A case study of the New York City trans-fat story for international application.

Heart disease is the leading cause of death in New York City and contributes to significant burden of disease in the United States and internationally. Excessive intake of artificial trans-fatty acids has been causally associated with increased risk of heart disease. This article describes New York City's 2007 trans-fatty acids regulation, which was aimed at lowering the prevalence of heart disease among the city's residents by prohibiting the use of trans-fatty acids in the preparation of food in the city's food outlets. The author describes sequentially: (1) formulation, (2) public consultation, (3) implementation and (4) evaluation of the policy. He proposes a strategic framework for food policy development for international policymakers who are considering similar regulations. The framework includes four domains: (1) background research, (2) stakeholder support, (3) effective policy implementation and (4) evaluation and dissemination.