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The Nutrition Rx for Healthier Youth. Leslie Bonci, MPH,RD,LDN University of Pittsburgh Medical Center. SETTING THE STAGE. Information Gathering Why are we here? Lessons Learned What’s been done? What Next? Where are we Headed?. INFLUENCERS?. Family lifestyle/eating patterns
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The Nutrition Rx for Healthier Youth Leslie Bonci, MPH,RD,LDN University of Pittsburgh Medical Center
SETTING THE STAGE • Information Gathering • Why are we here? • Lessons Learned • What’s been done? • What Next? • Where are we Headed?
INFLUENCERS? • Family lifestyle/eating patterns • Relationship with parents/family • Mass media • Physiological needs • Self-concept • Body image
WEIGHT INFLUENCERS • Genetics • Stress levels and response • Medications • Food supply • Physical activity • Developmental stages • Endocrine status • Role models • Environment
THE BLAME GAME • Fingers point to food, but it is really an Energy Balance issue • Food (what we eat) + Eating (why, when, how much,where we eat) = Nutrition • Nutrition + Activity (how much, how strenuous) = Energy Balance (+/-/=)
WHERE DO WE START? • Attitudes about food and eating are learned and reinforced at home • Often times, it is easier to give in or give up than argue • Parents/caregivers/teachers are role models
WHAT DO KIDS NEED TO KNOW ABOUT NUTRITION? • SETTING THE STAGE FOR OPTIMAL FUELING: • Need to educate about: • Food choices: What to eat/drink • Timing of meals and snacks • Portions: How much to eat • Not too much or too little but just right • Is NOT One size fits all
WHAT ABOUT PARENTS/ TEACHERS/COACHES? • Growth and development issues • Body needs the optimal amount of calories as well as protein, carbohydrate, fat, fluids, vitamins and minerals to grow well • A poorly nourished child cannot perform well on the field or in the classroom • Inadequate nutrition increases the risk of illness and injury • Overly nourished children are at a higher risk of becoming overweight, putting greater physical stress on the body
WHAT AM I HEARING • I’m tired • Other kids make fun of me • I have to eat “special foods • My body hurts • I don’t get picked for teams • I can’t eat my favorite foods
BODY COMPOSITION • Body Mass Index ( BMI) • BMI= weight/height² • Weight in kilograms • Height in Meters (m) squared • Related to both total FM and FFM • Correlations between BMI and fat and lean components of body composition vary among children and adolescents • http://www.cdc.gov/growthcharts.htm
JUST DI-ET • Dieting may result in: • Overeating • Undereating • Sneaking food • Undernutrition/malnutrition • Weight gain • Set up for failure • Disappointment
GROWING UP TODAY STUDY • Cohort of children who were offspring of the Nurses’ Health Study II participants • 3 yr follow up • Those on weight loss diets gained more weight relative to predicted body weight than non dieters AND were more likely to binge eat
WHAT ARE SOME OF THE BARRIERS? • Bad attitudes about food • Emphasis on the negative • Focus on one aspect of a food instead of the whole food • Blame placed on food/food groups for health concerns • Misinformation/too much information
BARRIERS (cont’d) • Separate food from emotions/eating habits • 24/7 availability of food • Too many choices • Food as a reward/diet as punishment • Eating is an afterthought • Time constraints resulting in fewer family meals • Cost • More eating out/emeals
CONSEQUENCES • Kids are not acquiring meal planning, food shopping and preparation skills • Eating in is a thing of the past • As participation in the production and sharing of meals diminishes, the expectations of satisfaction from food increases as does intake!
OTHER VARIABLES • Passivity- if we ignore it, it will go away • Whose responsibility is it anyways? • Assumption that kids are little adults • TV • Environmental challenges: • Home • School • Food deserts • Unsafe neighborhoods
WHAT ARE KIDS EATING? • Top heavy ( more fats and sweets) • Less than ideal amounts of filling,nutrient dense foods such as meat,poultry,fish, and dairy foods • Minimal amounts of high fiber,”chew” foods such as fruits and vegetables • Slightly less number of grain servings than desired
ISSUES • An already crowded curriculum results in: • Less time for physical activity • Less time for lunch • More time for sitting
OFF THE COUCH! • 1969: 80% of kids did daily sports • 2000: 20% of kids did daily sports • From 1980-2000 in children ages 12-19: • Obesity increased 10% • Calorie intake increased 1% • Physical activity decreased 13% • California study: Higher SAT scores seen in children with higher levels of fitness! • Exercising 2 times a week (vigorous) can result in a 4-5 pound weight loss/year
LATCHKEY KIDS • Make meals for themselves • Make snacks for themselves • Need to remain at home so outdoor activity may be nonexistent • Eating is companionship, comfort and something to do
INFLUENCE OF TV • Ads • New physical activity? • Eat while viewing • Brigham and Women’s Hospital study of 10,000 9-14 year olds:larger increase in BMI in those who spent more time watching TV/playing video games • Majority of kids watch at least 2 hours of TV a day- each additional hour lead to 1-2 pound weight gain/yr • By age 17 a child will have spent 38% more time in front of the TV than in school
Family Nutrition & Physical Activity Survey • Conducted by the American Dietetic Association as part of the Healthy Weight for Kids Initiative • Survey of 1230 families with kids ages 8-17
SURVEY FINDINGS • 43% of kids eat when bored • 16% eat when angry • 23% eat all or most of the time when engaging in sedentary activity • 21% of girls do NOT like what is offered to eat at school • 12% of boys do NOT like what is offered to eat at school
SURVEY FINDINGS • BODY SATISFACTION • Scale of 1-10 • 1: Very dissatisfied • 10: Very satisfied • Girls rate themselves as 6.4 • Boys rate themselves as 6.9
SURVEY FINDINGS • participation in physical activity with parents results in in child’s body satisfaction • age of the child body satisfaction • A family member telling a child to do something about his/her weight has a negative impact on body satisfaction • Children who report eating more nutritious foods have the highest level of body satisfaction
OTHER IMPORTANT OBSERVATIONS • Parents believe kids will outgrow weight problems and hesitate to take action • Parents are disengaged from their kids eating habits and ONLY recognize weight as an issue when health problems arise or if weight is of sufficient magnitude to interfere with school/work • Parents feel ill-equipped to handle weight issues with their children • Parents feel intervention will cause unhealthy eating disorders
OTHER OBSERVATIONS • Parents and kids relate obesity more to food than lack of activity • Kids and parents feel that eating healthy is negative or punishing • Children equate eating healthy with following rules
HEALTHY PARENTING INITIATIVE • Collaborative effort between WellPoint and the American Dietetic Association • Healthy Habits Quiz for Healthy Families
HEALTHY HABITS QUIZ • Do you have regularly scheduled mealtimes at home? • Do you eat meals together at least once a day? • Do you plan snacks? • Do you eat three meals a day? • Do you try to make mealtimes enjoyable?
