The Nutrition Rx for Healthier
Youth
Leslie Bonci, MPH,RD,LDN
University of Pittsburgh Medical
Center
SETTING THE STAGE
 Information Gathering
 Why are we here?
 Lessons Learned
 What’s been done?
 What Next?
 Where are we Headed?
INFLUENCERS?






Family lifestyle/eating patterns
Relationship with parents/family
Mass media
Physiological needs
Self-concept
Body image
WEIGHT INFLUENCERS









Genetics
Stress levels and response
Medications
Food supply
Physical activity
Developmental stages
Endocrine status
Role models
Environment
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 (+/-/=)
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
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
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
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
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
JUST DI-ET
 Dieting may result in:







Overeating
Undereating
Sneaking food
Undernutrition/malnutrition
Weight gain
Set up for failure
Disappointment
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
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
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
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!
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
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
ISSUES
 An already crowded curriculum
results in:
 Less time for physical activity
 Less time for lunch
 More time for sitting
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
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
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




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
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
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
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
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
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
HEALTHY PARENTING
INITIATIVE
 Collaborative effort between WellPoint
and the American Dietetic Association
 Healthy Habits Quiz for Healthy
Families
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?
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?
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
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
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
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
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!
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
WHAT CAN SCHOOLS DO?
 Ensure 20 minutes for student
athletes to eat
 Offer variety
 Performance buffets
 Ethnic food themes
 Food Bars:
 Pasta/Potato
 Tacos
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!)
WHAT MAKES THE CAFETERIA
APPEALING






Color
Cleanliness
Comfort
Well-lit
Not overly crowded
Color-coded nutrition information to
assist athletes with making food
choices
HAVE VISUAL DISPLAYS
15%
20%
65%
6
VISUAL DISPLAYS
 National Dairy council: www.drinkmilk.com
 Gatorade Sports Science Institute
www.gssiweb.com
 American Dietetic Association:
www.eatright.org
 Team Nutrition Home Page:
 http://www.fns.usda.gov/tn
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
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 homewww.jamiesdinners.com
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
MAKE IT FUN!
ISSUE OF VENDING MACHINES





Access times
Placement
Items chosen for purchase
How revenue generated is used
Messaging on the machine(s)
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
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
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
COMPONENTS OF A HEALTHY
LIFESTYLE







Actionable
All inclusive (food, habits, activity)
Support system
Sustainable
Realistic
Not life-changing
Affordable
BOTTOM LINE
 We can turn this around, one child at
a time
 Let’s EDUCATE, EMPOWER ENABLE,
and EXCITE our youth to Eat smart,
Play Hard
 YOU MAKE A DIFFERENCE!
RESOURCES
 www.ific.org ( kidnetic.com)
 Leader’s 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
CONTACT INFORMATION
 Leslie Bonci, MPH,RD,LDN
 412-432-3674
 E-mail: boncilj@upmc.edu