Priority Area: Physical Activity and Nutrition

The Burden of Physical Inactivity and Poor Nutrition

Major causes of morbidity and mortality in the United States are related to poor diet and physical inactivity. By maintaining a healthy diet and being physically active, individuals can achieve a healthy weight and reduce their risk of chronic diseases such as diabetes, heart disease and some forms of cancer, and strengthen bones to reduce the risk of osteoporosis.

Cardiovascular diseases are the leading causes of death in New York, killing almost 59,000 residents each year. Diabetes is the most rapidly growing chronic disease, affecting one out of every 12 adult New Yorkers. As more children in the United States become overweight and inactive, type 2 diabetes, which used to be diagnosed mainly in overweight adults, has become increasingly common in the youth population. It now accounts for 8% to 45% of new cases of childhood diabetes.

Obesity, which may be addressed through proper nutrition and physical activity, is a major risk factor for many chronic diseases, and has reached epidemic proportions both in New York and across the nation. The percentage of obese adults in New York more than doubled from 10% in 1997 to 24.2% in 2009 and, nationally, obesity among children and adolescents has tripled over the past three decades. According to a report by the New York State Comptroller’s Office, New York ranks second among states in adult obesity-related medical expenditures, with total spending estimated at nearly $7.6 billion (81% of which is paid by Medicaid and Medicare), and far exceeding the national average of 52%.1 Physical inactivity, poor nutrition, consumption of sugar-sweetened beverages and television viewing can contribute to excess weight gain in children and adults. In 2009, 26.4% of adult New Yorkers reported no physical activity in the past 30 days.

References

  1. Office of the State Comptroller. Preventing and Reducing Childhood Obesity in New York. 2008 Oct. 1-4 pp.

Objectives

  • By the year 2013, reduce the percentage of New York children who are overweight or obese so that:
    • The percentage of children (ages 2-4 years) enrolled in the Supplemental Nutrition Program for Women, Infants and Children Program (WIC) who are obese is no more than 11.6%.*
      (Baseline: 14.9%, WIC Program data, 2005)
    • The percentage of children ages 6-11 years who are obese is no more than 5%.*
      (Baseline: unavailable)
    • The percentage of children ages 12-19 years who are obese is no more than 5%.*
      (Baseline: unavailable)
  • By the year 2013, reduce the percentage of adult New Yorkers who are obese to no more than 15.0%.* (Baseline: 22.9%, BRFSS, 2006)
  • By the year 2013, increase the percentage of adult New Yorkers who engage in some type of leisure-time physical activity to at least 80%.* (Baseline: 74.0%, BRFSS, 2006)
  • By the year 2013, increase the percentage of adult New Yorkers who consume fruits and vegetables five or more times per day to at least 33.0%.* (Baseline: 26.0%, BRFSS, 2005)
  • By the year 2013, increase the proportion of New York mothers who breastfeed their babies at 6 months to at least 50%.* (Baseline: 39.5% of WIC mothers, WIC Program data, 2005)

    * Healthy People 2010 Objective

Indicators for Tracking Public Health Priority Areas

Each community's progress towards reaching these Prevention Agenda Objectives is tracked so communities can see how close they are to meeting these objectives.

Data and Statistics

New York State Department of Health Programs

Healthy Heart Program

  • The Healthy Heart Program addresses cardiovascular disease by reducing associated risk factors and improving detection and treatment, especially for hypertension, hyperlipidemia and stroke. It supports or collaborates with many partners to implement public health strategies in four sectors: worksites, schools, health care settings, and the community-at-large.
  • The environment in which people live, work, play and receive health care strongly influences physical activity, food habits and other health-related behaviors. Policy and environmental changes help people to be physically active, eat healthy foods, and receive evidence-based health care. Sample interventions include making communities more walkable, opening schools after hours for community use, establishing community gardens, implementing health risk appraisals at worksites, making it safer for children to walk and bike to school, and improving care for people suffering from strokes.
  • The Healthy Heart Program, with a panel of experts, developed Cardiovascular Health in New York State: A Plan for 2004 - 2010, which details 19 objectives to promote healthier behaviors, quality health care, and reduction of risks for heart disease and stroke.

