David Collier, MD, PhD
ECU Pediatric Healthy Weight Research
and Treatment Center
collierd@ecu.edu
“Take Off 4-Health” Healthy Lifestyle Camp
Nutrition Education Curriculum
Carolyn Dunn PhD, Nancy Harris MS RD LDN, Yancey Crawford MPH, Sarah Henes MA RD LDN,
Stephanie Kinner BA, Virginia Sutton MPH, Kathryn Kolasa PhD RD LDN & David Collier MD PhD
Nutrition Curriculum Development
Introduction
Obesity is now widely recognized as one of the most pressing public
health challenges in the United States. Eastern North Carolina (ENC)
has particularly high rates of obesity due in part to poverty, lack of
education and a large African American population which is
disproportionately affected. To address obesity in ENC, a healthy
lifestyle camp, Take Off 4-Health, was developed for overweight
adolescents. This poster describes the nutrition curriculum for the camp.
Camp Partnership
Take Off 4-Health is a collaboration between East Carolina University
(ECU), Brody School of Medicine’s Pediatric Healthy Weight Research
and Treatment Center, NC 4-H, North Carolina Cooperative Extension
(NCCE) and Pitt County Memorial Hospital’s Pediatric Healthy Weight
Case Management Program.
East Carolina University
• Medical Support
• Nutrition & Physical Activity Programming
• Development of Menus
• Recruitment of Scholarship Campers
NC Cooperative Extension
• Development of Nutrition Curriculum
• Printing of Nutrition Materials
• Materials for Family Packets
• Staff to provide Nutrition Instruction
NC 4-H
• Camp Facility
•Hiring & Training of Counselors
• Camp Programming
•Recruitment & Enrollment of Campers
• Day to Day Operation of Camp
• Collaborative team from ECU and NCCE reviewed literature & relevant
web sites and contacted professional list serves for camp-related
curricula
• Since few are published, modified two existing
NCCE curricula:
• Eat Smart Move More Weigh Less
• Families Eating Smart and Moving More
Camp Demographics & Outcomes
• N=34; 26 girls, 8 boys; majority African American (70%); mean age:14
• Mean BMI pre camp: 41.9
• Mean weight loss: 6.7 pounds or 2.5% of initial weight over 3 weeks
• Mean post camp BMI: 40.8 (Mean BMI change: > 1 BMI unit)
• Mean waist circumference decrease: 2+ inches
• Four-five month follow-up data is available for 19 campers; 17
completed all 3 weeks of camp
• Take Off 4-Health curriculum included:
• Camper cards
• Six, hour-long interactive nutrition lessons
• Training for camp counselors
• Take-home packet for campers & their families
Campers attending nutrition class
• Lessons were taught by two Family & Consumer Science agents and ECU dietitians
• Nutrition handouts are available at www.ecu.edu/pedsweightcenter (click on
“Programs & Activities” and then “Healthy Lifestyle Camps”)
• Attending camp was associated with a 3 unit decline in BMI for
these 17 youth (Figure 1)
• The average BMI z-score (indicates the number of standard deviations
above the mean BMI for gender and age) for the 17 campers has
continued to decline following camp
Figure 1: Mean BMI & Z-scores Over Time for 17 Campers
43.5
43
Camper Cards
2.59
42.8
2.58
42.5
42
• Each camper received a personalized nutrition prescription based on the MyPyramid
calorie levels for age, gender and sedentary activity level.
Front:
2.6
Back:
2.56
41.5
41
40.5
2.51
39.8
39.8
39.5
39
38.5
 Traditional camp activities such as hiking, boating & swimming
 Confidence and team building activities including a challenge
course & climbing wall
• Campers received nutrition handouts corresponding to each
lesson, a pedometer & a take-home packet at the end of camp
4
m
o.
F/
U
p
st
ca
m
• The camp provided sufficient education in a “real life” environment
for most campers to lose weight at a safe rate.
