Ten Behaviors that Promote a Healthy Weight in Preschool Children

Transcription

1 Ten Behaviors that Promote a Healthy Weight in Preschool Children Slide 1 Welcome to the online course, Ten Behaviors that Promote a Healthy Weight in Preschool Children, which is a Texas AgriLife Extension Service Professional Development Training Program for childcare providers and parents. This course will be presented in a voice-narrated format that allows you to follow along with a PowerPoint slide presentation. A high-speed Internet connection is required to complete the course. Content for this module is divided into multiple sections (see menu bar on the left for course outline), enabling you to complete and/or review content at your own pace. Printable handouts, if applicable, will be presented prior to the section in which they are referenced. In the next section, you will be directed to complete a brief, multiple-choice pre-learning assessment. Once you have completed the pre-learning assessment, you will be free to advance to the course content by clicking on the Next Section button at the bottom of the page. At the conclusion of this module, you will be directed to complete a post-learning assessment that will determine if you successfully pass the course. If at any time you wish to take a break from the module, simply log out and return to the course when you are ready to continue. When you sign back in to the module, you will be taken directly to the section where you left off. To review a section you have already completed, click on the desired section on the left menu bar. Introduction and Learning Objectives The learning objectives for Ten Behaviors that Promote a Healthy Weight in Preschool Children are listed below. At the conclusion of this module, participants will be able to: Slide 2 List three behaviors associated with a healthful weight; Describe how sleep and/or television viewing may affect weight; Explain why children do not eat the same amount of food from day to day; and List an educational tool that consumers have to aid in understanding how much food and what kinds of foods to offer children. From the First Lady to your local pediatrician, there s been much concern, and perhaps hand wringing, over what can be done to reverse the obesity trend. Child obesity is associated with type 2 diabetes, sleep apnea, hypertension, and other physical ailments, as well as negative social and emotional outcomes. Unfortunately, overweight children face a 70% chance of becoming overweight or obese as adults.

2 According to standards set by the Centers of Disease Control and Prevention, 17% of children are considered obese. For obese children, reversing obesity is very difficult and requires medical intervention with a physician. Lately, attention has shifted to the young preschool child and to the prevention of obesity. Today, we re going to review 10 behaviors that are supported by scientific research and known to be associated with healthy weight. Then we re going to look at the practical side of knowing how much food, and what kinds of food, should be offered to preschool children. Obesity is a very complex problem. At its most basic level, it s a matter of balancing energy intake with output. However, we know it s not that simple. Many factors, including the work, school, and home environments; the community structure; and regional and national policy and practices, as well as international factors, all play important roles. I wanted to share the figure on this slide with you at the onset of this course. It reminds us that promoting a healthy weight and preventing obesity is more complex than what is addressed by the admonition to move more and eat less. Slide 3 The American Academy of Pediatrics has identified four stages in the prevention and treatment of child obesity. Certain behaviors are recommended in Stage 1. We ll look at these behaviors and see how they fit with research findings. All four stages of obesity treatment are implemented under the guidance of a physician. Stage 1 is Prevention. In this stage, families learn about basic healthy lifestyle eating and activity habits, and the focus is on maintaining a healthful body weight. Stage 2 is Weight Management. A structured meal and snack eating plan is developed in this stage. Food and physical activity logs or diaries are used to monitor progress. It requires a Registered Dietitian and often a family counselor to implement. Stage 3 is Intervention. Structured goal setting, with weight loss through diet and/or physical activity, is planned in Stage 3. Frequent structured office visits with the doctor are needed. The physician s team includes a social worker, psychologist, nurse practitioner, exercise specialist, and others. Stage 4 is Extensive Care. This stage is for severely obese children and teens. The physician may prescribe medications, a low-calorie diet, or weight control surgery. This stage of medical intervention is usually delivered in children s weight loss centers having expertise in this level and type of care. Vegetables, Fruits and Sweetened Beverages Some of the 10 behaviors may be new to you, while other behaviors you may have heard of before. This next section discusses what children need more, or less, of in their eating plans. Please review the handout, Kid Friendly Veggies and Fruits.

