1. Eat Well Play Hard: How NYS Developed and Integrated Key Nutrition Strategies into All Program Efforts
Amy Koren-Roth, MS, RDN, CDN
NYS Department of Health
Division of Nutrition
*EWPH intervention began to be devoloped by DON of NYSDOH
in 1995, in response to the rise in both childhood and adult obesity.
It is more of a philosophy and framework for a consistent response that addresses both sides of the “energy equation” (PA and nutrition) - starting with pre-schoolers, since waiting until school age is often too late for prevention in many cases.

2. The Problem:
In 1995, 10% of NYS WIC participants age 2-5 were overweight
Prevalence of obesity in NYS school children ranged from 13-20%
Thanks to staff in our surveillance and analysis area, the issue of overweight in children came to our attention in the mid-90’s. By the turn of the century, everyone was talking about this trend.

3. The Approach:
Bring together Division of Nutrition Programs to chart a course of action (1995)
WIC/Farmer’s Market
Commodity Supplemental Food Program
Child and Adult Care Food Program
Hunger Prevention and Nutrition Assistance Program

4. No Money... No Mandate... Just resolve!
When we started this effort, we had no new funding and no mandate to make these changes. What we did have was a sincere desire, on the part of our Division leadership, to try to affect change.
Just resolve!

5. What it took: Development of infrastructure to support program efforts
Series of meetings of ~ 60 nutritionists over 2 years
Consensus around goal and core strategies
Flexibility to allow programs to incorporate strategies in their own way
Coordination role given to Nutrition Policy and Health Promotion Unit.
EWPH Annual Meetings held in 1997, 1998, 2000, 2001, 2002.
Regional Partnership Meetings organized and held 2003 – 2005.

6. What we wanted to achieve:
Develop positive behavioral strategies
Establish consistent nutrition and physical activity recommendations in child nutrition and health programs
Link and reinforce EWPH recommendations at the community level
Our approach to the problem has some basic tenets:
- Development of strategies that are positive, behavioral and represent life-long healthy choices (simple messages that aren’t confusing)
- Consistently implement the strategies and promote the messages in program policies, guidelines, training and educational materials - families hear the same thing wherever the go
- awarded 3 demonstration projects, which are in their final year and have become model communities

7. Eat Well Play Hard Goal
To prevent childhood overweight and reduce long-term chronic disease risks through the promotion of physical activity and targeted dietary practices with children over the age of two.
EWPH is a comprehensive public health intervention, aims to be positive and simple
Goal:
- prevent children from becoming overweight
- reduce chronic disease risks such as high blood pressure, type 2 Diabetes,
- through promotion of physical activity and targeted dietary practices with children over the age of 2
Alarming national trends:
today’s kids not meeting their nutritional needs: recently released vital signs show that children ate slightly more fruit than vegetables, 6 in 10 didn’t eat enough fruit and 9 in 10 didn’t eat enough vegetables nationally. In NY WIC, we found that there has been an increase in vegetable consumption.

8. Original Eat Well Play Hard Strategies (1996-Present)
Increase developmentally appropriate physical activity
Increase consumption of 1% or less milk
and low-fat dairy products
Choice of strategies: wanted them to be simple, positive, address multiple chronic diseases (CVD), cancer, osteoporosis)
The work that was done in the mid 90’s to identify key strategies to address still holds up almost 10 years later.
Increase consumption of vegetables and fruits

9. Newest Eat Well Play Hard Strategies (2006-Present)
Decrease exposure to television and other recreational screen time
Increase the initiation and duration of exclusive breastfeeding

10. Eat Well Play Hard Implementation
1997 – EWPH incorporated into DON Programs
1999 – EWPH Community Projects initiated
2001 – Adoption of EWPH by NYS Partners for Children
2002 – Action for Healthy Kids collaboration
2003 – Incorporated into NYS Overweight & Obesity Prevention Program
2005 – Activ8Kids! Collaboration

11. Eat Well Play Hard Implementation
2006:
The original EWPH goals and strategies were reviewed to determine if revisions/additions were needed.
2007:
Subcommittees were formed to conduct an extensive literature review of newly proposed core strategies (breastfeeding, whole grains, TV time, healthy snacking and portion sizes).

