Researchers agree that the health habits established during childhood set the stage for health behaviors and outcomes throughout the life cycle. “Many of the lifelong habits that jeopardize health are formed during childhood and adolescence” (Bandura, p.157, 2004) Current childhood obesity numbers in the US indicate an upward trend from infancy into adolescents. According to the National Center for Health Statistics, the prevalence of obesity among preschool-aged children, ages two-five is 13.9%; this prevalence jumps to 19.3% among adolescents, ages 12 – 19 (NCHS, 2017). Why does obesity prevalence increase with age? The simple answer is associated with the dietary risk behaviors that US children develop with age. As children age, the amount of fast food that they consume increases steadily, while their fruit and vegetable (F&V) intake decreases (Fryar, Carroll, Ahluwalia, and Ogden, 2020; CDC, 2018).
In 2018, the CDC reported fewer than one in 10 children ate the recommended amount of daily vegetables, and only four in 10 ate enough fruit. In stark contrast, 90% of US children between six and 18 consume too much sodium. The bottom line, F&V are being displaced by processed foods high in sodium (CDC, 2014); the impact, one in every six children in this country between the ages of eight and 17 has high blood pressure, a risk factor that can be addressed, in part, by dietary changes (CDC, 2014). The economic costs associated with obesity also need to be addressed as they represent a significant burden to society. Considerer the following statistic, in 2014, the total obesity-related cost of one 10-year-old was roughly $19,000. If we multiply $19,000 by the number of obese 10-year-olds at the time, the total cost of obesity of that age group alone would be roughly $14 billion (Eric, Wan, and Rahul, 2014). To put this figure into perspective, in March 2020, the World Bank approved a $14 billion package to help assist “…companies and countries in their efforts to protect, prevent and respond to the rapid spread of COVID-19” (Mejlak, 2020). The cost of childhood obesity, a preventable disease, in one age group, is equal to the cost of helping companies and countries respond to the threat of a global pandemic.
The priority population
The intended audience for this program is elementary school children ages three to 11 who attend a small private elementary school in Miami Dade, FL. The 180 children who attend this school come from predominantly Hispanic affluent families. There is a student-teacher ratio of 5:1, compared to the national average of 17:1 (Niche, 2021). The hope is that this program can serve as a model for other private elementary schools in the Miami, Dade area. In the past, children of affluence were often overlooked as a segment of the population under the general cultural presumption that children from affluent families are low risk. According to Luthar (2003), the phrase at risk is most often associated with low-income families. The target audience does not currently receive nutrition education at any point during the school day. However, it is impacted by the realities of the obesogenic environment and the body image messages of our culture.
Within the target audience, there have been instances of fat-shaming in kindergarten, anorexia, and body image issues in third grade, and growing concerns of children not eating throughout the school day. These adverse health behaviors can stunt growth and academic performance. Dr. Philip Newcomm, a private pediatrician who serves the intended audience, confirmed in an interview that the current pandemic restrictions had increased this age group’s BMI, “they are through the roof”. Dr. Newcomm asserted that COVID-19 had brought to the forefront the issue of weak nutritional guidance in the populating he serves.
Call to action
If these risk behaviors remain unaddressed, this population will be at the high end of the at-risk spectrum for developing either a chronic disease associated with obesity; or body image dissatisfaction, a gate-way behavior for other emotional and mental health issues (Birbeck and Drummond, 2006). The adults responsible for the physical, emotional, and intellectual development of the intended audience need to find a solution to this problem. Both the intended audience, elementary-aged school children and the adults responsible for their wellbeing, are primarily in need of power (Contento, 2016). The proposed program addresses the risk behaviors through knowledge acquisition and skill development.
While dietary changes are the solution, behavior change takes time. How much time? The Nutrition Education Act (2020) recommends 50 hours of nutrition education per student per school year. Independent researchers recommend a minimum of six months (Murimi, Moyeda-Carabaza, Nguyen, Saha, Amin, and Njike, 2018). The nutrition literacy program proposed in this rationale will align with the school’s current standards and live within the curriculum; it supports the premise that “mental health and physical health are inseparable. Successful prevention is inherently interdisciplinary” (NAHS, p. 19, 2019). The population-based health risk behaviors this program will address include (1) not consuming enough fruits and vegetables (CDC, 2018); (2) overconsuming sodium-rich foods (CDC, 2014); and (3) body image perceptions (Luthar, 2003). Evidence suggests that if these risk-behaviors remain unaddressed, the associated health-threats will continue to increase as the child ages making the trend harder to reverse and perpetuating the cycle of obesity, body dissatisfaction, and associated diseases. (Birbeck and Drummond, 2006).
