A PRACTICAL GUIDE TO IMPROVE AND MAINTAIN YOUR FAMILY S HEALTH

Transcription

1 A PRACTICAL GUIDE TO IMPROVE AND MAINTAIN YOUR FAMILY S HEALTH

2 The habits we form from childhood make no small difference, but rather they make all the difference Aristotle ( B.C.) Dear Parents We are really pleased that you have decided to participate in Family Connections. I know how hard it can be to help children maintain a healthy weight or how difficult it is to help a child who is already overweight to get back to a healthy weight. That is why we were developed this Connections workbook. We created this workbook because we believe Aristotle s words. The habits that children learn when they are young will be the habits that they stick with for most of their lives. You ll also notice that this workbook is targeted at you, the parent, because you have a unique and important responsibility to help shape your child s habits. Family Connections gives parents a practical guide to support the development of healthy habits for their children and to support healthy weight. The program is a balance of proven strategies from research and strategies based on the experiences of our weight management and pediatric staff. We are proud of this program and the impact it has on the lives of families with children who are overweight or at risk of becoming overweight. Congratulations on taking this first step and setting up a lifetime of healthy habits for your family! Sincerely, The Family Connections Team

3 Table of Contents: PART 1 PART ONE: DAY ONE... 1 Introduction.. 1 How do I know if my child is overweight?. 3 Body Mass Index: A Key Indicator 3 Calculating your BMI 4 Calculating your Child s BMI.. 6 Using Growth Charts 8 The Story of Shoestrings...10 What Causes Children to Become Overweight? 12 Concept Circles 12 Biological Cognitive 12 Environmental The Big PART ONE: DAY TWO.16 The Impact of Being Overweight 16 How You Can Help Your Child Avoid the urge to use fad or very low calorie diets Sentence Stems Activity PART ONE: DAY THREE 23 Healthy Habits for Healthy Families 23 Parent s P s and Children s C s (Division of Responsibility) Shoestrings and the P s and C s. 26 Begin with a Blueprint.27 Parenting Skills to Support Weight Regulation.. 29 Model Desired Behaviors 29 Observant of Positive Behaviors 29 Be Contingent and Consistent.. 30 Setting Boundaries...30 Getting Support from Others 31 Homework: Environmental quiz...34

4 Table of Contents: PART 2 PART TWO: DAY ONE...37 Home Environment..37 Nutrition Sample Menus..40 Snacks and on the go nutrition.43 Food Labels...45 Family Action Plan.46 PART TWO: DAY TWO...48 Changing Parent s Behavior...48 Parent s Personal Action Plan.50 Barriers and Strategies.51 Resources..52 Internet Sites..53 Books and Cookbooks

5 PART I: DAY 1 INTRODUCTION Welcome to Family Connections! By reading and using this workbook, you show your commitment to helping your family eat better and be more physically active. This is a big step, and it won t be easy. Many other parents, just like you, have been able to make changes in the way they parent and organize their home to help their families live healthier lifestyles and achieve a healthy body weight. Realizing that changes are needed is difficult and we are really pleased that you have made this first move forward to help your family live healthfully! Congratulations on starting to change your lifestyle to support your child s health! Just based on all the recent advertising and news broadcasts alone, you already know that children in the United States are heavier than they ever have been before. One in every five children is overweight. This is a 50% increase in the past ten years. Even in Colorado, one of the healthiest states in the union, the number of overweight children has risen at an alarming rate. There are a number of reasons that children become overweight. First, they have many more unhealthy food options at home and at school than most parents had when they were children. Second, the media continually targets the marketing of unhealthy foods to children. Third, parents are often poor role models for healthy eating and regular physical activity. Fourth, many parents believe children will out grow weight issues a belief that is simply not true so they don t support healthy eating and physical activity. What is really unfortunate for overweight children is the poor health conditions that await them in early adulthood. Overweight children are at higher risk for health problems such as diabetes and heart problems at much younger ages than their parents. Further, overweight children have to deal with teasing and bullying at school more than healthy weight children and, as a result, have more self-esteem, social, and psychological problems. The Family Connections workbook, developed by the Kaiser Permanente Colorado Weight Management Program, is intended to be a practical and supportive guide for parents of children who are overweight or at-risk of becoming overweight. By making positive changes now, families can create fun and active environments to lessen the chances for health problems for their child now and in the future. Our focus on parents highlights our underlying belief that an overweight child is a product primarily of their environment. This program is designed to facilitate family change and reduce the likelihood that a child will feel singled out as someone who can t control what they eat or do

