to reverse the obesity epidemic, for the first time in our history, children are predicted to have a shorter lifespan than their parents.14

The causes of obesity in the US and NYS are complex, occurring at social, economic, environmental and individual levels. There is no single solution sufficient to turn the tide on this epidemic. Successful prevention efforts will require multiple strategies, such as national, State and local policies and environmental changes that promote and support more healthful eating and active living and that reach large numbers of children and adults. These strategies must be supported and implemented in multiple sectors, including government agencies, businesses, communities, schools, child care, health care and worksites, to make the easy choice also the healthy choice.

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Goals, Objectives and Interventions

Overarching Objective 1.0.1:
By December 31, 2017, reduce the percentage of children who are obese:
  • By 5% from 13.1% (2010) to 12.4% among WIC children (ages 2-4 years). (Data Source: NYS Pediatric and Pregnancy Nutrition Surveillance System [PedNSS])
  • By 5% from 17.6% (2010-12) to 16.7% among public school children Statewide reported to the Student Weight Status Category Reporting system. (Data Source: NYS Student Weight Status Category Reporting [SWSCR]) (Prevention Agenda [PA] Tracking Indicator)
  • By 5% from 20.7% (2010-11) to 19.7% among public school children in New York City represented in the NYC Fitnessgram. (Data Source: NYC Fitnessgram) (PA Tracking Indicator)
Overarching Objective 1.0.2:
By December 31, 2017, reduce the percentage of adults ages 18 years and older who are obese:
  • By 5% from 24.5% (2011) to 23.2% among all adults.
  • By 5% from 26.8% (2011) to 25.4% among adults with an annual household income of < $25,000.
  • By 10% from 34.9% (2011) to 31.4% among adults with disabilities.
(Data source: NYS Behavioral Risk Factor Surveillance System [BRFSS]) (PA Tracking Indicators; Health Disparities Indicator)

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Goal #1.1: Create community environments that promote and support healthy food and beverage choices and physical activity.

Objective 1.1.1:
By December 31, 2017, decrease the percentage of adults ages 18 years and older who consume one or more sugary drink per day:
  • By 5% from 20.5% (2009) to 19.5% among all adults.
  • By 10% from 42.9% (2009) to 38.6% among adults with an annual household income of < $25,000.
(Data source: NYS BRFSS) (Health Disparities Indicator)
Objective 1.1.2:
By December 31, 2017, increase the percentage of adults ages 18 years and older who participate in leisure-time physical activity:
  • By 5% from 73.7% (2011) to 77.4% among all adults.
  • By 10% from 59.0% (2011) to 65.0% among adults with less than a high school education.
  • By 10% from 49.9% (2011) to 54.9% among adults with disabilities.
(Data source: NYS BRFSS) (Health Disparities Indicator)
(Also, see: Focus Area – Built Environment)
Objective 1.1.3:
By December 31, 2017, increase the number of municipalities that have passed complete streets policies from 23 (2011) to 46.
Complete streets are designed to allow residents to travel easily and safely, whether walking, biking or riding the bus, connecting roadways to complementary trails and bike paths that provide safe places to walk and bike.
(Data source: Tri-States Transportation Campaign)
(Also, see: Focus Area - Built Environment)

Interventions for Consideration

OVERALL

  • Adequately invest in proven community-based programs that result in increased levels of physical activity and improved nutrition. (Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities)

HEALTHY EATING

  1. Increase retail availability of affordable healthy foods that meet the needs of communities, especially those with limited access to nutritious foods. This includes but is not limited to: developing business models that support increased use of healthy, locally grown/developed and minimally processed foods, especially in high-need areas; linking to the Regional Economic Development Councils, establishing local and regional food hubs to provide new market outlets for local and regional "producers" and providing technical assistance on production planning and sustainable production practices; attracting retail grocery stores; improving offerings at small stores; starting and sustaining farmers' markets, fruits and veggies carts; and other innovative opportunities. (Institute of Medicine – Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth [IOM Nutrition Standards for Schools]; IOM – Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation [IOM Obesity Prevention]; Healthy People 2020 [HP2020]; MMWR Recommended Community Strategies and Measurements to Prevent Obesity in the United States [CDC Community Strategies])
  2. Adopt policies and implement practices to reduce overconsumption of sugary drinks, such as make clean, potable water readily available in public places, worksites and recreation areas; implement policies aimed at reducing overconsumption of sugary drinks; and educate the public about the risks associated with overconsumption of sugary drinks. (IOM Nutrition Standards in Schools; IOM Obesity Prevention; CDC Community Strategies)
  3. Adopt policies and implement practices to increase access to affordable healthy foods for individuals living in group homes or adult homes for people with disabilities. This includes linking with the NYS Office for Persons with Developmental Disabilities, the NYS Office of Mental Health, and the NYS Office of Alcoholism and Substance Abuse Services to improve offerings of healthful foods and health education activities in these settings.

