1. ADA Foundation/Knowledge Networks Family Nutrition and Physical Activity Survey Funded by a grant in memory of Allene Vaden

2. Study Purpose Expand knowledge of children’s attitudes and behavior patterns regarding weight, food selection, eating and physical activity patterns Assess parents’ awareness of children’s behaviors that influence weight Gain a deeper understanding of how parents and children relate to the topic of weight, eating and physical activity

3. Methodology Conducted three focus groups, children and parents, to learn best approach for topics Completed telephone interviews with (N=144) younger children (ages 8 - 2*) Completed online survey with (N=471) older children (ages 13 –17) Completed parallel online surveys with (N=615) parents (of younger and older children) *due to FCC regulations, children under age 13 are not permitted to participate in Internet surveys or online data collection of any kind.

4. Knowledge Networks Panel US Adult Population* Women 51% Age 18-34 34%33% Married 63%61% Working 74%67% Homeowner 74%71% Less than college 62%69% African-American 11%12% Over $75,000 25%22% — KN Panel Mirrors US Population *US Census

5. Survey Content Areas Why and when kids eat Children’s meal and snack purchase habits School lunch participation and barriers to participation Children’s involvement in physical activity Children’s role models Nutritional value of foods eaten, self-assessment Body size and satisfaction: self and family assessment Parental interaction: opportunities for modeling parents’ eating and physical activity Nutrition and body size communication Family habits relative to meal and bedtimes

6. Selected Survey Findings

7. Why Kids Eat Parents (78.5%) overestimated younger children’s (61.8%) hunger Parents (35%) underestimated the extent to which children (43%) eat “because they are bored” or “because they are depressed” at least some of the time Parents (8.5%) also underestimated that children (16%) eat because they are angry, sad, or depressed at least some of the time

8. Why Kids Eat Older children eat more frequently than younger children “all” or “most” of the time because Bored 15.9 vs. 7.7% Angry, sad, or depressed 6.2% vs. 4.3% Friends are eating 15.1% vs. 5.6% Younger children ( 13.2%) eat more than older children ( 7%) “all” or “most” of the time because parents/adults made them Boys ate more than girls because they were hungry (80.8% vs. 70.8%) “all” or “most” Girls ate more than boys “all” or “most” of the time because of being angry, sad or depressed (7.2% vs. 6.2%)

9. When Kids Eat CategoryAll or Most of the time Some of the time After school 53.8 %29.6% After dinner 23.3%32.0% While doing homework 15.8%36.6% While watching TV, video, games 23.3%45.2% While on phone 6.2%20.7%

10. Eat While I am Watching TV, Playing Computer Games 0.0% 0.2% 9.6% 9.3% 22.0% 34.7% 45.2% 42.0% 16.1% 10.7% 7.2% 2.9% 0.0%5.0%10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%50.0% All of the time Most of the time Some of the time Every once and a while Never Don't know Statistical Significance: p<.001 All Kids All Parents

11. 0.0% 0.6% 12.8% 7.8% 31.8% 40.6% 32.0% 34.6% 17.5% 12.8% 5.8% 3.2% 0.0%5.0%10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0% All of the time Most of the time Some of the time Every once and a while Never Don't know All Kids All Parents Eat in the Evening, After Dinner Statistical Significance: p<.001

12. Where Kids Buy Meals and Snack The majority of children purchase meals and snacks more frequently and from a wider array of venues than parents may realize With the exception of school lunch lines, parents under-predict this frequency

13. Food Purchase Habits Reported by Children and Parents’ Perceptions Purchase Opportunity Some DaysDaily/Most Days Parents’ Perception Daily/Most days School Lunch Line15.4%36.5%49.4% Vending, snack bars 19.4%19.8%11.5% Convenience stores, vendors 21.4%8.9%4.9% Grocery Stores18.9%10.5%5.5% Fast food, food court, other rest. 20.4%11%8.4% Pizza Delivery12.3%4.6%0.6%

14. School Lunch Participation More than 55% of children reported eating school lunch daily 21% reported sometimes taking a lunch from home and sometimes eating school lunch When asked how often children purchased from school lunch line, only 36% reported daily or most days Significantly more parents (49%) believed children purchased from lunch line daily or most days

15. Barriers to School Lunch Participation For those that did not eat school lunch, reasons given included: Do not like what is offered (38%) Parent prefers take lunch from home (25.9%) Not cool (22%) Friends do not eat it (22%) Prefer vending options (18.3%) Younger children’s decision not to eat school lunch appears to be driven more by friends’ decision not to eat school lunch Girls are more likely than boys to strongly agree that they do not eat a school lunch because they do not like the food served

16. Body Satisfaction/Size Parents are likely to inflate child’s body satisfaction Parents of boys report 8.07, boys own score 6.92 Parents of girls report 7.51, girls own score 6.43 Girls’ body satisfaction is slightly lower than boys’ Many more parents than children believe that their child’s body size “is fine as is,” and that their child need not gain or lose weight