The program will take place during the school day and will incorporate the following interventions (1) food literacy, (2) gardening, (3) fruit and vegetable (FV) sensory exploration. All three interventions use collaboration, inquiry, and guided exploration. The theoretical framework that will serve as the foundation for the program is Social Cognitive Theory. According to Bandura (2004), an effective nutrition intervention includes (1) information; (2) developments in social and self-management skills; (3) builds a resilient sense of self-efficacy; and (4) creates social supports for the desired changes. The ultimate goal is to place the learner in a position of power through knowledge acquisition and skill development.
As troublesome as this reality is, it represents an opportunity. An opportunity to design and implement a developmentally appropriate nutrition literacy program to improve the health-related quality of life of the intended population. This program will succeed because (1) it aligns with the school’s mission of caring for each child’s physical development; (2) it is researched based; (3) it empowers the individual through information, self-management skills, and autonomy (Bandura, 2004); (3) it is interdisciplinary and aligned with grade-level curricula standards. By incorporating the proposed nutrition literacy program, St. Philp’s Episcopal School will position itself as a leader in the community. It presents an opportunity for the school to deliver its promise to nurture each child intellectually, spiritually, and physically. Parents, educators, and community leaders are responsible for the health of this generation. The moment is now, let us be a part of the solution, innovation in nutrition education is the way of the future, and this program is part of that future.
Bandura. A. (2004). Health promotion by social cognitive means. Health Education Behavior 31(2):143-64. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/15090118/
Birbeck, D; and Drummond, M. (2006). Very young children’s body image: bodies and minds under construction. International Education Journal, 7(4), 423-434. Retrieved from: https://files.eric.ed.gov/fulltext/EJ854298.pdf
Contento, I. (2016). Nutrition Education: Linking Research, Theory, and Practice. (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
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Eric, A. F; Wan, C.K.G; and Rahul, M. (2014). lifetime direct medical costs of childhood obesity. Pediatrics 133 (5) 854-862. Retrieved from: https://pediatrics.aappublications.org/content/133/5/854
Fryar, C.D; Carroll, M.D; Ahluwalia, N; and Ogden, C.L. (2020). Fast food intake among children and adolescents in the United States, 2015–2018. NCHS
Data Brief, no 375. Retrieved from: Retrieved from: https://www.cdc.gov/nchs/data/databriefs/db375-h.pdf
Luthar S. S. (2003). The culture of affluence: psychological costs of material wealth. Child development, 74(6), 1581–1593. Retrieved from: https://doi- org.proxyau.wrlc.org/10.1046/j.1467-8624.2003.00625.x.
Murimi, M. W; Moyeda-Carabaza, A. F; Nguyen, B; Saha, S; Amin, R; and Njike, V. (2018). Factors that contribute to effective nutrition education interventions in children: a systematic review. Nutrition reviews, 76(8), 553–580. Retrieved from: https://doi.org/10.1093/nutrit/nuy020
Nation Center for Health Statistics. (2017). Prevalence of Obesity Among Adults and Youth: United States, 2015 – 2016. U.S Department of Health and
Human Services Data Brief number 288. Retrieved from: https://www.cdc.gov/nchs/data/databriefs/db288.pdf
National Academies of Sciences, Engineering, and Medicine. (2019). Fostering Healthy Mental, Emotional, and Behavioral Development in Children and
Youth: A National Agenda. The National Academies Press. Retrieved from: https://doi.org/10.17226/25201.
Nutrition Education Act, H.R. 5892, 116th Cong. (2020). Retrieved from: https://www.govtrack.us/congress/bills/116/hr5892/text
Mejlak, P. (2020). World Bank Group Increases COVID-19 Response to $14 Billion To Help Sustain Economies, Protect Jobs. The World Bank. Retrieved from: https://www.worldbank.org/en/news/press-release/2020/03/17/world-bank-group-increases-covid-19-response-to-14-billion-to-help-sustain-economies-protect-jobs
St. Philips Episcopal School. (2021). Mission statement. Retrieved from: https://www.saintphilips.net/about/mission/
St. Philips Episcopal School. (2021). Nutrition program. Retrieved from: https://www.saintphilips.net/wellness/nutrition/