It's All About You

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 It's All About You

• Delivering Personalized, Relevant, Doable Dietary
  Guidelines

Presented by Sue Borra, RD Michele M. Tuttle,
MPH, RD Linda Farr, RD, LD
Society for Nutrition Education 39th Annual
Conference July 17, 2006 San Francisco, CA
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Points for Today

• Who is the Dietary Guidelines Alliance?
• Partnership history
• Its All About You program revision
• Target audience
• Communicator testing

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The Dietary Guidelines Alliance

• The American Dietetic Association
• The American Society of Nutrition
• Food Marketing Institute
• Food Products Association
• Grain Foods Foundation
• Grocery Manufacturers Association
• International Food Information Council Foundation

• National Dairy Council
• National Cattlemen's Beef Association
• National Pork Producers Council
• Produce Marketing Association
• Society for Nutrition Education
• The Sugar Association
• Wheat Foods Council

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In Liaison With

• U.S. Department of Agriculture
• Center for Nutrition Policy and Promotion
• Cooperative State Research, Education and
  Extension Services
• U.S. Department of Health and Human Services
• Office of Disease Prevention and Health Promotion
• U.S. Centers for Disease Control and Prevention
• U.S. Food and Drug Administration
• National Institutes of Health
• Presidents Council on Physical Fitness and Sports

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Dietary Guidelines Alliance Mission

• To provide positive, simple, consistent messages
  to help consumers achieve healthy, active
  lifestyles consistent with the Dietary Guidelines
  for Americans

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Dietary Guidelines Alliance Common Goal

• To provide consumers with concrete, practical
  ways to apply the Dietary Guidelines to THEIR
  lives
• Healthy Eating
• Physical Activity
• Desire to close the gap between what consumers
  SAY and what they DO

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Activity Timeline
2003-04 Communicate about weight management
through portion size messagingNEED FOR MORE
CONSUMER RESEARCH
1995-96 Conducted extensive qualitative consumer
research
1999 Released the Its All about You Nutrition
Communicators Tool Kit
1996 to date Alliance messages resonate and
multiply!
2001-02 Identified portion size as a priority for
consumer message development and conducted
consumer research
1996 Launched the Its All About You campaign
2006 Top prioritiescommunicating new Dietary
Guidelines and helping consumers manage weight
1995 Alliance established
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Back in 1995. . .

• Preparing for release of Dietary Guidelines
• Growing concern that consumers were tuning out
  nutrition messages

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Consumers told us

• They believe good health is important
• Good health means eating well and getting enough
  exercise
• Consumers are tired of negative nutrition
  messages
• They want to hear what to do, rather than what
  not to do
• Other life priorities compete with healthy eating
  and physical activity
• Recommended actions must fit into current
  lifestylenot be additive

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Its All About YouMake healthy choices that fit
your lifestyle so you can do the things you want
to do.
BE REALISTIC
BE ADVENTUROUS
BE FLEXIBLE
BE SENSIBLE
BE ACTIVE
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1999 Released the Nutrition Communicators TOOL
KIT

• Video
• Leaders Guide
• Owners Manual For Your Body
• A unique consumer piece

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Message Multiplication
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Signs of Success

• More than 20,000 tool kits distributed
• Nutrition communicators report ability to
  effectively motivate consumer behavior change
• Video 92
• Leaders Guide 81
• Owners Manual 90
• My audiences were pleased to see that a healthy
  lifestyle isnt rocket science! Thanks, youll
  make my job so much easier.