Overweight and Obesity Prevention Program

  • The Overweight and Obesity Prevention Program aims to increase physical activity and improve nutrition among New York residents. The program’s current primary focus is the prevention of childhood obesity.
  • The New York State Strategic Plan for Overweight and Obesity Prevention identifies evidence-based strategies and promising approaches that can be replicated. Interventions that address the need for changing policies and environments to promote and provide options for healthy eating and more physical activity are highlighted.
  • Priority areas of the strategic plan are based on their potential for:
    • Increasing the perception of overweight and obesity as major public health threats.
    • Increasing early recognition of healthy weight, overweight, and/or excessive weight gain.
    • Promoting, supporting, and maintaining systemic and sustainable changes needed to make healthy eating and physical activity easy for everyone.
    • Expanding and improving surveillance and program evaluation.
    • Increasing initiation, exclusivity and duration of breastfeeding during infancy.
    • Increasing lifelong physical activity.
    • Improving lifelong healthy eating.
    • Decreasing exposure to television and other recreational screen time.
  • In addition to the tracking indicators, the Overweight and Obesity Prevention Program has established two indicators to monitor its impact on TV viewing:
    • Percentage of 9th - 12th grade students watching one hour or less per day of TV on an average school day (YRBSS 2007) for New York State and the United States.
    • Percentage of 9th - 12th grade students watching two hours or less per day of TV on an average school day (YRBSS 2007) for New York State and the United States.

Diabetes Prevention and Control Program

  • The Diabetes Prevention and Control Program (DPCP) collaborates with local, state and national partners to reduce and eliminate the burden of diabetes in New York State. Since its inception, the DPCP has transitioned from a focus on the control of diabetes complications to a comprehensive public health approach including prevention of type 2 diabetes and the promotion of healthy lifestyles across the lifespan. The DPCP has identified three goals to align with CDC's national diabetes program framework:
    • Prevent type 2 diabetes.
    • Prevent complications, disabilities and the disease burden associated with diabetes.
    • Eliminate diabetes-related health disparities.
  • In order to achieve these goals, the DPCP implements strategies within the following priority areas:
    • Public awareness and education.
    • Children and diabetes in schools and childcare settings.
    • Healthcare practice.
    • Access to care.
    • Sustainability and policy, systems and environmental change.
    • Public health tracking and evaluation.

Student Weight Status Initiative

  • A new approach to assess childhood obesity throughout the state is being implemented to:
    • Increase screening and early recognition of overweight and obesity by pediatric healthcare providers.
    • Collect, aggregate and report weight status data for public schools and school districts.
    • Provide local, county and statewide estimates of the prevalence of childhood obesity.
    • Target resources to populations most at risk for childhood obesity.
    • Identify what is working in schools and communities to help prevent and reduce childhood obesity.

Model Guidelines on Nutrition, Physical Activity and Media for After-School Settings

Child and Adult Care Food Program

  • Recognized as the gold standard for nutrition and food service in daycare centers, the Child and Adult Care Food Program currently serves more than half of all eligible daycare programs, including all Head Start centers in the state.

Eat Well Play Hard Program

  • Eat Well Play Hard (EWPH) is a childhood obesity prevention initiative incorporated into large-scale public health food and nutrition programs that serve low-income preschool children and their families in targeted communities. EWPH strategies are integrated into each program's food policies, nutrition education efforts, staff training, and marketing and outreach efforts. The core strategies for the EWPH intervention aim to:
    • Increase developmentally appropriate physical activity.
    • Increase consumption of 1% or fat-free milk and low-fat dairy products.
    • Increase consumption of fruits and vegetables.
    • Decrease TV and screen time.
    • Increase the initiation and duration of breastfeeding.
  • A total of 15 community projects cover 22 counties and involve a variety of settings including daycare centers, WIC clinics, schools, and after-school programs. The statewide goal for these projects is to establish sustainable, local collaborative partnerships that focus on creating environmental, policy and practice changes to increase healthy eating and physical activity at the community level.

Special Supplemental Nutrition Program for Women, Infants and Children

  • The Women, Infants and Children (WIC) Program supports the EWPH objectives through state policies and resources provided to WIC local agency staff and participants, such as encouraging low-fat dairy products for participants over age two and incorporating physical activity into WIC clinic education.

