myths and realities dayle hayes, ms, rd nutrition consultant billings, montana eatwellmt@aol.com

Myths and Realities

Dayle Hayes, MS, RDNutrition Consultant

Billings, Montana

EatWellMT@aol.com

To shape the eating habits and physical activity patterns of WIC families in ways that promote

healthy weights and reduce the risk of chronic

diseases.

MYTH #1:You have to “diet” to lose

weight and get in shape.

REALITY: DELICIOUS

NUTRITION helps your whole family enjoy good

health.

MYTH #2:Nutrition is really complicated

and expensive.

REALITY: EATING WELL

is as simple as choosing

more brightly colored foods.

MYTH #3:Good nutrition and weight

loss comes in a pill.

REALITY: WHOLE FOODS

have the nutrition power that our bodies crave.

MYTH #4:You have to exercise to lose

weight and get in shape.

REALITY:FUN ACTIVITY can help every body

move toward a healthy weight.

MYTH #5:You a need gym or fancy

equipment to physical activity.

REALITY:MOVING MORE

is as simple as putting one foot in front of the other.

MYTH #6:Getting fit is nearly

impossible in our busy lives.

REALITY:You can fit your

FITNESS into every day –

anytime, anywhere.

MYTH #7:A pregnant woman has to make a decision to breast

feed OR to bottle feed.

OR

REALITY:New moms can

choose a COMBINATION of breast and bottle

feeding.

MYTH #8:It’s very hard to keep kids from watching too much TV.

REALITY:SETTING LIMITS like on TV time – is

a very important parental job.

MYTH #9:At WIC, we only have 15 minutes to do nutrition ed.

REALITY:15 minutes of

PERSUASION can make a big

difference.

MYTH #10:If we give people enough

facts, they will change.

REALITY:Using effective tools

of INFLUENCE we can help

Keep your eye on the prize!

Research Updates

Susan L. Johnson, PhDThe Children’s Hospital of Denver

UC Health Science Center,

Denver, Colorado

Susan.Johnson@uchsc.edu

Eating Uses all of our Senses• Sight• Smell• Touching• Hearing• Tasting

• Balance• Motor control• Proprioception

Frontal Lobe Smell

Parietal LobeTouch

Temporal LobesHearing

Occipital LobesVision

Complementary Foods• Sitting stably w/out help• Extrusor reflex

disappears• Palmer grasp• Pincer grasp• Lateral tongue

movement• Gag reflex moves

Innate Likes and DislikesSteiner, J (1977). Taste and Development, Ed Wiffenbach,

US Dept HEW

• We are born liking sweet

• We are born disliking bitter and sour

Innate Likes and DislikesJ.A Mennella & G. Beauchamp (1991). Pediatrics, 88, 737-44.

• Flavors from maternal diet are transferred to amniotic fluid

• Fetus swallows fluid by the 2nd trimester

• Flavors also present in breastmilk

• May ease transition to solid foods

Breastfeeding may help prevent obesity

• Somewhat controversial

–Effects of environment and genetics may be as strong or stronger

• Duration of effects?

–Some report effects through adolescence

–Others say no effect after 5 y

• Strongest predictor of child weight is maternal weight

• Breast is definitely still best

Look and Listen to the Messages

Feeding behaviors and other motor development in healthy children

Carruth and Skinner (2002). J. Amer. Coll. Nutr.

BehaviorMean Age

(Months)

Age Range

(Months)Sitting unaided 4.0 1-9Brings toy to mouth 3.3 0.1-6.5Reaches for spoon 5.5 2.5-9.5Feeds self cracker 7.7 4-14Uses fingers to rake in food 8.7 5-20Brings top lip down on spoon to remove food 7.7 3.5-9.5

Brings spoon to mouth 14.4 9-20

Do parents hear children’s messages?

• How can we help them listen?

• What are the consequences if parents delay introducing solid foods?

• What are the consequences if they start solids too early?

The Tasks of Early Childhood

Age StageInfancy Trust vs. Mistrust

Reliance on consistency and security

Toddler Autonomy vs. Shame and DoubtSense that they are separate human beings.“Look at ME!” “NO!”

Early Childhood

Initiative vs. GuiltTaking risks within safe environments.“I will try.”

