The Nutrition Rx for Healthier Youth

1. The Nutrition Rx for Healthier Youth Leslie Bonci, MPH,RD,LDN University of Pittsburgh Medical Center

2. SETTING THE STAGE • Information Gathering • Why are we here? • Lessons Learned • What’s been done? • What Next? • Where are we Headed?

3. INFLUENCERS? • Family lifestyle/eating patterns • Relationship with parents/family • Mass media • Physiological needs • Self-concept • Body image

4. WEIGHT INFLUENCERS • Genetics • Stress levels and response • Medications • Food supply • Physical activity • Developmental stages • Endocrine status • Role models • Environment

5. 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 (+/-/=)

6. 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

7. 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

8. 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

9. 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

10. 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

11. JUST DI-ET • Dieting may result in: • Overeating • Undereating • Sneaking food • Undernutrition/malnutrition • Weight gain • Set up for failure • Disappointment

12. 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

13. 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

14. 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

15. 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!

16. 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

17. 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

18. ISSUES • An already crowded curriculum results in: • Less time for physical activity • Less time for lunch • More time for sitting

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. HEALTHY PARENTING INITIATIVE • Collaborative effort between WellPoint and the American Dietetic Association • Healthy Habits Quiz for Healthy Families

29. 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?

30. 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?

31. 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

32. 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

33. 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

34. 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

35. 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!

36. 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

37. WHAT CAN SCHOOLS DO? • Ensure 20 minutes for student athletes to eat • Offer variety • Performance buffets • Ethnic food themes • Food Bars: • Pasta/Potato • Tacos

38. 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!)

39. WHAT MAKES THE CAFETERIA APPEALING • Color • Cleanliness • Comfort • Well-lit • Not overly crowded • Color-coded nutrition information to assist athletes with making food choices

40. HAVE VISUAL DISPLAYS

41. 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

42. 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

43. 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

44. 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

45. MAKE IT FUN!

46. ISSUE OF VENDING MACHINES • Access times • Placement • Items chosen for purchase • How revenue generated is used • Messaging on the machine(s)

47. 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

48. 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

49. 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

50. COMPONENTS OF A HEALTHY LIFESTYLE • Actionable • All inclusive (food, habits, activity) • Support system • Sustainable • Realistic • Not life-changing • Affordable