community assessment of students within grand rapids ... · •poor dietary habits ... this class...

Community Assessment: Nutritional Habits of Students within Grand Rapids Public High School Ashley Bridges, Nicole Chambers, Lynda Chase, Jim Harrington, Sheila Lucas, Denise Lyon, Rebekkah McConnell, Dana Sartorius

How do we reach a generation that offers the best chance to

address the current health issues and societal habits related to improper diet and exercise?

Every generation makes its own

contributions to society

While each past generation has brought new ideas to our way of life they all have had one

thing in common:

They always think they have figured everything out and that the “kids” have little

to contribute and a lot to learn.

But just how

BIG is the

problem?

Obesity Trends* Among U.S. Adults BRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. Adults

BRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Obesity Trends* Among U.S. Adults BRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: http://www.cdc.gov/obesity/data/adult.html#Prevalence

Kent County

Overview • There is a growing concern in the U.S. about the health and

obesity rate of children

• According to the data shown on the Michigan Department of Community Health (MDCH, 2011.), there has been a trend of increased obesity rates in adolescents (grades 9-12) over the past 10 years

What Other Health Issues Can Obesity Cause?

Reference: NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Heart Disease Multiple types

of Cancer

Strokes Heart Attacks

Problem Statement

There is a need to develop interventional programs aimed at Grand Rapids Public High School children (grades 9-12), to help them make healthier choices regarding nutrition and activity to avoid or reduce elevated body mass indexes (BMI)and the associated health problems

Community Based Interventions

•Nutrition & Exercise Logs used in curriculum

• Increased Awareness & Education

•Student planted local garden

Nursing Diagnosis Risk for Nutrition Imbalance: More than body requirements

• Related to: • Excessive intake relative to metabolic body needs • Lack of nutritional knowledge needs, and/or

appropriate preparation • Poor dietary habits – psychosocial factors • Sedentary lifestyle – Socioeconomic status

• Secondary to: • Increased rates of obesity, diabetes, hypertension,

cancer • As Evidenced by:

• Weight 20% over ideal for height and frame • Reported or observed dysfunctional eating patterns • Eating in response to external cues such as time of day or social

situations

Intervention: Dietary and Exercise logs

• Incorporate a dietary and exercise log into classroom setting through a health education or physical education class in high school (grades 9-12)

• Use free web based programs such as My fitness pal or Fit day – students with smart phones can download theses apps for free or just use the web based form

Dietary & Exercise Logs Goals

Goals for Intervention:

• For students to become more aware of amount of food and fluid intake over a 24 hour period

• Students will be able to identify the behaviors associated with weight gain

• Participate in exercise program

Evidenced Based Intervention

Benefits of Dietary and Exercise Logs

• Visual of amount of actual caloric intake compared to recommended intake

• Students can see the benefits of how exercise effects the amount of calories taken in

• Can provide lifelong learning of label reading and portion control

“…lifestyle modification constitutes the mainstay of pediatric obesity treatment.”

Intervention Outcomes

Identify the Behaviors Associated with Weight Gain

• Weight loss/gain would be monitored weekly by the student using the online format chosen.

• Comparisons would be made using the information logged at the beginning of the semester and at the completion of the semester regarding amount of nutritious and empty calories consumed and a comparison of activities completed.

Appropriate amount of food and fluid intake over a 24 hour period • Comparison of 24 hour intake at

beginning and end of semester

Participate in exercise programming • Comparison of activity level at

beginning and end of semester

Barriers to nutrition and exercise log intervention • Students may log inaccurate amounts of food consumed or

exercise completed to get “better grade” or because of embarrassment

• Students may feel like recording weight, even in private logs, may be intrusion of privacy

• Some students may require specialized diets or approval from a physician before starting a exercise or “diet program”

• Possible permission from parents for students to enroll in this class or just incorporating it into already approved curriculum (i.e.- physical education or health awareness class)

• No computer or smart phone access while not in school

Intervention- Increase Awareness & Education in Students (grades 9-12) About Portion Size and Proper Nutrition • Incorporate proper portion sizes in health education

classes

• Have students develop a nutritional plan including portion sizes and a food log that is presented to peers

• Introduce students to websites and mobile phone apps to assist students with proper portion control and food logs

• Recognize foods used for “comfort” and how to avoid consuming empty calories

Websites such as Choosemyplate.gov and MyPyramid.gov discuss what correct portion

sizes are and how much of fruits, grains, vegetables, protein and dairy should be

included in a healthy diet

Intervention Outcomes • Students will demonstrate knowledge of basic nutrition and

portion size. As evidenced by grades, demonstration of appropriate portions size and nutritional choices on interim log checks

• Incorporate new knowledge into everyday life. As evidenced by healthy eating habits and healthy weight, and maintaining or improving BMI

• A week long log would be kept so students could identify what they ate, when, and how they were feeling when they consumed comfort foods. Also how to incorporate comfort foods in appropriate portion sizes

• Demonstrate appropriate serving size through hands on demonstration in health or physical education class

• Students able to verbalize at least two new healthy foods they have tried and liked this semester

• Students able to demonstrate one food source of calcium, iron, whole grain, fruit and vegetable

Barriers to Increasing Awareness & Education

• Permission from Grand Rapids School District would be needed to incorporate this into the health class curriculum

• Peers may not actively participate in presentations or be unwilling to try new foods

• Students may choose not to do the assignment

• Semesters for health class are 18 weeks long and class is taken only once during 9-12 grade

• Peer pressure and social disturbances create increased urges for comfort food

• Lack of parental guidance with meal planning or not having a family dinner

• Some students may have allergies or other health conditions that prevent them from making changes to their food choices

Intervention

Goal: To help educate about balanced nutrition, help students to reach adequate nutrition guidelines for vegetable and fruit intake, and

reduce or prevent obesity in Grand Rapids High School

Evidence Based Intervention “ Students and teachers across the country have already begun using their school gardens for benefits that go beyond the classroom. In this hands-on learning environment, students care for and watch their vegetables grow plus they have fun eating the fruits of their labor.” (www.letsmove.gov) The school garden is a primary prevention that can impact an individual as well as the community.