Erik Erikson’s Psychosocial Stages. www.internetmediator.com/divres/pg72.cfm

Experience and Food Preference

• Sullivan and Birch demonstrated that children come to prefer foods after they have a number of experiences with them

• It takes around 8-10 tries of a new food before children come to accept it

• We decided to repeat this study looking at some different foods

Natural History of Trying New Foods

1 23 4

56

78

9 10

Smell

Ignore

PlaySpit

Swallow0

2

4

6

8

10

12

14

16

18

Smell

Ignore

Play

Spit

Swallow# C

hild

ren

Time (wk)

Children learn about new foods by gradual experience

How do we support children and parents to try new foods?

• Offer many chances to try foods.

• Don’t force children to take a bite.

• Allow children to serve themselves.

• Avoid bribing or scolding children.

• Don’t be disappointed if they don’t like it right away. Hang in there! It changes.

• Encourage learning with all senses.

A Word about Self-regulation

• Infants can self-regulate the “how much” of eating

• Toddlers and young children must learn skills to learn to self-regulate their eating

• Motor

• Behavioral

• Emotional

• Cognitive

Self-regulation of Eating is Supported by the Feeding Relationship

• Parent knowledge

• Support of child’s development & mastery

• Dynamic exchange

Age Parent Job Child Abilities(Normally developing)

InfantsBirth – 9 mo

• Attend to cues• Offer appropriate food• Feed child• Child centered routine

• Knows hunger/ fullness

Toddlers9 – 24 mo

• Routines for eating• Variety and experience• Utensils & physical

structure• Opportunities for

mastery

• Knows hunger/ fullness

• Self-feeding begins

• Verbal communication

Early childhood2 – 5 y

• Routines for eating• Variety and experience• Utensils • Opportunities for

mastery• Eating with child

• Knows hunger/ fullness

• Self-feed• Self-serve• Conversation

Beverages & Self-Regulation

Issues & ConcernsInadequate vs. excess intakes

• Calories (or lack of)• Nutrients (Ca, Fe, Pro)• GI function (diarrhea)• Appetite / Satiety

Grazing • Dental caries• Habits (grazing)

9 oz 6 oz 4 oz

Infant Cues

Interested

Needs to eat

Past due!

Relationship btwn. formula concentration & rate of growth of normal infants

Fomon, et al. Journal of Nutrition. 98(2):241-54, 1969

• Varied formula concentration – High and low concentrations

• Infants given the concentrated formula consumed less volume

• High and low groups had essentially equal caloric intake

Children can self-regulate in response to juice drinks

• Children who are given juice drinks before the meal eat less at mealtime

• The nutrient density of their diets tends to decrease since juice drinks are low in vitamins and minerals

It’s not a perfect system…it can get off track

Adults can help put it back on track

• Focus on internal cues of hunger and fullness

• Make internal cues a regular part of eating

• Attend when children say they are hungry

• Listen when children say they are full

Optimal Environments

• Healthy emotional mealtimes

• Trust children’s abilities

• Repeated experience

• Variety and modeling

• Physical setup

• Consistent mealtime routines

• Recognize hunger and fullness

Success!

Help parents provide environments to support mastering the moment!

Working with Overweight Children

and their Families: Hard Lessons

LearnedSusan L. Johnson, PhD

The GoodLIFE Clinic

The Children’s Hospital of Denver Denver, Colorado

Susan.Johnson@uchsc.edu

Learning the Story

ElicitElicit ProvideProvide

LISTENLISTEN

Essential Principle—Being all EARS

Express empathyAvoid argumentationRoll with resistanceSupport self-efficacy

Develop discrepancy: where the client is vs. where they want to be

Tips for Learning the Story• Ask about a typical day• Include major events of day

– Waking– Eating– Daycare/preschool?– Activity – Sedentary pastimes– Bedtime

• Ask the parent about their concerns

• Use words like “falling behind” and “getting ahead”

• Be clear, concrete and focus on client needs and desires—not only your agenda

• Offer concrete strategies--have tools that teach good child-feeding practices

Communicating Concerns to Parents

Avoid assigning blame

• If a client feels that you are blaming them they will become more resistant to change

• Ask them for their views on why their child is “getting ahead of himself”

Identify areas for change

• If possible, have the client identify what they would like to change– Nutrition

– Activity

• Make the changes small and achievable

• Provide a method so that the client can keep track of what they are changing

Avoid asking for too much change

• Examine the barriers and the benefits to change

• Have the client determine how much they think they can do

• Be ready to accept no change—as this may open the door for future change

What’s our job?• Providing “nothing but the facts”

• Letting the clients choose all, some or none

• It is NOT your burden to GET the client to change

Creating a referral network

• Pediatric endocrinologists

• Psychologists—family and pediatric

• Social workers

• Pulmonologists

Helping clients come back for more

• RESPECT

• EMPOWER

• VISION

The Feeding Relationship

Jane Peacock, MS, RDFamily Health Bureau Chief, New

Mexico Department of Health.