PHYSICAL ACTIVITY

  1. Establish joint use agreements to open public areas and facilities for safe physical activity. (IOM Nutrition Standards in Schools; IOM Obesity Prevention; HP 2020; CDC Community Strategies)
  2. Adopt, strengthen and implement local policies and guidelines that facilitate increased physical activity for residents of all ages and abilities, including but not limited to: adopting complete streets policies that change how streets are designed and built, so that residents can travel easily and safely along community streets, whether they are walking, biking or riding the bus; connecting roadways to complementary systems of trails and bike paths that provide safe places to walk and bike; implementing traffic enforcement programs to improve safety for pedestrians and bicyclists; incorporating clear policy statements on pedestrian needs in a municipal Comprehensive Plan; considering pedestrian and non-auto transportation in site plan reviews; adopting zoning and other land-use regulations that place a priority on pedestrians over auto transportation; adopting active design guidelines that support the design of healthy buildings, streets and urban spaces; and, supporting smart growth strategies and zoning for new developments and revitalizing communities. Ensure that accessibility for people with disabilities and the elderly is a priority when adopting active design guidelines. (IOM – Local Government Actions to Prevent Childhood Obesity, 2009; HP 2020; CDC Community Strategies; HHS 2008 Physical Activity Guidelines for Americans)

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Goal #1.2: Prevent childhood obesity through early child-care and schools.

Objective 1.2.1:
By December 31, 2017, increase the number of school districts whose competitive food policies meet or exceed the Institute of Medicine recommendations
  • (Baseline is expected to be determined in 2012 from a collaborative NYS Department of Health/NYS Education Department project.
    (Data Source: NYS Education Department Local Wellness Policies, 2012)
Objective 1.2.2:
By December 31, 2017, increase the number of school districts that meet or exceed NYS regulations for physical education (120 minutes per week of quality physical education in elementary grades K-6; daily physical education for children in grades K-3).
  • (Baseline compliance: 5% 2008)
    (Data Source: Office of the New York State Comptroller)

Interventions for Consideration

EARLY CHILD CARE

Healthy Eating and Physical Activity

  • Adopt regulations and policies designed to implement standards that will support breastfeeding, quality nutrition, increased physical activity and reduced screen time in early childcare settings and increase staff training, community support and reinforcement of these regulations and policies. (IOM Obesity Prevention; IOM – Early Childhood Obesity Prevention Policies; The Surgeon General's Call to Action to Support Breastfeeding, 2011; Caring for Our Children, National Health and Safety Performance Standards, 2011)

SCHOOLS

General

  • Incorporate time into the school day so that students have adequate time to eat a nutritious lunch/snacks and engage in physical activity.

Healthy Eating

  • Increase the number of schools that establish strong nutritional standards for all foods and beverages sold and provided through schools, such as establishing sugary drink policies, promoting access to free drinking water and adopting Institute of Medicine nutrition standards for school foods sold/served outside of federal child nutrition programs (competitive foods and foods sold through fundraisers). (IOM Nutrition Standards in Schools; IOM Obesity Prevention)

Physical Activity

  1. Increase the number of school districts that meet the NYS Education Department Regulations of the Commissioner Section 135.4 – Physical Education. Interventions include opportunities to increase physical activity before, during and after school, such as active recess and encouraging school transportation policies that support walking and bicycling to school. (HP 2020; IOM Obesity Prevention; CDC School Health Guidelines to Promote Healthy Eating and Physical Activity [CDC School Health Guidelines]; National Association for Sport and Physical Education – Comprehensive School Physical Activity Guidelines [NASPE Guidelines]; NYS Education Department Regulations; HHS 2008 Physical Activity Guidelines for Americans)
  2. Develop and provide support for the implementation, monitoring and enforcement of NYS Education Department learning standards for physical education and nutrition in grades K-12. (HP 2020; IOM Obesity Prevention; CDC School Health Guidelines; NASPE Guidelines; NYS Education Department Regulations; HHS 2008 Physical Activity Guidelines for Americans)

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Goal #1.3: Expand the role of health care and health service providers and insurers in obesity prevention.