HEALTHY HABITS QUIZ • Do you avoid making everyone eat everything on their plate? • Do meals last longer than 15 minutes? • Do you eat only in designated areas of the house? • Do you avoid using food to punish or reward? • Do you enjoy physical activities together once or twice a week?
REAL WORLD SOLUTIONS • AT HOME: • Use kid-sized utensils, plates, glasses • Serve kid- friendly portions • Let kids learn when they are hungry/satisfied • Don’t overly restrict food • Encourage slowing down while eating • Make eating purposeful • Designate “No Eating” Zones in your home
PARENTS CHECKLIST • Do not nag • Offer regular family meals or improve on take-outs, ie. Sitting down and unwrapping/plating the food! • Set realistic goals for family meals • Frequently re-evaluate the schedule to maximize quality meal time
FOCUS ON THE WHOLE FOOD • Food is not just fat, carbohydrates or calories • Increase nutrient dense foods such as nuts, whole grain breads, legumes, vegetables, dairy foods • Bodies need carbohydrate, protein and fat every day
SENSE-SURROUND! • Taste and hands-on • Sweet, salty, spicy, mild? • Crunchy,creamy • Cold,hot • The “chew” factor • The “ fill” factor • The “Long-lasting” factor • The “excitement” factor
CHANGE THE EATING ENVIRONMENT • Make the eating environment conducive to success • Define goals • Have the foods around that will help with success • Keep trigger foods out of sight,or better yet, out of house, desk, locker, knapsack or car!
SCHOOL CHECKLIST • Change the menu- make haste slowly • Make eating healthy a school-wide initiative with incentives • Try to incorporate fitness into EVERY day or every class period • Provide time for kids to eat and play • Use videos/DVDs- Eating School/Body School • Teach concept of Energy Balance: Nutrition + Activity = Energy Balance
WHAT CAN SCHOOLS DO? • Ensure 20 minutes for student athletes to eat • Offer variety • Performance buffets • Ethnic food themes • Food Bars: • Pasta/Potato • Tacos
CAFETERIA STRATEGIES • Involve the Food Service Staff • KID SIZED ITEMS • Ask the students what they would like to see • Educate while the kids eat (This works especially well if they get class credit!)
WHAT MAKES THE CAFETERIA APPEALING • Color • Cleanliness • Comfort • Well-lit • Not overly crowded • Color-coded nutrition information to assist athletes with making food choices
VISUAL DISPLAYS • National Dairy council: www.drink-milk.com • Gatorade Sports Science Institute www.gssiweb.com • American Dietetic Association: www.eatright.org • Team Nutrition Home Page: • http://www.fns.usda.gov/tn
SCHOOL INVOLVEMENT • Some brand name items • Favorite recipe day • Bonus days • Give-away items • Pre event meal dress-up and festivities • Training table choices: < 30% cal from fat • Grab-and-Go concept
A PROGRAM THAT HAS WORKED • Jamie Oliver, The Naked Chef-has developed a program in schools in Great Britain called Feed Me Better • www.feedmebetter.com • Recipes for home- www.jamiesdinners.com
A CONCEPT • The Winning Plate • Goal: • Sit down to the plate • Step up to the win • Emphasis on food over supplements • Food/Activity as equal partners
ISSUE OF VENDING MACHINES • Access times • Placement • Items chosen for purchase • How revenue generated is used • Messaging on the machine(s)
VENDING MACHINE CHOICES • Pretzels/baked chips • Animal crackers/peanut butter crackers • Cereal boxes • Trail mixes • Granola/cereal bars • Fig Newtons/graham crackers • Sports drinks/juice/water
BOOSTER CLUBS • Snack items for athletes for practices and games • Co-ordinate pre-game meals and post-game energy replacers! • Booster club could sponsor nutrition information for the cafeteria
KIDS CHECKLIST • Take ownership • Think about what one is willing to take on AND give up? • Ask for help • Educate one another • Be an active participant in food choices and meal preparation, not just a spectator • Listen to body cues • Customize portions
COMPONENTS OF A HEALTHY LIFESTYLE • Actionable • All inclusive (food, habits, activity) • Support system • Sustainable • Realistic • Not life-changing • Affordable