health eating program

1
HEALTHY NUTRITION FOR CHILDREN

• Lynchburg Family Medicine
• Residency Grant Program
• February 14-15, 2012
• presenter Melvenia Lovelace,RD
• Melvenia.lovelace_at_centrahealth.com

2
Objectives/Goals

• To define the cause obesity
• To provide ways to promote healthy nutrition
• The learner will be able to planhealthy meals
  for successful
• weight balance

3
(No Transcript)
4

• Factors Contributing To Weight Gain

Calories
Portion Sizes
Fruits and Vegetables
Sweetened Drinks/Snacks
Low-fat milk
Exercise,Gym, Recess
Fast Food Snack Food
TV, Video and Computer Game Time
5
Weight Gain Medications
Disease Examples
Diabetes Insulin, sulfonylureas
Depression Tricyclics
Seizures Valproic acid, Tegretol
Hypertension Clonidine, a-blockers, ß-blockers
Hormones Progesterone
6
Definition

• Obesity is an abnormal accumulation of body fat,
  usually 20 percent or more over an individual's
  ideal body weight.

7
Calorie Balance Too HighWeight Gain Results
Growing Developing Metabolizing Exercising
Food Intake

8
Compared to Recommendations

• 84 of kids eat too much fat
• 91 eat too much saturated fat
• Only 15 get enough fruits
• Only 20 get enough vegetables
• Only 30 get enough milk
• Only 19 of girls aged 9 to 19 years of age meet
  calcium recommendations

9
Definition of Overweight Obesity

• Using BMI

ITEMS BMI GRADE
UNDER WEIGHT 18.5
NORMAL 18.5 24.9
OVER WEIGHT 25.0 29.9
OBESITY 30.0 34.9 I
OBESITY 35.0 39.9 II
EXTREME OBESITY 40 III
10
Prevalence of Obesity

• Childhood and adolescent obesity increased from
  5 to 16 in the last 20 years
• Adulthood obesity increased from 12 to 21 in 10
  years.
• 16 million US adults with BMI over 35
• 60 million US obese adults (BMI gt 30)

11
A Public Health Framework to Prevent and Control
Overweight and Obesity

• Food and Beverage Industry
• Agriculture
• Education
• Media
• Government
• Public Health Systems
• Healthcare Industry
• Business and Workers
• Land Use and Transportation
• Leisure and Recreation
• Community- and Faith-based Organizations
• Foundations and Other Funders

Social Norms and Values

• Home and Family
• School
• Community
• Work Site
• Healthcare

Sectors of Influence
Behavioral Settings

• Genetics
• Psychosocial
• Other Personal Factors

Individual Factors
Food and Beverage Intake
Physical Activity
Energy Expenditure
Energy Intake
Energy Balance
Note Adapted from Preventing Childhood
Obesity. Institute of Medicine, 2005.
Prevention of Overweight and Obesity Among
Children, Adolescents, and Adults
12
Weight gain related to

• Huge consumption of sweets, drinks, snacks.
• Kids eating what ever they wanted day and night.
• Many diets low in vitamins and minerals.
• Rotten teeth, poor sleep, lack of energy, HTN,
  pre-diabetes, excess weight, mood swings.
• Highly sedentary lifestyles
• TV and video games in most bedrooms
• Kids vegging out for hours and hours

13
Junk Food

• Fallacy if allowed to make their own choices,
  students will make healthy food selections.
• Junk food food with minimal nutritional value.
• Portion sizes of junk food have increased
  dramatically.
• Students consume junk food frequently.
• Soft drinks and other high sugar drinks
  contribute high numbers of calories to students
  diets.

14
Weight Gain Energy In

• 3500 calories 1 pound
• 100 calories extra per day
• 36,500 extra per year
• 10.4 lbs weight gain
• Question How much is 100 calories?
• Answer Not very much!
• 1 glass skim milk, or
• 1 banana, or
• 1 slice cheese, or
• 1 tablespoon butter

15
Slides provided by the USDA Center for Nutrition
Policy and Promotion
16
MyPlate Illustrates the Five Food Groups
17
MyPlate Key Messages for Consumers

• Balancing calories
• Enjoy your food, but eat less
• Avoid oversized portions
• Foods to increase
• Make half of your plate fruits and vegetables
• Choose at least half of your grains as whole
  grains
• Switch to fat-free or low-fat (1) milk
• Foods to reduce
• Compare sodium in foods, such as soups, breads,
  and frozen meals, choosing the foods with lower
  numbers
• Drink water instead of sugary drinks

