EFFECT OF NUTRITION CHANGES ON FOODS SELECTED BY STUDENTS IN A MIDDLE SCHOOL-BASED DIABETES...
-
Upload
coleen-shelton -
Category
Documents
-
view
216 -
download
1
Transcript of EFFECT OF NUTRITION CHANGES ON FOODS SELECTED BY STUDENTS IN A MIDDLE SCHOOL-BASED DIABETES...
EFFECT OF NUTRITION CHANGES ON FOODS SELECTED BY STUDENTS IN A MIDDLE SCHOOL-BASED DIABETES PREVENTION INTERVENTION PROGRAM: THE HEALTHY EXPERIENCE
The HEALTHY study group, Connie C. Mobley, Diane D. Stadler, Myrlene A. Staten, Laurie EI Ghormli, Bonnie Gills, Jill Harstein, Anna Maria Siega-Riz, Amy Virus
Presented by Aubrey Mahall
TSFE (Total School Food Environment)
Access to food determines dietary behaviors Children consume 35%-47% of daily intake
in school food environments NSLP and SBP
USDA provides nutritional standards and requirements
Federally subsidized “Competitive” food locations
A la carte, vending machines, school stores, and other school sponsored venues
“Competitive” Foods
Connecticut’s Healthy Food Certification (HFC) Provides monetary incentives to school districts that
choose to implement state nutrition standards for all foods sold to students outside of reimbursable school meals
For the 2006-2007 school year HFC (monetary incentives) were provided Food service directors were surveyed about the
availability of competitive foods before and after intervention
Food items frequently not purchased after HFC: Candy, full-fat ice cream, pastries, and cookies.
The HEALTHY Experience
4 integrated components: Nutrition Physical activity Behavioral knowledge and skills Communications and social marketing
Changes to TSFE enhanced by: Educational outreach Behavior change activities Promotional messaging
Purpose/Goal
To serve food and beverages of higher nutrient quality and
appropriate quantities
Hypothesis: The improvements in foods and beverages offered in TSFE would improve those selected and served to the students
Methods/Design
3 year, randomized, multicenter, school-based primary prevention trial 6 middle schools serving minority and low-
income pop’s Across 10 school districts located at 7 sites
across the country 4,603 students
6th – 8th graders Fall 2006 – Spring 2009
Procedures
Registered Dietitian at each site provided training and guidance to each school’s food service manager Coordinated achievement study goals for
district/school Educational events held during
lunchtime “Taste tests” of new products Unfamiliar food introduction Comparison of available items
Food departments given $3000 per year
Data Collection
Baseline and end of study Conducted by trained staff not involved in
implementation Aim to eliminate researcher bias
Nutrition data extracted from food service mgmt: Work production sheets, food/beverage
product specification sheets, and labels, recipes, and menus
Portion control: “Taken off the line,” selected by, or sold
Data Analysis
Nutrition Data System for Research Outputs a complete breakdown of nutrients
USDA Nutrient Data Laboratory NSLP
Entrees with high protein/carb and 400 kcal SBP
Considered high-fat if >30% kcal from fat High-fiber foods
Grain-based food or legumes > 2g dietary fiber per serving
A la carte Category specific: cookies, pizza, and ice cream
Results: Table 1
Results
More intervention than control schools had success in all goals except for fiber, fruit, and vegetable goals
High percents of both schools served no more than 6 oz 100% fruit juice and only low-fat milk at SBP
Little change in participation numbers of NSLP and SBP More students participate in NSLP than SBP
Intervention schools served significantly more grams of fiber from grain-based foods Yet still no difference in servings per student of high-
fiber grain-based foods
Results: Figure 1
Discussion
Changes in food served contribute to future beneficial effects: Greater reductions in BMI, % of students with
waist circum. > 90th percentile, and fasting insulin levels.
Reduction in high-fat foods, desserts, and added-sugar beverages was successful for NSLP
Research RD’s requested greater availability of high-fiber products Higher cost of fiber-rich foods
Discussion: What can we do?
Barriers to F/V consumption: Food service decisions controlled by
district, not school Cost and availability of F/V at given time Lack of student familiarity with variety
of F/V Juicing?
Allows student control and creativity in choosing
Drawbacks: cost of juicers, cost of all the added fruits and veggies, cleaning juicers after each student may take a long time for a lunch period
Strengths Challenges
Integrates nutrition with education, physical activity, and
learning experiences
Integrative nature: can’t single out which changes
most effective
Sample size: 4000+ Annual food bidding process
Middle schools across the country A la carte items finance school activities
Use of dietitian Availability and cost of F/V or higher-fiber options
Educational events held during lunchtime
Potential better method of tracking a la carte
computations
$3000 per year to schools No knowledge of serving consumption/plate waste
Implications
Basis for future research Education on “competitive” foods and
changing their availability/desirability As RD’s:
Our knowledge and skills are crucial in school food service systems in order to combat childhood obesity
This study outlines the major barriers to fruit/vegetable/fiber intake
Need for creativity and innovative ideas to accomplish these goals
BB Questions
Stacy: As a future Dietitian would you recommend instead a focus on removing processed foods, foods high in sugar (including fruit juice), and starchy foods like corn and potatoes (often referred to as vegetables) from the school menu instead?
Rachel: At the end of the article, the Healthy Hungry Free-Kids Act was mentioned. I’ve heard of it before, but not much beyond that. How has this act affected school meal programs?
Smart Snacks
in School
Smart Snacks in School
“The Smart Snacks in School nutrition standards support better health for our kids and echo the good work already taking place in schools across the country. The new standards preserve flexibility for time-honored traditions like fundraisers and bake sales, and provide ample transition time for schools.”
Targets: More of the foods we should encourage Less of the foods we should avoid. Targeted beverage standards allowing variation by age
group. Flexibility for important traditions. Ample time for implementation.
Sources
Mobley C, Stadler D, Virus A, et al. Effect of Nutrition Changes on Foods Selected by Students in a Middle School-Based Diabetes Prevention Intervention Program: The HEALTHY Experience. Journal Of School Health [serial online]. February 2012;82(2):82-90. Available from: Academic Search Complete, Ipswich, MA. Accessed September 3, 2013.
Long M, Henderson K, Schwartz M. Evaluating the Impact of a Connecticut Program to Reduce Availability of Unhealthy Competitive Food in Schools. Journal Of School Health [serial online]. October 2010;80(10):478-486. Available from: Academic Search Complete, Ipswich, MA. Accessed September 3, 2013.
Kakarala M, Keast D, Hoerr S. Schoolchildren's Consumption of Competitive Foods and Beverages, Excluding à la Carte. Journal Of School Health [serial online]. September 2010;80(9):429-435. Available from: Academic Search Complete, Ipswich, MA. Accessed September 3, 2013.
Snelling A, Yezek J. The Effect of Nutrient-Based Standards on Competitive Foods in 3 Schools: Potential Savings in Kilocalories and Grams of Fat. Journal Of School Health [serial online]. February 2012;82(2):91-96. Available from: Academic Search Complete, Ipswich, MA. Accessed September 3, 2013.
United States Department of Agriculture. Smart Snacks in School. http://www.fns.usda.gov/cnd/governance/legislation/allfoods.htm Accessed: September 9th, 2013.