Fostering Healthy Children & Families. Jill Anne McDowall MSc. RD October 30, 2015

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1 Fostering Healthy Children & Families Jill Anne McDowall MSc. RD October 30, 2015

2 The Plan Eating healthy isn t easy Childhood obesity Ellyn Satter Feeding Dynamics Model Ellyn Satter Family Meal Series Ellyn Satter Eating Competence Model NutriSTEP

3 Today, IT S HARDER TO BE HEALTHY

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5 In addition to

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8 SO WHERE HAVE WE ENDED UP? CHILDHOOD OBESITY ON THE RISE Source: Global Strategy on Diet, Physical Activity, and Health. Childhood Overweight and Obesity. Retrieved from

9 Childhood Obesity One of the most serious public health challenges of the 21st century. Prevalence has increased at an alarming rate. The problem is global.

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14 Childhood Obesity: The Reality Overweight and obese children are likely to stay obese into adulthood. They are more likely to develop diseases like diabetes and cardiovascular diseases at a younger age. It could be prevented.

15 Prevention Literature Review Aspects interventions associated with positive outcomes: Parent/family involvement Home activities Reduced screen time Combined nutrition & physical activity interventions Longer-term interventions & follow-up Behavioural models Universal programs School-based supports Source: Obesity Prevention and Management Review, Paul Chaulk, Atlantic Evaluation Group Inc., April 2014

16 Family Meals Not a new concept

17 Also not an EASY concept!

18 Family is Regardless of how you choose to define your family unit, whether it is traditional or unique, your definition is of the family unit that works for you. Whether made of blood relatives, friends, pets, or a combination of these, your family can offer you the support you need to thrive.

19 The True Value Meal! The family meal is one way in which a family provides stability and support to its members. A family meal combines two basic needs: Nourishment Connection And pleasurable food

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21 FEEDING DYNAMICS MODEL ELLYN SATTER

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23 The Broader Context a positive environment Child overweight can be prevented by providing a positive environment that supports normal growth and development in all children. Take the emphasis off diagnosis and treatment

24 Emphasize the Whole Child Seek community-based approaches that emphasize raising happy, healthy, productive children, whatever their size. Emphasize programs that nurture children nutritionally, physically, and emotionally, and allow each child to grow in his or her constitutionally appropriate way. Emphasize the family meal in all nutrition and parenting education and intervention.

25 Emphasize providing, not depriving or pressuring Avoid interventions and messages intended to get children to eat less or weigh less. Avoid messages that complicate family meals and take away from the pleasure of eating, food selection, and food preparation. To consistently provide meals and snacks, parents must find the food richly rewarding to provide and eat

26 hence The VALUE MEAL

27 MASTERING FAMILY MEALS SERIES Ellyn Satter

28 Mastering Family Meals The how not the what Step 1: No meals & don t want them! Eat food you enjoy at mealtime Step 2: Get the meal habit Make them your idea Step 3: Add on, don t take away Tweak menus to add interest Only 1 or 2 changes at a time Use snacks to support meal time

29 Mastering Family Meals The how not the what Step 4: Do family-friendly feeding Just a get a meal on the table Always offer bread, high & low fat foods, forbidden foods Step 5: Avoid virtue Not sustainable Reintroduce pleasure Cooking, Planning & Shopping

30 THE EATING COMPETENCE MODEL

31 The Joy of Eating: Being a Competent Eater Being positive & comfortable with eating. Being matter-of-fact and reliable about getting enough enjoyable food.

32 The Joy of Eating: Being a Competent Eater Competent eaters Do better nutritionally Are more active Sleep better Better lab tests More self-aware & self-accepting

33 The Joy of Eating: Being a Competent Eater Feed yourself faithfully. Give yourself permission to eat. Pay attention it s a process.

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35 ecsi II Scoring Factor analysis and scoring All items are scored on a Likert scale and assigned values as following: Always=3; Often =2; Sometimes=1, Rarely=0; Never=0. Total the scores for each subsection and total the scores overall for the entire test. Interpretation of scores Eating competence: 1 to 48. Cutoff is 32 and above. Eating Attitudes: 1 to 15 No cutoff assigned. Contextual Skills: 1 to 15 No cutoff assigned. Food Acceptance: 1 to 9 No cutoff assigned. Food Regulation: 1 to 9 No cutoff assigned.