17. How Kids Describe Their Body Size Significantly more girls (33%) describe their bodies as “slightly overweight” compared to boys (24%), although slightly more boys (4.5% than girls (2.0%) described their bodies as very overweight/heavy More older children (50.7%) reported being “slightly overweight” than younger children (40.3%); more younger (38.2%) children felt they were about the “right weight” than older (24.4%)

18. What Should the Child Do About His/Her Weight? 42.9% 24.8% 10.7% 5.9% 33.4% 57.3% 7.8% 10.7% 0.6% 0.0% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% Lose a little weight Lose a lot of weight Not do anything--is fine as he/she is Gain a little weight Gain a lot of weight GirlsParents of Girls 28.1% 21.2% 7.5% 3.9% 39.5% 54.4% 20.9% 19.2% 1.3% 0.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Lose a little weight Lose a lot of weight Not do anything--is fine as he/she is Gain a little weight Gain a lot of weight BoysParents of Boys All differences are statistically significant at p<.001

19. Overweight v. Non-Overweight Gender: 45.7% boys, 54.3% girls Mean Nutrition Rating: 5.75 (SD 1.86) Child Body Satisfaction Rating: 4.73 (SD 2.42) Been on a Diet: 67.7% Yes, 32.3% No Kid’s Report of Mom’s Body: 60.6% Overweight 39.4% Not Overweight Kid’s Report of Dad’s Body: 56.1% Overweight 43.9% Not Overweight Parent avg. BMI (from profile) Mean=30.41, SD=7.81 Gender: 53.4% boys, 46.6% girls Mean Nutrition Rating: 6.43 (SD 1.85) Child Body Satisfaction Rating: 7.60 (SD 2.04) Been on a Diet: 29.1% Yes, 70.6% No Kid’s Report of Mom’s Body 44.1% Overweight 55.9% Not Overweight Kid’s Report of Dad’s Body 40.3% Overweight 59.7% Not Overweight Parent avg. BMI (from profile) Mean=27.81, SD=6.70 Overweight Kids (Self-Report) N=196 Non-Overweight Kids (Self-Report) N=414

20. Physical Activity Habits Most children report participating in a team sport or group physical activity, although significantly more younger (81.3%) than older children (56.7%) reported these activities Girls (31.3%) are significantly more likely than boys (21.25) to prefer sedentary, indoor activities Parents over-predicted extent that children preferred outdoor activities (37.3% vs. 26.2%) Parents of boys (14.9%) more than of girls (7.8%) predicted their children preferred spending time being active vs. sedentary

21. Parent-Child Interaction Nearly 80% of children eat with parent/adult daily or most days, while only 15% play a sport, bike ride, or other activities On a daily basis, boys are significantly more likely than girls to report eating a meal (54.7% vs. 47.9%) or engaging in physical activity (21.4 % vs. 9.1%) with their parent/adult 42% of children reported going to fast food restaurants or food courts with parent/adult one of more times a week and 47% reported grocery shopping one or more days

22. Parents Are Role Models Children, regardless of age, report that a parent serves as a role model, or the person s/he “would like to be like most.” As a child grows older, however, the degree to which a parent is a role model lessens, however mother is still top choice Boys are more likely to select a father as a role model, while girls more often select their mother

23. Children's Top Choices for Role Models Boys Top Responses Father (19.3%) Sports celebrity (18%) Unsure/No one (13.8%) Mother (8.3%) Girls Top Responses Mother (25.3%) Unsure/No one (12.8%) Music celebrity (11.8%) Actor/Actress (6.9%)

24. Factors Related to Body Satisfaction Variables significantly related to child’s body satisfaction: Nutrition of foods consumed (self-report) Child ever being on a diet Describing body as overweight Family member telling child to do something about weight Age of child (as age increases body satisfaction decreases) Physical activity with parent (as activity increases, so does body satisfaction) Parent physical activity (Weakly related) Body size of mother (Weakly related) Ethnicity

25. Factors Related to Self- Reported Nutrition Variables significantly related to self-reported nutrition of foods child consumes: Gender of child (girls report lower nutrition/consumption ratings) Age of child (as child grows older, self-reported nutrition decreases) As regular meal times decrease, nutrition self-report decreases (To a lesser extent) as regular bed times decrease, nutrition self-report decreases As eating meals with parent decreases, nutrition self- report decreases Number of hours primary shopper works outside the home is negatively related to self-reported nutrition

26. Factors Related to Belief in Need for Weight Loss Variables significantly related to child believing s/he should lose weight: Gender of child (girls) Mom being overweight Physical activity with parent (as increases, prob. of child believing s/he should do something about weight decreases) Age of child Self-report nutrition of foods child consumes Parent communicating to child about need to do something about body size

