Appendix B
Criteria for Nutrition and Physical Activity Strategies and Objectives

Related to obesity

The purpose of the plan is to provide guidance for policies that will improve nutrition and physical activity environments in order to achieve related health benefits; in particular the reduction and prevention of obesity and chronic diseases such as diabetes and cardiovascular disease.


The focus of the plan is on population-based strategies and policy and environmental changes to foster a reduction in obesity. Health education is an equally important, complimentary approach.

Evidence-based, theoretically sound, or recommended by nationally recognized authorities or experts

  • Evidence-based:

    The criteria used by the Task Force on Community Preventive Services will be used as the criteria to determine whether a strategy is evidenced-based as follows:

    1. Most suitable: studies with concurrent comparison groups and prospective measurement of intervention (strategy) and outcome.
    2. Moderate suitability: studies with retrospective designs or multiple pre or post measurements but no concurrent comparison group
    3. Least suitable: single pre and post measurements and not concurrent comparison group OR exposure and outcome measured in a single group at the same point in time.
  • Strategies that have multiple studies in categories one and two indicating the same outcome are strongly evidence-based. Strategies where there are some, but not a sufficient number of studies in categories one and two to make strong statements of evidence-based effectiveness, would rank lower on being evidence-based. If studies fell into category three or if there were no formal studies, then the effectiveness of the strategy is not evidence-based.

  • Theoretically sound:  For strategies that have not been formally studied, there needs to be a logic model linking the strategy to the intended goal. The plan might include a recommendation that if a strategy that is theoretically sound, but not evidence-based, is undertaken, it is important to include an outcome, rather than a process evaluation.
  • Recommended by a national group:  Generally, nationally recognized authorities or experts recommend strategies that are based on quality standards relevant to their work. Therefore, recommendations by nationally recognized groups support the strategy as being evidence-based, theoretically sound or otherwise advisable. If the strategy is not evidence-based, it is important to include an outcome, rather than a process evaluation.

Large impact for the resources used

Strategies that affect a relatively large portion of the population have the potential to have a greater impact in reducing obesity than those that affect a relatively smaller portion of the population. Therefore, DOH recommends ranking strategies that affect a large portion of the population relatively higher than those that affect fewer people.


It is important to know how successful a particular strategy is in helping to meet an objective. Therefore, DOH recommends that objectives that are measurable be ranked higher than those that are not measurable. Being measurable does not mean that they are currently measured, only that they are written in a manner that makes them capable of being measured.