6 The purpose of the workbook is to: 1. Encourage a healthy lifestyle for all family members. 2. Give basic nutrition and physical activity information. 3. Teach helpful parenting skills. 4. Give strategies that will change the home environment. 5. Help parents change their own habits so they can role model healthy eating and physical activity for their families. The Family Connections message is an easy one to follow: Healthy families are those who every single day are: Physically active Limit the amount of television and computer games played Eat a variety of fruits and vegetables Limit soda or sugared drinks How to use this workbook: This workbook was designed to be completed over a two-week period and to fit your personal needs. Part I is formatted into three sections with daily activities so that you can complete each section in a day and then use the learned skills for a day before moving on to the next section. You should be able to complete Part I in one week. Part I provides background on assessing your child s weight and activities to help parents work through weight-related issues. Part II of the workbook is formatted into two sections with daily activities for each day. You should be able to complete Part II in one week. Part II provides information on changing your home environment, increasing physical activity, and the basics on nutrition. The workbook is also intended to be a reference for parents to refer back to as needed. It is not intended to replace medical treatment or advice for the treatment of obesity, but rather as an aid to help parents follow through on healthy weight management goals for their families. Any specific concerns or questions about a child s health should be asked directly of a Kaiser Permanente health care provider. Begin by Reading the Next Page to Get Started on a Healthier and Happier Family!

7 Overweight, at Risk for Overweight, and Obesity Chances are that your child is overweight or at-risk-for overweight. But what does that mean? Recently, the word overweight has been used to replace the term obesity when referring to children who are at a high health risk because of their weight. Both an overweight child and an obese adult are heavier than is healthy based on his or her height. Being at-risk-for overweight is the new term for children who are heavier than is healthy based on his or her height but their health risk is less than children who are overweight. Sometimes parents explain away their child s weight issues by believing that the child is just big boned, will grow out of it, or have gained weight because of genetic factors. Although any of these things are possible, each is very rare. Doctors and other health care professionals are the best people to determine whether your child or adolescent's weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight. Body Mass Index The key indicator of healthy or unhealthy weight is a Body Mass Index (BMI). For adults, BMI is based on height and weight. For children, it is necessary to calculate BMI and then use a BMI growth chart since children are still growing. Children who are identified as overweight or at-risk-for overweight using the standard of BMI charts are more likely to have excess lipids in blood, elevated insulin, and high blood pressure. BMI is a good indicator of body fat the higher the BMI the more body fat an individual is likely to have. Finally, BMI is a consistent measure that can be used to track body size throughout life. In the next couple of pages we will help you determine your own BMI and the BMI of your child. If you would prefer to get a fast calculation on line you can visit the web sites below. Calculate your own BMI using the formula provided or using this on-line calculator at: Calculate your child s BMI by using this on-line calculator: Fast Fact: Researchers have found that approximately 60% of 5 to 10 year-old children who were overweight had at least one risk factor for cardiovascular disease, and 20% had two or more risk factors

8 Adult BMI Determine your own BMI. It is the same calculation for anyone over 20 years old. Anyone younger than 20 years old should use the method used for children. BMI can be calculated using pounds and inches with this equation. BMI = ( Weight in Pounds (Height in inches) x (Height in inches) ) x 703 But if you would like to get a good estimate of what your BMI is, you can use the following instructions and table on the next page. Steps to determine your BMI use the Adult BMI table: 1. Find your weight on the top row. (Use the weight that is closest to your own). 2. Find your height in the first column. (Use the height that is closest to your own). 3. Draw a line from your weight down the column. 4. Draw a line from your height across the row. 5. Where the lines intersect you will find your BMI. For adults BMI falls into one of the following categories. Our example person would be considered overweight. Where do you fall in these categories? BMI Weight Status Below 18.5 Underweight Normal Overweight 30.0 and Above Obese

