According to the Department of Health and Mental Hygiene (DOHMH), obesity levels over the past 20 years have doubled in the United States. In NYC, obesity has reached epidemic proportions: close to 60% of the adult population is either overweight or obese. Often, the problem begins very early in life: about 50% of elementary school age children are not at a healthy weight or are considered obese. To combat obesity and reduce the health risks associated with it, NYC has created multiple initiatives under the Physical Activity and Nutrition (PAN) program. Overweight adults and children face increased risk of diabetes, heart disease, stroke, high blood pressure, arthritis and cancer. Poor eating habits also contribute substantially to higher obesity rates. The likelihood of obesity increases with age and is found to be more common among older adults, women, African-Americans, Hispanics, and the poor. Fortunately, obesity is preventable and even a modest amount of weight loss can improve a person's wellness and reduce health risks. Environmental factors and technological innovation have created conditions conducive for obesity. Processed foods are readily available and contain high levels of sugar, fat and salt. With many NYC children suffering from excess weight or obesity, a major focus has been placed on school food programs in an effort to curb obesity and related chronic diseases. As a result, several initiatives have been implemented to target communities with higher obesity rates characterized by lower rates of physical activity and fruit/vegetable consumption. The DOHMH works closely with childcare centers, preschools and parents to provide useful insights into child nutrition and physical activity. The Eat Well, Play Hard Program targets childcare centers in neighborhoods throughout NYC. At eligible childcare centers and preschools, registered dietitians provide lessons on the importance of integrating good nutrition and physical activity for children ages 3 to 4. Workshops for parents are intended to be enjoyable, engaging and often include food tastings and cooking. Topics for discussion include: the importance of family meals, appropriate portion size, enjoyable ways to be physically active, and how to incorporate a healthy diet into meals while on a budget. The Healthy High Schools Initiative works with high schools to implement healthy food and non-food fundraisers instead of junk food. GrowNYC and the DOHMH have launched a pilot project where a limited number of schools will be given the opportunity to explore alternative produce or plant sales for fundraising. Move-To-Improve is another initiative offered by the City. It is a comprehensive and engaging way to help teachers integrate physical activity into classroom academics. The initiative requires schools to fulfill the New York State Education Department mandate for 120 minutes of physical education per week. In NYC, convenience stores called "bodegas" are everywhere and many rely on them for daily shopping needs. However, healthy choices like fruit, vegetables and low-fat milk may be limited at these locations. Since 2005, the Healthy Bodegas Initiative (HBI) has helped more than 1,000 bodegas in Harlem, the South Bronx and Central Brooklyn increase theirassortment of healthy foods like fresh fruit and vegetables, whole grain bread, low-fat milk and dairy, and low salt canned foods. Additionally, bodegas are encouraged to apply for permits that allow them to sell fresh produce in storefronts. The HBI also helps stores promote and advertise their healthier items to customers in high-need areas throughout NYC. Green Carts are mobile food carts that offer fresh produce in certain NYC areas. Local Law 9, signed by Mayor Bloomberg in 2008, established 1,000 permits for Green Carts throughout the five boroughs. A Green Cart can only sell raw fruit and vegetables that haven't been modified or processed. Obesity costs employers an estimated $45 billion per year. It increases employee absenteeism and contributes to lost productivity within the workplace. To combat obesity in the workplace, NYC has launched its own initiative to incorporate healthier food for city employees. Private employers are also encouraged to join these efforts by providing useful guidelines regarding appropriate food and beverage items to serve at meetings and corporate events. Shape Up New York is a free family fitness program offered at public parks, community centers and housing sites around NYC. Fitness classes are open to adults and children and offer many types of exercise activities. The program is aimed at encouraging the development of a healthy lifestyle and improving participant self-esteem through energetic physical activity in a non-competitive environment.