3 Slide 4 Now, we ll begin to review 10 behaviors that support a healthy weight and may help to prevent obesity. Many of these behaviors are helpful tips for people of all ages. Today, we re going to discuss these 10 tips as they relate to the preschool child. The first tip relates to the importance of eating plenty of vegetables and fruits. The current Food Guidance System from the U.S. Department of Agriculture is MyPlate. MyPlate states this first tip well make half your plate vegetables and fruits. It recommends that a three-year-old child be offered about 1½ cups of vegetables each day. It s very important to offer a wide variety of vegetables to children. It helps to make sure all the vitamins, minerals, fiber, and antioxidants are provided in the eating plan. Sometimes, getting young children to eat vegetables can be a challenge. One of the biggest things parents can do to get their children to eat vegetables is to eat vegetables themselves. Modeling plays an important role in getting children to eat vegetables. Children also need to be offered new foods 10 to 12 times before they re willing to try them. Research shows that parents often give up offering new foods after 5 to 6 attempts. Often, parents assume the child does not like that food and then stop offering it altogether. This results in a very narrow range of food acceptance by the child. Parents should be encouraged to keep exposing their children to vegetables, while maintaining a pleasant meal time. With regard to fruits, MyPlate recommends that a three-year-old child be offered about 1½ cups of fruit each day. Most of that fruit should be offered whole or cut up not as juice. The American Academy of Pediatrics recommends no more than ¾ cup of 100% juice per day for children. This is because drinking too much juice may: Slide 5 add too many calories to the daily eating plan, displace solid foods, and curb the child s appetite for more nourishing foods and promote tooth decay. Our second behavior has to do with limiting sugar-sweetened beverages. Nearly 40% of the total energy consumed by children aged 2 to 18 years is in the form of empty calories. Children are drinking more sugar-sweetened beverages than milk. In general, children are consuming 173 kcal per day of sweetened beverages and only 146 kcal per day of milk. In other words, about 10% of children s total calorie intakes are being consumed in the form of soda and other sweetened beverages. Sweet drinks such as juice blends, soda, and fruit aids have no place in the young child s diet. This is because they contribute empty calories. Empty calories describe foods that offer calories but do not provide any nutrients or dietary fiber. Examples of empty calories include regular soda beverages and other sweetened beverages, such as sweet tea.

4 It s best not to eliminate sweetened drinks entirely from the eating plan. Instead, treat sweetened beverages and candy as once-in-a-while foods. This helps children to understand moderation. On a day-to-day basis, young children should be served milk, water, or 100% juice to drink. Sedentary Behavior and Physical Activity You might be surprised to learn that the American Academy of Pediatrics recommendation regarding children s sedentary behavior is to limit television, and other forms of screen time, to no more than two hours daily. Slide 6 The American Academy of Pediatrics recommends that children over the age of 2 years have no more than 2 hours of total screen time a day. And children who are younger than 2 years should have no screen time at all. The TV should be removed from children s bedrooms, or better yet, not placed in the child s bedroom in the first place. Research demonstrates that children who have a TV in their bedroom watch 4½ hours a week more television than children who do not have a TV in their bedroom. Also, don t let children eat while watching television. This can result in the consumption of too many calories. Other options to television viewing may be playing, taking a family walk, or dancing to music. Slide 7 Many of us need to be more physically active. According to guidelines, children should have at least one hour of active physical play each day. We know from research that children are more likely to be physically active if their parents are physically active. We can t over-emphasize the importance of role modeling for your children. A good rule of thumb for determining if a preschool child is getting enough physical activity is to ask yourself, do they: play outside, or in a room where they are free to run around, several times a day; have 2 hours or less of screen time per day; sit for no more than 60 minutes at a time; and breathe hard and sweat when actively playing? Young children need unstructured play time. One hour of physical activity can be broken up into short periods of time throughout the day.