Objective 1.3.1:
By December 31, 2017, increase the percentage of children and adolescents ages 3-17 years with an outpatient visit with a primary care provider or obstetrics/gynecology practitioner during the measurement year, who received appropriate assessment for weight status during the measurement year:
  • 29% from 58% (2011) to 75% among residents enrolled in commercial managed care health insurance.
  • 5% from 72% (2011) to 75% among residents enrolled in Medicaid Managed Care or Child Health Plus.
(Data Source: NYS Quality Assurance Reporting Requirements [QARR]) (PA Tracking Indicator)
(Also, see: Focus Area – Child Health)
Objective 1.3.2:
By 2017, increase the percentage of infants born in NYS hospitals who are exclusively breastfed during the birth hospitalization by 10% from 43.7% (2010) to 48.1%.
Data Source: Bureau of Biometrics and Biostatistics, NYSDOH; NYC Office of Vital Records, NYC DOHMH)
(Also, see: Focus Area – Maternal and Infant Health)

Interventions for Consideration

  1. Ensure public and private health insurance coverage of, access to, and incentives for breastfeeding education, lactation counseling and support. (The Guide to Clinical Preventive Services)
  2. Ensure public and private health insurance coverage of, access to, and incentives for routine obesity prevention screening, diagnosis and treatment, including diabetes prevention programs. (IOM Obesity Prevention)
  3. Increase the capacity of primary care providers to implement screening, prevention and treatment measures for obesity in children and adults through quality improvement methods and other training approaches, reimbursement and payment incentives. (IOM Obesity Prevention)
  4. Establish professional training programs in prevention, screening, diagnosis and treatment of overweight and obesity. Training should reach across the spectrum of medical, nursing, physician assistant schools; dietetics; allied health programs such as community health workers; and in continuing education. (IOM Obesity Prevention)
  5. Link health care-based efforts with community prevention activities such as comprehensive school-based obesity prevention programs; community-based, nationally recognized diabetes prevention programs; and breastfeeding counseling and support systems. (IOM Obesity Prevention)

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Goal #1.4: Expand the role of public and private employers in obesity prevention.

Objective 1.4.1:
By December 31, 2017, increase by 10% the percentage of small to medium worksites that offer a comprehensive worksite wellness program for all employees and that is fully accessible to people with disabilities.
Baseline to be determined.)
(Data Source: NYSDOH Healthy Heart Program Worksite Survey)
Objective 1.4.2:
By December 31, 2017, increase the percentage of employers with supports for breastfeeding at the worksite by 10%.
Baseline to be determined.
(Data Source: NYSDOH Healthy Heart Program Worksite Survey)
(Also, see: Focus Area – Maternal and Infant Health)

Interventions for Consideration

  1. Increase the number of employers who offer benefits, coverage and/or incentives for obesity prevention, including breastfeeding support and obesity treatment. (IOM Obesity Prevention)
  2. Strengthen business practices that are aligned with NYS Labor Law to support breastfeeding at work, including but not limited to: providing an accessible, clean, private and safe space other than a restroom where breastfeeding mothers can express or pump breast milk; having a refrigerator available to store expressed breast milk; having a written policy allowing time off during the work day for mothers to express breast milk; and establishing a NYS Worksite Breastfeeding Friendly Designation Program.
  3. Develop community partnerships to increase comprehensive worksite wellness programs among small- to medium-sized employers, and ensure that the programs are appropriate for people with disabilities. (IOM Obesity Prevention)
  4. Implement evidence-based wellness programs for all public and private employees, retirees and their dependents through collaborations with unions, health plans and community partnerships that include but are not limited to increased opportunities for physical activity; access to and promotion of healthful foods and beverages; and health benefit coverage and/or incentives for obesity prevention and treatment, including breastfeeding support. (IOM Obesity Prevention)
  5. Increase adoption of food procurement and vending policies based on the Dietary Guidelines for Americans among public and private employers, including government agencies. (CDC Community Strategies)

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Interventions by Level of Health Impact Pyramid