27. Application of Study Findings

28. What can the RD do with this information? All dietetic professionals are equipped with knowledge and resources to guide families to better eating & activity habits Utilize data by breaking into messages One-on-one counseling Group lectures Written articles

29. Utilize Data to Communicate Key Messages One-on-one counseling A recent survey of children ages 8-17years and their families showed……. Insert a key finding from the survey pertinent to the topic you are discussing….What do you make out of this information? Let the family/child “digest” the information and tell you how they interpret it and what it means to them in terms of potential change

30. Breaking down the data into key messages: Group setting: Take a message or a set of messages and share at a community gathering, PTA meeting, religious group, work-site lunch-and-learn, professional group meeting Written form: Take a message or group of messages and write a short article for a newsletter (neighborhood, community, school, work, professional) for a newspaper, or create handouts for your clients

31. Key Findings to Communicate Children pick parents as their number one role model Parents spend little time being physically active with their child – however most parents do eat and watch TV with children almost daily Children have multiple opportunities away from parents to purchase meals and snacks Parents do not realize all the times during the day children are eating Children’s degree of body satisfaction is influenced by parents’ attitudes, nutrition and exercise-related factors and many children perceive themselves as overweight and/or needing to lose some weight

32. Message to Parents About Being a Role Model Although parents of young children may be acutely aware of this, as the child ages, they may or may not perceive themselves as an important role model Parents can model: Healthy eating habits A commitment to being physically active

33. Message to Parents Regarding Physical Activity A recent survey of children ages 8-17 years, and their parents, showed that many parents spend time engaging in some activities with their children, like eating, watching TV or movies, and playing video games. But, most parents did not play sports or engage in any physical activity with their children on a regular basis. What do you make out of this?

34. Encourage Parents to Be Active with Their Children Message to parents: Be a role model by finding activities or sports that your family can enjoy Find ways to be active in even the little things in life like daily routines Make activity a priority for you personally Message to children: Everyone needs to be more physically active Any type of activity is good, not just sports Get your parents involved being active with you - they need it, and you do too!

35. Message About Purchasing Meals and Snacks Message to parents: Be aware that this happens often Be aware of when and where it happens Talk to your child about food choices outside the home Message to children: Keep healthy eating in mind when purchasing food…. Making healthier food selections does not mean you are not “cool” Balance, variety and moderation - make snacks count

36. Message About When Children Are Eating Message to parents: Be aware that children are eating at multiple times during the day Be aware that children eat while doing other activities like homework, watching TV, playing on the computer Talk to your child about being aware of when they eat and take time out of activity to enjoy a snack Message to children: Take a break from your computer game to have a snack and really enjoy it Try to limit snacking while watching television

37. Message to Parents About Food Selection Plan menus together, let them pick some of their favorite meals Take children to the store and have them help by reading labels and selecting produce Get them involved in food preparation Let them learn on their own by purchasing magazines and books that have sound nutrition information Consider discuss how they use their allowance and if they are buying too many snack items Be a positive role model

38. Message About Determinants of Body Satisfaction A recent survey of children ages 8-17 years showed that children had a tendency to be less satisfied with their body when: they felt their diet was less nutritious, they spent less time being physically active, had dieted, or had someone in their family be negative about their weight. Tell me your thoughts about this.

39. Message About Increasing Children's Body Satisfaction Discuss that parents and children MAY feel better about themselves if they eat a more nutritious diet and become more physically active Discourage dieting behaviors among children and teens, particularly any diet that is unsupervised or a “fad” diet Encourage parents to not comment negatively about children’s weights -- even if a child is overweight, all children need good self-esteem to face the challenges ahead of them

40. Message about Children’s Perception of their Weight A recent survey of children ages 8-17 years showed that about half of all the girls and a third of all the boys felt that they needed to lose weight. When they had described their body, however, less of them had described themselves as overweight. What do you make out of this?

41. Message about Children’s Perception of their Weight Message for parents: Children may feel as if they need to be a certain size or shape in order to feel “OK” Parents should talk to their children about how they feel about their body size and positive and encouraging, regardless of body size – avoid negative remarks about their own weight or size Message to children: We all come in different shapes and sizes, we are unique and not cut out from the same “cookie-cutter” Eating a healthy diet and being active are the best ways to keep our bodies strong, healthy and toned

42. Summary Stress a family focus for healthy weight Parents have multiple opportunities to influence children Children name their parents as leading role model Parents are spending time each day with children eating and watching TV – could use this time to promote healthy lifestyle choices and include fun physical activities Children said they will talk to parents about weight and nutrition – another great opportunity for parents to be positive If parent suggests child should lose weight, child is influenced so parents need to be careful with approach, be supportive no matter what child’s weight/body shape

43. This presentation was developed for the American Dietetic Association Foundation by: Alicia M. Moag-Stahlberg, MS, RD Aida Miles, MMSc, RD, CSP, CNSD