9 ADULT BMI TABLE Weight (lbs)

10 Child BMI BMI is different for children because they are still growing. Children's body fatness changes over the years as they grow. Also, girls and boys differ in their body fatness as they mature. This is why BMI for children is determined based on gender and age. The same calculation that you completed above is used for children, but a second step in determining weight status includes plotting the BMI on a gender specific growth chart. The growth chart includes percentile curves that reflect childhood growth patterns. If a child is at the 75 th percentile it means that he or she has a higher BMI than 75 percent of the children of the same gender and height. Follow these steps to determine your child s weight status: 1. Determine your BMI from the Child BMI TABLE. (Use the same steps you used to find your BMI). 2. Use the Chart for Girls or Chart for Boys and find your child s age at the bottom. 3. Draw a straight line up from your child s age. 4. On the side of the chart find your child s BMI (from step 1). 5. Draw a straight line across from your child s BMI. 6. Draw a dot on the spot where the two lines you just drew cross one another. 7. If the dot is above the 95% wave your child is overweight. If it is above the 85% but below the 95% then your child is at risk of becoming overweight. Since children are getting taller, simply looking at how much your child weighs doesn t give you an idea of how healthy a weight it is for them. Determining your child s BMI for age about every 6 months is a good way to see if you are making progress. Guide Box for Children s BMI Greater Than 85% = At Risk Greater Than 95% = Overweight

11 CHILD BMI TABLE Weight (lbs) If your child is taller than 5 6 or weighs more than 160lbs then you can use the ADULT BMI TABLE on page

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14 The Story of Shoestrings Shoestrings is an eleven-year-old boy who loves to play video games and watch TV after school every day. He gets his name because his shoelaces are always untied and he trips over them constantly. He is always excited to tell people about his latest video game conquest or about the story from his favorite TV show. On a typical day in the life of Shoestrings he dresses in the latest fad: baggy pants and large T-shirts. When grown-ups ask him about why he wears such big clothes he just says it is because he likes the style, but really it helps him to hide his oversized body and makes it easier for him to fit in at school. Most mornings he isn t very hungry so he only eats a little at breakfast usually just a pop tart. At school, Shoestrings can hardly wait for the lunch bell to ring, he is always feeling starved by noon. His mom gives him a lunch and some extra money for a healthy snack everyday. On most days, Shoestrings uses his lunch money to buy snack cakes and candy. The lunch monitor doesn t seem to mind and Shoestrings is sure his mom won t find out. After school he heads home on his own and rushes straight to the video games and TV in his bedroom. But first he gets a snack, a nice piece of cake, to celebrate finishing a hard day at school. When Shoestrings begins to play his video games and watch TV, he munches on chips and drinks soda pop, not too much though, just a couple of bags of chips and a few sodas. He doesn t really keep track of what he is eating or how much he eats. In the evening Shoestrings has dinner with his family and even though he isn t very hungry (since he had so much snack food after school) his mom makes him clean his whole plate. He doesn t like his vegetables much so he tries to take as few as possible and fill his plate with potatoes or French fries. After dinner Shoestrings does a little homework and his mom rewards him with a bowl of ice cream. After that he sneaks in some more video game time and falls asleep to the sound of television in his bedroom

15 One day after school, Shoestrings and his mom went to the doctor. The doctor asked all sorts of questions about what Shoestring ate, what physical activities he did, and what his friends were like. When Shoestring answered about what he ate, that he didn t really do much physical activity (except walking to and from the car before and after school), and didn t have many friends he began to feel badly about himself. His mom was surprised too and felt like a bad parent letting Shoestrings live such an unhealthy lifestyle. Then the worst news of all came, the doctor told Shoestrings that he was overweight, in fact he was heavier than 95% of all other boys his age. The pediatrician also described some really bad diseases like diabetes and heart problems that Shoestrings would probably get if he didn t change how he ate and the physical activity that he did. The doctor suggested making some small changes in how Shoestrings ate and the activities that he did after school. This was hard for Shoestrings and his mom to hear. Shoestrings thought the doctor was overreacting because he felt fine, so what if walking for more than a block or so made him breathe heavily. He also worried that he would get worse at his video games and was scared they would take his TV out of his room

16 What Causes Children to Become Overweight? This is a complex question and it has a complex answer. You may have some questions about how a child becomes overweight. The easy answer is that a child becomes overweight when she/he has an energy imbalance eating too much food and not getting enough physical activity. Although this is the primary cause that makes children overweight, the issue is much more complex. As you can see from the concept circles above, a child s weight is influenced by his/her biology, cognition (what they think about healthy eating and physical activity), and environment. As a parent you are the common denominator in each of these areas. First, there are biological factors that can lead to unhealthy weight gain. There is no doubt that genetics play a role in whether a child is overweight or not. For example, children with one overweight parent are also more likely to be overweight. Similarly children born to mothers with diabetes have an increased risk of becoming overweight. However, the influence of genetics is used regularly by parents of overweight children as a reason to avoid making good changes in eating and activity habits. The fact is the influence of genetics on children s unhealthy weight gain is very small. Most often a parent being overweight has much less to do with his/her genes and much more to do with his/her behavior