Focus Area 1: Reduce obesity in children and adults.
Levels of Health Impact Pyramid*Interventions
Counseling and Education
  • Ensure public and private health insurance coverage of, access to and incentives for breastfeeding education, lactation counseling and support.
Clinical Interventions
  • Ensure public and private health insurance coverage of, access to and incentives for routine obesity prevention screening, diagnosis and treatment.
  • Increase the capacity of primary care and other providers to implement screening, prevention and treatment measures for obesity in children and adults through quality improvement and other training methods, plus reimbursement and payment incentives.
  • Establish health training programs across the professional spectrum to include instruction in prevention, screening, diagnosis and treatment of overweight and obesity.
Long-Lasting Protective Interventions
  • Link health care-based efforts with community prevention activities.
  • Develop community partnerships to increase comprehensive worksite wellness programs among small- to medium-sized employers.
  • Implement evidence-based wellness programs for all public and private employees, retirees and their dependents through collaboration with unions, health plans and community partnerships.
Changing the Context to Make Individuals' Decisions Healthy
  • Adequately invest in proven community-based programs that result in increased levels of physical activity and improved nutrition.
  • Define/Innovate business models that support increased use of healthy, locally grown/developed/ minimally processed foods.
  • Increase retail availability of affordable healthy foods that meet community needs, especially those with limited access to nutritious foods.
  • Adopt policies and implement practices to reduce overconsumption of sugary drinks.
  • Adopt policies and implement practices to increase access to affordable healthy foods for individuals living in group homes or adult homes for people with disabilities.
  • Establish joint use agreements to open public areas and facilities for safe physical activity for all, including people with disabilities.
  • Adopt, strengthen and implement local policies and guidelines that facilitate increased physical activity for residents of all ages and abilities.
  • Adopt regulations and policies to implement standards supporting breastfeeding, quality nutrition, increased physical activity and reduced screen time in early childcare settings. Increase community support and reinforcement of these regulations and policies.
  • Incorporate time into the school day so that students have adequate time to eat a nutritious lunch/snacks and engage in physical activity.
  • Increase the number of schools that establish strong nutritional standards for all foods and beverages sold and provided through schools.
  • Increase the number of school districts that meet the NYS Education Department Regulations of the Commissioner Section 135.4 - Physical Education.
  • Develop and provide financial support for the implementation of NYS Education Department learning standards for physical education and nutrition in grades K-12.
  • ncrease the number of employers who offer benefits, coverage and/or incentives for obesity prevention and treatment.
  • Strengthen NYS Labor Law and business practices that support breastfeeding at work.
  • Increase adoption of food procurement and vending policies based on the Dietary Guidelines for Americans among public and private employers, including government agencies.
Socioeconomic Factors
  • Develop and implement community-led, place-based interventions targeted to address the social determinants of health in high-priority vulnerable communities.
  • Reduce educational disparities by race, ethnicity, and income that underlie disparities in obesity risk factors, obesity, and obesity-related diseases.

* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Interventions and Activities by Sector

Changes can be made across all sectors to reduce illness, disability and death related to reduce obesity in children and adults. Below are examples of how your sector can make a difference.

Healthcare Delivery System

  • Adopt hospital policies to support use of healthy, locally grown foods in cafeteria and patient meals.
  • Adopt healthy meal and beverage standards for meals sold and served in hospitals.
  • Set example for community through breastfeeding-friendly hospitals and practices.
    • Increase the number of Baby-Friendly Hospitals.
    • Promote preventive interventions for obesity in pre- and post-natal care.
  • Assist with referrals to community resources.
  • Conduct Continuing Medical Education (CME) programs for health professionals, including programs on diet, exercise, stress, coping, obesity and disabilities.
  • Offer information regarding availability of parks and trails to and in discussions with patients seeking free activities close to home.
  • Support school-based health centers in obesity prevention interventions.
  • Facilitate referrals for wellness services.

Employers, Businesses, and Unions

  • Partner with regional economic development councils and State business association for messaging on obesity prevention, including promoting access to healthy foods and increasing opportunities for physical activity.
  • Connect schools and hospitals in rural areas to cross-promote obesity reduction activities.
  • Engage business associations to promote/make visible and value obesity reduction.
  • Site businesses with access to transit, walking and bicycling facilities, and develop workplace facilities and incentives that encourage active commuting.
  • Require health insurance contracts to cover obesity and diabetes prevention programs.
  • Require health insurers to cover nutrition education, lactation counseling, and other preventive strategies during pre- and post-natal care to promote recommended gestational weight gain and breastfeeding, and to prevent maternal, infant and child obesity.

Media

  • Use public service announcements to promote healthy eating, physical activity and breastfeeding.
  • Increase the time allotted for programming that supports disease prevention.
  • Help community organizations develop communication strategies to promote disease prevention and breastfeeding.
  • Increase the time allotted for programming that supports breastfeeding.
  • Conduct breastfeeding promotion/obesity prevention media campaigns
  • Create public service announcements and other programs that show people with disabilities included in public health activities as well as in healthy eating and physical activity messages.

Academia

  • Conduct research to support evidence-based approaches to reducing obesity.
  • Identify emerging best practices.
  • Evaluate obesity prevention initiatives.
  • Develop data to strengthen the case for return on investment in obesity reduction programs and share with policymakers.
  • Develop information for regional economic development councils about the benefits of locally produced, minimally processed foods.
    • Develop the economic case for active transportation at the local level.
    • Develop lists of model practices and resources for schools.
  • Develop an economic benefits argument on implementing worksite wellness that is specific to New York State.
  • Identify model practices in breastfeeding promotion among NYS employers.

