Live Healthy

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Live Healthy! Weight Management, Nutrition Counseling, and Physical Activity: How Wellness Fits Into the PuzzleIntroductions of presenters.2Learning ObjectivesIdentify three changes you can implement to improve students nutrition- and exercise-related behaviorsList three staff members to recruit for collaborationDescribe results from various research studies on nutrition, exercise, and health behavior changeDescribe components of the Behavioral Ecological Model3Juliebriefly review objectivesPaper on your table to help you organize your thoughts.3Whats Coming?Healthy Eating and Active LifestylesPolicy changesLive Healthy! campaignGuidance for each staff member on centerCurriculum to educate studentsGuidance to change the centers cultureWebinarsLaunch, competitions, quarterly campaigns

4We have some things coming down the pike including PRH changes, a campaign, guidance for each staff member, a sample curriculum, cultural recommendations, webinars, and a launch. Today were going to give you a sneak preview of this toolkit.4It takes a village to promote student health.

5We wanted to start by sharing the view that it takes a village, or an entire JC center, to promote health. It cant happen in wellness alone.5The Triumvirate

Three powerful individuals, each a triumvir The core: health and wellness, recreation, and food service

6All of what weve designed relies on the thought process that there are three powerful groups in charge of promoting student health: the health and wellness center, including nursing, physicians, mental health, TEAP, and oral health; recreation staff; and food service. Change in nutrition and physical activity takes members from all three of these groups to be truly effective. 6Who Else?Social DevelopmentInstructorsCD/AdministrationFinanceSGACommunity ConnectionsOthers

7And it cant stop there. There are so many other people on centersocial development, instructors, administration, finance, SGA, and the community that play a vital role.

A little overwhelming, huh?7ButToday, its not about them.

[Insert higher power of choice] grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.-Reinhold Niebuhr8But today, its not about them.8Today, we are talking about how you can help students be the best they can be.(Whether you are a nurse, psychologist, social worker, substance abuse provider, physician, or counselor)

9Today, we are talking about how you can help students be the best they can be. Of course all of these people play an important role, but you cant control what they do. But you can control what you do and how your department contributes to healthy eating, exercise, and weight management. So, today is all about your role.9And We Are Moving

Those who sit most of the day have larger waists than those who sit less.Jogging does not offset an otherwise sedentary lifestyle.Lack of muscle contraction for long periods of time may short-circuit unhealthy molecular signals causing metabolic diseases. Source: Judson O. (2010). Stand up while you read this! The New York Times. Retrieved online from http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/. Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.

Chronic sitting results in tight hamstrings, flat back, kyphosis, and weakened iliopsoas muscles.1010What Does Underwear Have to Do With It?NEAT - Nonexercise Activity Thermogenesis physical activity other than volitional exercise (ADL, fidgeting)Interindividual differencesLean individuals have higher NEAT and increase NEAT if overeat

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From: Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.Nonexercise Activity Thermogenesis (NEAT) and Exercise Comparison1212Game Break!True or False?Educating students 1:1 about making healthy choices is more effective than changing cafeteria policies to promote healthy choices.

13FalseInterventions that target the culture and policy are more effective than interventions that try to change individual behaviors.Behavioral Ecological Model

15Individual: taste, cost, convenienceInterpersonal: friends, family, relationships- influence when, how, where eat and acceptance of body compositionOrganizational: influences options available for food, exercise facility; day schedule; outings.Community: influences options availablePublic policy: can have major impact; NY governor- food stamps for foods of limited nutritional value; sin tax on non-nutritious foods; menu labeling, calorie content; urban development regulations; 15Assess, counsel, AdvocateLive Healthy! 16AssessmentBMI ratio of weight to height

Waist circumference

Intake formFood journalingExercise journaling 17Bring tape measure to demonstrate waist circumference

17Discuss Food JournalsWhat made it easier to eat well?

What made it more challenging?

How might you use this information on center?18Game Break!True or False?

A healthy BMI range is different for different ethnic groups.