18
Grains Group

• The amount of grains that you need depends on
  your age, sex, and level of physical activity
• Generally, men and women need between 68 ounces
  (oz) of grains every day
• 1 oz is about one slide of bread, 1 cup (C) of
  breakfast cereal, or ½ C of cooked rice, cereal,
  or pasta
• Key message Make at least half of your grains
  whole grains

19
Limit foodshigh in sodium, addedsugars, and
refined grains
20
Vegetables Group

• Eat more dark-green vegetablesbroccoli, spinach,
  and other dark-leafy greens
• Consume more orange vegetablescarrots and sweet
  potatoes
• Include more dry beans and peaspinto beans,
  kidney beans, and lentils
• Generally, men and women should consume 2½ C
  every day
• Key message Make half of your plate fruits and
  vegetables

21
Fruits Group

• Eat a variety of fruit
• Choose fresh, frozen, canned, or dried fruit
• Go easy on fruit juices
• Try to consume 2 C every day
• Key message Make half of your plate fruits and
  vegetables

22
Drink WellLimit Sweetened Beverages

• Tips
• Decide what drinks are available in your home
• Offer water or non/low-fat milk instead of juice
  or soda
• Mix 100 fruit juice with water and limit to
• 4-6 oz. for 1-6 years
• 8-12 oz for 7-18 years

23
(No Transcript)
24
Dairy Group

• Includes all fluid milk products and many foods
  made from milk
• Choose low-fat or fat-free milk, yogurt, and
  other milk products
• If you do not or cannot consume milk, choose
  lactose-free products or other calcium sources,
  such as fortified foods and beverages
• Depending on age, consume 2½3 C every day
• Key message Switch to fat-free or low-fat (1)
  milk

25
Switching to fat-free or low-fat (1) milk makes
a difference!

Whole 2 1 Fat-free
165 calories 125 calories 100calories 85calories
Calories saved 40 65 80
26
Protein Group

• Includes all foods made from meat, poultry,
  seafood, beans and peas, eggs, processed soy
  products, nuts, and seeds
• Choose low-fat or lean meats and poultry
• Bake it, broil it, or grill it
• Vary your protein routinechoose more fish,
  beans, peas, nuts, and seeds
• Generally, men and women need 5½6 oz every day

27
Know the Limits on Fats, Sugar, and Sodium

• Get most of your fat sources from fish, nuts, and
  vegetable oils
• Limit solid fats (butter, stick margarine,
  shortening, and lard) and fried foods that
  contain these
• Check Nutrition Facts labels to keep saturated
  fats, trans fats, and sodium low
• Choose foods/beverages low in added sugarsthey
  contribute calories with few, if any, nutrients

28
Chapter 2Balancing Calories to Manage Weight
29
Groups reduced to 1,500 mg SODIUM

• African Americans ages 2
• Adults ages 51
• People ages 2with high blood pressure,
  diabetes, or chronic kidney disease

30
(No Transcript)
31
Definition of a Calorie A unit of measure of
energy in food
32

• Nutrients that have Calories and provide ENERGY
• Proteins
• Carbohydrates
• Fats

33
Treatment Approach

• Initial goal 10 weight loss
• Significantly decreases risk factors
• Rate of weight loss
• 1 to 2 pounds per week
• Reduction of caloric intake 500-1000 per day
• Slow weight loss is more stable
• Rapid weight loss is almost always followed by
  weight gain
• Rapid weight loss increases risk for gallstones
  electrolyte abnormalities

34
Calculating BMI

• BODY MASS INDEX
• Weight (lb)/height (in)2 x 703
• or
• weight (kg)/height (m)2
• BMI is an effective screening tool it is not a
  diagnostic tool
• For children, BMI is age and gender specific, so
  BMI-for-age is the measure used
• Ages 2-20 years

35
AVERAGE RECOMMENDATIONS FOR KIDS CALORIES

• 2-3 yrs 1000-1400 calories/day
• 4-8 yrs 1400-1600 calories/day
• 9-13 yrs girls 1600-2000 calories/day
• 9-13 yrs boys 1800-2200 caloreis/day
• 14-18 yrs girls 2000 calories/day
• 14-18 yrs boys 2200 calories/day

