Transcript What’s in the Home is What’s on the Plate: Evidence

What’s in the Home is What’s on the Plate:
Evidence-based strategies for counseling
families about the home food environment
October 20, 2010
Presenters:
Paul Estabrooks, PhD, Associate Professor, Human Nutrition, Foods & Exercise,
Virginia Tech
Moderator:
James M. Rippe, MD – Leading cardiologist, Founder and Director,
Rippe Lifestyle Institute
Recording of the October 20, 2010 webinar and PDF download of PowerPoint
available at: www.ConAgraFoodsScienceInstitute.com
Approved for 1 CPE (Level 2) by the American Dietetic Association Commission on Dietetic Registration
Orlando Health is an approved provider of continuing nursing education by the Florida Board of Nursing (Provider No. FBN 2459).
Orlando Health is an approved provider of continuing nursing education by the North Carolina Nurses Association, an accredited
approver by the American Nurses Credentialing Center’s Commission on Accreditation (AP085).
Nutri-Bitessm Summary
What’s In the Home is What’s on the Plate:
This webinar covered:
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Physical Environment and Social Environment that children
encounter at home and school exert an influence on the development
of children’s healthy eating and physically active lifestyles.
Simple modifications in the home environment can positively support
child food and activity options.
A systems approach that integrates research, cooperative extension
and local health clinics shows promise in making meaningful
changes.
Incorporating an assessment of the home food and activity
environment can provide additional insights for targeted nutrition
counseling strategies.
Kaiser Permanente Colorado Family Connections background
available: http://www.innovations.ahrq.gov/content.aspx?id=2516
From the Oct 20, 2010 webinar presentation by Paul Estabrooks
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
The Evidence
• The Home Social Environment
• Parents serve as role models for both
physical activity and diet behaviors .
• Active role modeling is most effective—
doing things with their children.
• Unfortunately it also works to role model
sedentary behavior--parents who play
computer/electronic games with kids
have more sedentary children.
• Older children may be less influenced by
parental role modeling compared to
younger children
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
The Evidence
• The Home Social Environment
• Families with more rules about TV
watching had children who watch less TV
• Encouragement and monitoring of eating
and activity is related to improved family
eating and physical activity
• Enhancing communication skills and
providing opportunities for children to
contribute to decision making is related
to improved eating and activity
• Household rules or policies are effective*
• The way parents parent is important.
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
The Evidence: Examples
Authoritative
Restrictive
Child Age is Important
Kremers, Brug, de Vries, & Engels, 2003; Bowne, 2009;
Rhee, Lumeng, Appugliese, Kaciroti, & Bradley, 2006
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
The Evidence
• The Home Physical Environment
• The availability and accessibility of foods
has been consistently related to
consumption.
• Having healthy foods prepared and with
easy access for children improves
eating habits
• Variety and quantity of foods is a better
predictor of healthful eating rather than
presence or absence alone
• Plate, bowl, and cup size influence the
amount of food consumed
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
The Evidence
• The Home Physical Environment
• Activity equipment is inversely associated
with TV time and positively correlated with
physical activity
• Pay TV and electronic games at home
predicted increased sedentary behavior
• Fewer TVs in the home is related to lower
weight status of family members
• Location matters—TV/electronic equipment
in bedrooms is strong predictor of
sedentary behavior
• More outdoor play equipment is associated
with more outdoor play time
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
Evidence-informed Intervention Framework,
Strategies, and Activities for Health Promotion
Concept
Increased Parental
Behavioral Health Skills
Strategy
Enhance parental personal motivation:
o weight,
o nutrition
o physical activity
Increased Parenting Skills Reframing the problem
Setting healthy limits
Parental Modeling
Parents provide an example of healthy
lifestyle behaviors for child.
Example of Potential Activity
Personal goal setting and barrier
resolution
Activities to demonstrate the parental
responsibilities and role in child’s
weight
Demonstrate
o parent leadership,
o general parenting skills,
o effective parent-child
communication.
Model enjoyment of healthy foods and
physical activity
Engage child in physical activities
together
Structural Home
Environmental Changes
Restructure the home environment to:
o support healthy food and
activity options
o reduce options for unhealthy
choices.
Practicing regular meal times and
scheduling between-meal snacks
Involve child in decision making for
enjoyable physical activity
From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks
Family Connections
• To determine the relative effectiveness an additive process that
included:
– a) a self-help workbook for parents (mailed),
– b) two small group sessions with a registered dietitian,
– c) ten tailored counseling sessions over 6 months
• To determine if > 50% dose of telephone intervention heightened
effectiveness
Kaiser Permanente Colorado Family Connections background available:
http://www.innovations.ahrq.gov/content.aspx?id=2516
From the Oct 20, 2010 webinar presentation by Paul Estabrooks
How can you apply these findings within your
practice?
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Customize educational materials: Family Connections workbook is available as an
open-source resource as a potential starting point. Customize the material to the
target population; consider ethnicity and the community's recreational resources.
Consider telephone follow-up over a longer period of time (i.e., 6 or more times
over 6 months): Determine whether the program can be integrated into the
organization’s existing phone system or an independent system must be created.
Create partnerships that can help with participant identification/motivation or
follow-up: Introduce the program to local physicians, highlighting any
evidence to support its effectiveness. Solicit physician input on the appropriate
process for screening patients and identifying those who may not be good candidates.
Create a monitoring and evaluation system: Identify who will conduct periodic
assessments of participants' progress; establish frequency for assessments. Create a
system to document parent involvement, including how many phone calls they
complete.
From the Oct 20, 2010 webinar presentation by Paul Estabrooks
Home Food Environment Webinar:
Reference List
1. Koehly LM, Loscalzo A. Adolescent obesity and social networks. Prev Chronic Dis 2009;6(3):A99.
2. Estabrooks PA, Shoup JA, Gattshall M, Dandamudi P, Shetterly S, Xu S. Automated telephone counseling for parents of
overweight children: a randomized controlled trial. Am J Prev Med 2009;36(1):35-42.
3. Gattshall ML, Shoup JA, Marshall JA, Crane LA, Estabrooks PA. Validation of a survey instrument to assess home
environments for physical activity and healthy eating in overweight children. Int J Behav Nutr Phys Act 2008;5:3.
4. Shoup JA, Gattshall M, Dandamudi P, Estabrooks P. Physical activity, quality of life, and weight status in overweight children.
Qual Life Res 2008;17(3):407-12.
5. Golan M. Parents as agents of change in childhood obesity--from research to practice. Int J Pediatr Obes 2006;1(2):66-76.
6. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev
2004;62(1):39-50.
7. Golan M, Weizman A. Familial approach to the treatment of childhood obesity: conceptual mode. J Nutr Educ
2001;33(2):102-7.
8. Kremers SP, Brug J, de Vries H, Engels RC. Parenting style and adolescent fruit consumption. Appetite 2003;41(1):43-50.
9. Rhee KE, Lumeng JC, Appugliese DP, Kaciroti N, Bradley RH. Parenting styles and overweight status in first grade.
Pediatrics 2006;117(6):2047-54.
10. Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med
2006;31(4 Suppl):S45-56.
11. Estabrooks PA, Shetterly S. The prevalence and health care use of overweight children in an integrated health care
system. Arch Pediatr Adolesc Med 2007;161(3):222-7.
12. Estabrooks PA, Fisher EB, Hayman LL. What is needed to reverse the trends in childhood obesity? A call to action. Ann
Behav Med 2008;36(3):209-16.
From the Oct 20, 2010 webinar presentation by Paul Estabrooks