Strategies for Improving Nutrition
Policies & Environments
•Center TRT: 26 Strategies Based on Best Available
Evidence
•CDCs Recommended Nutrition Strategies
• Media, Access, Point of Decision Information, Price, and
Social Support & Services (MAPPS) interventions
Center TRT: Intervention
Strategies
• http://centertrt.org/?p=find_strategies
Intervention strategies are broad approaches to
address healthy eating, physical activity and
obesity prevention. Each of the intervention strategies
described in this section can be part of an overall
strategy to prevent obesity in states and communities.
More often than not, multiple strategies will be
combined to create a comprehensive obesity
prevention initiative. These intervention strategies
answer the question: What are the best available
options for taking action to prevent and control
obesity?
26 strategies/One Stop
Shopping, based on:
1. CDC’s Community Strategies and Measurements to
Prevent Obesity in the U.S. (COCOMO)
2. CDC’s Guide to Breastfeeding Interventions
3. The Community Guide by the Community Prevention
Services Task Force
4. IOM’s Early Childhood Obesity Prevention Policies
5. IOM’s Local Government Actions to Prevent Childhood
Obesity
6. Convergence Partnership’s Promising Strategies for
Creating Healthy Eating & Active Living
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Active Transportation
• Changing Access and Availability to Favor Healthy Foods and
Beverages
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Community-Wide Campaigns to Promote Healthy Eating
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Community-Wide Campaigns to Promote Physical Activity
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Comprehensive Nutrition Programs in a Single Setting
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Decreasing Screen Time and Other Sedentary Behaviors
• Education for Mothers about Breastfeeding during Prenatal and
Intrapartum Periods
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Food and Beverage Marketing to Favor Healthy Foods and Beverages
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Increase Purchasing and Use of Foods from Local Farms
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Increasing Access to and Number of Places for Physical Activity
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Individual Counseling about Healthy Eating
• Individually-tailored Health Behavior Change Programs to Increase
Physical Activity
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Maternity Care Practices in the Hospital Setting
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Media Campaigns and Social Marketing Promoting Breastfeeding
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Peer Support for Breastfeeding
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Point-of-Decision Prompts for Stairwell Use
• Point-of-Purchase and Point-of-Decision Labeling to Favor Healthy
Foods and Beverages
• Pricing Strategies (Including Taxation) to Favor Healthy Foods and
Beverages
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Professional Support for Breastfeeding by Health Professionals
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School Nutrition Programs to Promote Healthy Eating
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School-Based Physical Activity and Physical Education
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Social Support for Healthy Eating
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Social Support for Physical Activity
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Support for Breastfeeding in the Workplace
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Urban Design-Policy and Zoning to Facilitate Physical Activity
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Urban Planning-Zoning Approaches to Facilitate Healthy Eating
Go to the TRT web site for:
• a brief description of the strategy,
• the documents that support the strategy,
• the setting in which the strategy would be
implemented,
• several examples of the strategy in action,
• the TRT-reviewed interventions that
employ the strategy, and
• resources and tools related to
implementation of the strategy.
Recommended Community
Strategies and Measurements to
Prevent Obesity in the United States
“Where people live, work and play affects their health.”
http://www.cdc.gov/NCCDPHP/DNPAO/Publications/index.html
Recommended Community
Strategies & Measurements to
Prevent Obesity in the United
States
http://www.cdc.gov/obesity/downloads/community_strat
egies_guide.pdf
Recommended Strategies and
Associated Measures in 6 Categories
1. Promote availability of affordable healthy food
& beverages
2. Support healthy food and beverage choices
3. Encourage breastfeeding
4. Encourage physical activity or limit sedentary
activity among children & youth
5. Create safe communities that support physical
activity
6. Encourage communities to organize for change
Process
• Literature search & analysis resulted in
179 policy-level strategies.
• Select expert panel rated each strategy:
– 47 most promising (26 nutr, 17 pa)
• Strategies were matched with appropriate
measures & expert review resulted in 25
recommended strategies with measures.
• Pilot tested in 20 local settings & modified
for a final total of 24 strategies.
Criteria used by the Select Expert Panel to
rate each proposed strategy
Criterion
Description
Reach
The strategy is likely to affect a large percentage of the
target population.
Mutability
The strategy is in the realm of the community's control.
Transferability
The strategy can be implemented in communities that
differ in size, resources, and demographics.
Effect size
The potential magnitude of the health effect for the
strategy is meaningful.
Sustainability of
health impact
The health effect of the strategy will endure over time.
11 nutrition strategies
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Healthy foods in public service venues
Affordable food in public service venues
Geographic availability of supermarkets
Incentivize retailers for healthy foods
Mechanisms for purchasing foods from farms
Incentives for food from local farms
Restrict unhealthy foods/bevs in public venues
Smaller portions in public venues
Limit ads for less healthy foods
Discourage consumption of sugar-sweetened bevs
Increase support for breastfeeding
1. Communities Should Increase Availability
of Healthier Food and Beverage Choices in
Public Service Venus.
