1. Creating Positive Health Outcomes for Children by Improving Their Nutritional Environment in Schools Mari Richardson, MPH Student Walden University PUBH 6165-3 Instructor: Robert Marino Winter Quarter, 2011

2. Learning Outcomes Describe the effects of poor nutrition Define healthy eating and quality nutrition Recognize the need for change in the school nutrition environment Discover ways to improve school based nutrition Develop a school health program that promotes healthy eating Implement policies and standards for better school nutrition

3. What is Poor Nutrition? Too many or not enough calories Improper balance of carbohydrates, protein, and fat Not enough fiber Not enough minerals (e.g. calcium) Lack of the proper amount of vitamins in our diet (e.g. vitamins A, B, C, D, E, and K) The Columbia Electronic Encyclopedia. (2007). Columbia University Press. Retrieved from http://encyclopedia2.thefreedictionary.com/nutrition

4. Effects of Poor Nutrition on Children Undernourishment Overweight/Obesity Anemia Dental Caries Chronic Diseases World Health Organization [WHO]. (2007). Integrating poverty and gender into health programs: a sourcebook for health professionals. Retrieved from http://www.wpro.who.int/NR/rdonlyres/8856985D- 6646-4C98-AF5D-B7DDF43CEA06/0/Nutritionmodule2.pdf

5. Undernourished Children Have problems learning Have trouble recovering from infections and injuries Experience poor growth Have behavioral problems Have low energy Nemours. (2011). Kids health: hunger and malnutrition. Retrieved from http://kidshealth.org/parent/growth/feeding/hunger.html

6. Overweight/Obesity Caloric imbalance Prevalence = 19.6% in ages 6-11, 18.1% in adolescents 12-19 Associated with high cholesterol, hypertension, respiratory disorders, and diabetes in children Causes psychological stress Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. (2008). Prevalence of high body mass index in US children and adolescents. JAMA 2010;303(3):242–9. U.S. Surgeon General. (2007). Overweight and Obesity: Health Consequences. Retrieved from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm

7. Iron Deficient Anemia Prevalence = 2% of children age 6-11, 6% of adolescents age 12-19. Anemia causes: – Fatigue – Reduced resistance to infection – Low attention span – Impairs learning Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. (1997). Prevalence of iron deficiency in the United States. JAMA ;277:973--6.

8. Dental Caries Linked to sugar consumption Affects 52% of children ages 6-8 and 67% of 12- 17 year olds. Annual school time lost = 50 million hours Causes infection, pain, and tooth loss American Academy of Pediatrics. (2010). Overview of dental caries. Retrieved from http://www.aap.org/oralhealth/cme/page4.htm

9. Chronic Diseases Coronary Heart Disease Cancer Stroke Osteoporosis U.S. Surgeon General. (2007). Overweight and Obesity: Health Consequences. Retrieved from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_con sequences.htm http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_con sequences.htm Centers for Disease Control and Prevention [CDC]. (1999). Effects of childhood eating patterns on chronic disease risks of adults Retrieved from http://www.cdc.gov/mmwr

10. Healthy Eating and Quality Nutrition Carbohydrates Protein Fats Vitamins Minerals Fiber U.S. Department of Agriculture. (2010). My pyramid.gov: tips and resources. http://www.mypyramid.gov/tips_resources/index.html.

11. Daily Caloric Proportions Ages 4-8 Girls =1200-1800; Boys =1400-2000 Ages 9-13 Girls =1600 -2200; Boys =1800-2600 Ages 14-18 Girls =1800 -2400; Boys =2200-3200 U.S. Department of Agriculture. (2005). Dietary guidelines for Americans. Retrieved from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf

12. Daily Macronutrient Proportions Protein = 10% - 30% of caloric intake Carbohydrates = 45% - 65% of caloric intake Fats = 25% - 35% of caloric intake Fiber = 14 grams per 1,000 calories for children U.S. Department of Agriculture. (2005). Dietary guidelines for Americans. Retrieved from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf

13. Physical Activity Children and teenagers need at least 60 minutes every day Aerobic Activity Muscle Strengthening Bone Strengthening Centers for Disease Control and Prevention. (2010). How much physical activity do children need? Retrieved from http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html

14. Need For Change In Duval County Public Schools 70% = failed President’s physical fitness test 27.9% and 28.4% = overweight Duval county middle and high school students 49 = where we ranked last year in childhood obesity Duval County Health Department. (2009). Healthy kids, healthy Jacksonville: a community call to action to reduce childhood obesity. Retrieved from http://www.dchd.net/files/DCHC_ActionPlanRev.pdf

15. Ways to Improve School Nutrition Healthier options in vending machines Education on health, nutrition, physical activity, BMI, and safe weight loss Healthy and well balanced meal options in the cafeteria Increased opportunities for physical activity in the classroom Centers for Disease Control and Prevention [CDC]. (2004). The role of schools in preventing childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/physicalactivity/pdf/roleofschools_obesity.pdf

