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Monday, 10/20/2014

Obesity Prevention in Children: Strategies for Parents and School Personnel

Obesity Prevention in Children: Strategies for Parents and School Personnel

By Jessica Blom-Hoffman, PhD, NCSP
Northeastern University

The high incidence of children classified as overweight or obese in this country has become a major national concern.  In his Call to Action, the U.S. Surgeon General referred to obesity and overweight as "a public health issue that is among the most burdensome faced by the Nation" (U.S. Department of Health and Human Services, 2001, p. 1).  

Risk Factors

Over the past 3 decades, the percentage of overweight school-age children has nearly quadrupled (4% in 1965 to 15% in 2001).  In addition, data collected as part of the National Health and Nutrition Examination Survey (see "Resources" below) revealed that ethnic minority children and children from poorer families are at increased risk for overweight and obesity.  For example, Mexican American and African American children and adolescents are twice as likely as their Caucasian peers to be overweight.  Obesity is associated with a number of serious medical conditions including premature death, type 2 diabetes, heart disease, stroke, hypertension, sleep apnea, osteoarthritis, gallbladder disease, asthma, breathing problems, cancer, and depression.

Prevention Strategies

The epidemic rate of obesity in this country is a major problem. However, it is important to recognize that obesity in many cases can be a preventable health condition.  While many factors including genetic predisposition contribute to obesity, dietary behaviors and rates of physical activity are two major factors that can be modified. Schools, families, and communities can work together to alter the trend toward obesity.  Teaching about healthy diet and the importance of maintaining a health activity level to young children is important as obesity is more easily prevented than treated.  It is important to begin prevention efforts early in childhood because obesity in adolescence is the strongest predictor of obesity in adulthood. The following strategies are suggestions for parents and school personnel to work together to promote the health and well-being of our nation's children. 

Prevention Strategies for Parents and Caregivers

  • Be good role models.  Show your children how important it is for all family members to make healthy food choices.
  • Provide your children with healthy food choices. Provide snacks that are low in fat, sodium, and refined sugar and are high in fiber, vitamins, and minerals. 
  • Encourage young children to develop good eating habits and preferences for healthful foods because eating behaviors that develop during childhood tend to track into adulthood.
  • Do not prohibit your children from eating unhealthy foods.  The key is moderation.  Limit fast food.  
  • Watch your children's portion sizes and make sure the diet is consistent with the recommendations of the food guide pyramid. 
  • Consult your child's pediatrician or nurse to find out how much food your child should be eating if you are not sure what portion sizes are appropriate for your child, or consult the resource books listed below. 
  • Limit television viewing.  Research suggests that increased television viewing is related to the development and maintenance of obesity.  This is not surprising given the number of advertisements for unhealthy foods targeted at child consumers, the sedentary nature of watching TV, and the fact that most people eat while viewing TV. 
  • Encourage your children to be active, but ensure appropriate safety precautions. For example, make sure your children wear protective gear including a helmet when they ride a bike or roller blade.
  • Work with community groups to develop safe walk-to-school programs if it is unsafe for your children to walk to school.
  • Learn about supervised activities offered by after-school programs at schools and community centers if you live in a neighborhood that is unsafe for children to play in the street or on the playgrounds.
  • Involve your children in food purchasing by taking your children food shopping and allowing them to help select healthy foods.  Also, involve your in the food preparation process such as washing vegetables and pouring and stirring ingredients.  
  • Give your children specific praise for making healthy food choices.  For example, "I like how you ate all of your spinach!  It will make you very healthy and strong."
  • Remember that food preferences develop over repeated exposure and time.  Try to present new foods in small quantities and encourage your children to just take a bite at first.  Over time, you can increase the portion size of the new food. 
  • Make sure your children try to eat at least five servings of fruits and vegetables each day, such as 100% fruit and vegetable juices and raw, cooked, canned, or dried fruits and vegetables.  Easy accessibility to fruits and vegetables is important.  Have fresh fruits and vegetables such as grapes and baby carrots washed and placed in a prominent location in the refrigerator.     
  • Be an advocate for your children at school.  Does your school have a vending machine that allows children to purchase soda and candy at school?  If so, speak with the principal and other administrators and the parent-teacher organization about the possibility of having the vending machine disperse water, 100% fruit or vegetable juice, milk, and healthier snacks (such as granola bars, boxes of raisins, graham crackers, and pretzels). This alternative enables the school to earn money, but not at the expense of its students' health.   
  • Suggest fresh fruits and vegetables and low-fat and skim milk be served in the cafeteria if it does not do so. Speak with the principal, food service administrators, and the parent-teacher organization. 
  • Discuss alternatives with fundraising organizers if your school engages in fundraising activities that encourage children to eat candy, chips, and other foods that contribute to childhood overweight and obesity. Suggest a fresh fruit sale.