Overview
• Limited availability of healthier food and beverage options
can be a barrier to healthy eating and drinking. Healthier food
and beverage choices include, but are not limited to, low
energy dense foods and beverages with low sugar, fat, and
sodium content (11). Schools are a key venue for increasing
the availability of healthier foods and beverages for children.
Other public service venues positioned to influence the
availability of healthier foods include after-school programs,
child care centers, community recreational facilities (e.g.,
parks, playgrounds, and swimming pools), city and county
buildings, prisons, and juvenile detention centers. Improving
the availability of healthier food and beverage choices (e.g.,
fruits, vegetables, and water) might increase the consumption
of healthier foods.
Evidence
• CDC's Community Guide reports insufficient evidence to
determine the effectiveness of multicomponent schoolbased nutrition initiatives designed to increase fruit and
vegetable intake and decrease fat and saturated fat intake
among school-aged children (22,23). However,
systematic research reviews have reported an association
between the availability of fruits and vegetables and
increased consumption (24,25). Farm-to-school salad bar
programs, which deliver produce from local farms to
schools, have been shown to increase fruit and vegetable
consumption among students (12). A 2-year randomized
control trial of a school-based environmental intervention
that increased the availability of lower-fat foods in
cafeteria à la carte areas indicated that sales of lower-fat
foods increased among adolescents attending schools
exposed to the intervention (26).
Suggested measurement
• A policy exists to apply nutrition standards
that are consistent with the Dietary
Guidelines for Americans to all food sold
(e.g., meal menus and vending machines)
within local government facilities in a local
jurisdiction or on public school campuses
during the school day within the largest
school district in a local jurisdiction.
MAPPS
• Media, Access, Point of Decision Information,
Price, and Social Support & Services (MAPPS)
interventions
• List of strategies put together in 2009 by CDC to
support applications from states and local health
departments for prevention initiatives for
nutrition, physical activity and tobacco.
• Each strategy has some evidence for
effectiveness.
http://www.cdc.gov/chronicdisease/recovery/docs/Additional_in
formation_for_N_and_PA_MAPPS_strategies_cleared.pdf
Media
• Media and advertising restrictions
consistent with federal law
• Promote healthy food/drink choices
• Counter-advertising for unhealthy choices
Access
• Healthy food/drink availability (e.g., incentives to food
retailers to locate/offer healthier choices in underserved
areas, healthier choices in child care, schools, worksites)
• Limit unhealthy food/drink availability (whole milk, sugar
sweetened beverages, high-fat snacks)
• Reduce density of fast food establishments
• Eliminate transfat through purchasing actions, labeling
initiatives, restaurant standards
• Reduce sodium through purchasing actions, labeling
initiatives, restaurant standards
• Procurement policies and practices
• Farm to institution, including schools, worksites,
hospitals, and other community institutions
Point of Purchase/Promotion
• Signage for healthy vs. less healthy items
• Product placement & attractiveness (e.g.
as part of healthy corner store)
• Menu labeling
Price
• Changing relative prices of healthy vs.
unhealthy items (e.g. through bulk
purchase/ procurement/competitive
pricing)
Social and Support Services
• Support breastfeeding through policy
change and maternity care practices
MAPPS Evidence and Resources
• Evidence for the MAPPS interventions:
http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA
_MAPPS_strategies_cleared.pdf
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“Example: “9. Procurement
policies and practices
establish mechanisms and guidelines for obtaining
healthier foods, including fresh fruits and vegetables.
They can be used to promote healthier foods, including
fruits and vegetables, at workplace cafeterias; in
workplace vending machines; and at meetings, events,
and conferences. Examples of such practices might
include the modification of food and beverage contracts
at schools or the identification of vending suppliers who
carry healthier vending items at worksites.”
– Document lists 4 resources
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Resources for Procurement
Policies
Strategy 6: Provide incentives for the production, distribution, and
procurement of foods from local farms. From: Recommended community
strategies and measurements to prevent obesity in the United States:
Implementation and measurement guide. This guide provides 24
recommended strategies to encourage and support healthy eating and
active living along with measures to help communities track their progress
over time. http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf
CDC’s Lean Works! offers interactive tools and evidence-based resources
to design effective worksite obesity prevention and control programs.
http://www.cdc.gov/leanworks/index.html
Growers' Collaborative is a program organized by Community Alliance with
Family Farmers (CAFF). The collaborative organizes small, family farms
into a single marketing unit. This lightens the marketing and distribution
burden from farmers and provides a more unified delivery option for
purchasers, such as public and private grade schools, colleges, hospitals,
and corporate cafeterias.
http://www.caff.org/programs/growerscollaborative.shtml
Making it Happen! School Nutrition Success Stories provides a collection of
success stories describes approaches that schools, districts, or states have
used to improve the nutritional quality of foods offered at school.
www.cdc.gov/HealthyYouth/MIH
http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for
_N_and_PA_MAPPS_strategies_cleared.pdf
In Class Groups
• Select one strategy to address your
priority issue from one of these:
– Center TRT
– CDC Recommended Community Strategies
– MAPPS list
• Using the ideas presented about this
strategy in the document, start to lay out
your approach to applying the strategy in
Delridge/White Center.