36
WHAT ARE HEALTHY FOODS We should never label
foods as either GOOD or BAD. This can restrict
eating or lead to negative attitudes toward food.
Healthy foods are those that are
nutrient-rich or have a large amount of key
vitamins and minerals for their calories. It
is critical to make each calorie count
especially when weight may be an issue.
You dont have to give up your favorite foods to
eat a healthy diet just try to have your
core choices nutrient-rich and round out with
other foods. Colorful fruits and
vegetables, lean meats, beans, low fat and fat
free dairy and nuts are examples of ideal
foods.
37

• Ways to be a role model would be
• never skip meals
• limit junk food in the house
• eat and prepare food with your
• children
• try new foods but dont force children
• to eat
• turn off the TV while eating
• be active yourself.

38
Foods and Food Components to Reduce

• Fats
• Saturated fatty acidsless than 10 of calories
• Less than 7 reduces risk of CVD further
• Replace with poly- and monounsaturated fatty
  acids (not with sugar or refined grain)
• Trans fatsas low as possible
• Cholesterolless than 300 mg per day
• Effect small compared to saturated and trans fats
  new
• Egg yolksup to 1 per day new
• USDA 2010 DIETARY GUIDELINES

39
Food is to be enjoyed!
Food is not nutritious untilit is eaten.  
Smarter Lunchrooms 2011
40
BAGEL
20 Years Ago
Today
140 calories 3-inch diameter
How many calories are in this bagel?
41
BAGEL
20 Years Ago
Today
140 calories 3-inch diameter
350 calories 6-inch diameter
Calorie Difference 210 calories
42
CHEESEBURGER
Today
20 Years Ago
333 calories
How many calories are in todays cheeseburger?
43
CHEESEBURGER
Today
20 Years Ago
590 calories
333 calories
Calorie Difference 257 calories
44
FRENCH FRIES
20 Years Ago
Today
How many calories are in todays portion of fries?
210 Calories 2.4 ounces
45
FRENCH FRIES
20 Years Ago
Today
610 Calories 6.9 ounces
210 Calories 2.4 ounces
Calorie Difference 400 Calories
46
SODA
20 Years Ago
Today
85 Calories 6.5 ounces
How many calories are in todays portion?
47
SODA
20 Years Ago
Today
250 Calories 20 ounces
85 Calories 6.5 ounces
Calorie Difference 165 Calories
48
Eatmorenutrient-densefoods
48
49

• Another name for nutrient-dense foods is
  nutrient-rich foods

50
Nutrient-dense foods andbeverages include ALL

• Vegetables/fruits
• Whole grains
• Seafood
• Eggs
• Dry beans/peas
• Unsalted nuts/seeds
• Fat-free/low-fat milk/milk products
• Lean meats/poultry

51
THE NUTRITION LABELCHALLENGE
52
(No Transcript)
53
Nutrition Facts Label doesnt separate added
naturally occurring sugars

• Added sugars are sugars and syrups added to
  foods or beverages during preparation or
  processing
• 1 teaspoon sugar about 4g of added and/or
  naturally occurring sugar

54
Other sugars occur naturally in foods like
milk, fruit, and some vegetables they arent
the added sugars that are the concern
55
One or Two Servings?
Single Double Serving DV Serving DV Serving
Size 1 cup (228g) 2 cups (456g) Calories 250 500
Calories from Fat 110 220 Total
Fat 12g 18 24g 36 Trans Fat 1.5g 3g Saturated
Fat 3g 15 6g 30 Cholesterol 30mg 10 60mg 20 S
odium 470mg 20 940mg 40 Total
Carbohydrate 31g 10 62g 20 Dietary Fiber 0g
0 0g 0 Sugars 5g 10g Protein
5g 10g Vitamin A 4 8 Vitamin C 2
4 Calcium 20 40 Iron 4 8
56
No Daily Value

• Trans Fat
• Sugars
• Protein

57

Overweight Sensitivity

• Replace with
• Unhealthy weight
• Healthy weight
• Family behavior change
• Focus on lifestyle
• Healthier food choices
• Activity or play

• Avoid
• Obese, heavy, overweight, fat
• Ideal weight
• Fix the child
• Focus on weight
• Diets or bad foods
• Exercise

58
WAYS TO ENCOURAGE BETTER EATING HABITS FOR YOUR
CHILD

• Be that positive role model
• Plan cook meals together
• Offer kid-size servings
• Give your child a good start with breakfast

