Lora Beth Brown EdD, RD,
Brigham Young University
The Nutrition Course

 201: Society, Nutrition & Chronic Disease
 2 credits; Nutr 100 prerequisite
 Course emphasizes behavioral & social sciences,
not physiology or biochemistry
 Students
 Exercise Science, Health Science, and Nutrition majors
 Future health professionals
 Enrollment varies from 50-150/semester
Assignment’s Purposes

 To increase awareness of environmental barriers
to & opportunities for a healthy nutrition
environment in the United States.
 To recommend ways to reduce barriers &
expand opportunities.
 To evaluate the recommendations: Are they
realistic?
The Assignment

 Students photographed what they saw as nutritionrelated barriers & opportunities in the environment.
 They posted photos on a web platform & described
how each was a barrier or opportunity &
recommended a way to reduce the barrier or expand
the opportunity.
 They viewed & evaluated barriers & opportunities
posted by students in their online discussion group.
Cook your own meals! It’s hard for students to find time but it’s
much healthier. You can control portion sizes and ingredients and
limit the processed foods. It brings back memories of family
dinners, making meals both physically and emotionally fortifying.
Dinner Calendar on the Fridge. I make a 2-week dinner calendar
to know what to buy and I don't have to think about what to
make for dinner every day. I have a nutritious dinner every day
and I save money. Expand this opportunity by involving
roommates and friends in planning meals together
The Great Wall of China, and Tupperware, and utensils, and
pots…” With fast food, you throw away a paper bag. Cook a
healthy meal and you're left with... this. When time is limited,
cooking’s no fun because of cleaning up afterward! Solutions? Put
as many different food groups into one dish as possible. Get
different roommates.
Baby Annie Eating Fruits and Vegetables. Feeding babies and
young kids lots of fruits and veggies helps them develop a taste
for healthy foods at a young age.
Poor Example. This photo represents a common barrier of parents
feeding their children vegetables but being a bad example. This
barrier can be reduced by teaching the parents the importance of
eating as healthy as they want their children to eat
On campus vending. Students in a hurry can grab something
really quick and nutritious. The apples are almost sold out too -a good sign that students want to eat healthy – they just need
opportunities to do so when on the run.
Overly Accessible Junk. The glass window and bright packages
are visually appealing and attract unsuspecting students.
Machines in high traffic areas give students an excuse to not pack
healthy a healthy lunch. "I'll just grab something on campus.“
Solution? Tuck vending machines in out of the way places.
Vending Machine Prices. Big price differences between
unhealthy soda (60 cents) and healthy juice ($1.60). You don't
want to spend a lot of money at the vending machine so often you
settle a cheaper but less nutritious drink or food. Solution?
Reduce the price of healthy things or raise the price of unhealthy
things so that the price difference is eliminated.
Healthy Food On Sale. People usually buy more of things when
they're on sale. If we could have more healthy foods on sale and
make them cheaper, we'd have more people eating healthy and
not buying as much junk food.
Buy One Get One Free. This just doubles the calories and fat
they’re consuming. Instead they should offer something healthier
instead of another burger. Chances are one person will eat both of
the burgers if given one free. Offering something like a fruit cup
or a small bag of carrots would be so much healthier.
Waiting In Line, The Candy Aisle. Everywhere we wait – the store, the
carwash -- candy and drinks surround us and are calling to us. It might
affect sales but it would help our health to move these candies and
drinks to the places they belong in their respective aisles.
Supermarket Fruit. This fruit was at the store entrance -- one of
the first things you see. This is an opportunity: Move the healthy
foods to the front, so you don’t have to pass the unhealthy stuff
before getting to the healthy section. This course of action
represents opportunity.
Community Co-Op. This is a "standard share" at a local co-op: 5 different
types of fruits and vegetables, 2 pounds of chicken/ground beef/bacon and a
loaf of stone-ground bread (for only $27.81 after tax) -- affordable, healthy
foods. The co-op could advertise better. If more people knew about it I think
more people would take advantage of the opportunity.
Refrigerators in Cheap Apartments. Not enough fridge space for 6 girls to
store good foods like fruits and vegetables. We can’t buy healthy foods because
there’s not enough room to store them. Campus Housing should mandate
refrigerator shelf space for each person in the apartment. The landlord will
have to do something: install bigger fridges or an extra one.
All day and all night too. We are bombarded with opportunities
to eat poorly. With 24 hour availability it’s convenient, especially
if you have to work late -- probably not choosing the “healthier”
option. Consumers need to choose the more nutritious foods.
Taco Tuesday. I went to Del Taco with a bunch of friends and we
got 100 tacos for only $33.00 dollars. That’s an incredible price for
poor students but it’s not nutritious.
Drinks Available At The Gym. Monster energy drinks that we
sell at our gym is completely contradictory to our purpose:
promoting healthy & fitness. Reduce the barrier by providing
only beneficial, needed drinks like water and Gatorade.
Obligated to eat it. Almost every weekend my mother-in-law
visits and brings snacks like this. Every time we’re hungry we
instinctively reach for the sugary and salty snacks. We feel bad
just throwing away things she has graciously given us …
Home Health Donation . How often are gifts from companies or
friends just junk food? Instead of candies for gifts, we should
advise people to send fruit baskets.
Clean the Sink. We paid to eat an outrageous amount of ice cream
out of a "kitchen sink." Americans are obsessed about eating large
amounts of food in one sitting, just to say we did it. This encourages
overeating for social recognition. Americans will gradually learn
portion control as food service establishments stop providing such
large portion sizes with catchy names to entice consumers.
Over 350 pounds eat free. This Las Vegas restaurant is called the
Heart Attack Grill – it almost idolizes an unhealthy diet by
inviting people over 350 pounds to eat for free. A way to reduce
this barrier is to create healthier all-you- can-eat buffet options.
Happiness is Junk Food. This gas station on State Street is promoting
unhealthy food and telling everybody unhealthy food will make you
happy. Reduce the barrier by removing the sign (obviously), but also to
talk to the gas station owners about how unhealthy food harms people
and try to get them to promote healthy food instead.
Students’ evaluation of the
st
assignment (1 semester)