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Consumers Reconfirm Message Platform in 2004

• Consumers said the messages are
• positive
• motivating
• good reminder
• common sense
• not overly stringent
• can fit for many situations

This is more of a lifestyle change. It is not a
diet.
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2005 Dietary Guidance

• Dietary Guidance Evolves
• Evidence-based process
• Personalization
• New Principles to Communicate
• Weight management
• Energy balance
• Nutrient density
• Moderate fat messages, with emphasis on types of
  fat

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Dietary Guidelines Alliance 1995 to 2006

• DGA Continued Commitment to
• Delivering consistent messages to reduce consumer
  confusionSpeaking with one voice
• Combining limited resources for greater impact
• Committing to meet long-term nutrition
  communications needs
• Partnering (public-private) to communicate
  CONSUMER RESEARCH-BASED messages that will help
  consumers live a healthier lifestyle

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Remaining Relevant

• Adapt tips to current nutrition science and
  recommendations
• Consider current communications environment
• Consumer test, consumer test, consumer test!

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Evaluation and Testing of Its All About You
Materials

• Focus Group Results with
• Nutrition Educators
• Michele M. Tuttle, MPH, RD

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Research Objective

• To test the updated Its All About You materials
  with Nutrition Educators
• Content and format of the Owners Manual
• Content and format of the Video
• Content of the Leaders Guide

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Study Overview

• Its All About You Materials
• Owners Manual
• Video
• Leaders Guide

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What Is a Focus Group?
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Methodology
Methodology

• Four focus groups with nutrition educators
• Two in Baltimore, MD
• Two in Chicago, IL
• Two informal focus groups with consumers (video
  only)
• One in urban workplace
• One in suburban home

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Owners Manual Content
Focus Group Responses Positive Aspects
I think thats why I liked it so muchit took
the dry language of the Dietary Guidelines and
made it more user-friendly.
Its upbeat and positive.
Lots of good tips.
You knowthis is great. Theres probably
nothing youre ever going to create that is going
to be perfect for me in my clinical setting, so
Im going to grab the pieces that I like and just
modify it.you might improve it but Im still
going to dissect it a little bit.
It gives specific ideas of what actions
someone can take to be healthier.
I liked the personal warranty plan. I like
having people make self-management goals based on
all the other facts that are in there.
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Owners Manual Content
Focus Group Responses Negative Aspects
Its All About You focuses on your body.but
being healthy is not just about the food you
eat and activity you do, its how you relate to
stress in your life.
I think this is like a little bit too much to be
actually useful.
It was positive but overwhelming. It was just
too much.
I also dont think its very culturally
sensitive.
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Owners Manual Format
Focus Group Responses
Positive Responses
Negative Responses
Well, the print should be larger. Its too busy
on some pages.
I like the bullet pointed tips.
I think the wealth of tips is fine but you might
want to take half of them and put them on the
back of the page. increase the font and make it
double-sided.
The headings all run together. I think you
could probably space those out.
Too busy.
The pictures jump out at me more than the
suggestions. I think they dominate the pageI
think they distract me.
Theres open space for me to write, for my
clients to make notations which is nice you
might want to consider actually allocating a box
for notes-to-self.
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Recommendations for the Owners Manual

• Content
• Create a detailed table of contents
• Break tips into subtopics
• Provide space for goals under each major message
  area
• Review tips to ensure cultural sensitivity
• Include tips for hydration, emotional eating
• Include recipe resources

• Format
• Increase the font size
• Increase white space
• Two page layout
• Reduce tips
• Adjust logo headings
• Review, balance the graphics with text

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Its All About You Video What Do YOU Think?
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Its All About You VideoFocus Group Responses

• Nutrition Educators Said...

Obnoxious.
Cheesy.
Silly.
Fun.
Ultra quirky.
Entertaining.
I think everything was really humorous which I
think is necessary.that last segment was over
the top.
Why does Jason have a gut?
I think that the little bit of humor, even the
strange stuffmakes you remember. Its way goofy
and you can remember it.
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Its All About You VideoFocus Group Responses

• Consumers Said..