Albuquerque, New Mexico

janep@doh.state.nm.us

One way to prevent overweight is to

establish and maintaining a positive feeding relationship

from birth.

Leane W/A O-30 months

Leane W/H 2-6 years

Leane BMI

Leane weight for age

The early intervention:

Teach positive feeding from birth

OPTIMUM FEEDING: INFANTS

• Time care and feeding for quiet alert state

• Feed in response to baby’s cuesEllyn Satter’s CHILD OF MINE, Ch 4, Understanding your newborn; Ch 5, Breastfeeding your baby; Ch 6, Formula-feeding your baby

OPTIMUM FEEDING: INFANTS

• Feed baby as much or little as she wants

• Accept baby’s own growth inclinations

• Understand impact of temperamental differences on feeding

Ellyn Satter’s CHILD OF MINE, Ch 4, Understanding your newborn; Ch 5, Breastfeeding your baby; Ch 6, Formula-feeding your baby

© 2003 From ELLYN SATTER’S FEEDING IN PRIMARY CARE PREGNANCY THROUGH PRESCHOOL: Easy-to-read Reproducible Masters. In press.

© 2003 From ELLYN SATTER’S FEEDING IN PRIMARY CARE PREGNANCY THROUGH PRESCHOOL: Easy-to-read Reproducible Masters. In press.

Optimum stage-related feeding: Birth to preschool

DIVISION OF RESPONSIBILITY INFANT

• Parent: What

• Child: How much

Satter, E. How to Get Your Kid to Eat…But Not Too Much

DIVISION OF RESPONSIBILITYTODDLER AND OLDER

• Parent: What, when, where

• Child: How much, whether

Satter, E. How to Get Your Kid to Eat…But Not Too Much

FOR CHILDREN TO EAT WELL, ADULTS MUST FEED WELL

• Choose and prepare food

• Have regular meals and snacks

• Make eating time pleasant

• Provide mastery expectations

• Let children grow up to get bodies that are right for them

FEEDING WELL MANDATES TRUSTING CHILDREN TO DO THEIR

JOBS WITH EATING

• Children will eat• They know how much to eat • They will grow predictably• They will eat a variety• They will mature with eating

DIVISION OF RESPONSIBILITY IS EVIDENCE-BASED

Satter, Ellyn, Child of Mine; Feeding with Love and Good Sense, Bull Publishing 2000

• Supports food acceptance – Appendix I (10 Ref)

• Supports food regulation – Appendix J (16 Ref)

• Supports healthy growth – Chapter 2 (17 Ref)

Key question:

What is interfering?

Leane W/A 0-36 months

9 months

ASK FEEDING QUESTIONS

• How is feeding going?

• How do you feel about feeding?

• How do you feel about your child’s size and shape? Growth?

• Is there anything about feeding you would like to be different?

CROSSING DIVISION OF RESPONSIBILITY:

Food restriction scares children and makes them overeat when they can

ELLYN SATTER’S FEEDING WITH LOVE AND GOOD SENSE Video and Teacher’s Guide “Older Baby”

ACCEPT CHILD’S DRIVE TO “DO IT MYSELF”

• Include child at family meals

• Choose “safe” food to pick up, chew, swallow

• Give many chances to experiment, learn to like food

• Time snacks so child can be hungry, not too hungry, at meals

• Let child eat much or little

Ellyn Satter’s CHILD OF MINE, Chapter 7, Feeding your older baby

© 2003 From ELLYN SATTER’S FEEDING IN PRIMARY CARE PREGNANCY THROUGH PRESCHOOL: Easy-to-read Reproducible Masters. In press.

