Health literacy at work to address overweight and obesity in adults: The development of the obesity action kit Correspondence to: Christina Zarcadoolas, Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA Christina.zarcadoolas@ mssm.edu Christina Zarcadoolas 1 , Yvette Sealy 2 , Joslyn Levy 3 , Michelle Dresser 4 , Diego Ponieman 5 , Shiu May Young 6 , Lisa Littman 1,7 , Kelly Larson 8 , Lynn Silver 4 1 Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA 2 Fordham University Graduate School of Social Service, New York, NY, USA 3 Joslyn Levy & Associates, LLC, NY, USA 4 New York City Department of Health and Mental Hygiene, Queens, NY, USA 5 Department of Internal Medicine, Mount Sinai Hospital New York, NY, USA 6 University of Virginia, Charlottesville, VA 7 Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA 8 New York City Department of Health and Mental Hygiene, NY, USA Abstract Overweight and obesity are chronic conditions affecting approximately 68% of adults and 31.7% of children ages 2–19 in the United States. Our aim was to apply an ecological model of health lit- eracy to better understand consumer needs relating to overweight and obesity, and use this information to develop an Obesity Action Kit for the New York City (NYC) Department of Health and Mental Hygiene’s (DOHMH) Public Health Detailing Program. Methods included: (1) conducting a health lit- eracy load analysis on a wide range of existing con- sumer messaging about overweight and obesity, (2) in-depth interviews with providers, and (3) focus groups with consumers. Provider themes included a universal concern about patient obesity and frus- tration with lack of success as well as an appreci- ation of the complexity of the issue, including its strong cultural drivers. Consumer themes included skepticism about providers’ role in helping them manage weight; strong cultural contextualizing; emotional distress and self-blame; poor food avail- ability; and the desire for positive, empowering messages about weight management. Findings were translated into the content of the Obesity Action Kit. Our target population included primary care providers visited by the Public Health Detailing Program and overweight residents resid- ing in low-income communities of NYC. Keywords: Obesity, Health promotion, Provider education, Academic detailing, Nutrition training, Health literacy Background Overweight and obesity are chronic conditions affecting as many as 68% 1 of adults and 31.7% 2 of children and adolescents in the United States. The rate of overweight and obesity has dramatically doubled between 1980 and 2002 for adults and tripled for children and adolescents. When New York City (NYC) data are examined by socio- economic status and race, the prevalence of over- weight and obesity in select neighborhoods and races is among the highest in the nation. For instance, in East and Central Harlem as well as Central Brooklyn, 31% of adults are obese and 33.8% are obese in South Bronx as compared to only 21% of residents being obese in all other neigh- borhoods of NYC. In the South Bronx, 7 out of every 10 residents are overweight or obese (71.3%). In Central Brooklyn and East and Central Harlem 6 out of 10 are obese or overweight. 3 Black and Hispanic New Yorkers – of all income levels – are more likely to be obese than white New Yorkers. Even among residents with household incomes 88 © W.S. Maney & Son Ltd 2011 DOI: 10.1179/175380611X13082296179316 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2