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

jamcdowall@gov.pe.ca

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