17 months

Leane W/A 0-36 months

LEANE 17 MO: ANSWERS TO FEEDING QUESTIONS

• She is sneaking food

• Leanne’s food demands are constant

• Limit at meals, no snacks

• They are worn out

TODDLER: TEACH TO BE PART OF FAMILY

• Have family meals; scheduled snacks• Not let the child graze• Eat with the child• Teach the child to behave at mealtimes• Not short order cook• Let the child experiment, eat much or little

Ellyn Satter’s CHILD OF MINE, Chapter 8, Feeding your toddler

PRIMARY INTERVENTION: Education and early problem-solving

• Teach stage-related feeding

• Teach about normal growth

• Intervene at the first sign of growth disruption

• Even if treatment is called for, keep the intervention primary

LEVELS OF INTERVENTION WITH FEEDING

• Primary—Education, early problem-solving

• Secondary—Detailed evaluation and treatment

• Tertiary—Detailed evaluation and treatment of complex or entrenched problems with adjunct specialists, ie, physician, psychotherapist

WIC’s job is to get children started right

Emphasize Growth, not

WeightJane Peacock, MS, RD

Family Health Bureau Chief, New Mexico Department of Health.

Albuquerque, New Mexico

janep@doh.state.nm.us

Interfering with normal growth may precipitate

weight gain.

Children are excellent regulators and tend to grow in accordance with their genetic

endowment.

Weight for age 0-24 months

Length for age

CHILDREN TEND TO GROW PREDICTABLY

NORMAL GROWTH CAN BE CONSISTENTLY

AT THE MEAN

50th %TILE W/L

Weight for Length

NORMAL GROWTH CAN BE LOW AND

SLOW

LOW CONSISTENT W/L

Weight for Length

NORMAL GROWTH CAN BE HIGH AND FAST—IF IT IS CONSISTENT

Weight for heightBMI

BMI PLOTTINGS MAY DISTORT PATTERNS

High consistent W/H…

…inconsistent on BMI curve

EVIDENCE-BASED

Satter, Ellyn, Child of Mine; Chapter 2 —Your Child Knows How to Eat and Grow

• High or low consistent growth is normal

• A single growth point tells nothing

Arbitrary growth cutoffs put pressure on feeding

and distort growth.

ERICA 10 MONTHS

Food restriction

Weight for length

© 2003 From ELLYN SATTER’S FEEDING IN PRIMARY CARE PREGNANCY THROUGH PRESCHOOL: Easy-to-read Reproducible Masters. In press.

ERICA 5 YEARS

Optimum feeding age three years

Weight/height

BMI

Optimum feeding

ERICA

PARENTS WHO CAN UTILIZE PRIMARY INTERVENTION

• Can self-evaluate

• Can accept the child's point of view

• Can set aside agendas

• Can change with advice, information

EVIDENCE-BASED Satter, Ellyn, Child of Mine; Chapter 2—Your

Child Knows How to Eat and Grow

• Food restriction likely to weight

• Parental self-restraint child obesity risk

INFORMING THE PARENT

• Child relatively large

• Certified for WIC on that basis

• Parents worry, try to feeding

• We’ll help you feed well

Growth divergence may or may not be normal.

SLOW DIVERGENCE OVER TIME IS LIKELY

TO BE NORMAL

Weight for Age 2-20 yr

RAPID GROWTH DIVERGENCE MAY NOT BE NORMAL

Leane weight for age 0-36 mo

RAPID GROWTH DIVERGENCE

MAY BE NORMAL

Adele weight for length 0-18 months

DIVERGENT WEIGHT IN WIC

• Ask feeding questions

• Optimize feeding

• Do not limit food intake—even indirectly

CHILDREN COME IN ALL SIZES

The Principles of Influence

Pam McCarthy, MS, RDChange Agent

St. Paul, Minnesota

pammccarthy@attbi.com

Principle of Influence: Be likable 

Actions that make you likable:

· Make your client feel good about herself

· Accept and like your clients

· Make your client feel comfortable, welcome and relaxed

· Talk about things you share in common

Principle of Influence: Be likable  

Actions that make you likable:

· Be positive.

· Avoid words that have harsh or negative connotations.

· Present situations as temporary.

Principle of Influence:

Give them something. 

Give them something — but use emotion.

Principle of Influence:

Give them “exclusive” information, tips and messages

Principle of Influence:

Let them know what others are doing.

Formula for success:

Describe action.

Talk about the emotional benefits of taking that action.

Add a dash of facts or logic.

Tell them others are already doing it.

Principle of Influence:

The desire for consistency is a central motivator of behavior.

Ask questions like:

“What will you do first?”

“When do you plan to start?”

“How do you think it will unfold?”

Try verbal confirmations like:

· “Are you willing to give (action) a try?”

