changing complex behavior for feeding kids

CHANGINGCOMPLEX BEHAVIOR

f o r

FEEDING KIDS

Eszter Erdélyi@[email protected](415) 990-0588

THE BIG PICTURE PROBLEM

IT’SA CONUNDRUM

In spite of the fact that all parents are highly motivated to feed their children healthy…

©EszterErdélyi2015 All rights reserved

IT’SA CONUNDRUM

They fail spectacularly…

1   Growing percentage of kids overweight, obese


IT’SA CONUNDRUM

They fail spectacularly:

1   Growing percentage of kids overweight and obese2   Most parents will admit to having “picky eaters” and arguing around eating


IT’SA CONUNDRUM

They fail spectacularly:

1   Growing percentage of kids overweight and obese2   Most parents will admit to having “picky eaters” and arguing around eating3   Drowning in advice from every possible channel, yet healthy, affordable and doable feeding feels unobtainable


HOW DID THIS

HAPPEN?

While a healthy-eating kid is a relatively simple measure, feeding akid even one time is the result of a

complex series of interdependent decisions and actions


Every parent has been told to feed more broccoli to their child…

…….very few ever succeeded


The successful outcome of a “feeding event” depends on much more than purchasing and offering the healthy food

Did you prepare it tasty?

Did you offer it 15 times?

Did you involve the child in preparation?

Does your child know how to taste

new food?

Did you model broccoli eating?


WHY CAN’T WE JUST DO WHAT

OUR PARENTS DID?

Fundamental changesin eating and feeding from the parental perspective


To provide a • reasonably nutritious • age-appropriate• within-budget• available • doable • and enjoyable meal • three times a day every day

seems a very different business today than it was even 10 years ago all over the world


What food is in our budget? Higher socio-economic status is correlated with healthier feeding and eating• although not because healthier food is more expensive in every case, but because

higher education and more resources are required to navigate the “foodscape”• In countries where large segments of the population newly live in urban environment the

opposite trend is true, more resources lead to less healthy feeding and eating

The quality of the affordable diet has changed for large segments of the population


What type of food we are surrounded with has changed

We typically find “food-like substances” and processed food in our environment with higher propensity than it is advised to consume them. It is more difficult to pick and choose a healthy selection and portion from what is readily available at the stores, take-out, fast food establishments, restaurants, vending machines and other sources of food around us.


Diet related information has changed: it’s confusing at best and misleading at worst

What food-related information to trust?

Food advertising, especially to children, has not subsided in spite of attempts by the industry to self regulate

Labels are written to correspond to regulations, difficult to understand, difficult to read, difficult to use for making shopping decisions

Fast changing research is hard to interpret if you are a layperson (for example mercury in fish)


The attention to and quality of regular school meals has deteriorated

School-provided lunches - rushed affairs often involving low-quality food, optimized for other objectives than student health

Same old lunchbox – parents fail to provide nutritious lunch in a bag, home sent lunches consistently do not meet nutrition criteria even of the school-provided lunches


Parents ability and skill to prepare food from scratch has changed

Time to cook? Even 30 minutes spent with food preparation takes organizing and setting priorities.

Fewer people know how to cook from scratch even simple things such as a bowl of soup

Take out and fast food is a ready alternative


Parental attitudes have changed

Several of the feeding principles which contribute to raising a healthy eater are counterintuitive for today’s prevalent parental attitudes: offering new food 15 times, allow children to decide how much to eat?


The short term objective takes precedent over the long term objective of raising a healthy eater

Parents feel compelled to bribe or coerce children to achieve the objective of eating healthier right now instead of following feeding principles to raise competent eaters for life

Satter EM. Eating Competence: definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39:S142-‐S153


The role of eating in our lives has changed

How to orchestrate the social aspects of eating so it’s pleasant for everybody? Where did the family meal go?


The structure of eating has changed

Where did the three-main-meals-a-day go?

Snacking several times a day is customaryConsuming food or “food-like substance” called “snack” when hungry instead of meals is encouraged by the food environment

Eating on the move is socially acceptable

Eating and feeding children junk is socially acceptable


COMPLEX DECISION MAKING

Feeding a child one time is the result of 10+ independent decisions each of which can sabotage the expected outcome of healthy eating


Plan what to eat at least a day in advanceBalance the meal (protein-‐carbohydrates-‐fat)

Buy ingredientsSelect marginally better processed foodAdd fresh (fruit or vegetable)

Store the food properlyPrepare the breakfastInvolve child in preparation

Sit down to eat at table, no distractionsEat together to model eating

Chew food wellTry new breakfast food regularly

No disciplining, bribing, forcing at the table

Did your child eat it? At the end there is still personal taste

Optimal decision tree leading to eating a healthy breakfast


No plan, instead eat what is in the fridgeBought what is advertised/convenient/in budgetBelieved the promises on the front of the boxAte food poured from a boxAte only carbohydrates

Happy if you get it done on your own, no involving childHave no time to sit down with childEating while moving, in the car

Parent only drinks coffee, skips breakfastNever learnt how to try new foodSwallows un-‐chewed food

Breakfast is an unpleasant event

Conclusion: My child simply does not like healthy breakfast, or eating breakfast at all

Instead what happens:


To find out how the separate decisions and actions accumulate and influence the expected outcome of the feeding event we conducted original research identifying parental perceptions of problems and barriers when feeding

Even one decision in the flow can sabotage the expected outcome of the “feeding event”