17 Second, there are cognitive factors that can lead to an unhealthy weight. Behavioral factors are shaped by the way a child thinks (cognitive) and the environments where children live, learn, and play. This is probably not a news flash children think about doing and eating the things that they like then they do and eat the things that they like. The challenge is to find healthy foods and physical activities that are enjoyable for your child. Another challenge is to change the home environment so that children have positive role models for healthy eating and physical activity, access to a variety of healthy food and activity options, and ongoing support and assistance from their parents to lead a healthy lifestyle. Third, there are environmental factors that can lead to an unhealthy weight gain. We can break unhealthy weight gain in childhood into the Big 5 specific things that cause overweight children

18 THE BIG FIVE REASONS KIDS GAIN WEIGHT THE BIG 5 1. Not enough regular physical activity. Children need to be physically active for at least 60 minutes everyday. In the story about Shoestrings we describe a little boy who is basically doing no physical activity at all. He doesn t walk or ride his bike to school. Few schools provide daily physical education classes and if they do, the time in class (about 30 minutes) is not enough to help the children get the 60 minutes they need everyday. 2. Too much television and video or computer game time. Children who spend more than 2 hours per day watching television or playing computer/video games are more likely to become overweight. What s tricky is that children, like Shoestrings, get really good at sedentary games and then start to equate their personal worth with how good they are at the game. 3. Too much soda, sugared drinks, and unhealthy snack food. Just like Shoestrings, typical children in the United States have lots of access to unhealthy foods and these foods are what kids eat most often. Shoestrings ate a couple bags of chips and drank a few sodas that snack had almost all the calories that Shoestrings needs in a day but none of the vitamins and minerals. Even doing a good thing to help manage weight eating breakfast can backfire if the foods that are eaten are unhealthy (e.g., Shoestrings pop tart). Finally, even fruit juice can cause unhealthy weight gain because it is high in calories but has no fiber to help make a child feel full. 4. Too few fruits and vegetables. Believe it or not, this is one food group that you can eat as much as you want. Fruits and vegetables are healthy options for snacks and as the primary dish for dinner. Children who eat about 9 servings of fruits and vegetables everyday are much more likely to be a healthy weight. 5. Parents. Parents of children have the greatest influence on what their children eat and do. They help children form opinions and beliefs about foods and activities. Unfortunately, most parents are teaching their children, through example, to eat poorly and do little physical activity. When parents role model by watching television for 2-3 hours a night, they teach their children that watching that much TV is okay. When parents don t eat fruits and vegetables regularly they teach their children it is okay to skip these healthy foods. On the other hand, parents who do physical activity with their children are more likely to have children who are not overweight

19 Of course a number of other things can contribute to your child becoming overweight. Skipping breakfast, unhealthy school lunch options, the convenience of unhealthy food as snack options, or eating regularly at fast food or other restaurants are all things that contribute to overweight children. But if you, as a parent, could make changes to the Big 5 causes of unhealthy weight gain for children, you would be amazed to see the differences in your life and the life of your child. ACTION STEP! Of the Big 5. what are areas that could be improved in your family? What are the areas that your family is succeeding in? Here are some things that it would be good to keep track of for your child. Look at the questions below and watch what your child eats and does tomorrow. Don t try and change anything, just do the usual. Start by monitoring: ο How much time your child spends doing physical activities then write the time here: ο How much time your child watches television then write the time here: ο How much soda or sugared drinks your child has then write the number of servings here (count every 8 ounces as one serving): ο How many servings of fruits and vegetables your child has then write the number of servings here (count ½ cup or one piece as a serving): ο How you (the parent) are eating and being active and write it down here: This is the end of DAY 1. Start DAY 2 once you have finished monitoring a full day of your child s and your own Big 5 habits