5 Make Meals Count Life gets hectic sometimes, and there s no choice but to get a grab-and-go dinner. However, doing this too often has consequences. Slide 8 A behavior associated with healthful weight is eating at home more often than eating out in restaurants or fast-food establishments. Food eaten outside of the home accounts for about a third of a typical child s caloric intake. We know from research conducted by the USDA - Economic Research Service that when children consume food away from home, they consume more calories and have a lower overall diet quality. When eating out, children are less likely to have fruit, vegetables, whole grain, and milk servings compared to meals prepared and eaten at home. In other words, children may be getting too many calories and too few nutrients when eating out. Slide 9 Families should eat at the table and with the TV turned off. Children consume about 18% of their total energy intake while watching television on weekdays and a whopping 26% of their calorie intake on weekends. Eating while watching TV can lead to a pattern of mindless eating, which means eating in the absence of hunger. Instead, plan scheduled meal and snack times. In one research study, children who watched more television and ate fewer family meals were more likely to be overweight by the third grade. Overweight children watched about two hours per week more television and had fewer family meals than children who were never overweight. Slide 10 Behavior 7 reinforces the importance of eating breakfast. Parents and caregivers should model eating breakfast with their children. According to research, adult breakfast consumers tend to live a generally healthier life than breakfast skippers. Breakfast consumers tend to be more physically active and are less likely to smoke cigarettes. Children who don t eat breakfast don t do as well in school as children who do eat breakfast. Some young children may not want to eat as soon as they wake up. Offering them simple breakfast options, such as fruit or toast after they have had time to wake up, may help. Involve the Family Of all the 10 behaviors associated with healthful weight, this next one may be the most important.

6 Please review the handout, Be a Healthy Role Model for Children. Slide 11 Whenever we re implementing change, it s important to consider the whole family. Efforts to achieve and maintain a healthful weight are more successful when the whole family is involved. For example, it may not be reasonable to forbid children from drinking sweetened beverages or eating while watching television when they see the adults of their family doing it. Therefore, lifestyle changes should be aimed at families, not individuals. It s particularly true when interventions target children. Productive and strong parenting behaviors that aid in the prevention of child obesity are: establishing regular meal and snack times, avoiding the use of food as a reward, and serving as a role model for healthy eating and physical activity. Child Feeding Best Practices A best practice is an activity or behavior that has been proven to be effective based on experience and/or research findings. Please review the handout, Phrases that Help and Hinder. Slide 12 Children should learn how to serve themselves food and beverages as appropriate for their age and skills. As with any other behavior that s learned, this takes practice. Parents can offer very young children small, age-appropriate servings and then let the child know that they can have second helpings. Also, children shouldn t be encouraged to eat when they aren t hungry, as this could lead to a lifetime of eating in the absence of hunger. Eating food when not hungry may lead to obesity. The handout, Phrases that Help and Hinder, has some suggestions on how parents can effectively promote positive eating habits in children. Parents shouldn t let children eat when they re bored. This can be avoided by offering set snack times midway between meals. When it comes to candy and soda, moderation is key not total avoidance. Children need to learn to enjoy treats in moderation, as part of a healthful eating plan. Research has shown that when children are not allowed any treats, it often causes them to overeat treats whenever they have the opportunity. Eating in the absence of hunger should be avoided whenever possible. Sleep Well New research suggests sleep may be related to body weight.

7 Slide 13 It s fitting that we end our 10 behaviors with this final behavior get a good night s sleep. There s new research on the relationship between inadequate sleep and obesity. When sleep is too short in duration, appetite hormones are affected. This makes the person more hungry and, therefore, more likely to eat too much food. Adults who don t get enough sleep are more likely to be obese. This may be true for children, too. While there is no definitive scientific research on the amount of sleep children need, it s generally recommended that: Infants between the ages of 3 to 11 months have 14 to 15 hours of sleep each day; Toddlers, 12 to 24 months, should have about 12 to 14 hours of sleep each day; Preschoolers, aged 2 to 5 years, should get about 11 to 13 hours of sleep each day; and School-age children should have about 10 to 11 hours of sleep daily. Review of 10 Behaviors Let s review the 10 behaviors that are associated with healthy weight. Please review the handout, Ten Behaviors that Promote a Healthy Weight in Children. Slide 14 As parents and child caregivers, we need to role model positive lifestyle behaviors to the young children in our care. Although these behaviors may sound familiar, like something grandma would have told us, we now know that they are backed by scientific research. These 10 behaviors will not only help maintain a healthful weight, they will help prevent children from forming bad habits that promote obesity. MyPlate Eating Plans for Preschoolers At this point, use the handouts we ve provided to plan three meals and two snacks for a fiveyear-old child who gets the recommended one hour of physical activity each day. Review the handout, Choose MyPlate: 10 Tips to a Great Plate. Slide 15 Now we re going to switch gears. We ve talked about 10 behaviors that promote a healthy weight. Let s now talk about the practical side of how much food, and what kinds of foods, should be offered to children. MyPlate, which replaced the Food Pyramid, reminds us of what to eat and how much to eat. The messages are directed to the individual.