19Sara- if you dont like this game break, take it out. 19TRUEPeople of Asian decent experience obesity-related diseases at a lower BMI than those of European heritage. An optimum BMI for those of African decent is under debate.Source: Rakugi, H. & Ogihara, T. (2005). The metabolic syndrome in the Asian population. Current Hypertensive Reports. 7(2), 103-109.Van Houten, B. (2004). Optimal BMI for black women undertermined. OB/GYN News. Retrieved online from: http://findarticles.com/p/articles/mi_m0CYD/is_20_39/ai_n6346067/.Assess, counsel, Advocate Live Healthy! 21Game Break!True or False?

Health care providers should deliver a directive message to their overweight patients to help them lose weight.

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FALSEA directive style often backfires.Framing Messages24AOL Searchsigns of obesityDue to the sensitive topic and the team not wanting to hurt anyone's feelings, no pictures were taken to show signs of obesity...25Why Motivational Interviewing Style?Respectful

Accepting

Encouraging

Mobilizing 2626Just because students know how to eat healthy, does not mean they will. Food preference is linked to culture, feelings, and although teaching nutrition is important, changing behavior and attitudes is often more important.Nutrition Education, Food and Nutrition, Job Corps Community Website, 201027

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29Communication StylesAggressive Im superior and right.

Passive Im weak or shaky.

Assertive Although you and I have our differences, you are equally right to express yourself.

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31The Art of Nondefensive CommunicationEliminates defensiveness

Liberates honesty

Builds integrity

Inspires compassion32The Art of Nondefensive CommunicationDrops defenses and opens up

Direct feedback without being judgmental

Express our own beliefs without being adversarial

Set firm boundaries that create expectations33Nondefensive QuestionsFunction is to gather informationNo need to control how the student answersYour demeanor is sincere, calm, relaxedAsked in a neutral toneNonopinionated Effect is disarmingLeaves student accountable for the response

34Nondefensive Statement FormatOvert message: reporting what you hear

Covert message: reporting what you see

Interpreting cause or motive

Your own reaction to the student

35Preparation for Nondefensive StatementsAcknowledge viewpoints dont apply to all

Dont try to convince everyone to agree

Recognize value of students experience

Prepare open statements

36Nondefensive PredictionsHow we will respond to the students choice?

Neutral in voice and body language

Creates security for the student and yourself

37 Effective PredictionsThe consequences are as small as possible

The student has max. opportunity for control

The consequences are self-contained

No foreseeable ramifications we cant tolerate38

39Rolling with Resistance

My whole family is overweight. Ill never be thin.I really like good food. More meat, please!Youre crazy if you think Im getting off this couch.4040Game Break!True or False?

Genetics plays a large role in a persons metabolism (i.e., how many calories a person burns in a day at rest).

41You look a little tired time for a game break. 41

FALSEOur genetics affect our weight, but they do not usually affect our metabolism.This is actually false. Genetics plays a large role in weight, not so much of a role in metabolism.Any idea what genetics affect? 42

Genes and WeightFTO (~55% carry A allele), leptin (mutation prevalence unknown) and MC4R (~6% mutation) are important genesIncrease the attractiveness of highly-palatable foodsLoss of control (LOC) of eatingNever feel full

Sources: Cecil, J.E., Tavendale ,R., Watt, P., Hetherington, M.M., Palmer, C.N. (2008). An obesity-associated FTO gene variant and increased energy intake in children. New England Journal of Medicine. 359(24), 2558-2566.den Hoed M, et al.(2009). Postprandial responses in hunger and satiety are associated with the rs9939609 single nucleotide polymorphism in FTO. American Journal of Clinical Nutrition. 90(5),1426-32.Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, ORahilly S. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. New England Journal of Medicine. 2003;348:1085-95.Tanofsky-Kraff, M., Han, J.C., Anandalingam, K., Shomaker, L.B., Columbo, K.M., Wolkoff, L.E., Kozlosky, M., Elliott, C., Ranzenhofer, L.M., Roza, C.A., Yanovski, S.Z., Yanovski, J.A. (2009). The FTO gene rs9939609 obesity-risk allele and loss of control over eating. American Journal of Clinical Nutrition. 90(6), 1483-8.43This slide could be an entire session unto itself, but I have about a minute to give you a rundown of this. There are hundreds and hundreds of genes that control weight and more to be discovered. Interestingly, none of them have a strong effect on metabolism. There are three genes that dominate the literature. These genes work roughly the same. They dont control metabolism, they control our thoughts about food and our urges to eat.

