1 Equivalence of PDA, CFG Conversion of CFG to PDA Conversion of PDA to CFG.
Fostering Healthy Children & Families€¦ · Nutrition Concerns Canadian Community Health Survey...
Transcript of Fostering Healthy Children & Families€¦ · Nutrition Concerns Canadian Community Health Survey...
Fostering Healthy Children & Families
Jill Anne McDowall MSc. RD
October 30, 2015
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®
Today, IT’S HARDER TO BE HEALTHY
In addition to…
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 http://www.who.int/dietphysicalactivity/childhood/en/
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.
http://www.who.int/end-childhood-obesity/en/
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.
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
Family Meals – Not a new concept
Also not an EASY concept!
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.
http://family.lovetoknow.com/about-family-values/meaning-family
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
http://www.cbc.ca/news/canada/manitoba/teens-who-eat-with-family-
are-healthier-study-1.3288682
FEEDING DYNAMICS MODEL ELLYN SATTER WWW.ELLYNSATTER.COM
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
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.
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…
…hence The VALUE MEAL
MASTERING FAMILY MEALS SERIES
Ellyn Satter
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
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
THE EATING COMPETENCE MODEL
The Joy of Eating: Being a Competent Eater
Being positive & comfortable with eating.
Being ‘matter-of-fact’ and reliable about
getting enough enjoyable food.
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
The Joy of Eating: Being a Competent Eater
Feed yourself faithfully.
Give yourself permission to eat.
Pay attention…it’s a process.
http://ellynsatterinstitute.org/cms-assets/documents/202545-442073.es-res-lohse-web-slides.pdf
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.
Bringing Nutrition Screening to Toddlers & Preschoolers with NutriSTEP®
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®
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
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
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
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
Nutrition Assessment
Comprehensive approach to determine
nutritional status
Purpose is to assess or clarify a previously-
identified nutrition problem and/or unhealthy risk
factor behaviours related to nutrition
Involves medical, nutrition and medication
histories, physical examinations, anthropometric
measurements, and laboratory tests
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
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
Ethical Nutrition Screening
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)
NutriSTEP® is …
Knowledge Translation
NutriSTEP® website www.nutristep.ca
NutriSTEP ® Implementation Toolkit
NutriSTEP ® online community
NutriSTEP® Implementation Studies
Targeted implementation studies (2007-2011)
Kindergarten registration
Preschool screening program
Best Start hubs
Family Health Teams
Immunization clinics
NutriSTEP® is …
Implementation
Ontario: Accountability Indicator (2014)
New Brunswick: universal screening since 2011
And now PEI: universal through Public Health Nursing clinics
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
Nutri-eSTEP
Online access to NutriSTEP® screening
Dietitians of Canada website (www.nutritionscreen.ca)
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
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
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)
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
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
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
For More Information
Health PEI’s Public Health & Family Nutrition Program
Jill Anne McDowall
902-368-4414
NutriSTEP® Website:
www.nutristep.ca
THANK YOU FOR YOUR TIME
Good Question…
More Resources
http://www.gov.pe.ca/photos/original/hw_cph
oar2012.pdf
http://www.who.int/end-childhood-obesity/en/
https://njaes.rutgers.edu/spotlight/eating-
together.asp
www.nutristep.ca
http://www.ellynsatterinstitute.org