Feed them and weigh them. Such were the words of nutrition education pioneer, Mary Schwartz Rose, in regards to some of the earliest studies on malnutrition.
Today, though the topic of discussion has shifted from malnutrition to obesity, nutrition education still promises healthier and happier lives. However – while some programs promote fruits and vegetables, and others promote physical activity – not enough check if they work.
Many turn away from the mention of the word evaluation. Given the lack of resources – trained staff, packed school days and of course, money – the “e” word is often placed on the back burner. However, with the advent of the Let’s Move! Initiative, the Healthy Food and Community Change Initiative and the Putting Prevention to Work Initiative, schools are teaming up with research universities to evaluate their programs and compete for funding.
On October 4th, the New York City Nutrition Education Network brought together experts in nutrition education for Promoting Healthy Eating Patterns in School-Aged Children: Does Nutrition Education Really Work?, to discuss what works, what doesn’t and what’s missing from New York City’s school-based nutrition interventions.
Isobel Contento, PhD, professor of nutrition and education at Columbia University’s Teachers College, summarized her latest literature review, by providing a list of elements that contribute to effective school-based nutrition education:
- Nutrition education is about helping people eat better, not just providing nutrition information. Programs that are behavior or action-focused are most effective.
- Theory or evidence, such as social cognitive theory, theory of planned behavior and self-determination theory should be used whenever possible to predict behavior change.
- Personalized feedback through self-assessment is important for older children.
- A duration and intensity of 30-50 hours per year, or about 6 sessions, is necessary to make medium changes in attitudes and behavior.
- Involving the family is important for younger children.
- Curricula tailored for cultural relevance is more engaging.
- Web activities, video games and other innovative multimedia technology, increases child engagement, as seen with Escape from Diab and Nano Swarm.
- Teacher professional development, also known as capacity building, or train-the-trainer, helps schools help themselves, and allows schools to continue nutrition education well after a third party leaves.
- A healthy school food environment is important to familiarize children healthy foods, modeling healthy food consumption and reinforcing classroom nutrition education.
- Multi-component interventions that include after-school activities, special events and school wellness policies, offer greater exposure to health messages, especially if programs lack in duration and intensity (#4), as seen in the HEALTHY Study and the School Nutrition Policy Initiative.
- Interventions that engage the wider community are most effective, and challenging, as evident by Shape Up Somerville and CATCH.
Now that we know what works, the speakers discussed some challenges:
Dr. Contento noted that more research is needed to recognize the most appropriate measures for health outcomes, as well as developing validated instruments to measure such outcomes. Pamela Koch, EdD, RD, professor of nutrition and education at Teacher’s College, and Director of the Laurie M. Tisch Center for Food, Education & Policy, cited the difficulty of measuring water intake among children using the Eat-Walk survey.
Dr. Contento and Dr. Koch are both involved in the evaluation of the Middle School Science Curriculum to Reduce Obesity, which includes an integrative school science curriculum with elements of nutrition and physical activity. The evaluation involved 10 schools and over 900 students across New York City.
Jeannie Fournier, manager of CookShop, Food Bank For New York City’s centerpiece nutrition education program, cited more struggles: culturally-sensitive lessons, expensive whole foods, little class time, lack of kitchen resources, buy-in with schools and children with learning disabilities.
CookShop offers SNAP-eligible youth with the knowledge and tools to create low-cost, healthy meals. The program offers four separate train-the-trainer curricula tailored to different ages, including CookShop Classroom for Elementary and After-School, EATWISE, for teens, and CookShop for Families. To date, the program has reached over 42,000 children, teens and adults across NYC, including Staten Island. Food Bank’ three-year evaluation, with Johns Hopkins University, is still in progress.
Christina Dyer, MS, RD, nutrition education coordinator at the New York City Department of Health & Mental Hygiene, presented on Eat Well Play Hard, a childhood obesity prevention initiative originating from the New York State Department of Health. The initiative includes Eat Well Play Hard in Child Care Settings and Growing Healthy Children, both of which are implemented in child care centers that take part in New York State’s Child and Adult Care Food Program.
Some of the barriers Ms. Dyer noted were: inability to alter measuring tools, issues with returning surveys and complexities between the Institutional Review Board, an ethics review committee designed to review research involving humans, and the DOHMH.
By the end of the conference, it was clear that childhood nutrition education has made major progress since the days of Mary Schwartz Rose. However, only 39% of NYC schools are currently offering nutrition education, and even fewer are evaluating their effectiveness.
Visit NYCNEN to read about more upcoming events like this one.