FTO (Fat Mass and Obesity-Related Gene) is the shiny new gene in the gene-obesity literature. Its so popular and so exciting mostly because its so prevalent. This affects of this gene are actually strongest in older children and adolescents, peaking at age 20. So, researchers have conducted a lot of the research on this gene in children. We have two copies of every gene, right? In a group of over 2,000 schoolchildren, researchers found that 14% AA, 49% AT, 37% TT. AAs heavier than ATs, ATs heavier than TTs. Then they took a subset of these kids to an all you can eat buffet and told them to have at it. The ones with one or two mutated genes ate more fattening foods (more chocolate, candy, fatty meats, etc.) than those without the mutation. The ones with two copies of the mutated gene ate worse than the ones with one copy. They were more likely to say that they felt out of control while eating; they were more drawn to the fattening foods and less drawn to fruits and vegetables.

Leptin and MC4R work not exactly the same, but in a similar fashion. Leptin is actually a hormone produced in fat tissue controlled by a gene. It is from the Greek Lepos which means thin. You know how after Thanksgiving, you cant stand to even think about food? Researchers think that leptin might be to blame for that food overdose feeling. Its also been implicated in NEAT.

MC4R isnt quite as comment but it accounts for between 3-5% of all severe obesity cases (BMI>40).

Leptin linked to high fructose corn syrup. Shapiro A, Mu W, Roncal C, Cheng KY, Johnson RJ, Scarpace PJ. (2008). Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding. Am J Physiol Regul Integr Comp Physiol. 295(5), R1370-5.

(Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, ORahilly S. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. N Engl J Med 2003;348:1085-95.)

43Why Are We Talking About This?Be ready to help change the thinking I cant lose weight because I have a slow metabolism

A lot of people are normal weight regardless of FTO, MC4R, leptin or any of the other 400+ genes that control obesity

Help students learn their triggers

Im built just like my mom.44It wasnt a coincidence that genetics was our game break after we talked about communicating with students and rolling with resistance. Along with I dont like to exercise and I dont like the way healthy foods taste you are probably going to be challenged with, My whole family is overweight, Ill never be thin and I cant lose weight because I have a slow metabolism. Now you know that genetics is not really controlling metabolism, its controlling perception and thoughts. That differentiation is really important. A lot of people control their weight, even with a genetic susceptibility to gaining weight. This can open a door for students to help students learn their triggers and overcome urges for unhealthy food and stop the LOC.

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Overeating as an AddictionGame Break!True or False?

The same parts of the brain are responsible for both food and cocaine addiction.

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TRUEFunctional neuroimaging studies revealed that good smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse.Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.47How It WorksCraving, wanting, and liking occur after early and repeated exposures

Decreased sensitivity in dopamine reward system/D2 receptor density

MRI studies ID changes in the hippocamupus, insula, and caudate

Sources:Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.Pelchat. (2009). Food addiction in humans. Journal of Nutrition. 139, 620-622.48Food Addiction and Obesity: Evidence from Bench to Bedside Yijun Liu, Ph.D.; Karen M. von Deneen, Ph.D.; Firas H. Kobeissy, Ph.D. & Mark S. Gold, M.D.AbstractObesity has become a major health problem and epidemic. However, much of the current debate has been fractious and etiologies of obesity have been attributed to eating behavior or fast food, personality issues, depression, addiction, or genetics. One of the interesting new hypotheses for epidemic obesity is food addiction, which is associated with both substance-related disorder and eating disorder. Accumulating evidences have shown that there are many shared neural and hormonal pathways as well as distinct differences that may help researchers find why certain individuals overeat and become obese. Functional neuroimaging studies have further revealed that good or great smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various forms of addictions. Most importantly, overeating and obesity may have an acquired drive like drug addiction with respect to motivation and incentive; craving, wanting, and liking occur after early and repeated exposures to stimuli. The acquired drive for great food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation. Keywords body-weight control, brain imaging, food intake, reward, substance abuseSweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes Jeffrey L. Fortuna, Dr.P.H. AbstractContemporary research has shown that a high number of alcohol-dependent and other drug-dependent individuals have a sweet preference, specifically for foods with a high sucrose concentration. Moreover, both human and animal studies have demonstrated that in some brains the consumption of sugar-rich foods or drinks primes the release of euphoric endorphins and dopamine within the nucleus accumbens, in a manner similar to some drugs of abuse. The neurobiological pathways of drug and sugar addiction involve similar neural receptors, neurotransmitters, and hedonic regions in the brain. Craving, tolerance, withdrawal and sensitization have been documented in both human and animal studies. In addition, there appears to be cross sensitization between sugar addiction and narcotic dependence in some individuals. It has also been observed that the biological children of alcoholic parents, particularly alcoholic fathers, are at greater risk to have a strong sweet preference, and this may manifest in some with an eating disorder. In the last two decades research has noted that specific genes may underlie the sweet preference in alcohol- and drug-dependent individuals, as well as in biological children of paternal alcoholics. There also appears to be some common genetic markers between alcohol dependence, bulimia, and obesity, such as the A1 allele gene and the dopamine 2 receptor gene. KeywordsA1 allele, cross sensitization, dopamine 2 receptor, nucleus accumbens, sucrose concentration, sweet

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Specifically SugarSugar-rich foods release euphoric endorphins and dopamine w/in nucleus accumbens as do narcotics

Craving, tolerance, withdrawal, and sensitization seen in both

Large number of AODA-dependent people, and the children of alcoholic fathers, have a sweet preference

Common genetic markersSource: Fortuna,, J.L. (2010). Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes. Journal of Psychoactive Drugs. 42(2), 147-151.49Sweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes Jeffrey L. Fortuna, Dr.P.H. AbstractContemporary research has shown that a high number of alcohol-dependent and other drug-dependent individuals have a sweet preference, specifically for foods with a high sucrose concentration. Moreover, both human and animal studies have demonstrated that in some brains the consumption of sugar-rich foods or drinks primes the release of euphoric endorphins and dopamine within the nucleus accumbens, in a manner similar to some drugs of abuse. The neurobiological pathways of drug and sugar addiction involve similar neural receptors, neurotransmitters, and hedonic regions in the brain. Craving, tolerance, withdrawal and sensitization have been documented in both human and animal studies. In addition, there appears to be cross sensitization between sugar addiction and narcotic dependence in some individuals. It has also been observed that the biological children of alcoholic parents, particularly alcoholic fathers, are at greater risk to have a strong sweet preference, and this may manifest in some with an eating disorder. In the last two decades research has noted that specific genes may underlie the sweet preference in alcohol- and drug-dependent individuals, as well as in biological children of paternal alcoholics. There also appears to be some common genetic markers between alcohol dependence, bulimia, and obesity, such as the A1 allele gene and the dopamine 2 receptor gene. KeywordsA1 allele, cross sensitization, dopamine 2 receptor, nucleus accumbens, sucrose concentration, sweet

49TEAP Specialist/Team RoleWork with students who are struggling with both addictions/cravings

Be cognizant of replacing one addiction with another

Another good reason to work closely with recreation50

The Mind and the BodyBED DSM-V Proposed Diagnostic CriteriaRecurrent episodes of binge eating. An episode of binge eating is characterized byboth of the following:Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstancesSense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eatingThe binge-eating episodes are associated with three (or more) of the following:Eating much more rapidly than normalEating until feeling uncomfortably fullEating large amounts of food when not feeling physically hungryEating alone because of being embarrassed by how much one is eatingFeeling disgusted with oneself, depressed, or very guilty after overeatingMarked distress regarding binge eating is presentThe binge eating occurs, on average, at least once a week for three monthsThe binge eating is not associated with the recurrent use of inappropriate compensatorySource: American Psychiatric Association. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=372. 52Prevalence of BEDNational Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm. 2% of the general population

53Prevalence of BEDNational Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm. 10-15% of the mildly overweight people

54Prevalence of BEDNational Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm. Prevalence is much higher in morbidly obese people.

55Disordered Eating75% of women between ages 25-45 eat, think, and behave abnormally around food some of the time.