20 PART I: DAY 2 THE IMPACT OF BEING OVERWEIGHT OR AT RISK OF OVERWEIGHT It is hard to hear about childhood weight problems, the obesity epidemic, and the poor health outcomes associated with unhealthy weight. But, you are not alone in dealing with children who are overweight. In 1999, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years in the United States were in the same situation as Shoestrings they were overweight. That percent of overweight children is nearly 3 times higher than it was in the U.S. in Just like Shoestring s doctor said, when children are overweight they are at higher risk for heart disease, high cholesterol and high blood pressure. Each of these conditions can be chronic and cause damage to a child s heart, lungs, and blood systems that could last for a lifetime. Similarly, type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents as a direct result of being overweight. The most frightening part of this is that diabetes has devastating negative effects on many body systems and can result in blindness and amputations at relatively young ages if it is not managed. Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. Overweight or obese adults are at-risk-for the same health problems including heart disease, type 2 diabetes, high blood pressure, and some forms of cancer that overweight children will be exposed to later in life. Probably the most immediate consequence of overweight as perceived by the children themselves is social discrimination. Overweight children are teased more often than normal weight children. This often results in poor self-esteem and depression. It is difficult to have a positive body image when the media promotes unrealistic thin images as the ideal body weight. In our story, Shoestrings wore baggy clothing to cover up his size. He did that because he felt bad about the way he looked. Being an overweight child is serious business. Fast Fact: One in every five children is overweight. This is a 50% increase in the past ten years

21 What does my child need to do? At our Weight Management Program, a common request that we get from parents of overweight children is for a diet for their child. While this sounds like a simple solution, short-term diets are just that short term and should be avoided for a number of reasons. Why your child should not be on a diet : 1. Children don t typically get all the vitamins and minerals they need when they follow a restrictive diet and this can result in stunted growth and lower bone density putting them at greater risk for broken bones. 2. Dieting can delay puberty. 3. Children who are put on a restrictive diet are more likely to develop eating disorders such as binge eating or they may learn to sneak or hide food. 4. Children who go on and off diets as they grow up are more prone to being overweight later in life. 5. Children who are put on a diet are singled out from your family and his or her peers. Imagine the impact on a child s self-esteem when she (or he) is given different food at the dinner table than her siblings because she is overweight. Imagine the same child having to pass on birthday cake at a friend s party because it doesn t fit with the diet. We also get a lot of telephone calls at the Weight Management Program from parents of young children who are overweight or at-risk-of becoming overweight. Often these parents are frustrated because they know how their child should eat. They also know how much physical activity that their child should do. They have told their child over and over again to stop watching so much television, to stop eating so many potato chips, and to stop drinking so much soda. These parents always want us to talk to their child so that we can convince him or her that they should lead a healthier lifestyle. The truth is that it is the parent s responsibility to provide structure and support so children can make healthy decisions. The structure and support has to be consistently and lovingly provided over time to help shape a child s eating and physical activity habits. The first step is to commit to the idea that it is your responsibility to lead a healthy lifestyle. It is your responsibility to set up your family and home in such a way that it promotes healthy eating and physical activity. The days of a do as I say parenting are over. It is time to begin the do as I do style of parenting. You demonstrate consistently, over time, how to eat healthfully and be regularly physically active

22 There are a number of ways to change your family and home to support healthy eating. You can do this for everyone in your family without singling anyone out or making anyone feel bad. Your goal for you, your child, and your family is: to be healthy, eat lots of fruits and vegetables, get lots of physical activity, cut back on how much you watch television. Where do I start? Parents who are successful at helping their children be more active, eat more fruits & vegetables, drink fewer sugared drinks, and watch less TV may have one thing in common they changed their behavior along with their children s behavior. So the answer to the title of this section is, You start with you. Now is a good time to pull out the monitoring action step results that you did yesterday. Knowing what your child was doing and eating should give you a good sense of the environment you have provided for him/her. The most important thing about the activity is what you did. So, a good beginning is with the beliefs you have about eating and physical activity. Not surprisingly, many of your beliefs about food and physical activity were developed when you were a child. Look at these common phrases about eating you probably heard once or twice growing up. Clean your plate before you leave the table. Better eat now or you will be hungry later No dessert until you finish everything The consistent message in these phrases is: eat more, even if you feel full. How often did you hear the phrase stop when you feel full because you know best when to stop eating? Probably not very often, but actually it is true. Research on infants and toddlers demonstrate that they will eat only until they are satisfied and will seldom consume more than they need. By 8 or 9 years old children have heard the common phrases above and have learned to eat more than they need. We learned from our parents to show excitement with sweet foods such as cake or ice cream, so when our children try these treats we reinforce them by telling them how good the food is