· “Can I count on you to give me feedback on (action) next time?”

· “Will Annie get to try (action) this month?”

End the encounter on a high note.

TV Time: Helping WIC

Families Make Better ChoicesCarolyn Dunn, PhD.

NC Cooperative Extension Service

NC State University,

Raleigh, North Carolina

carolyndunn@ncsu.edu

TV Time…Helping WIC families make

better choices

•98% of all US homes have at least one TV

•TV is the #1 source of news and understanding about current events for the nation’s children.

eleVT ision

You Know You May Be

Watching Too Much TV

When…

• The first thing you do when you enter the room is turn on the TV.

• You eat all your meals in front of the TV.

• There are as many TVs in your home as people.

You Know You May Be Watching Too Much TV When…

• You’re watching a show you don’t like when you realize it’s a repeat and you didn’t like it the FIRST time either.

• You know the theme songs to all the shows in prime time.

You Know You May Be Watching Too Much TV When…

• The number of shows you absolutely cannot miss is equal to or greater than the number of days in the week.

• The clerk at the video store knows you on a first name basis.

You Know You May Be Watching Too Much TV When…

• Your cable goes out and you have the cable company on speed dial.

• The hall closet is dedicated not to coats and hats but to DVDs, videotapes and video games.

• The last thing you do at night before closing your eyes is turn off the TV.

You Know You May Be Watching Too Much TV When…

How Much?

•On average, children 2-11 watch 23 hours/week (teens 22 hours). This does not include videos and playing video games.

•Average more than 4 hours/day.

How Much?

•American children 2-17 spend up to 1/3 of their waking hours in front of the television.

•20% of 9 year olds watch 6 hours per day!

1984 1990

AAP suggested that TV has potential to increase violent behavior and may contribute to obesity. Cautions parents to limit the time watching TV and monitor viewing choices.

AAP reaches same conclusion about TV viewing in children and makes similar suggestions to parents.

Television Over The Years

1993 1998

Most children in the US spend more time watching TV than any other activity besides sleeping.

Children spend an average of 900 hours per year in school and an average of 1500 hours watching TV (21-23 hours per week).

Television Over The Years

Current Recommendations From The American

Academy of Pediatrics

< 2 years old – none

> 2 years old – no more than 2 hours per day

What TV Does To Our Brains…

• TV viewing slows the brains alpha waves so you feel relaxed and passive – which explains why the longer you watch, the harder it is to stop.

• The longer a child watches the more difficult they are to distract.

What TV Does To Our Brains…

• TV viewing is negatively related to children’s academic achievement (less homework/reading).

• Amount of time spent in front of the TV relates to how well children do on standardized tests.

What TV Does To Our Brains…

• Children’s reading skills are not developed while watching TV.

• Children who don’t play with friends don’t learn the social skills needed for classroom interaction.

What TV Does To Family Time…

What TV Does To Our Bodies…

Overweight in children has

almost doubled in the past decade.

Link between overweight in children

and TV viewing.

What TV Does To Our Bodies…

Study at Johns Hopkins - children who watched TV 4+ hours were significantly heavier than children who watched 2 or less.

Stanford study – children who were involved in a one-year curriculum to decrease TV viewing gained significantly less body fat than control (did not suggest other activities just decrease video games, videos and TV viewing).

What TV Does To Our Bodies…

What Are Our Children Watching?

90% of viewing by children is of

programs that are not designed for

children.

What Are Our Children Watching?

Children learn behavior by

mimicking what’s on TV

What Are Our Children Watching?

24% increase between 1991 and

1998 of commercials and promotions aired

by broadcast networks

Food producers and the fast food industry

if they are successful…

we all eat more

Advertisers for video/film industries

if the are successful…

we all buy more

Television industry

if they are successful…

we all watch more

Simple Solutions To Turn

Off The

1Get The TV Out Of The Bedroom

Simple Solutions To Turn

Off The

2Agree On A

Media Budget

Simple Solutions To Turn

Off The

3Set Clear Limits

Simple Solutions To Turn

Off The

4Make lists of things

you want to do – involve children in talking about other things they can do.

Simple Solutions To Turn

Off The

5Don’t keep the TV on

all the time – tune into specific shows

Simple Solutions To Turn

Off The

6Don’t watch TV during meals.

Simple Solutions To Turn

Off The

7Watch with

children

TV Time…Helping WIC families make

better choices