The Hunger Prevention and Nutrition Assistance Program

  • The Hunger Prevention and Nutrition Assistance Program (HPNAP) ensures that the state’s emergency food system supports EWPH objectives by establishing policies and resources for emergency food relief organizations, such as food banks, food pantries, soup kitchens and shelters. Examples of these efforts include:
    • The HPNAP policies require that at least 10 percent of HPNAP food funds are spent on fresh produce and a minimum of two percent are spent on non-flavored low-fat or non-fat fluid milk.
    • Food recovery projects, food banks, and other contractors are increasing the availability of fresh produce, including locally grown produce, in food pantries, soup kitchens and emergency shelters by establishing and operating community gardens, collecting leftover produce on farms through gleaning initiatives, participating in Community Supported Agriculture, and delivering fresh produce to low-income areas.
    • Just Say Yes to Fruits and Vegetables is a Food Stamp Nutrition Education Program designed to increase access to and consumption of fruits and vegetables by individuals and families receiving food stamps and WIC benefits.

New York State Strategic Alliance for Health

The Strategic Alliance for Health program is working to create healthier communities through sustainable, innovative, evidence- and practice-based community health promotion, and chronic disease prevention efforts that promote policy, system, and environmental change. Albany, Broome, Orange, and Schenectady counties are funded through this program to work with schools and the community to encourage physical activity, healthy eating, and tobacco-free choices in order to reduce the burden of diabetes, cardiovascular disease, and obesity. Interventions are targeted to populations most in need with a special emphasis on reaching at-risk populations including specific racial and ethnic groups, those limited by income and insurance coverage, those with high chronic disease rates, and individuals with disabilities.

New York City Strategic Alliance for Health

The Centers for Disease Control and Prevention funds the New York City Department of Health and Mental Hygiene to support the New York City Strategic Alliance for Health. The Alliance targets the South Bronx and East and Central Harlem to address physical activity, nutrition, and tobacco use within schools and the broader community. The New York Academy of Medicine, a non-profit organization based in East Harlem whose mission is to address the health challenges facing the world's urban populations, co-convenes and supports the effort with planning, evaluation, and communications expertise.

Strategies - The Evidence Base for Effective Interventions

County Strategies and Partners Matrix

The County Strategies and Partners Matrix for Physical Activity and Nutrition was compiled from the 2010-2013 community health assessments submitted in 2009 by 32 local health departments. It describes how local health departments collaborate with hospitals and community organizations to plan and address this priority to improve population health outcomes.

Reports

All Ages

  • CDC Report about the Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance

    Student physical activity may help improve academic performance including academic achievement; academic behavior; and factors that can positively influence academic achievement. This report is a literature review that examines the existing research on the relationship between school-based physical activity, including physical education and academic performance. It spans 23 years of research and includes 50 studies.

  • Exercise and Physical Activity: Your Everyday Guide

    The National Institute on Aging has updated "Exercise and Physical Activity: Your Everyday Guide." The National Institute on Aging is part of the National Institutes of Health, and the goal of their research is to improve the health and well-being of older adults.

  • The Healthy Communities, Obesity Prevention and the Law

    Communities interested in using laws to address obesity will find helpful this research report from the National Conference of State Legislatures. Funded by the Robert Wood Johnson Foundation, Promoting Healthy Communities and Preventing Childhood Obesity: Trends in Recent Legislation provides an overview of a wide variety of state legislation enacted in 2009.

  • The Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and Obesity - Final Report, May 2006

    This report describes current patterns in eating away from home and potential strategies to reduce calorie consumption in these settings. The report examines: 1) Understanding and influencing consumer behavior with regard to away-from-home foods; (2) increasing the availability of lower-calorie products, menu items, and meals at establishments that provide away-from-home foods; and (3) providing consumers with nutrition information regarding away-from-home foods.

  • Physical Activity Guidelines for Americans

    The Federal Government has issued its first-ever physical activity guidelines. They describe the types and amounts of physical activities that offer substantial health benefits.

  • Recipes for Change: Healthy Food in Every Community

    The just-released Convergence Partnership's Recipes for Change: Healthy Food in Every Community, authored by the Prevention Institute, aims to increase access to healthy foods by highlighting the innovative prevention strategies already working in communities across the country. Recipes for Change showcases opportunities to change the food system to benefit our physical, economic, social, and environmental health: from fresh food financing to school nutrition standards to food procurement policies. Fueled by research, innovative policies, and grassroots energy, the movement to increase access to healthy foods and to create a sustainable, equitable food system can provide a springboard for public action and local activism.