23 Sentence Stem Activity The activity is designed to help you identify your feelings, beliefs, and opinions about food, activity, body image and parenting. Some of the sentence stems may bring on strong memories of pleasant or negative feelings about the way that you dealt with food or physical activity in your family. It is perfectly fine to have these feelings! The most helpful approach to this activity is to be very honest with your responses there are no right or wrong answers. The purpose of the activity is to help you get a good picture of your feelings and how you may have come to develop certain beliefs. This activity will be really helpful if all the caregivers of your child complete it. If you are a single parent, then do this activity with a good friend. First, each of you read the introductory words below. Second, each of you should write down how you would finish each statement. Third, take a couple of minutes to reflect on your responses. Fourth, share your responses with your partner and talk about how your responses differed, how they are the same, and how your beliefs could influence your child and his/her weight. 1. Being a parent is 2. When I was a child, my family mealtime "rules" were 3. Our current family rules for mealtimes are: 4. When I was a child, my physical activity was: 5. My child's weight is most affected by:

24 When we use the Sentence Stem Activity in our Weight Management Program we always get a lot of really interesting information. The following paragraphs summarize typical responses we get from parents. If you had a tough time coming up with things for the sentence stems this information should help. Being a parent is Most folks describe being a parent as a caregiver, a teacher, or someone who provides unconditional love. We also hear that being a parent is challenging and can be stressful. All of these things are true and sometimes parents believe that helping their child deal with being overweight is just too much stress and sends a message that they only love their child if he/she is thin. But it isn t about wanting your child to be thin it is about wanting your child to be healthy. Helping your child make healthy food and physical activity choices may be difficult initially, but it will pay off in the long run. The first step is to believe that you can make a change, understand that there will be challenges, and be consistent in changing your parenting to foster healthy eating and physical activity. When I was a child, my family mealtime "rules" were How did you do with family rules around eating? Some of the common responses to this one include: cleaning your plate, eating together as a family, eat what s prepared, try everything, eat everything you take, and no television during dinner. Some of these rules are excellent eating together & no television for example. When families eat together, children are less likely to overeat. If children are able to watch television during dinner they stop paying attention to how much they eat and to their internal cues that tell them when they are full. Other of the rules, like cleaning your plate, send the wrong message to children. That rule suggests that it is more important to pay attention to what s on your plate rather than paying attention to whether you feel full or not. Our current family rules for mealtimes are Did you notice a pattern between your family rules now with the family rules that you had as a child? It is really common that we continue the same rules we heard from our parents. This is because family rules are a way that we see to find structure. Family rules and structure are great if they are the right kind of rules. Some of the parents who come to our program have no family rules because they had a negative experience with the rules their parents set for them. Without some structure it is difficult to keep your family s eating and activity habits on the healthy track. When I was a child, my physical activity was You probably won t be surprised to know that many folks do not have a tough time completing this sentence for their childhood activities, but have a tough time completing it

25 for their own family today. The most common response for activity that their family completes today is doesn t do much. Another response is that families don t have time to be physically active with the amount of work parents have to do and the amount of homework children are expected to complete. Time is a real barrier to physical activity; another barrier is neighborhood safety. Think about how often you played outside on your own as a child or walked to and from school. Now think about how many children do that today. It was much easier when you were young and it didn t take much effort on your parents part they could just send you outside to play. On a more positive note, some families walk together for a half-hour after dinner to have some time to socialize with each other. Other parents have become involved in advocacy at their children s schools working towards having safe times for their children to be active and developing safe-walk-toschool programs. My child's weight is most affected by What is surprising is that most parents realize what affects their child s weight. Not enough physical activity, too much television or screen time, too much unhealthy food, and not enough healthy food are all things that can cause your child s weight to increase. After doing the monitoring action step you probably have a better idea. The problem is that parents often put the blame on their child even their young children who likely don t control the types of food and opportunities of physical activity that are made available to them. Remember the last of the Big 5 causes of childhood weight problems (it was parents)? Parents are important because they control the food and activities that go on when their children aren t in school. Parents of young children are also their child s most influential role model

