Improving the Nutritional Standards of Students in New York Primary and Secondary Schools Cheryl Hilliman, RN, MSN, FNP, WCC Walden University In partial.

Improving the Nutritional Standards of Students in New York Primary and Secondary

Schools  

Cheryl Hilliman, RN, MSN, FNP, WCCWalden University

In partial fulfillment of the requirements for PUBH 8165Dr. Raymond Thron

July10 2009

Purpose of the Presentation

1. To increase the knowledge and awareness of the benefits of healthy food choices that are culturally-appropriate and tailored to specific students in Primary and Secondary Schools in Brooklyn, New York.

2. To increase the knowledge and awareness of the benefits of daily exercise in maintaining good health among students in Primary and Secondary Schools in Brooklyn, New York.

Objectives Objective1. To increase students awareness and knowledge of the

components of a healthy diet2. To increase the perception about the significant health risks that

are associated with unhealthy eating habits3. Increase compliance with diet and physical education regulations

in New York State school system.4. To improve communication and collaboration of diet and physical

exercise programs among community members,, community partners and statewide stakeholders

5. To implement effectiveness of interventions to improve dietary and exercise curriculum that will improve health outcomes among students in New York State.

Intended Audience

Students in New York Primary and

Secondary Schools

Classes K6 – K12

Age Range 9 – 18+ years

Background of the Problem

• Increasing obesity rates are also affecting children and adolescents in the U.S. The prevalence of obesity among children and teenagers in the U.S. has tripled in the past 20 to 30 years to 16.5% among children, aged 6-19 years, and doubled to 10.3% among preschool children, aged 2-5 years (Hedley et al., 2004). The prevalence of obesity among elementary school children in NYS has also increased dramatically between 1988 and 2003-2004. Based on measured height and weight in 2003, 24% of elementary school children (grades K-5) in New York City were obese. Recent data indicate that 29.5% of high school students in New York City and 28.3% of high school students in upstate New York are overweight or obese. As in adults, minority youth are disproportionately affected by overweight and obesity.

How to Prevent Overweight

Prevention is they key to eliminating obesity. Recognizing symptoms of a problem before it actually becomes a problem defines prevention. There are simple ways to recognize if your body and health are deteriorating. Most health related issues can be prevented and obesity is no exception.

Preventing Obesity• Over-eating during childhood days contributes greatly to obesity.

The rate of formation of new fat cells is the fastest during the early stages of our lives; over-eating will cause a greater rate of formation which gives rise to fats. However, after adolescence the number of fat cells does not grow any further. Therefore, over-eating in children, especially in infancy stages, might have planted the seeds for obesity for the child in the later stages of his or her life. For those people who become obese in the middle or old ages, most of the obesity results from the enlargement of pre-existing fat cells. This type of obesity is much easier to solve as compared to the ones who have grown obese since young. Therefore, it is vital to learn how to prevent obesity in your childhood this will prevent obesity in the future.

• I

Knowing the foods you eat and why you eat them

• In order to know the food that are healthy. In this presentation we will focus on the

• Dietary Reference Intakes (DRI), • MyPyramid • 2005 Dietary Guidelines for Americans, • Reading food labels, • Selecting appropriate portion sizes, • Importance of water in our bodies • Physical Activities in relation to dietary intake

Nutrient Recommendations

• Standards in the U.S. and Canada are the Dietary Reference Intakes (DRI)– A set of four lists of values for measuring the

intakes of healthy people• Estimated Average Requirements (EAR)• Recommended Dietary Allowances (RDA)• Adequate Intakes (AI)• Tolerable Upper Intake Levels (UL)

Food groups

• The DRI committee has set values for– Vitamins– Minerals– Carbohydrates– Fiber– Lipids– Protein– Water– Energy

• These set food values are found in our daily intake Meat; Milk and milk products eggs; Grains; Oils; Vegetables; Fruits

Adjusting nutrient intakes

• Within your own age and gender group, the DRI committee advises adjusting nutrient intakes in special circumstances that may increase or decrease nutrient needs– Such as illness, smoking, or vegetarianism

The Dietary Guidelines

• The Dietary Guidelines provide science-based advice on dietary recommendations to prevent disease through a healthy diet and physical activity.

Purpose of MyPyramid

MyPyramid helps individuals use the Dietary Guidelines to:• Make smart choices from every food group.• Find balance between food and physical activity.• Get the most nutrition out of calories.

• Stay within daily calorie needs.

MyPyramid Color bands

• Color bands represent that all food groups are needed each day for good health.

Food Groups are Color Coded

FRUITS

VEGETABLES

GRAINS

MEAT FISH PEAS BEANS EGGS NUTS

MILK AND MILK PRODUCTS

OILS

Foods to we must use in moderation

What determines the amount of our food intake?

