1. Obesity Prevention in New York City: Improving Health through System, Infrastructure, and Environmental Change Strategies Gretchen Van Wye, PhD, MA Deputy Director, Chronic Disease Prevention New York City Department of Health and Mental Hygiene Lancaster Summit May 24, 2012

2. Overview of NYC

3. New York City 8.4 Million residents 5 boroughs (counties) Many neighborhoods Ethnically diverse  35% White  27% Hispanic  24% Black  36% Foreign-born 21% live in poverty 1.8 million on Supplemental Nutrition Assistance Program (SNAP) Bronx Manhattan Queens Brooklyn Staten Island

4. Obesity Has Been Increasing in Adults Self reported obesity, NYC, 1994-2010

5. 57% of adults overall and 70% of adults in high-need areas are overweight or obese

6. 9.3% report diabetes

7. 30.3% drank one or more sugar-sweetened beverages per day.

8. Citywide Prevalence: 11.6%

9. The Obesity Problem: No Balance Calories consumed exceeds calories burned Physical activity: Has been designed out of our environment Food is now: Ubiquitous Cheap High in Calories Served in Large Portions Heavily Promoted

10. Food is Ubiquitous: Food Store Density in New York City Food outlet typeOutlets per square kilometer Food stores Supermarkets and medium-sized groceries3.5 Fruit and vegetable markets1.6 Bodegas/convenience stores16.6 Other food stores10.4 Restaurants Fast food3.4 Pizza4.2 Other restaurants38.9 Total78.6 Source: Rundle A et al. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect 2009;117:442-447.

11. Cost: Junk foods are Cheaper Compared to Fruits and Vegetables (F&V)

12. Who would expect this many calories (more than half a day’s worth for most adults) in one meal?

13. Source: The World of Coca Cola, Atlanta Georgia 2011. 16 ounces of Coke used to be enough for 3 people!

14. Exploding Beverage Sizes: McDonald’s Drinks Have Grown 457% Since 1955 1. Young L. The Portion Teller Plan: The No-Diet Reality Guide to Eating, Cheating, and Losing Weight Permanently. New York: Morgan Road Books, 2005. Print ; McDonald’s Website, retrieved November 10, 2010: http://nutrition.mcdonalds.com/getnutrition/nutritionfacts.pdf

15. Promotions encourage customers to purchase large portions to get “value” McDonald’s and Wendy’s have dropped the Supersize, Biggie and Great Biggie descriptors and now call the same huge sizes Medium or Large …Heavily Marketed...

16. Healthy Eating 16 Promote environmental changes that increase access to healthy foods and decrease consumption of unhealthy foods Encourage adoption of healthier food procurement standards in public and private settings Continue to lead and expand the National Salt Reduction Initiative and manage the national salt monitoring system Support the achievement of baby-friendly hospital status among NYC hospitals

17. Goal: Reduce by 5% the percentage of adults who consume 1 or more daily sugar sweetened beverages Impact: Approximately 93,000 of 1,856,000 adult NYers who reported consuming an average of 1 or more SSBs per day in 2010 How: Educating New Yorkers on the harms of sugary drink consumption Develop additional standards for healthy foods and beverages in new settings, for example meetings and events located at City agencies Reducing Consumption of Sugar-Sweetened Beverages

18. Reducing Sodium Consumption Goal: Monitor trends in sodium and key nutrients in US processed foods as part of the National Salt Reduction Initiative (NSRI) goal to reduce sodium in packaged and restaurant foods by 25% by 2014 Impact: Impact all of the US population- approximately 311 million people How: 28 companies have committed to date Monitoring changes in sodium through databases and company reports -- analyses underway Decrease sodium content in foods by 25% over 5 years Decrease population sodium intake by 20% over 5 years Reduce risk of heart disease– the leading cause of death in US

19. Baby-Friendly Goal: Increase from 2 to 12 the number of NYC public and private hospitals that are certified as Baby Friendly and increase the number of hospital working to become more baby friendly. Impact: Approximately 78,750 births in NYC over the next 5 years; 46,000 mothers of low SES. 25 of 40 maternity hospitals in NYC. How: By establishing and running a Hospital Learning Collaborative and providing technical assistance.

20. Early Successes

21. Obesity Prevalence in K-8 Decreased from 21.9% to 21% NYC Fitnessgram data, 2006-2010

22. Decrease in Sugary Drinks

23. Decrease in Percent of Adults Eating No Fruits & Vegetables

24. Thank you! Gretchen Van Wye, PhD, MA Deputy Director – Chronic Disease Prevention New York City Department of Health & Mental Hygiene gvanwye@health.nyc.gov