In an interview with Childhood Obesity, Susan Kansagra, MD, MBA, discusses the city's initiatives to improve the nutrition and physical activity environments and support healthy eating and active living.
New York City has become well known for cutting-edge health campaigns related to portion size for sugar-sweetened beverages, NYC Green Carts, and the Active Design Guidelines, among others. Which has had the greatest impact on childhood health in the city?
Dr. Kansagra: We have started to see declines in childhood obesity rates, especially for younger children.
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There may be a number of reasons for this decline. In general, we have tried to make the environment, in which adults and children reside, healthier by increasing opportunities for physical activity, increasing access to healthy foods, and reducing consumption of unhealthy foods.
To increase physical activity, we have worked to engineer physical activity back into daily life. For example, we have created “Active Design Guidelines” for architects and urban planners on how they can incorporate design elements, such as open stairwells, bike lanes, and play spaces, in our buildings, streets, and city.
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These guidelines are incorporated into new city construction projects. In schools, we have trained teachers on how to incorporate physical activity into the classroom. We have also run mass media campaigns that show New Yorkers how to “Make NYC Your Gym” by including physical activity in everyday routines.
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We also encourage active transportation, such as walking, biking, and using public transportation, which also increases physical activity.
To increase access to healthy foods, the city has tried to lead by example by setting nutrition standards across all city agencies, including schools. We are also increasing access to healthy foods in retail settings by working with bodegas to offer healthier goods, introducing Green Carts (mobile fruit and vegetable vendors located in high-need areas), and by distributing Health Bucks (vouchers for redeeming fresh produce at farmers' markets).
To reduce consumption of unhealthy foods, we are focusing on sugary drinks—a leading driver of the obesity epidemic.
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We are educating adults and children about the health consequences of sugary drinks, including the increased risk of obesity and related health outcomes. We also are continuing to fight the legal challenge against our cap on portion sizes of sugary drinks.
The CDC found that from 2006–2007 to 2010–2011, the largest decrease in the prevalence of childhood obesity—from 20.2% to 18.2%—in New York City was in children ages 5–6.
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Are there data that show to what this decline can be attributed and, particularly, in this age group?
Dr. Kansagra: It is difficult to ascribe a single cause to this decline as the decrease in childhood obesity rates coincides with a number of efforts over the last decade, including implementation of standards to improve food in schools and day care centers, media messages educating on the risks of sugary drinks, breastfeeding promotion efforts, and improvements to the food package offered through the Women, Infants and Children nutrition program. Given that obesity has been only increasing, the downward trend that has been seen in 5 to 6 year olds is encouraging.
Could you outline some of the environmental approaches to health in New York City, such as the Active Design Guidelines and the promotion of stair climbing, that would be most applicable to children and families?
Dr. Kansagra: Our approach is about making it easier to engage in healthy activities, including physical activity. As part of the city's efforts to increase physical activity, we have added bicycle lanes and created pedestrian plazas and play spaces. Given that New York City is a vertical city, we have also worked to promote the use of stairs in both residential and commercial buildings. We also work with architects and urban planners to build our city in a way that makes it more conducive to playing, walking, and bicycling. We also have implemented physical activity programs in schools and parks throughout the city.
Some of the initiatives spearheaded by the New York City Department of Health have not been approved, such as the plan to limit the size of sodas and the SNAP Demonstration Project, which was rejected by the USDA. What have you and your team learned from these setbacks and what do you have planned for the future of these initiatives?
Dr. Kansagra: We need to continue to engage communities and policy makers around key public health problems and solutions to address them. Innovative and “out of the box” ideas can sometimes encounter resistance initially. When smoke-free air policies and the trans fat restriction were first introduced, they were met with resistance, but now public support for these policies is very high. In fact, since the implementation of the trans fat restriction, 16 cities and states have passed similar regulations and the FDA recently proposed measures that would eliminate artificial trans fats from the food supply.
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We need to continue to innovate and implement solutions that can have an impact at a population level.
What plans are there for future health campaigns in New York City to further address childhood obesity?
Dr. Kansagra: We will continue to educate New Yorkers on the benefits of healthy eating and active living, change the environment to support individuals in making healthier choices in their lives, and look for innovative solutions to tackle this issue. Obesity threatens to undo the gains we have made in life expectancy over the last two centuries. We must continue to strive for bold, innovative solutions to turn this epidemic around.
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