56Source: University of North Carolina at Chapel Hill, news release, April 22, 2008

Obesity and DepressionWhat came first?Obesity causes depression?Depression causes obesity?

57Depression and anxiety disorders are present at higher rates in obese patientsStudy:54 obese adolescents50% of sample had psychopathologyAssociated with poor treatment complianceStronger correlation in women than menThose with Major Depressive Disorder (MDD) were more likely to be obese (OR=1.43)57Obesity Causes DepressionMechanism 1 Body image and lack of exercise lead to depressive symptomsMechanism 2Hormones produced by fat cells cause depressionSource:Emersson, A., et al. (2010). An obesity provoking behaviour negatively influences young normal weight subjects' health related quality of life and causes depressive symptoms. Eating Behavior. 11(4), 247-252.Taylor, V.H. & MacQueen, G.M. (2010). The role of adipokines in understanding the associations between obesity and depression. Jounal of Obesity.. 2010, (1-6).

Ugh I wish I hadnt signed up for this stupid research study.58Mechanism 1talk about research studyMechanism 2 58Depression Causes ObesityEmotional eating in overweight populationsHigh negative affect (worry more about their bodies)Low negative affectNo effect in normal weight people

Source: Jansen, A., Vanreyten, A., van Balvern, T., Roefs, A., Nederkoorn, C., & Havermans, R. (2008). Negative affect and cue-induced overeating in non-eating disordered obesity. Appetite. 51(3); 556-562.

Someone who feels bad about their body is more likely to overeat when sad than someone who feels okay about the way they look. 59Emotional eating--subtypes of people who have high negative affect and a subtype that has low negative affecthypothesis that two different subtypes would respond differently to triggers. Study looked at overweight/obese and normal weight participants, then clustered them into high and low negative affect subtypes. Then they induced a negative mood and put out tasty treats. The triggers elicited overeating only in the overweight/obese high negative affect subtype. Overweight participants with a more positive affect did not eat more after the negative mood induction. Normal weight people did not change their eating behavior based on mood. Shows that individual differences play a crucial role.

People in studies have been pretty evenly split into high negative affect and low negative affect types.

High negative affect people worried more about their bodies.

59Risk and Protective Factors Protective FactorsBody satisfactionServings of fruits and vegetablesEating breakfastRegular moderate to vigorous physical activityMilk intake (boys only) Family meals eaten together

Risk FactorsWeight concernTeasing/pressure (peer and parental)Poor body imageUse of unhealthy weight control methodsPeer dietingOverweight friends and family membersSugar-sweetened/diet beverage consumptionSources: Haines, J., Kleinman, K.P., Rifas-Shiman, S.L., Field, A.E, & Austin, S.B. (2010). Examination of shared risk and protective factors for overweight and disordered eating among adolescents. Archives of Pediatric and Adolescent Medicine. 164(4), 336-343.Haines, J. Neumark-Sztainer, D., Wall, M., & Story, M. (2007). Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity. 15(11), 2007.60

Strategy 1: Exercise

62http://www.youtube.com/v/0AdeoDqpmv8National Weight Control Registry (NWCR)There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity. 78% eat breakfast every day. 75% weigh themselves at least once a week. 62% watch less than 10 hours of TV per week. 90% exercise, on average, about 1 hour per day.

Source: National Weight Control Registry (2010). Retrieved online: http://www.nwcr.ws/Research/default.htm 63How Exercise Really WorksStrongest predictor of sustaining weight loss

Doesnt really burn that many calories

Weight reduction due to improvements in psychological factorsmood, self-efficacy, self-concept

Study=significant weight loss in exercise intervention, but only 19% could be directly attributed to kcal expenditure

Direct correlation between weight loss and mood scoreSources: Aneesi, J.J. (2008). Relations of mood with body mass index changes in severely obese women enrolled in a supported physical activity treatment. 1(2)88-92.Annesi, J.J., Gorjala, S. (2010). Changes in theory-based psychological factors predict weight loss in women with class III obesity initiating supported exercise. Journal of Obesity. 2010;1-4. doi:10.1155/2010/17195764

Strategy 2: CounselingOther Successful TreatmentsCognitive therapy more successful than standard of care in preventing weight regain