8 An overall eating plan should approximate MyPlate s proportions, which include: ½ of the plate with vegetables and fruits; ¼ of the plate with grains; ¼ of the plate with protein foods; and for dairy: o 2 one-cup servings of dairy each day for children age 2 to 3 years, o 2½ one-cup servings of dairy each day for children age 4 to 8 years, and o 3 one-cup servings of dairy each day for everyone over the age of 9 years. On the MyPlate website, there are additional messages for parents regarding key behaviors supported by scientific research that are proven to be best practices. Slide 16 Daily calories needs depend on age, gender, and physical activity level. This is true for both adults and children. By viewing the table on this slide, you ll see that the estimated calorie needs of preschool children vary from 1,000 to 1,600 calories, depending on their age, gender, and physical activity levels. For example, many three-year-old boys and very active girls need about 1,400 calories daily. With children, daily food intake can vary widely from week to week or even day to day, especially if they are having a growth spurt. This information provides general guidance on how much food should be offered to children. Children may eat more or less food. Parents and caregivers should discuss food needs with the child s doctor. Slide 17 Shown here is a sample 1400 calorie eating plan. Notice what is not included in the plan: sodas, candy, and other forms of empty calories. Children should be offered healthful food choices throughout the day during scheduled meals and planned snacks. Serving milk with meals and water with snacks is a best practice. Serve age-appropriate portion sizes, and allow children to have more food if they are still hungry. As children age, they should learn to serve themselves the amount of food they ll need according to their hunger. This may result in small servings. For the grain group, in general, 1-ounce of grain is one slice of bread, one 6-inch tortilla, or ½ cup of cooked pasta, rice, or oatmeal. For the protein foods group, a portion of meat, poultry, or fish the size of a deck of cards is 3 ounces. One-ounce equals one egg, ¼ cup cooked beans, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds.

9 Remember, the provided handouts give general guidance on how much food to offer each day to a preschool child. Children may eat more or less food. If you re concerned about the food intake of a child or have questions, please contact the child s pediatrician. Slide 18 Today, we reviewed 10 behaviors associated with healthy weight that are supported by scientific research studies. Many of these behaviors apply to adults as well as children. When making any kind of change, it s best to involve the whole family. We also reviewed the general guidance on how much food, and what kinds of foods, to offer preschool children. Remember, children may eat more or less depending on their gender, age, and physical activity level. Specific questions about a child s weight and if they are eating enough, or too much, food should be addressed with the child s pediatrician. References and Additional Resources Kumanyika et al. International Journal of Obesity Related Metabolic Disorders Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 2007 Food neophobia and picky/fussy eating in children: A review. Appetite The use and misuse of fruit juice in pediatrics. Pediatrics How sweet it is: Sugar-sweetened beverage consumption, obesity, and cardiovascular risk in childhood. Journal of the American Dietetic Association Couch kids: Correlates of television viewing among youth. International Journal of Behavioral Medicine Television viewing and television in the bedroom associated with overweight risk among low-income preschool children. Pediatrics How Food away from Home Affects Children s Diet Quality. USDA/ERS, October Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-age children. Journal American Dietetic Association Children s food consumption during television viewing. American Journal of Clinical Nutrition Family correlates of breakfast consumption among children and adolescents: A systematic review. Appetite Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research

10 Using the family to combat childhood and adult obesity. Preventing Chronic Disease Treating childhood obesity: Family background and variables and the child s success in a weight-control intervention. International Journal of Eating Disorders Beyond parenting practices: Family context and the treatment of pediatric obesity. Family Relations The benefits of authoritative feeding style: Caregiver feeding styles and children s food consumption patterns. Appetite Eating in the absence of hunger and overweight in girls from 5 to 7 years of age. American Journal of Clinical Nutrition Empower children to develop healthful eating habits. Journal of the American Dietetic Association The link between short sleep duration and obesity: We should recommend more sleep to prevent obesity. Archives of Disease in Childhood Sleep & Children. American Academy of Sleep Medicine Never enough sleep: A brief history of sleep recommendations for children. Pediatrics Additional Resources Academy of Nutrition and Dietetics - Centers for Disease Control - Author This module was developed by: Sharon Francey Robinson, PhD, RD, LD Associate Professor and Nutrition Specialist Texas AgriLife Extension Service Texas A&M System 2012 Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating