Brenner FIT: Childhood Obesity Training...Allure of Diets and Exercise . Brenner Children’s...
Transcript of Brenner FIT: Childhood Obesity Training...Allure of Diets and Exercise . Brenner Children’s...
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Brenner FIT: Childhood Obesity
Training Presented by: Stacy Kolbash, MS, RD, LDN and
Sara Ebbers, MSW
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Brenner Children’s Hospital
Welcome
•Pediatric Obesity
•Allure of Diets
•Environmental Stressors
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Brenner Children’s Hospital
2 out of 3
Adults
1 out of 3
Children
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Brenner Children’s Hospital
North Carolina
• Nearly 1/3 of children 10-17 years old are
overweight or obese
• 50% in some areas
• National rankings
• 5th in childhood obesity
• 10th in overall obesity
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Brenner Children’s Hospital
Body Mass Index
• Best screening tool for weight status in children
• Predicts adiposity well
• Varies by age and sex in children
• BMI = weight (kg)
height (m)2
Adult Classification BMI kg/m2
Underweight: <18 Normal weight: 18-24.9 Overweight: 25-29.9 Obese: 30-39.9 Morbidly Obese: ≥ 40
5.NPA.3.3 8.NPA.1.1
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BMI and Children
What’s the Difference?
110 Pounds 9 years old 5 feet tall BMI = 22
110 Pounds 14 years old
5 feet tall BMI = 22
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110 Pounds 14 years old
5 feet tall BMI = 22
110 Pounds 9 years old 5 feet tall BMI = 22
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Brenner Children’s Hospital
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Brenner Children’s Hospital
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Brenner Children’s Hospital
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Brenner Children’s Hospital
Allure of Diets
and Exercise
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Brenner Children’s Hospital
What Has Already Been Tried
• Diets
• Counting calories
• Eliminating foods & food groups
• Skipping meals
• Snacks are bad
• Restriction/Forbidden foods
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Brenner Children’s Hospital
Evidence • During 3 year follow up, dieters gained more weight than non-
dieters. (Field, AE Pediatrics 2003)
• Dietary restraint, self-labeled dieting, exercise for weight control, and use of suppressants and laxatives predicted increased risk of obesity. (Stice, J Consult Clin Psych 1999)
• Girls who were already overweight at 5, who received higher levels of restriction, have the highest EAH (Eat-in-Absence-of Hunger) scores at 9, and the greatest increases in EAH overtime. (Birch, Am J Clin Nutri 2003)
• Among those at high risk for obesity, elevated weight appears to elicit restrictive feeding practices, which in turn may produce additional weight gain. (Faith Pediatrics 2004)
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Brenner Children’s Hospital
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We Live in an
Unhealthy World
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Brenner Children’s Hospital
Weight Bias
4:54
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Brenner Children’s Hospital
Calories Eaten
Calories Burned
Friends
Culture
Co
mm
un
ity
Income level
Media
Income level
Ne
igh
bo
rho
od
Media use
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Brenner Children’s Hospital
Weight Loss Recommendations
for Children
• Children ages 6-11 should also have slow,
gradual weight loss of 1 pound per month
• Children ages 12-18 could safely lose 0-2
pounds per week
• As children grow, they become taller
which naturally increases their weight.
During this time a small weight gain is a
success.
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Brenner Children’s Hospital
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Brenner Children’s Hospital
Weight Bias
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Brenner Children’s Hospital
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Brenner Children’s Hospital
What is it like to be me?
In 1961 a study was conducted
In 2001 The study was repeated
• Overweight children were
liked the least in comparison
to other children by peers.
• The outcome was the
the same, with one exception,
results indicated the dislike
was 41% worse
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Brenner Children’s Hospital
Reframing how we see
and treat obese kids
All children, despite physical size,
just want to belong
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Brenner Children’s Hospital
Self Esteem & Body Image as
it relates to Obesity
• Fear of becoming the one
who is picked on / bullied.
• Disconnected understanding
of health consequences of
poor nutrition, if weight gain
is not evident.
• Looks to unrealistic media
images for role-models
Challenges of “Average” size kids
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Brenner Children’s Hospital
Self Esteem & Body Image as
it relates to Obesity
Challenges of overweight kids
• Fear of being bullied about weight
• Clothing not fitting well
• Boys and gynecomastia
• Cannot fit in desk
• Not able to keep up physically
with other kids
• Feeling like people don’t look beyond their weight
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Brenner Children’s Hospital
Helping a Child to Create a
Positive Body Image
• Take the time to listen
• Ask for permission if you
give advice
• Be a role model
• Be inclusive in all activities
• Demystify the media
• Compliment actions and be
specific
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Brenner Children’s Hospital
Teasing and Bullying
• Pattern of behavior is
established
• Behavior has a negative
impact on victim
• An imbalance of power is
established
• 42% of Brenner FIT
patients have been teased
When does
teasing become
bullying?