Foods and moodsdecrease body-related worrying/increase self esteem

Note: Antidepressants only effective in BED

Source:Werrij, M.Q., Jansen, A., Elgersma, H.J., Ament, A.J., & Hospers, H.J. (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. Journal of Psychosomatic Research. 67(4); 315-324.6666Practical SolutionsHave a recreation schedule on your desk

Incorporate exercise into groups

Foods and Moods curriculum

Screen for disordered eatingPartnership with outside treatment facility

Brief cognitive behavioral therapy

Collaborate with recreation staff

Food addictions group67

Diet and the Dentist

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71Cass Job Corps Center

Jamie Sjo, RN, HWM72

73Obesity is a risk factor for periodontal disease* and dental caries lesions.

Gregg Hiatt, DDS, Center Dentist*Journal of Periodontology, Aug 201074

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E76

Toothpaste AToothpaste B77

78Beware of

Sugar and AcidCooked starches too!Duration and frequency matter!79Protective Factors Saliva Fluoride, Ca, P AntibacterialsNo CariesCaries ProgressionRisk FactorsAcidogenic BacteriaFrequent carbohydrates Sub-normal salivaDisease IndicatorsCavities/dentinEnamel lesionsRestorations < 3 yrWhite spotsJohn Featherstone, Young, Wolff, 2007The Caries Imbalance80Small changes can lead to enormous results over time.According to Oprah Magazine:*

Willpower is like a muscle that gets stronger with useFocus on a small taskPractice *February 10

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Hmmmit is any wonder I caught cavities from fast food too?82Assess, counsel, AdvocateLive Healthy! 83Being a Consultant

84HWC can influence individual and perhaps interpersonal through 1:1 programming and intervention; However, anything higher than that in the model requires involvement of center wide participation! How do we get others to buy in?84Game Break!True or False?

Labeling a healthy food with a heart or other icon is the most effective way to get students to choose healthy foods.

85FalseLabeling with an icon is a mixed bag; although there is some evidence that providing calorie information on menus reduces the number of calories people eat. Source: Albright, C.L. et al. (1990). Restaurant menu labeling: impact of nutrition information on entre sales and patron attitudes. Health Education Quarterly. 17(2), 157167.Harnack, L.J. & French, S.A. (2008). Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices. International Journal of Behavioral Nutrition and Physical Activity. 26(5); 51.RESULTS: Six studies were identified that met the selection criteria for this review. Results from five of these studies provide some evidence consistent with the hypothesis that calorie information may influence food choices in a cafeteria or restaurant setting. However, results from most of these studies suggest the effect may be weak or inconsistent. One study found no evidence of an effect of calorie labeling on food choices.

Regardless of labeling, the #1 reason people choose food is taste. If something is labeled as healthy, some people will perceive it as tasteless and wont choose it. 86Game Break!True or False?

Slightly reducing the cost of healthy foods in comparison to unhealthy foods will encourage healthier eating.

$0.1087TrueAs little as a 10% reduction in cost of healthy foods will encourage an increase in consumption of healthy foods. Larger reductions encourage people to buy more snacks and consume more calories.Source: French, S.A. (2003). Pricing effects on food choices. Journal of Nutrition. 133(3), 841S-843S.Game Break!True or False?

Watching and discussing a health-related documentary, like Food, Inc., is more effective in eliciting behavior change than imparting basic nutrition knowledge during a health class.

89TrueStudents in a Food and Society course ate more vegetables and decreased high-fat dairy compared to students in a standard nutrition course.Source: Heckler, E.B., Gardner, C.D., & Robinson, T.N. (2010). Effects of a college course about food and society on students eating behaviors. American Journal of Preventative Medicine. 38(5), 543-547.Students in a Food and Society course ate more vegetables and decreased high-fat dairy compared to students in a standard nutrition course.

90Game Break!True or False?

Tangible prizes (e.g., t-shirts, gift cards) are the most effective way of motivating adolescents to change a health behavior.

91 91FalseFun activities, support, competence, and autonomy are effective ways of motivating students.Source: Ryan R.M. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 55(1), 68-78. doi:10.1039/0003-066x.55.1.68Any questions about your piece of the puzzle?

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