Fun.
Juvenile.
Cheesy.
Silly.
We pretty much know all this stuff but you know
what, I dont think about it a lot. It is a good
remindermaybe they could cut out the silliness.
But, its okay to be reminded.
Goofy.
Physical activity is such a big issue, I thought
they could do a lot better. Its such a narrow
thing to focus only on laser tag. I dont see an
adult playing laser tag.
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Its All About You Video Survey Responses
Overall Assessment
Consumers Memorable Information (n13)
Consumers Useful for Improving Habits (n 13)
NEs Helpful for Clients/ Patients (n34)
Consumers Clear Easy to Understand (n13)
NEs Clear Easy to Understand (n34)
?
3.5
3.8
3.7
3.8
4.1
Be Realistic
?
3.5
3.7
3.7
3.9
4.1
Be Adventurous
?
3.1
3.8
3.9
3.8
4.2
Be Flexible
?
3.5
3.7
4.1
4.0
4.2
Be Sensible
?
3.0
2.8
3.3
3.2
3.6
Be Active
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Recommendations for the Video

• Have a voiceover read each IAAY message.
• Conclude each segment with summary of key
  messages and tips.
• Freeze the action when tips are presented in the
  video or present the tips at the conclusion of
  each segment.
• Modify last video segment by editing it to focus
  on more realistic activities.
• Consider creating a humor warning that the
  video contains extreme silliness and
  exaggeration.
• Have Jason acknowledge that he struggles with his
  weight.

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Leaders Guide ContentFocus Group and Survey
Responses
I like the different statsthey did surveys with
consumer groupsI thought that was
interestingbecause this is stuff that we all
knowsometimes, as educators we have different
opinions of what we think the consumers want and
in reality its not necessarily their take on
it.
I think they could have spelled out how to use
it over a series of sessions. Use this part
once. Start with the video. I mean actually go
through step by step how to break it down, how to
add to it. You know, how to work with it.
May want to add more feedback in the section on
lessons learned from consumers. I feel the
consumer feedback in this packet is more
meaningful than the communicators feedback.
Negative comments may help to teach other
educators what not to do.
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Recommendations for the Leaders Guide

• Provide detailed lesson plans presenting the IAAY
  material over a series of group sessions or
  weeks.
• Include a lessons learned section that will
  provide educators with ideas and insights on
  teaching IAAY.
• Include talking points that can be used to
  introduce the Owners Manual and video.
• Video Provide talking points that can be used
  between segments, discussion questions to
  generate interaction.

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Additional Improvements

• Create a PowerPoint presentation
• Develop a poster with messages for classes

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Behind the Dietitians Door

• Recipes for Practical Application
• of the Tool Kit

Linda T. Farr RD,LD www.NutritiousTable.com
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San Antonios 5 Missions
Mission San Juan
Mission San José
Mission San Antonio The Alamo
Mission Espada
Mission Concepción
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San Antonio Credit Union
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Group Class Preparation

• Study Video and Communicators Tool Kit
• Determine Class Format
• Introduction 10 minutes
• DVD 30 minutes
• Discussion 10 minutes
• Break 10 minutes
• Supplies
• Laptop w/ speakers, projector
• Tool kit handouts, evaluation form
• Business cards
• Credits for annual review or prizes

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Positive Feedback
Humor kept me focused
Informative in a fun way.
Modules were short and sweet.
We see ourselves in the video.
Layout of information is simple and doable.
Personal Warranty Plan and writing goals make it
more realistic.
It motivates me to start somewhere
Very practical in a cleaver way.
I like the highlights and tips at the bottom of
the screen.
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Negative Feedback
Some parts were a little cheesy.
No discussion of drink options, dining out vs.
home cooking, good vs. bad fats
Handouts need color and larger print.
Handouts not eye friendlykind of a busy look.
I didnt get the message about taking one step
at a time and building upfrom the Be Active
message.
Main character not physically appealing.
Want specific dietary guidelines goals for
exercise.
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Group Rating VideoExcellent/Good
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One Month Follow-up
I learned that I dont have to drastically
change all my habits from one day to another.
 Thats one of the things that was holding me
back.  I realized I have to set small goals for
myself.  