• Encourage drinking low fat milk water
• Plan afternoon snacks
• Pay attention to hunger cues
• Avoid skipping meals
• Restrictive diets are usually not best for kids

59
REDUCE THESE Foods and Food Components
60
Little Changes. Big Rewards.
61
Balance Between Food and Physical Exercise

• Stay within your daily calorie needs
• Keep physically active for 30 minutes most days
  of the week
• Know that you may need about 60 minutes a day of
  physical activity to prevent weight gain
• Understand that you may need 6090 minutes of
  physical activity to sustain weight loss
• Help children and teens get 60 minutes of
  physical activity every day or most days

62
Lets Get Moving!

• decreased physical activity

• more weight gain

• overweight

• further decreases in physical activity

63
Breakfast
1-2 3-5 6-12
Milk ½ cup ¾ cup 1 cup
Juice/Fruit or Vegetable ¼ cup ½ cup ½ cup
Grains/Breads ½ serving ½ serving 1 serving
64
Quiz-Breakfast

• 1 Egg Cheese Omelet Link Sausage Whole
  Wheat Toast Milk

65
Quiz-Breakfast

• 1 Egg Cheese Omelet Link Sausage Whole
  Wheat Toast Milk

No Missing Fruit/Vegetable
66
Lunch/Supper
1-2 3-5 6-12
Milk ½ cup ¾ cup 1 cup
Meat/Meat Alternate 1 ounce 1½ ounces 2 ounces
Fruits and/or Vegetables (2 or more) ¼ cup total ½ cup total ¾ cup total
Grains/Breads ½ serving ½ serving 1 serving
67
Snack
Choose two 1-2 3-5 6-12
Milk ½ cup ½ cup 1 cup
Meat/Meat Alternate ½ ounce ½ ounce 1 ounce
Fruit/Vegetable ½ cup ½ cup ¾ cup
Grains/Breads ½ serving ½ serving 1 serving
68
(No Transcript)
69
Resources used

• Dietary Guidelines for Americans, 2010
  http//www.cnpp.usda.gov/DGAS2010-PolicyDocument.h
  tm
• ChooseMyPlatehttp//ChooseMyPlate.gov
• Selected Messages for Consumershttp//www.cnpp.us
  da.gov/Publications/DietaryGuideline/2010/PolicyDo
  c/SelectedMessages.pdf
• DGA2010 Slide Presentationhttp//www.cnpp.usda.go
  v/DGAs2010SlidePresentation.htm

70
WEBSITES FOR RECIPES AND MEALS

• WWW.KASHI.COM/KID/FRIENDLY
• www.nhlbiinfo_at_nhlbi.nih.gov
• www.tabasco.com
• www.totalrecipesearch.com
• www.nutrigrain.com
• www.hellooperator.com
• www.truMoo.com

71
Websites cont.

• www.kids-meal-ideas.com
• www.hhs.gov
• Deliciously healthy
• Kids health
• www.smallstep.gov
• www.nhlbi.nih.gov

72
Thank you for participating in Portion
Distortion! For more information about
Maintaining a Healthy Weight visit
www.nhlbi.nih.gov
73
Policy Documents Research Reviews

• Current
• u Weighing the Risks and Benefits of BMI
  reporting in the school setting
• Position Paper available on our website.
• u Determinants of Energy Imbalance (coming soon)
  
• The Center is co-chairing a CDC sponsored effort
  in coordination with 6 other universities to
  determine the
• current state of knowledge regarding the causes
  of obesity and to make recommendations for future
  research and interventions.
• u Carbohydrates and Obesity (coming soon)
• Currently in-press Functional Food
  Carbohydrates, Chpt. 10, Biliaderas C and
  Izydorczyk M, eds. Boca Raton CRC Press. 2005.
• u Clarifying Concepts about Macronutrients
  Effects on Satiation and Satiety
• Published in the Journal of the American
  Dietetics Association, 1041151-3, 2004.
• u Prevention of Type 2 Diabetes in Youth
  Etiology, Promising Interventions and
  Recommendations
• Appears in Pediatric Diabetes 4174-209, 2003.

74
REFERENCES

• www.rd411.com
• Nebraska extension office
• Food and Drug Administration
• Center of Disease Control
• Childrens Health and Disability Prevention
• Program
• www.healthykids.nsw.gov.au
• www.letsmove.gov

75
continues

• www.usda.gov
• www.healthystart.com
• www.kidseatright.org/volunteer

76
The End!