26 ACTION STEP! Through the sentence stem activity we have helped you think about some family rules to support or detract from healthy eating and physical activity for your family. But there are some great family rules that be a great help to setting your family on the right track. Look at the list of family rules below and pick two that fit for you and your family. Start using those rules tomorrow. If you can t find two rules from this list make one or two up of your own. Make sure that they are rules that will apply to the whole family and not just to one or two family members. Once you have implemented the rule, stick to it! ο An hour of physical activity for your children everyday (let them choose what activities to do) ο Limit screen time (television, computer, video games) to less than 2 hours per day. ο Provide enough fruit and vegetable options so your children can eat 5 to 9 each day. ο Limit soda or sugared drinks to 8 ounces a day (includes fruit juices and drinks) ο For drink options allow milk or water. ο Must try a bite of every food provided (don t need to eat it all!) ο Fruit & vegetable served with every meal. ο Sit down at the table for meals (no distractions!) ο Dessert two times a week (no more, no less) ο Do a family walk everyday ο Do some physical activity together with your children everyday ο Schedule your meals and snacks regularly so your children know when to expect food This is the end of DAY 2. Start DAY 3 once you have implemented your two rules for a day

27 PART I: DAY 3 HEALTHY HABITS FOR HEALTHY FAMILIES Now you have had a chance to try to some new family rules. Some of the rules were probably pretty familiar. In fact, 4 of the Big 5 targeted changing the behaviors from the Big 5 causes of childhood weight problems. When trying to change family health habits, it can be difficult to know the division of responsibilities. Although we have highlighted the responsibilities of parents and noted that parents are the key player in changing child health habits, children also have their own responsibilities when it comes to healthy eating and physical activity. Ellyn Satter, a well-known dietitian helped to divide healthy weight management responsibilities of parents and children. She called it minding your P s and C s. As you might guess the P s are the parents responsibilities and the C s are the child s responsibilities. Although, Satter provided the P s and C s for parent and child responsibilities related to eating they can also be applied to physical activity. Parents are encouraged to plan, prepare and provide. 1. PLAN the type of food you should buy and have in your home 2. PREPARE healthy food options for mealtimes and snack times 3. PROVIDE healthy food options in a positive way Children are encouraged to choose whether, what and how much to eat 1. CHOOSE whether to eat or not 2. CHOOSE what to eat from variety of healthy food options 3. CHOOSE how much to eat at scheduled mealtimes and snacks

28 Parent s Responsibilities..PLAN TYPES OF HEALTHY FOOD OPTIONS IN YOUR HOME First, planning means that as a parent you should plan the types of food you should buy and have in your home. Parents should also plan when meals and snacks will be offered, where foods will be eaten, and what rules should be followed. Just like with food planning parents should also plan regular options of physical activity, when physical activity can be done, and rules for physical activity (and sedentary behaviors)..prepare HEALTHY FOOD OPTIONS FOR MEALTIMES Second, it is your responsibility as a parent to prepare healthy food options for mealtimes and snacks. It is also important to prepare options so that your family s diet reflects a well-rounded one with lots of fruit and vegetables. It is also good to include your children in your preparation. Having them plan and prepare meals with you will increase the likelihood that they will enjoy and eat healthy foods. Physical activity also takes preparation. Parents should be prepared to provide options for physical activity by talking with their children to find out the types of things that they would like to do. PROVIDE HEALTHY FOOD OPTIONS TO YOUR CHILDREN Third, once you have planned and prepared healthy eating and physical activity options for your family, parents should provide and make those options available. When providing healthy options it is important to do so in a positive way. Having your children involved in planning and preparing is a great way to ensure a positive view. It is not the parents responsibility to force their children to eat or do the things that they have planned or prepared. It is time to allow your child to have the options of choosing to eat or do what you have prepared. This doesn t mean that the child has the choice to replace the healthy options with unhealthy ones (e.g., doesn t want to go for a family walk and wants to watch television instead), it simply means they have a choice within the planned, prepared, and provided options. Once the options are made available, parents should be good role models for their children