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Brenner Children’s Hospital
Modeling of Healthy Living
and Social Inclusion
• Live the healthy lifestyle
you talk about
• Take interest otherwise
rejected children
• Find what is truly
interesting about a child
and highlight it
• Be Genuine
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Brenner Children’s Hospital
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Brenner Children’s Hospital
Our Tool box
•Rewards and Incentives
•Balanced Plate
•How We Eat
•Traffic Light Foods
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Brenner Children’s Hospital
Classroom Tools
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Brenner Children’s Hospital
Draw your dinner from yesterday
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Brenner Children’s Hospital
Typical American Plate
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Brenner Children’s Hospital
Balanced Plate
Lean protein
Starch/ grains
Fruits
&
Vegetables
1/4
1/4
1/2
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Brenner Children’s Hospital
Classroom Tools
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Brenner Children’s Hospital
Food Zones
Green Zone
Yellow Zone
Red Zone
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Brenner Children’s Hospital
Protein Chicken/Turkey Breast
Lean deli meat
Egg whites/substitutes
White fish, Shrimp
Salmon
Lean ground beef
2% low-fat cheese
Egg with yolk
Hot dogs
Regular ground beef
Fried Fish
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Brenner Children’s Hospital
Starch Whole Wheat bread products
Old Fashioned Oatmeal
High Fiber/Low sugar cereals
Wild or brown rice
White bread products
Honey Bunches of Oats
Regular Pasta
Enriched white rice
Croissants
Cinnamon Toast Crunch
Macaroni & Cheese/Ramen Noodles
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Brenner Children’s Hospital
Fruits & Vegetables
All non-starchy vegetables
Salsa
Whole Fruit
Coleslaw with light mayo
Starchy vegetables
Fruit with added sugar
Veggies in cream or cheese
Fried vegetables
Coleslaw with reg mayo
Fruit Juice
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Brenner Children’s Hospital
Snacks
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Brenner Children’s Hospital
Examples of Mini-Meals
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Brenner Children’s Hospital
Snacks Vegetables & Fruit
Lean deli meat, 2% String Cheese
Cheerios, Triscuits
Light popcorn
Pretzels, Baked Chips
Nuts, Peanut Butter
Goldfish crackers
Fruit snacks
Cheez-It, Pop tarts
Ice Cream, Cookies
Fruit Juice
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Brenner Children’s Hospital
GAME
TIME!!!
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Brenner Children’s Hospital
What We Drink
• Sugar drinks
• Gatorade, 20 oz
• Jumping jacks=60 min
• Walk= 1 hour 40 min
• 100% Orange Juice, 16 oz
• Play with kids, 1 hour 40 min
• Shoot baskets, 1 hour 25 min
• Low Sugar drinks < 3 grams sugar, 8 oz
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Brenner Children’s Hospital
Drinks Skim or 1% milk
Water
SF Flavored waters
Crystal Light
2% milk
Flavored milk
Diet soda
Whole milk
Regular soda
Fruit drinks
Sports drinks
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Brenner Children’s Hospital
Tipping the Scales
• 100 extra calories a day
• 1 small juice box (6.75 oz)
• 4 bites of pizza
• 3 bites of cupcake
• 1 snack size candy bar
• 180 days of school = 18,000 calories
• 5 pound weight gain over school year
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Brenner Children’s Hospital
Classroom Tools
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Brenner Children’s Hospital
How We Eat…
Just as important as what we eat
Environment and Mind-body connection
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Brenner Children’s Hospital
Building
Awareness
• Eating Location
• Limiting Distractions
• Mindfulness
• Eating Pace
• Fork Game
• Conversations Starters
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Brenner Children’s Hospital
Food Messages
• Pressure and Expectations
• Clean Plate Club
• Food Hierarchy
• “You have to eat your
vegetables”
• Cupcakes and pizza
• Modeling
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Brenner Children’s Hospital
Trying Something New
•“Ewww, that is gross!”
•Familiar foods
•Culturally diverse
•Repeated exposure
•Trying 14 times
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Brenner Children’s Hospital
Classroom Tools
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Brenner Children’s Hospital
“The best reward for any student
is to help them find that intrinsic
reward of knowing that they did
their best.”
– Julie Johansen, Huntington Elementary, Emery S.D.
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Brenner Children’s Hospital
Rewards and Incentives
• Food Rewards:
• Contradicts healthy
messages taught in
school
• Contributes to poor
health/eating habits
• Increases preference for
sweets
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Brenner Children’s Hospital
Rewards and Incentives
What do kids really want?
• Reduced homework
• Attention
• Recognition that they did a good job
• Encouragement
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Brenner Children’s Hospital
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Brenner Children’s Hospital
Brenner FIT
713-BFIT(2348) www.brennerchildrens.org/brennerfit