Benefits of the garden:

• Educates on the importance of balanced nutrition

• Helps to prevent and reduce childhood obesity

• Increases intake of vegetables and fruits

• Teaches skills that can be used throughout the individual’s life

• Provides open gathering area for students and community

• Beautifies School Grounds

• Encourages school involvement and raises school spirit

• Produces extra food that can be donated to shelters and food pantries

(Czyman, Wierenga, & Sielawa, 2009)

Resources -Plot of land on school property or neighboring area -Donations for equipment from local businesses/organizations or private donors -Basic gardening equipment like shovels and seeds to plant -Experienced gardener to lead project

Action Plan -Hold educational sessions to educate about gardening skills, importance of balanced nutrition, and provide healthy recipes utilizing the yield of the garden -Have students plant garden and harvest fruits and vegetables

Barriers Possible barriers to the success of this intervention are : -If the “schools were reluctant to have the gardens on-site as they feared it would increase expenses related to custodial staff, electricity, and water.” (Czyman, Wierenga, & Sielawa, 2009) -The lack of money to fund the project if enough donations are not received -Insufficient resources like not having an experienced gardener to lead the project or not having the proper equipment

Outcomes -Increase in the percent of students who have adequate vegetable and fruit intake

Measure this outcome by comparing the percent of students who report adequate intake at the end of the harvest to the percent recorded before the garden was planted as reported through surveys

-Students will have a greater knowledge of a balanced diet

Measure this outcome through testing before planting the garden and after harvest

-Prevent or reduce obesity in the students

Measure this outcome through BMI measurements pre and post intervention

Models for Change

“The nurse’s role is to promote a positive climate for change, serve as a catalyst for change, assist with various steps of the change process, and increase the individual’s capacity to maintain change.” (Pender, Murdaugh, & Parsons, 2011)

Health Promotion Model

Intervention-

Dietary and Exercise Logs

Outcome-

Health-promoting behaviors

•Nutrition

•Physical Activity

Self-Efficacy and Social Cognitive Theory

Intervention-

Increase Awareness & Education in Students (grades 9-12) About Portion Size and Proper Nutrition

Outcome-

Self Efficacy

Transtheoretical Model of Change

Intervention-

School Garden

Outcome-

•Assess the progress of the changed behavior

•Determine whether the change can be sustained long term

And if we don’t decided to change?

Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Care Expenditures Data, January 2012

And who will end up paying the bill if things don’t change?

You Will

Or Can You Do Better?

So are you going follow the same path as the previous

generations…

The Choice is Yours

Royalty Free Images from Foto search Stock Photography. Fotosearch and Photosearch are trademarks of Foto search, LLC. Retrieved from websites on: 10/26/2012

Images retrieved from: http://www.fotosearch.com/photos-images/obesity_8.html

Images retrieved from: http://www.fotosearch.com/photos-images/health_8.html

References Best, C. (2011). Appy Days –My Fitness Pal. Retrieved from http://www.munchforhealth.com/tag/food-log/

CDC website http://www.cdc.gov/obesity/data/adult.html#Prevalence

Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Care Expenditures Data, January 2012

Czyman, D., Wierenga, J., & Sielawa, J. (2009, April). Pioneering healthier communities, West Michigan a community response to the food environment. Health Promotion Practice 10(2)146-155. DOI: 10.1177/1524839908331269

Grand Rapids Public School (2012-2013) High school curriculum guide. Retrieved form: http://www.grps.org/images/departments/academics/pdfs/curriculum_guide_2012-13.pdf

Harkness, G.A., DeMarco, R.F.. (2012). Community and Public Health Nursing. Philadelphia, PA: Lippincott Williams & Wilkins

References iTunes Preview. (2012).Piatto: portion matters. Retrieved from: https://itunes.apple.com/app/piatto-portions-matter/id467064416?mt=8

Let’s Move! America’s move to help raise a healthier generation of kids. (n.d.) Retrieved from http://www.letsmove.gov

Ludwig, D. (2012). Weight loss strategies for adolescents: A 14 year old struggling to lose weight. Journal of the American Medical Association. 307 (5): 498-508

Michigan Department of Community Health. (2011). Critical Health Indicators. Retrieved from: http://www.michigan.gov/mdch/0,1607,7-132-2944_5327_47055---,00.html

NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Pender, N. J., Murdaugh, C. L., & Parsons, M. A., (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson Education

References

Royalty Free Fotosearch and Photosearch Stock Photography. LLC. Retrieved from http://www.fotosearch.com/photos-images/obesity_8.html on 10/24/2012

Stang J, Story M (2005) Nutrition education and counseling. Guidelines for Adolescent Nutrition Services. (pp. 55-61). Retrieved from: http://www.epi.umn.edu/let/pubs/adol_book.shtm

United States Department of Agriculture. (2012) Choosemyplate.gov. Retrieved from: http://www.choosemyplate.gov/

United States Department of Agribusiness. (2012). MyPyramid.org. Retrieved from: http://www.mypyramid.org/plan.php

Wilkinson, J.M., (2005). Prentice Hall nursing diagnosis handbook with NIC interventions and NOC outcomes. Upper Saddle River, NJ: Pearson/Prentice Hall