• Note that if you are physically active each day, you can afford to eat more calories to meet your energy needs

• The more active you are, the higher the energy allowance you “earn

• The USDA Food Guide ensures that a certain amount of each of the five food groups is represented in the diet

• The diet planner begins by assigning each of the food groups to meals and snacks

• The plan can then be filled out with real foods to create a menu

• The Daily Values (DV) reflect the needs of an “average” person. The daily caloric intake for a normal person is 2,000 - 2,500 calories a day

Food Exchange System

• Exchange systems can be useful as a careful diet planner, especially…– those wishing to control calories– those who must control carbohydrate intakes– those who should control their intakes of

protein and saturated fat

OUR CULTURES DETERMINE HOW WE EAT

MEXICAN

US DEEP SOUTH DIET

Controlling your calories

• To control calories using the diet planner you must learn the serving equivalents

• The trend in the U.S. has been toward consuming larger food portions– Especially foods rich in fats and sugar

• Body weights have been creeping upward– Suggesting an increasing need to control portion sizesRestaurants often deliver help to ensure repeat business

• a server on a cafeteria line may be instructed to deliver the amount that is specific to the person’s needs

• fats-food burgers range from one-ounce child-sized burgers to a three-quarter-pound triple deluxe

Controlling your portion size and counting your calories

Controlling your portion size and counting your calories

Controlling your portion size and counting your calories

• Among volumetric measures, 1 “cup” refers to an 8-ounce measuring cup, filled to level

• Tablespoons and teaspoons refer to measuring spoons, filled to level

• Ounces signify weight, not volume

Exchange systems

• Exchange systems can be useful in when using a diet planner, especially…– those wishing to control calories– those who must control carbohydrate intakes– those who should control their intakes of fat

and saturated fat

Exchange systems

• The exchange system highlights a fact that the USDA Food Guide also points out:– Most foods provide more than just one energy

nutrient– The focus on energy nutrients leads to some

unexpected food grouping in the exchange lists

• High-fat meats and many cheeses are listed together as “high-fat meats”

• Fat constitutes the predominant form of energy in these foods, followed by protein

Exchange systems

• An exchange system lists the estimated carbohydrate, fat, saturated fat, and protein contents of food portions, as well as their caloric values– With these estimates, exchange system users

can make an educated approximation of the nutrients and calories in almost any food they might encounter

Food Labels

• In addition to required information, labels may make optional statements about the food being delicious, or good for you in some way, or a great value– Some of these comments are reliable– Many others are based on less convincing

evidence

Reading Food Labels

Things that you will find on food labels

– The common or usual name of the product– The name and address of the manufacturer, packer, or

distributor– The net contents in terms of weight, measure, or count– The nutrient contents of the product– The ingredients, in descending order of predominance by weightOnly the top portion of the panel conveys information specific to the

food inside the package– The bottom portion is identical on every label– It stands as a reminder of the Daily Value (DV)

What Food Labels Must Include

– Not every package need display information about every vitamin and mineral

• A large package must provide all of the information listed on the previous slide

• A smaller label provides some of the information in an abbreviated form

Food Labels Must Include About Serving Size and Calories from Fat• Serving size

– Common household and metric measures allow comparison of foods within a food category

– This amount of the food constitutes a single serving and the portion that contains the nutrient amounts listed

– As of 2005, serving sizes on labels are under review Servings per container

– Number of servings per box, can, package, or other unit

• Calories/calories from fat– Total food energy per serving, and energy from fat per

serving

Food Labels Must Include About Serving Size and Calories from Fat

• Nutrient amounts and percentages of daily values– Total fat. Grams of fat per serving with a breakdown showing

grams of saturated fat and trans fat per serving– Cholesterol. Milligrams of cholesterol per serving– Sodium. Milligrams of sodium per serving – Total carbohydrate. Grams of carbohydrate per serving

• Including starch, fiber, and sugars• With a breakdown showing grams of dietary fiber and sugar• The sugars include those that occur naturally in the food plus any

added during processing• The terms “net carbs,” “impact carbs,” and related terms have not

been defined scientifically – May appear on a label to imply that a food contains less digestible

carbohydrate than similar foods (this may or may not be the case

The label must state the contents of these nutrients expressed as percentages of the Daily Values

• The label must state the contents of these nutrients expressed as percentages of the Daily Values– Vitamin A– Vitamin C– Calcium– Iron– Some, such as those for fiber, protein, vitamins, and most

minerals, are akin to other nutrient recommendations• They suggest an intake goal to strive to reach

– Other daily values, such as those for cholesterol, total fat, saturated fat, and sodium, constitute healthy daily maximums

– Nutrient claims on food labels• If a food meets specified criteria, the label may display certain

approved nutrient claims concerning the product’s nutritive value

Food labels

Getting a Feel for the Nutrients in

Foods

Food Feature: Getting a Feel for the Nutrients in Foods

Water

• The body needs more water per day than any other nutrient– One can survive a deficiency of any other

nutrient sometimes for months or years– One can only survive a few days without

water– In less than a day, a lack of water alters the

body’s chemistry and metabolism

Water

• Water makes up a large amountof our body weight

• Water is found in– Blood vessels– Cells– Chemical structure of cells, tissues, organs

• Water participates in many chemical reactions

Why Is Water One of the Most Important Nutrient?