  • Reversing Obesity in NYC

    This October 2008 report educates people about food policy choices for New York City. The target audience is health professionals, advocates, and policy makers.

  • Robert Wood Johnson Foundation Briefs: Playgrounds and Trails Can Support Physical Activity

    The first brief shows that when playgrounds are safe to use and easy to access, they're more likely to help children be active. Locating playgrounds close to home and ensuring that they have safe, well-maintained equipment brings more kids to the playground and helps them get more physical activity while they are there. The second brief notes that a growing body of research shows walking, biking and hiking trails to be a cost-effective way to promote physical activity and potentially even reduce medical costs. It also finds that more research on children's use of trails is needed.

  • Robert Wood Johnson Reports on Physical Activity

    The environment in which people live can make it easier, or more challenging, to be physically active. Physical changes to communities can create safe, healthy environments that encourage and promote active living.

  • Rudd Center for Food Policy and Obesity - Yale University

    This report describes policy initiatives to increase the availability of healthy foods in low-income neighborhoods.

  • RWJF Toolkit Offers Resources to Prevent Childhood Obesity

    Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation, created an Action Strategies Toolkit, in close collaboration with 11 national policy-maker organizations. The toolkit offers practical examples of policy approaches and resources that can help state and local policy-makers prevent childhood obesity and improve children's health.

  • United States Dietary Guidelines for Americans

    The guidelines are jointly issued by the Departments of Agriculture and Health and Human Services. They provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.

  • United States National Physical Activity Plan

    The United States National Physical Activity Plan is a comprehensive set of policies, programs, and initiatives that aim to increase physical activity in all segments of the population. The Plan is the product of a private-public sector collaborative. Hundreds of organizations are working together to change our communities in ways that will enable every American to be sufficiently physically active. The Plan aims to create a national culture that supports physically active lifestyles. Its ultimate purpose is to improve health, prevent disease and disability, and enhance quality of life.

Children

  • Childhood Obesity, Volume 16, Number 1 Spring 2006

    This volume reviews evidence on how the dramatic changes in ways Americans, work, live and eat may have caused obesity to increase and examines how best to address each of the possible causes.

  • Food Marketing to Children and Youth: Threat or Opportunity?

    This report provides a comprehensive review of the scientific evidence on the influence of food marketing on diets and diet-related health of children and youth. It includes recommendations for different segments of society to guide the development of effective marketing and advertising strategies that promote healthier foods, beverages, and meal options for children and youth.

  • Local Government Actions to Prevent Childhood Obesity

    The Institute of Medicine (IOM) released Local Government Actions to Prevent Childhood Obesity, a report that identifies specific actions that local governments can take to improve healthy eating and increase physical activity in communities. Highlighted in the report are twelve policies that have the greatest potential for impact, including incentive programs to attract grocery stores to underserved areas, complete streets policies, and joint use. The report underscores the opportunity for local communities to promote health equity through implementation of these actions. IOM’s careful examination of these policies and its resulting recommendations adds another layer of consensus to the growing momentum for environmental and policy change efforts across the country.

  • Nutrition Standards for Foods in Schools: Leading the Way toward Healthier Youth

    This report describes IOM’s recommendations about appropriate nutritional standards for the availability, sale, content and consumption of foods in schools.

  • Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase 1 Proposed Approach for Recommending Revisions.

    This report provides the IOM committee’s approach for school lunch and breakfast programs prepared at the request of USDA.

  • Preventing Childhood Obesity: Health in the Balance

    This report examines the nature, extent, and consequences of obesity in children and youth, including the social, environmental, and dietary factors responsible for its increased prevalence. It provides goals and recommendations for preventing obesity and promoting healthy weight in children.

  • Progress in Preventing Childhood Obesity: How Do We Measure Up?

    This report describes progress made by obesity prevention initiatives in the United States over the past two years. The report emphasizes the importance of childhood obesity prevention policies and programs.

  • Progress in Preventing Childhood Obesity: Focus on Communities

    An Institute of Medicine (IOM) symposium describes viable strategies and promising practices and approaches for obesity prevention.

  • Progress in Preventing Childhood Obesity: Focus on Industry

    An IOM symposium summary highlights promising practices and approaches for addressing barriers to obesity prevention initiatives for schools, communities and industry.

