The Nutrition Rx for Healthier Youth

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The Nutrition Rx for Healthier Youth

• Leslie Bonci, MPH,RD,LDN
• University of Pittsburgh Medical Center

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SETTING THE STAGE

• Information Gathering
• Why are we here?
• Lessons Learned
• Whats been done?
• What Next?
• Where are we Headed?

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INFLUENCERS?

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

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WEIGHT INFLUENCERS

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

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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 (/-/)

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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

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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

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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

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WHAT AM I HEARING

• Im tired
• Other kids make fun of me
• I have to eat special foods
• My body hurts
• I dont get picked for teams
• I cant eat my favorite foods

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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

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JUST DI-ET

• Dieting may result in
• Overeating
• Undereating
• Sneaking food
• Undernutrition/malnutrition
• Weight gain
• Set up for failure
• Disappointment

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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

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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

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BARRIERS (contd)

• 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

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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!

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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

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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

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ISSUES

• An already crowded curriculum results in
• Less time for physical activity
• Less time for lunch
• More time for sitting

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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

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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

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INFLUENCE OF TV

• Ads
• New physical activity?
• Eat while viewing
• Brigham and Womens Hospital study of 10,000 9-14
  year oldslarger 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

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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

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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

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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

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SURVEY FINDINGS

• ? participation in physical activity with parents
  results in ? in childs 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

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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

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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

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HEALTHY PARENTING INITIATIVE

• Collaborative effort between WellPoint and the
  American Dietetic Association
• Healthy Habits Quiz for Healthy Families

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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?

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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?

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REAL WORLD SOLUTIONS

• AT HOME
• Use kid-sized utensils, plates, glasses
• Serve kid- friendly portions
• Let kids learn when they are hungry/satisfied
• Dont overly restrict food
• Encourage slowing down while eating
• Make eating purposeful
• Designate No Eating Zones in your home

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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

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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

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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

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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!

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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

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WHAT CAN SCHOOLS DO?

• Ensure 20 minutes for student athletes to eat
• Offer variety
• Performance buffets
• Ethnic food themes
• Food Bars
• Pasta/Potato
• Tacos

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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!)

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WHAT MAKES THE CAFETERIA APPEALING

• Color
• Cleanliness
• Comfort
• Well-lit
• Not overly crowded
• Color-coded nutrition information to assist
  athletes with making food choices

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HAVE VISUAL DISPLAYS
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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

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SCHOOL INVOLVEMENT

• Some brand name items
• Favorite recipe day
• Bonus days
• Give-away items
• Pre event meal dress-up and festivities
• Training table choices
• Grab-and-Go concept

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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

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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

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MAKE IT FUN!
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ISSUE OF VENDING MACHINES

• Access times
• Placement
• Items chosen for purchase
• How revenue generated is used
• Messaging on the machine(s)

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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

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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

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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

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COMPONENTS OF A HEALTHY LIFESTYLE

• Actionable
• All inclusive (food, habits, activity)
• Support system
• Sustainable
• Realistic
• Not life-changing
• Affordable

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BOTTOM LINE

• We can turn this around, one child at a time
• Lets EDUCATE, EMPOWER ENABLE, and EXCITE our
  youth to Eat smart, Play Hard
• YOU MAKE A DIFFERENCE!

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RESOURCES

• www.ific.org ( kidnetic.com)
• Leaders Guide to Healthy Eating and Active
  Living for Kids and Families
• www.wellpoint.org
• Healthy Habits for Healthy Kids booklet
• www.cdc.gov
• VERB campaign and National School Fitness
  Foundation

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CONTACT INFORMATION

• Leslie Bonci, MPH,RD,LDN
• 412-432-3674
• E-mail boncilj_at_upmc.edu