16. How to Develop a Program That Promotes Healthy Eating Get parents involved Survey students and get them excited Review nutrition and physical activity curricula Interview nutrition professionals Centers for Disease Control and Prevention [CDC]. (2003). Building a healthier future through school health programs. Retrieved from http://www.cdc.gov/HealthyYouth/publications/pdf/PP-Ch9.pdf

17. Implement Policies and Standards Requirements for physical activity Standards for foods and beverages offered in schools Comprehensive nutrition education Coordinate school food service with nutrition education Centers for Disease Control and Prevention [CDC]. (2007). School based obesity prevention strategies for policymakers. Retrieved from http://www.cdc.gov/HealthyYouth/policy/pdf/obesity_prevention_strategie s.pdf

18. Conclusion Poor nutrition = imbalance in carbohydrates, fat, protein, fiber, vitamins, and minerals Effects of poor nutrition = undernourishment, obesity, anemia, dental caries, and chronic diseases Quality nutrition = proper caloric, macro, and micro proportions Ways to improve school nutrition = provide healthier options in cafeteria and vending machines, in depth education on nutrition to students, and increase opportunities for exercise How to develop a program = get parents and students involved, review current curricula, and interview nutrition professionals Implement policies and standards for physical activity, foods offered at school, and nutrition education

19. References American Academy of Pediatrics. (2010). Overview of dental caries. Retrieved from http://www.aap.org/oralhealth/cme/page4.htm Centers for Disease Control and Prevention [CDC]. (1999). Effects of childhood eating patterns on chronic disease risks of adults. Retrieved from http://www.cdc.gov/mmwrhttp://www.cdc.gov/mmwr Centers for Disease Control and Prevention [CDC]. (2003). Building a healthier future through school health programs. Retrieved from http://www.cdc.gov/HealthyYouth/publications/pdf/PP-Ch9.pdf Centers for Disease Control and Prevention [CDC]. (2004). The role of schools in preventing childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/physicalactivity/pdf/roleofschools_obesity.pdf Centers for Disease Control and Prevention [CDC]. (2007). School based obesity prevention strategies for policymakers. Retrieved from http://www.cdc.gov/HealthyYouth/policy/pdf/obesity_prevention_strategies.pdf Centers for Disease Control and Prevention. (2010). How much physical activity do children need? Retrieved from http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html Duval County Health Department. (2009). Healthy kids, healthy Jacksonville: a community call to action to reduce childhood obesity. Retrieved from http://www.dchd.net/files/DCHC_ActionPlanRev.pdf http://www.dchd.net/files/DCHC_ActionPlanRev.pdf

20. References cont… Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. (1997). Prevalence of iron deficiency in the United States. JAMA ;277:973--6. Nemours. (2011). Kids health: hunger and malnutrition. Retrieved from http://kidshealth.org/parent/growth/feeding/hunger.html http://kidshealth.org/parent/growth/feeding/hunger.html Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. (2008). Prevalence of high body mass index in US children and adolescents. JAMA 2010;303(3):242–9. The Columbia Electronic Encyclopedia. (2007). Columbia University Press. Retrieved from http://encyclopedia2.thefreedictionary.com/nutrition http://encyclopedia2.thefreedictionary.com/nutrition U.S. Department of Agriculture. (2005). Dietary guidelines for Americans. Retrieved from http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pd U.S. Department of Agriculture. (2010). My pyramid.gov: tips and resources. http://www.mypyramid.gov/tips_resources/index.html http://www.mypyramid.gov/tips_resources/index.html U.S. Surgeon General. (2007). Overweight and Obesity: Health Consequences. Retrieved from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm World Health Organization [WHO]. (2007). Integrating poverty and gender into health programs: a sourcebook for health professionals. Retrieved from http://www.wpro.who.int/NR/rdonlyres/8856985D-6646-4C98-AF5D- B7DDF43CEA06/0/Nutritionmodule2.pdf

21. Further Reading Action for Healthy Kids: www.actionforhealthykids.orgwww.actionforhealthykids.org American Dietetic Association: www.eatright.orgwww.eatright.org Better Health Research: www.betterhealthresearch.com/poor-diet www.betterhealthresearch.com/poor-diet Centers for Disease Control and Prevention: http://www.cdc.gov/HealthyYouth/obesity/ http://www.cdc.gov/HealthyYouth/obesity/ Food and Drug Administration: http://www.fda.gov/newsevents/speeches/ucm053648.htm http://www.fda.gov/newsevents/speeches/ucm053648.htm Healthy Jacksonville: www.healthyjacksonville.comwww.healthyjacksonville.com Mayo Clinic: http://www.mayoclinic.com/health/childhood- obesity/DS00698http://www.mayoclinic.com/health/childhood- obesity/DS00698