 Favorable responses to Likert-scaled questions
(1= negative, 5 = positive)
 Ease
3.8 ± 0.7
 Usefulness
 Enjoyable
 Made them think
3.7 ± 0.9
3.8 ± 0.8
3.8 ± 0.8
 Open-ended question: What did this assignment
contribute to your learning in this course?
Contributions to learning

 More aware of barriers & opportunities
 Personal or professional applications
 “Not much”
62%
26%
12%
 “It helped me to really look at the barriers but also see the good
things that help us eat better.”
 “…there are all sorts of positive & negative influences
surrounding me. I just need to recognize the effect they might be
having on me.”
 “…I can identify potential areas of change in the way Americans
currently think about & eat food. As a health professional I can
help change these things for the better.”
Retrospective pretest

Now that the semester is
over, how aware are you of
the barriers to and
opportunities for good
nutrition for the US
population?
Based on what you know
now, how aware would you
have been of the barriers to
and opportunities for good
nutrition for the US
population before doing
this assignment?
Very aware
70%
10%
Somewhat aware
26%
61%
Not very aware
1%
23%
Not at all aware
1%
3%
Awareness improved
Quality of students’
recommendations

 Nearly all focused on teaching individuals to
change their behavior or were unrealistically
simple suggestions.
 This provided an introduction to the Social
Ecological Model, to consider how complex it is to
improve the nutrition environment.
Dietary Guidelines for Americans, 2010
Chapter Six (p 55)
In future semesters…

 Discuss the Social Ecological Model before they do
the assignment.
 Add questions to the assignment, to improve the
quality and depth of their recommendations
 What specific changes are needed in at least 2
additional factors or levels of the Model?
 How realistic is your recommendation?
 Be more discriminating in “grading” the
assignment.
Assignment’s advantages

 More “creative,” less “academic”
 A way for quiet students to participate more
actively
 Made use of interactive, out-of-classroom
learning
 Capitalized on students’ media-savvy skills
My Reflections…

The best learning often comes through discovery.
 Did I tell them, or did they tell me?
 It takes several iterations to develop an effective
assignment.

 I welcome your suggestions and questions.
 Have fun developing innovative assignments using
cell-phone photo capabilities!
Lora Beth Brown, EdD, RD
Lorabeth_brown@byu.edu