Community-Based Health and Human Service Agencies

  • Create linkages with local health care systems to connect patients to community preventive resources.
  • Expand public-private partnerships to implement community-based obesity preventive services.
  • Support training and use of community health workers to provide breastfeeding support.

Other Government Agencies

  • Advocate for nutrition education in high-needs area by local dietetics clubs/associations.
  • Develop standards for healthy eating and physical activity for individuals in group homes and adult homes.
  • Assist in the development of nutrition education standards.
  • Support education opportunities for school food-service workers on nutrition and wellness.
  • Assist in the development of food procurement policies.

Governmental (G) and Non-Governmental (NG) Public Health

  • Provide technical assistance to community groups and local government wishing to create or enhance parks, playgrounds and trails as physical activity opportunities for residents, including those with disabilities. (NG)
  • Provide guidance, training and support to communities to have skills to increase access to physical activity and nutrition. (G)
  • Promote opportunities for availability of healthy foods. (G)
  • Use social media to promote awareness of key obesity prevention strategies/practices, including a focus on populations affected by racial, ethnic, educational attainment and economic disparities. (G)
  • Increase awareness of obesity as a risk factor for chronic disease. (G, NG)
  • Educate lawmakers about the need for increased prevention funding. (NG)
  • Share information with policymakers about benefits of promoting healthy local foods. (NG)
  • Dedicate funds for trails, complete streets, safe routes to school and active transportation infrastructure and programs. (G)
  • Increase State parks infrastructure repairs and improved park operations. (G)
  • Collaborate with Child and Adult Care Food Program (CACFP) and WIC to promote breastfeeding-friendly early childcare centers. (G)
  • Recognize schools and daycares that have policies/practices that promote obesity prevention. (G)
  • Educate lawmakers about schools' low compliance of schools with physical education standards and the need to increase monitoring, evaluation and enforcement. (G, NG)
  • Encourage the community to support implementation and compliance with Office of Children and Family Services (OCFS) new regulations affecting child day care centers and homes. (NG)
  • Push for improved compliance with physical education requirements. (NG)
  • Develop training for allied health professionals on obesity screening, prevention and referrals. (G)
  • Create social marketing messages to promote breastfeeding education as the norm. (G)
  • Advocate for insurance coverage for obesity and diabetes prevention programs. (NG)
  • Work with the NYS Council on Food Policy to develop, promote and enforce food procurement guidelines for all State agencies. (G)
  • Help identify models for best practices for worksite wellness at small and medium businesses/worksites. (G)
  • Encourage participation in online tools such as the "Fit-Friendly" programs. (NG)
  • Support establishment of obesity prevention coverage for public and private insurance. (NG)
  • Provide private insurance and Medicaid incentives for births in Baby-Friendly Hospitals. G)

Policymakers and Elected Officials

  • Strengthen enforcement and investigation of motor vehicle traffic violations that endanger pedestrians and bicyclists.
  • Implement measures to preserve green space equitably, especially throughout urban neighborhoods.
  • Increase local and State parks infrastructure repairs and improved park operations.
  • Expand providers' awareness and knowledge of standards for obesity screening and prevention.  Educate and advocate for restrictions on marketing and distribution of baby formula "gifts" through health care providers and hospitals. Communities

Community

  • Mobilize advocates to increase demand for healthy environments, food choices and improved opportunities for physical activity.
  • Support use of funds for trails, complete streets, safe routes to school, active transportation infrastructure and programs and other non- motorized transportation enhancements.
  • Increase awareness of and demand for additional local and State parks infrastructure repairs and improvements in park operations.
  • Increase awareness of and demand for open space protection in each community.
  • Support pedestrian facilities with all new development and open space or other recreational facilities with all new residential development.
  • Increase awareness of and demand for improved school and child care practices.
  • Encourage awareness of and demand for breastfeeding counseling/education.
  • Advocate for restriction of marketing of unhealthful products to kids.
  • Advocate for restriction of marketing of infant formula
  • Provide resources and availability of parks and trails to employers to augment worksite wellness programs.
  • Advocate for stronger breastfeeding support at work laws/enforcement.

Philanthropy

  • Fund training programs for education and child care professionals on obesity interventions and related regulations.
  • Provide resources to communities for obesity prevention interventions.
  • Support research efforts aimed at informing the evidence base for obesity prevention.

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