 I found out that my eating habits were out of
control.  Looking at the portion sizes and
comparing them to everyday items was very
helpful. I realized what I called a portion size
was two to three times larger than it should
have been. 
I am still walking 1hr ½ a day and staying away
from high sugar foods. The motivation is still
there, lost about 40 lbs. The message I took from
the class was keep your body healthy.
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Problem List Cheat Sheet

• Feeling Guilty Be Flexible
• Food Boredom Be Adventurous
• Cant make changes Be Realistic
• No time to cook/plan Be Realistic
• No time to exercise Be Active
• Weekend overeating Be Sensible
• Temptations at work Be Sensible
• Failure if not perfect Be Realistic
  Be Flexible

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30-45 Minute Follow-Up Session

• Discuss positive changes
• Discuss barriers to change
• Determine Messages to address barriers
• Show video2 segments at most
• Discuss Handouts
• Client makes own Warranty Plan goals
• Re-direct giant leaps

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Typical Clients
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The Caretaker

• Barriers
• Puts herself last
• Blames her choices on others
• No meal planning
• Eats quickly or skips meals
• Toolkit Messages
• Be Realistic
• - Cant walk 2 miles? Walk 20 minutes
• Be Adventurous
• - Choose bagged salad with precooked meats or
  canned beans
• - Eat cucumbers w/ dip instead of chips w/ dip
  for snacks

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Divorced Rut Eater

• Barriers
• Doesnt know how or care to cook
• Repetitive food choices
• Feels deprived and hungry often
• Wants to get in shape for dating
• Toolkit Messages
• Be Sensible
• - Portion sizes
• Be Active
• - Small stepswear a pedometer
• Be Adventurous
• - New food choicescouscous, frozen grapes

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The Work-A-Holic

• Barriers
• Seeks self-help from internetmagical cure
• No time for meal planning or cooking
• Business lunches and entertaining control choices
• Likes extremes, numbers and detail
• Toolkit Messages
• Be Sensible
• - Portion size guidelines
• Be Adventurous
• - Choose precooked meats or bagged salad
• Be Active
• - Walk the stairs at work

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Young Executive on the Way Up

• Barriers
• Prefers fast foods--No cooking skills, no time
• Likes repetitive food choices
• Large portions
• Excessive calories and alcohol on weekends
• Vending machine snacker
• Toolkit Messages
• Be Realistic
• - Good general overview
• Be Sensible
• - Portion sizes
• Be Flexible
• - Regular cokes only at the movies
• Be Active
• - Add basketball or tennis with friends

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Negative Client Comments
Tuna every day isnt healthy.
Jason isnt physically appealing.
What is couscous and that spicy lettuce? How
much is a serving and what food group do they go
in?
Why didnt they demonstrate walking or other
exercises?
Im not bored with my choices and I like eating
the same foods.
Pre-cut and pre-cooked foods may be too
expensive for some.
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Positive Client Comments
I like the idea of getting husbands and others
involved in meal preparation.
I like the icons on the handouts.
I agree that I tend to get in a rut.
The video was lively and interesting.
The video is done well.
The engine and toolkit theme worked for me and
should get more men involved.
It was good that an Asian female was included in
this video.
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Most Appropriate Clients

• Chronic Fad Dieters
• Visual Learners
• Rigid
• Students
• No Desire or Skills to Cook
• Good General Health
• Focused on Lifetime Changes
• Overscheduled Soccer Moms

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Least Appropriate Clients

• Experienced Healthy Eaters
• Complex Special Diets
• Elite or Professional Athletes
• Eating Disorders
• Vegetarian

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Lindas Final Thoughts

• More fun for me and the client
• Brought out the coach in me and softened my
  information pushing rut
• Client discussions more revealing
• Client guided toward evaluation of previous
  behaviors and setting own goals
• Group classes can nurture group change and peer
  support.

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Its All About You
BE REALISTIC
BE ADVENTUROUS
BE FLEXIBLE
BE SENSIBLE
BE ACTIVE