29 Children s Responsibilities..CHOOSE WHETHER TO EAT First, children should be given the opportunity to choose whether they eat or not. When there is a regular schedule of meals and snacks children can choose not to eat. This means that the clean your plate types of rules don t apply. It also means that the child should be aware that choosing not to eat at one time means they won t have the option to eat again until the next regularly scheduled meal or snack. Children should also have the option of when to be physically active or not. However, the child should also know that he/she needs to be physically active at least 30 minutes everyday, but they can choose when they do that activity....choose WHAT TO EAT Second, children should have the opportunity to choose what they eat from a variety of healthy food options or the types of physical activity they do. Allowing your children to participate in planning and preparing the healthy options will increase the chances that the child will make good healthy choices. If your child really likes a particular food that they shouldn t eat too much of then when you plan and prepare for meals only include that option occasionally. For example, if you provide chicken, pasta, and broccoli but your child eats mostly pasta and very little chicken or broccoli, then it would be appropriate to limit the number of meals where you provide pasta. CHOOSE HOW MUCH TO EAT Third, let your child choose the amount of food they eat at regularly scheduled mealtimes and snacks. Surprisingly, when parents put food on their children s plate they put on more than the child would him/herself. It is also important to remove any television, computer, or video (DVD) distractions. Having distractions actually causes children (and adults) to overeat. Also, children putting food on their own plates will help developmentally (e.g., hand-eye coordination). Similarly, when you take your child out to play or to let them be physically active, try not to set limits on the amount of time. Children are great judges of when they are too tired to carry on & they will sleep really well when they are done

30 Shoestrings and the P s and C s Shoestring s mom decided to try the P s and C s in their home. She didn t want to make all the changes at once, but picked a couple of areas where they could start using the P s and C s. She decided to take some time on Saturday to plan her shopping list and come up with some ideas for the family to be active together. Since Shoestrings didn t really like to take time for breakfast, his mom put wholegrain cereal bars on her shopping list. She left chips and pop off the list. Before finishing her list, she went to Shoestrings and asked him what types of fruits and vegetables he liked and added these to her list. She also asked Shoestrings and his sister what types of activities they might like to try with the whole family. As a family, everyone sat down to dinner on Saturday night and decided that they were going to do something active together twice every week. Shoestrings and his sister would each get to choose one night each week and which activity they did. On Sunday night, Shoestring s mom washed and prepared several types of fruits and vegetables for Shoestrings to choose as part of breakfast and after-school snacks. She even prepackaged some of the fruits and vegetables so that they would be easy for family members to grab if they were in a hurry! On Monday morning, Shoestrings was able to choose a cereal bar and either grapes or oranges for breakfast as he was running out the door. He thought it was fun to be able to choose part of his breakfast! After school, Shoestrings went to get a bag of chips and pop and discovered there wasn t any! At first, he was really mad about this, but when he opened the fridge, he saw all the different types of prepared fruits and vegetables and decided that maybe these were OK for an after-school snack. Shoestring s sister had chosen Monday night as her family activity night and she chose to go for a walk around their neighborhood. Shoestrings thought this might be boring, but they started watching and counting all the squirrels and it was actually really fun! After the walk, Shoestrings was looking forward to choosing his night for a family activity. He thought maybe he would wait until later in the week after all he didn t want to forget how to play his video games. By the end of the week, the whole family was eating more fruits and vegetables and looking forward to their two evenings of family activities!

31 Begin with a Blueprint You have learned that your child s weight is caused mostly by behaviors. For example children are more likely to become and remain overweight when they aren t very active, watch too much television, eat too few fruits and vegetables, and drink too many sodas and sugar drinks. You have also learned about the responsibilities that parents and children have in making healthy choices. So, your job as a parent is to help your child change his/her behaviors without making your child feel isolated or singled out from the rest of the family. The best ways for parents to do this are to: 1) Develop or refine parenting skills related to healthy eating and physical activity. For example, parents who are consistent in their encouragement and support are more likely to see changes in their child s behavior. 2) Change the family and home environment to support healthy eating and physical activity for all family members. For example, having toys that encourage physical activity in a place where your child will most likely use them can help a child do 60 minutes of physical activity. 3) Role model healthy behaviors for the family. Simply changing your behavior is not enough, it is important that your child is active with you and sees you eating healthy foods. 4) Change their behaviors so that they eat healthfully and are physically active regularly. This can be done by goal setting and monitoring the things that you do and eat. You as a parent have an important part in your child s environment and in their beliefs about themselves and their weight. Over the next few pages and activities we will focus on these four ways to help change your child s eating and activity behaviors. 1) What parenting skills will you use to ensure your family ο Gets 60 minutes of physical activity everyday? ο Has less than 2 hours of screen time everyday? ο Eats 5 to 9 fruits and vegetables everyday? ο Drinks less than a cup of soda or sugared drinks a day?