PARENTS MAKE TWO TYPES OF DECISIONS WHEN

FEEDING

“ ”

Routine decisions

How you “run the ship”, the regular decisions parents make to provide what when and where to eat we call routine

decisions


“ ”

Leverage decisions

Food- and eating-related choices parents make with the aim of influencing children’s attitude to eating and particular foods we call

leverage decisions


CUMULATIVE DECISION IMPACT

Routine decisions often made on autopilot

Plan meal

Shop

Select

Prepare food

Provide structure


If you do not have a plan and have to ask “What do I feed my child now?”, you fall back on what’s conveniently available in your hostile food environment

Plan meal

Shop

Select

Prepare food

Provide structure

The least practiced decision in feeding is planning which incidentally is the best vehicle for introducing change


Plan meal

Shop

Select

Prepare food

Provide structure

Very difficult to stay on plan when faced with industrial marketing, hard to go outside your immediate environment for buying food on a regular basis

How and where you procure food will largely decide the quality of of what you eat and consequently your health status


Plan meal

Shop

Select

Prepare food

Provide structure

Knowledge desperately needed - lots of confusing misleading nutrition information and fast-changing science

Learning how to select food from what is available is almost more important than eating a healthy meal


Plan meal

Shop

Select

Prepare food

Provide structure

Cooking from scratch regularly provides the best way to improve your child’s diet and eating habits but it is hard to do

Limited cooking skills and time available to cook makes default to buying prepared/processed food more likely


Plan meal

Shop

Select

Prepare food

Provide structure

Once you have one you have to feed your child several times a day every day

Providing main and mini meals at regular intervals and places is challenged by lifestyle, budget, food advertising, availability and popular culture


Involve child

Model eating behavior

Apply eating techniques

Design social aspects

Practice feeding dynamics

Extra dimensions of involving (teaching and supervising) are difficult for most parents – plus it’s a messy proposition

Involving a child in preparing meals looks like asking for trouble


Involve child





Parents are unaware of the strong impact of both their own eating behavior, and their use of food and sweets in particular for rewarding good behavior

The strong impact of parental behavior around food is implicit


Involve child





Most children were never taught what to expect when tasting new food, how to chew thoroughly or eat mindfully, or allowed to experiment with food

Eating a variety of foods including vegetables is a skill, acquiring it requires learning first how to taste new food


Involve child





The most conducive environment for healthy eating is a pleasant social experience for everyone –no disciplining

Eating together becomes parenting time by default, disciplining, arguing about food interferes with the eating experience


Involve child





Parents responsible for what, when & where only, child decides whether to eat and how much

Most children lose their ability to self control eating when parents interfere

Satter EM. Eating Competence: definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39:S142-‐S153


BEHAVIOR CHANGE MODELS

Changing any kind of behavior requires three things

Motivation Ability/Skill Trigger

BJ Fogg: A Behavior Model for Persuasive Design Persuasive Technology Lab Stanford University


Parental motivation to change feeding behavior is layered

General parental motivation for feeding healthy is strong but parents notoriously fail to recognize overweight status

Diagnosis of obesity, diabetes and related comorbidities, food allergy, sensitivity, other digestion related and developmental conditions and eating disorders may provide strong motivation to change feeding behavior

In the absence of above feeding behavior is most motivated at the outset – new baby


Ability/skill required for changing feeding behavior is different in every case

Parents have different individual skill profilesdistributed among the feeding decision categories

Some of the abilities related to feeding have constraints outside the parental influence at least in the short term – “cul de sac” from the change perspective

Children have different “eating personalities” and genetic influencers, parents need different skills for feeding one child versus another


Triggering healthy feeding practices has to be more specific than generally thought

Changing behavior in separate decision categories requires separate triggers

Parents can only handle one smallish change at a time, trigger has to match in specificity

Trigger fatigue: “Why, I plan our meals now and my child is still a picky eater!”


FEEDING YOUR KIDS PROGRAM

There is a need for aiding better feeding behavior outside the clinical setting

Successful feeding behavior change programs have been addressing all aspects of parental behavior over several months/years from a clinical setting

Pediatric weight management programs are very costly and not available to a large audience

A range of new apps available focus on recording food eaten as a proxy for behavior change or improving nutritional value of meals have also been falling short

David Ludwig ,Suzanne Rostler: Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/ Fake Food World Mar 18, 2008


The Feeding Your Kids program prototypes a new approach to behavior change

Guides users through a complex decision flow using behavior change tools for desired improvement in cumulative decision impact

Explicitly builds user skill profile, so users at any combination of skill-level can join and experience improvement in desired objective


Feeding Your Kids captures the unique characteristics of the complex decision flow of feeding

The decision-making flow is uniquely designed from the parental perspective and corresponds to actual life experience

Expected daily activity represents such small scope of change that it is doable immediately

The altered feeding decision steps generate small successes (“A-ha” moments) to maintain user commitment

The altered decision making steps combine for accumulated impact


Feeding Your Kids meets parents where they are by building their skill profile

All parents have motivation, but they have widely varying skills and circumstances, consequently different ability to execute any triggered feeding behavior

Changes require ability to deviate from what is convenient and what is suggested by the food environment (the assumed baseline), the program uniquely provides parents with the personal vision of how the improved skill builds the overall profile


www.feedingyourkids.com@FeedingYourKidswww.feedingyourkidsfoundation.org

changing complex behavior for feeding kids

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