12. Eat Well Play Hard Implementation
2008:
DON Policy on Flavored Milk was developed
Fruits and vegetables became a significant focus
OPC made aware of the significant food package changes proposed by WIC
DON Recipe Committee was formed to establish recipe standards

13. Eat Well Play Hard Implementation
2009:
Focus was utilization of FNS messages surrounding fruit/vegetable and low-fat milk consumption
WIC: increased breastfeeding promotion in hospitals and expanded peer counselor program
Increased awareness of the Governor’s obesity prevention agenda and the NYS Council on Food Policy

14. Eat Well Play Hard Implementation
2010:
Fruit and vegetable promotion
FNS messaging (secondary targets)
Obesity Prevention Council voted on priority issues to address in the coming year. Possibilities included:
Breastfeeding
Water
Sodium
Promotion of locally grown food

15. Highlights of Accomplishments Consistent Policies & Procedures
Annual WIC Nutrition Services Plan focus on EWPH strategies
WIC Healthy Lifestyles grants
WIC Vegetable & Fruit demonstration project
These are some examples of how our programs mesh the EWPH strategies with their core business
automated system has low fat milk as default setting for children over age 2, family has to ask to get whole or reduced fat milk, findings show when the nutritionists recommend trying low fat milk, participants often will
ask parents about children’s tv viewing, active play and food questions

16. Highlights of Accomplishments Consistent Policies & Procedures
HPNAP minimum nutrition standard for emergency meals requires vegetables and fruits
HPNAP Nutrition Policy Workgroup
10% for vegetables and fruit
2% for milk
HPNAP has doubled the required percentage of HPNAP dollars to be spent on V&F and fluid milk by our direct service contractors and food banks.

17. Highlights of Accomplishments Consistent Policies & Procedures
EWPH strategies incorporated into CACFP sponsor reviews and new sponsor training
EWPH incorporated into “Crediting Foods Guide” and other CACFP publications
Day care menu database

18. Highlights of Accomplishments Consistent Policies & Procedures
Activ8Kids! School Tool Kit (2006)
NYS Model Approach for Healthier Schools
Local school wellness policies
School nutrition guidelines
Promoting PA in youth
NYS supporting laws and regulations

19. Highlights of Accomplishments Education & Training
For program participants….
“Just Say Yes To Fruits & Vegetables” (SNAP-ED funded)
WIC Nutrition Education Curriculum
CACFP Team Nutrition Training Grant
Fit WIC
Eat Well Play Hard in Child Care Settings (SNAP-ED funded)
The researchers found the following statistically significant results when they compared children in child care centers who received the EWPHCCS program to children in centers that did not receive the program:
 Increase in children’s daily at-home consumption of vegetables
 Increase in children’s at-home use of 1% or fat-free milk
 Increase in reports of the rate of child-initiated vegetable snacking
 Trend toward increased parental offerings of vegetables
Past two years have started Farm to Pre-school component at certain day care centers and a sustainability piece – Champions.

20. Highlights of Accomplishments Education & Training
For professionals….
EWPH Annual Meetings & Regional Partnership Meetings
1% or Less trainings & tool kits
EWPH listserv –training and funding opportunities
Fit WIC
Schools
SPIN
On-line training through Cornell Nutrition Works
Cornell Nutrition Works will be up by Summer 2006.

21. EWPH…Is it Working? Increased access to vegetables & fruit
HPNAP emergency food network – Approx $5.1 million exclusively for V/F
WIC Vegetable & Fruit Demonstration Project
88.6% of checks redeemed (FFY 2012)

22. EWPH…Is it Working? Just Say Yes to Fruits & Vegetables
84% of participants said they intend to prepare JSY recipes on their own
88% of participants said they intend to eat more F & V
Farmer’s Market expansion – use of Health Bucks
Data from the end of year 2012
NYC has had a Stellar Farmer’s Market component since 2002 and in 2011 started expansion of model in Rochester FM and will be adding two additional FMS upstate next summer. Partner with Food Banks and City HD to provide $2 Health Bucks to participants who complete the survey after class to increase purchasing power.

23. Prevalence of obesity among 2-4 year old children participating in WIC, NYS 2002 - 2011
New York was one of the 18 states, CDC mentioned that had some decline in childhood obesity rates based on 2011 PEDNESS data.

24. EWPH………
It’s working !
Can an approach like this work in your state too?