Prevention Strategies for School Personnel

  • Be a good role model.  Show your students how important it is for you and them to make healthy food choices.
  • Be an advocate of healthy eating in school. If your school has a vending machine that allows students to purchase soda and candy at school,  work with administration and parents to limit vending machine options to water, 100% fruit and vegetable juice, milk, and healthier snacks (such as granola bars, boxes of raisins, graham crackers, and pretzels).  Your school will still earn money without compromising students' health.
  • Incorporate nutrition education lessons into the curriculum.  Learning is improved when new information is presented in a familiar context.  You can implement nutrition education information into science, math, language arts and health lessons. 
  • Incorporate a family involvement component when working with young children, because young children rely on caregivers to purchase and provide healthful foods. 
  • Inform families about what their children are learning regarding healthy eating in school.
  • Offer concrete, culturally appropriate suggestions for parents to help their children make healthful choices.   
  • Avoid using candy as a reward.  When candy is used as a reward, children are more likely to develop preferences for these foods.  In effect, when candy is used as a reward, its value will increase. 
  • Suggest and use alternative fundraising activities that do not involve the sale of candy, cookies, and cake. 
  • Discourage junk food and candy in school.  Institute no junk food days in your building.  Help students understand that foods high in sugar and fats are fine to eat as long as they are eaten in moderation. 
  • Expose students to healthful foods during nutrition education lessons.  Taste testing is an enjoyable activity for children.  Many children have never eaten certain types of fruits and vegetables.  However, before doing taste-testing activities at school, check with your students' caregivers to make sure they are not allergic to any of the foods you will be serving. 
  • Supplement nutrition education lessons with class trips to the fruit and vegetable section of a local grocery store or a farm.  Lessons can focus on selecting ripe fruit and vegetables, learning how fruits and vegetables grow, and tasting fresh fruits and vegetables.   
  • Establish a class-wide motivational system to encourage students to eat a healthful breakfast every day.  For example, you can set up a weekly raffle with a mystery motivator prize that students can enter each day by bringing in a signed breakfast raffle ticket to the classroom.  If students are eligible to participate in the school breakfast program, you can give them a blank raffle ticket that they can have the food service staff sign that they ate breakfast that day.  If students eat breakfast at home, their caregivers can sign the breakfast raffle ticket. 
  • Understand that the provision of knowledge does not necessarily translate into behavior change.  Simply informing students about the importance of daily physical activity and healthy eating behaviors does not mean they will adopt these behaviors.  It is also important to provide students with an environment that supports these behaviors, motivation and reinforcement for engaging in these behaviors, and role models who espouse these behaviors.
  • Help students set realistic, well-defined, measurable goals for themselves regarding healthy eating and physical activity.  For example: "I will eat five servings of fruit and vegetables each day." "I will eat breakfast every day this week." "I will play basketball at least 4 days this week."  In addition to setting the goal, have them record their progress over time.  Students' performance on their goals can be graphed and incorporated into a math lesson.   

Resources

Center for Disease Control. (2003). National Health and Nutrition Examination Survey. Available: www.cdc.gov/nchs/nhanes.htm

Dietz, W. H., & Stern, L. (1999).  The official complete home reference guide to your child's nutrition.  Elk Grove Village, IL: American Academy of Pediatrics.  Available: 888-227-1770.

Shield, J., & Mullen, M. C. (2002).  The American Dietetic Association guide to healthy eating for kids: How your children can eat smart from five to twelve.  New York: Wiley. ISBN: 0471441449.

U.S. Department of Health and Human Services (2001).  The Surgeon General's call to action to prevent and decrease overweight and obesity.  Rockville, MD: Author. Available: www.surgeongeneral.gov/topics/obesity/default.htm

Websites/Organizations

American Obesity Association-www.obesity.org/subs/childhood/prevention.shtml

Dole 5-A-Day-www.dole5aday.com

Food and Nutrition Information Center (food and nutrition resources for grades preschool through 6)-www.nal.usda.gov/fnic/pubs/bibs/edu/preschool.html

© 2004, National Association of School Psychologists. Jessica Blom-Hoffman, PhD, NCSP, is an Assistant Professor of School Psychology at Northeastern University in Boston, MA.  Her research is focused on developing, implementing, and evaluating school-based programs that promote healthful eating behaviors in young children. Reprinted from Helping Children at Home and School II: Handouts for Families and Educators (NASP, 2004).