Interactive Lessons
Sample Handout
Key Messages of Lessons
Lesson
Title
Key Message
Key Skills
Discussion
Hands-On
Re-Think
Your Drink
Calorie Beverages:
-can contribute lots of calories to the
overall diet
-may not provide satiety
-can be replaced with calorie-free
beverages to decrease total calories.
*Strategies to choose caloriefree or lower calorie
beverages.
*beverage clocks illustrated
how to substitute (Figure 1)
How can you
make better
choices to
achieve a
healthy weight?
-analyzed labels of
common drinks.
-made drinks from
fruit juice and seltzer.
Enjoy More
Fruits and
Vegetables
Fruit and vegetables:
-in their natural state, are low in
calories and fat.
-are KEY to a weight loss/weight
maintenance.
*for snacks and meals.
strategies to make fruits and
vegetables more available for
meals/ snacks.
Snack clocks illustrated how
to make healthier snack
choices throughout the day.
How can you
make better
choices to
achieve a
healthy weight?
-analyzed food labels
with “fruit” in the
name; asked to “Find
the Fruit.” -taste tests.
Reading
Food Labels
Food labels useful to:
-compare different foods
-help control portions
-identify food lower in fat and
calories.
use the nutrition facts panel
to compare two foods and use
ingredient list to see food
contents.
Use common label terms (i.e.,
fat-free, low-fat)
How can you
make better
choices to
achieve a
healthy weight?
-presented with 5
snack and 5 beverage
choices; used
information on the
package to make the
healthier choice.
Eat Smart
When You
Eat Out
Eating out:
-is related to increased weight due to
serving sizes and food preparation
techniques.
-make healthy choices when you eat
out
-might not be as healthy as choosing
to prepare and eat meals at home
Strategies to eat more meals
at home.
Strategies to choose healthier
options when eating out
including choosing smaller
portions.
How can you
make better
choices to
achieve a
healthy weight?
-used an interactive
multimedia CD to
choose from 6 fast
food restaurants; tote
board indicated
nutrients for the
foods chosen.
Portion
-sizes have increased over the years
-control is a key factor in achieving a
healthy weight.
-that are large can lead to consuming
more calories than you need.
-selection needs to be mindful
*Demonstrations to use hand
to estimate portion sizes and
strategies to right-size
portions.
*Use stoplight method (rarely,
sometimes, anytime) to teach
variety and moderation.
How can you
make better
choices to
achieve a
healthy weight?
-participated in a
mindful eating
exercise and activity
with the stop light
food to “budget” what
they eat.
 Nutrition, group counseling and physical activity classes
• Campers were served 3 family-style meals and two snacks
daily based on standard camp menus that were modified by
pediatric dietitians to ensure nutrient needs, reduce fats & sugars
and increase whole grains & fiber.
2.5
2.46
Po
Pr
ec
am
p
• Youth participated in:
Z score
Conclusions
Camp Overview
• Held at the Eastern 4-H Center in rural eastern NC
2.52
2.48
38
• 3-week residential camp for obese 12-18 year old boys and girls
BMI
2.53
40
Pediatric Healthy Weight Case Management Program
• “Bridge” Program for Parents during Camp to Prepare Home Environment
• Monthly Meetings for Campers & Families after Camp
• Case Management Services for Scholarship Campers
2.54
Right_Size
Your
Portions
Re-Think Your Drink Graphic
• The menu and recipe modifications improved the nutrient value and
energy density of the meals and were acceptable, affordable and
have the potential for use in all 4-H camps.
• Campers used, though not consistently, the personalized camper
cards. Use may be improved if campers, counselors and food
service staff had more intensive training.
• Campers improved their ability to recognize appropriate portion
sizes. This skill may be strengthened through a 2-5 minute
demonstration of nutrition tips to reinforce topics taught in classes.
• The topics selected were appropriate for the age group; however it
was recommended that campers have additional opportunities
to practice newly learned skills (i.e. role play and skits) and the
materials include popular media such as videos and “You Tube”
clips to keep campers engaged.