36 Bringing Nutrition Screening to Toddlers & Preschoolers with NutriSTEP

37 Overview Toddler & preschool nutrition concerns Nutrition screening & assessment Ethical issues in nutrition screening NutriSTEP program Development of NutriSTEP How PEI is using NutriSTEP How you could use NutriSTEP

38 Nutrition Concerns Canadian Community Health Survey (2004) 54% of toddlers and 31% of 4-8 year olds met CFG recommendations for vegetables & fruit Milk and milk products were less than CFG recommendations Quebec 4 year olds (2002) Below daily CFG recommendations: 21% vegetables & fruit, >50% milk, 61% meat 85% offered pop, fruit or sport drinks regularly; 20% having daily; 9% consuming 3 times/day Fast foods, 72% once/week

39 Nutrition Concerns Alberta 4-5 year olds (2012) Below CFG recommendations: 30% vegetables & fruit; 24% grains Weekly servings of choose least often : 79% Nutri-eSTEP (2014) ~50% of toddlers and preschoolers did not meet CFG recommendations for grains ~50% of preschoolers did not meet CFG recommendations for fruits

40 Physical Growth Concerns Increase in proportion of Canadian children who are overweight/obese In 1978, 21% of 2-5 year olds were overweight In 1978, 0% of 2-5 year olds were obese In 2004, 21% of 2-5 year olds were overweight/obese In 2004, 6% of 2-5 year olds were obese In 1978, 13% of 6-11 year olds were overweight In 1978, 0% of 6-11 year olds were obese In 2004, 26% of 6-11 year olds were overweight/obese In 2004, 8% of 6-11 year olds were obese

41 Nutrition Screening The process of identifying factors known to be associated with dietary or nutritional problems The purpose is to differentiate individuals who are at risk of, or who have, poor nutritional status The first step in addressing nutrition problems through further assessment and treatment

42 Nutrition Assessment Comprehensive approach to determine nutritional status Purpose is to assess or clarify a previouslyidentified nutrition problem and/or unhealthy risk factor behaviours related to nutrition Involves medical, nutrition and medication histories, physical examinations, anthropometric measurements, and laboratory tests

43 Why Screen For Nutritional Risk? Raise awareness and knowledge Promote early intervention Target children at risk Streamline referral process Prioritize services Identify needs within a population

44 What is Ethical Nutrition Screening? Targeting of screening to the right people Identification of nutrition problems and appropriate course of action (e.g. assessment, resources) Having a referral/resource framework that meets needs Including follow-up after screening

45 Ethical Nutrition Screening

46 NutriSTEP is A nutrition screening program for young children Two 17-item questionnaires that can be completed by parents in ~5 minutes Toddler NutriSTEP (18-35 months) Preschool NutriSTEP (3-5 years)

47 NutriSTEP is Knowledge Translation NutriSTEP website NutriSTEP Implementation Toolkit NutriSTEP online community

48 NutriSTEP Implementation Studies Targeted implementation studies ( ) Kindergarten registration Preschool screening program Best Start hubs Family Health Teams Immunization clinics

49 Implementation NutriSTEP is Ontario: Accountability Indicator (2014) New Brunswick: universal screening since 2011 And now PEI: universal through Public Health Nursing clinics

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51 Nutrition Risk Attributes Food & fluid intake Frequency of intake of foods and fluids Physical growth & development/weight concerns Weight and height; oral motor skills; parent s comfort level with growth Factors affecting food intake and eating behaviours Food security; psycho-social feeding environment Physical activity & sedentary behaviour Indoors and outdoors; screen time

52 Nutri-eSTEP Online access to NutriSTEP screening Dietitians of Canada website ( Parents complete online versions of NutriSTEP Parents receive immediate results What is going well What to work on Comprehensive feedback messages based on results Links to trusted and credible resources

53 Prevalence of Nutrition Risk Approximately 15-16% of children are at high risk and should receive further nutrition assessment and interventions A further 12-17% of children would benefit from social and community services to improve their diet and health habits and reduce their nutrition risk

54 Implementation of NutriSTEP on PEI Started October 1, 2015 Public Health Nursing offices 18-month visits 4-year visits Referral structure Low Risk provided with information Moderate Risk referral to Dietitian (group) High Risk referral to Dietitian (individual)

55 Steps Towards Implementation Select a site coordinator Use NutriSTEP Implementation Toolkit Train those involved in the process Identify resources to meet needs Develop referral maps for services Monitor and evaluate process and outcomes Use results to inform practice and service delivery

56 NutriSTEP Screening Models in Ontario Kindergarten orientation events Pre-kindergarten orientation days Electronic Medical Record (EMR) Parent and Child Drop-in Playgroup Junior kindergarten classes Screening Clinics 18-month well-baby visits

57 Other Activities Further Steps NutriSTEP development with school-aged children (6-11 years) Testing of efficacy and effectiveness of preschool nutrition screening Database development for NutriSTEP data NutriSTEP incorporation into electronic medical records Population health surveillance

58 For More Information Health PEI s Public Health & Family Nutrition Program Jill Anne McDowall jamcdowall@gov.pe.ca NutriSTEP Website:

59 Good Question THANK YOU FOR YOUR TIME

60 More Resources oar2012.pdf