• Delivers nutrients and removes waste from cells

• Water is a, nearly, universal solvent– Dissolves amino acids, glucose, minerals, etc.

for transport– Fatty substances are packaged with water-

soluble proteins for transport in the blood and lymph

Water acts as a cleansing agent in our bodies

• Water is the body’s cleansing agent– Nitrogen wastes, produced during

metabolism, dissolve in blood and must be removed before they build up to toxic levels

– Kidneys filter these wastes from the blood and, mixed with water, excrete them as urine

• Diseased kidneys cannot perform this function that is the reason why dialysis is necessary for such persons

The Body’s Water Balance

• Water balance– Water intake needs to be equal water loss Otherwise dehydration or water intoxication can occur Dehydration– Water loss– Progression of symptoms: thirst weakness exhaustion and

delirium death

• Water intoxication– Dangerous dilution of body fluids resulting from excessive water

ingestion– Symptoms: headache, muscular weakness, lack of

concentration, poor memory, loss of appetite

Importance of Physical activities

• Note that if you are physically active each day, you can afford to eat more calories to meet your energy needs

• The more active you are, the higher the energy allowance you “earn”

In addition to setting nutrient standards, experts around the world recommend daily physical activity to help people stay healthy and live long

Importance of Physical activities

• The American College of Sports Medicine (ACSM) makes these minimum suggestions to maintain a healthy body:– Engage in physical activity every day– Exercise at a comfortable level– Exercise for a duration of at least 30 minutes

total per day

Benefits of Fitness

• People who regularly engage in just moderate physical activity live longer on average than those who are physically inactive

• A sedentary lifestyle with smoking and obesity combined are risk factors for developing cardiovascular disease, some forms of cancer, stroke, diabetes, and hypertension

Benefits of Fitness

– Improved body composition• A balanced program of physical activity limits body

fat and increases or maintains lean tissue

– Improves bone density• Weight-bearing physical activity builds bone strength

and protects against osteoporosis

– Enhanced resistance to colds and other infectious diseases

– Lower risk of some kinds of cancer• Lifelong physical activity may help to protect against

colon cancer, breast cancer, and some other cancers

The Essentials of Exercise

• Flexibility– The capacity of the joints to move through a

full range of motion– The ability to bend and recover without injury

• Muscle strength– The ability of muscles to work against

resistance

The Essentials of Exercise

• Muscle endurance– The ability of a muscle to contact repeatedly

within a given time without becoming exhausted

• Cardio-respiratory endurance– The ability to perform large-muscle dynamic

exercise of moderate-to-high intensity for prolonged periods

Benefits of Fitness

– Stronger circulation and lung function – Lower risks of cardiovascular disease

• Physical activity lowers BP, slows resting pulse rate, lowers total cholesterol, and raises good cholesterol– Reducing the risk of heart attack and strokes

• Some research suggests that physical activity may also be of benefit by reducing intra-abdominal fat stores

Exercise and Physical

• Fitness depends on a certain minimum amount of– Physical activity

• Bodily movement produced by muscle contractions that substantially increase energy expenditure

– Exercise• Planned, structured, and repetitive bodily

movement that promotes or maintains physical fitness

Students Learning ActivitiesActivity #1 Interactive activities selecting portion sizes Activity # 2 Group Presentation – Members of each group would present one or two of their cultural dish, state the various type of nutrition it contains and when the dish is usedActivity # 3 URL Link Reading food Labels and making choices in selecting which of the food selected is better and reason why they are betterActivity # 4 Evaluating foods served in the schools’ cafeteria and discussing findings with groupActivity # 5 Evaluating snacks served in the school’s vending machine and (a) discussing findings with group and (b) stating the actions that should be taken to ensure vendors change the types of foods they put into the vending machines.Activity # 6 Contacting vending machine owners demanding them to change the content of the vending machine to foods with more nutritional values

Learning Materials

• Plastic foods representing sources of each food group

• Computers for interactive exercises

• Videos

Source

• Sizer, F. and Whitney, E. (2008). Nutrition: Concepts and Controversies. (11th ed.). Minneapolis: West Publishing.

• NYS, Pediatric Nutrition Surveillance System (PedNSS), 2003 NHANES, 1999-2002, J Am Med Assn 2004; 291: 2847-2850.

• NY U.S. BRFSS 2003, age-adjusted to the 2000 U.S. population. NHANES 1999-2002; J Am Med Assn 2004;291:2847-2850

2005 Dietary Guidelines • www.mypyramid.gov/kids -