  • Progress in Preventing Childhood Obesity: Focus on Schools

    This brief summary addresses themes for moving forward with obesity prevention efforts including empowering local schools and communities, and developing long-term strategic plans.

  • Reducing Children’s TV Time to Reduce the Risk of Childhood Overweight: The Children’s Media Use Study (March 2007).

    This study identifies many of the challenges in effectively communicating with families on limiting children’s screen time and discusses the issues that must be addressed when developing messages.

  • Safe Routes to School

    This document reports on the first three years of this program — what communities are accomplishing, where the program is today and where it can take this country in the future.

  • Medicaid Managed Care Performance Improvement Projects. 2009-2010 Pediatric Obesity-Summary of Projects

    This summary describes 2009-2010 projects by managed care providers targeted at reducing childhood obesity.

  • School Districts' Compliance with Physical Education Regulations

    A sample of school districts across New York State indicates that elementary school students are not receiving State-required physical education classes, according to an audit released by New York State Comptroller Thomas P. DiNapoli. Schools are generally meeting State physical education requirements for middle and high school students, but are falling short for students in kindergarten through sixth grade.

Resources

CDC Division of Nutrition, Physical Activity and Obesity

CDC provides information about public health approaches to address the role of nutrition and physical activity in improving the public's health and preventing and controlling chronic disease. It includes epidemiological and behavioral research, surveillance, training and education, intervention development, health promotion and leadership, policy and environmental change, communication and social marketing, and partnership development.

The Center for Science in the Public Interest

This organization provides information on a variety of nutrition issues including trans fat, menu labeling, sugar-sweetened beverages, school nutrition policies and more.

CDC Weight Management Research to Practice Guides

An overview of the science on different nutrition topics is summarized for public health professionals, including implications for practice. Topics to date include away-from-home food consumption, fruit and vegetable consumption, portion sizes, decreasing sugar-sweetened beverages consumption, breastfeeding and pediatric overweight risk reduction, and low-energy-dense foods.

Maternal and Child Health Library

The Maternal and Child Health Library at Georgetown University has released a new edition of the knowledge path, Physical Activity and Children and Adolescents. This electronic guide points to resources that analyze data, describe public health campaigns and other promotion programs, and report on research aimed at identifying promising strategies for improving physical activity levels within families, schools and after-school programs, child care and early childhood education settings, and communities. The knowledge path also presents resources about physical activity for children and adolescents with special health care needs.

National Diabetes Education Program

The National Diabetes Education Program (NDEP) is a federally-funded program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention. The program includes over 200 partners at the federal, state and local levels, working together to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of type 2 diabetes. NDEP translates the latest science and spreads the word that diabetes is serious, common, and costly, yet controllable and, for type 2, preventable.

Return on Investment

Worksite Wellness

This website provides examples of companies saving money in a variety of areas due to wellness programs at the worksite.

CDC Website to Help Employers Combat Obesity

The Centers for Disease Control and Prevention launched LEANWorks!, a website designed to help businesses address obesity. LEAN stands for Leading Employees to Activity and Nutrition. The website was developed particularly for small and mid-size companies, which typically have limited resources to devote to obesity prevention efforts. CDC LEANWorks! helps employers calculate the cost of obesity for their organizations and develop tailored approaches to help control these costs through interventions such as fitness classes, lunchtime health education sessions, and weight management programs.

Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small

This resource is a guide for large and small employers to plan effective health promotion programs for their employees, providing a positive return on investment.

Community-Based Physical Activity Interventions

Seven physical activity interventions to reduce disease incidence are cost-effective and offer good value for money spent.

American Journal of Health Promotion: Economic Return on Investment of Worksite Wellness

Economic Return on Investment of Worksite Wellness is a formal meta-evaluation of 56 economic return studies of worksite health promotion programs.

Partners

More Information

Bureau of Community Chronic Disease Prevention
Address: Riverview Center, Room 350. 150 Broadway, Albany, NY 12204
Email: hhp@health.state.ny.us
Voice: 518-408-5142
Fax: 518-474-3356

Division of Nutrition
Address: Riverview Center,6th Floor West, 150 Broadway, Albany, NY 12204
Email: ewph1@health.state.ny.us
Voice: 518-402-7090
Fax: 518-402-7220