Lesson Plan

Title of Health Intervention:

Avoiding the Pitfalls of Portion Size: Understanding how much is on your child’s plate.

Health Topic: Childhood obesity and the results of overindulging and not understanding portion control

Intended Audience:  

The lesson is geared towards parents with young children between the ages of 3-12. Parents have been told by their pediatrician that their children are heading towards being overweight.

Procedures:

Set up tables, chairs, turn on the computer, pull up PowerPoint for videos, set up portion displays, set out bring cards and chips, and have handouts prepared.

Introduction:

Hello, my name is Tracy; I will be your health educator today specializing in portion size and control. In the next half hour, I will explain what childhood obesity is, how potion size is contributing to obesity in children, talk about portion distortion and give tips on how to size down out portions.

We live in a world where everything is SUPER SIZED which in some instances can be great! SUPER SIZED televisions, SUPER SIZED cars, and SUPER SIZED special movie effects, but one place that being considered SUPER SIZED is not okay is when it comes to our children.  This is what we are going to focus on over the next 30 minutes.  We are going to learn how not to SUPER SIZE our children through using portion control.

Describe portion control review bingo game

a.         Hand out game cards

b.         Explain directions of game

Background:

For the past decade and a half childhood obesity has been on the rise and is continuing to grow. There are facts and statistics that prove childhood obesity is a serious and rising problem, and change is needed. 

·         “Over the past thirty years, childhood obesity has tripled” (Centers for Disease Control and prevention [CDC], 2011a).

·         “The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 20% in 2008. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period” (CDC, 2011a).

·         “Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese” (CDC, 2011b).

Risks associated with obesity:

There are many health risk associated with childhood obesity which can lead to health problems in adulthood.

·         “High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD)” (CDC, 2012).

·         “In one study, 70% of obese children had at least one CVD risk factor, and 39% had two or more” (CDC, 2012).

·         “Increased risk type 2 diabetes” (CDC, 2012).

·         “Breathing problems, such as sleep apnea, and asthma” (CDC, 2012).

·         “Joint problems and musculoskeletal discomfort” (CDC, 2012).

·         “Fatty liver disease, gallstones, and heartburn” (CDC, 2012).

·         “Obese children and adolescents have a greater risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood” (CDC, 2012).

Health risks later:

Children who are obese have a greater chance of becoming as obese adult.  Diseases and health conditions associated with adult obesity include heart disease, sleep apnea, and diabetes. Disease carried over from childhood can result in severe cases in adulthood shortening a person’s life span (CDC, 2012).

Contributors:

Low Physical Activity

Many children are living sedentary lifestyles. Nowadays it seems the majority of time is spent in front of the television, computer, playing video games, on our phones, and social networking.  All these activities promote sedentary lifestyles and in my opinion are contributing to the unhealthy lifestyle most Americans are living and the rise in childhood obesity. These activities contribute to snacking and filling up on junk, causing us to feel full so we’re not hungry when it is time to eat a real meal (CDC, 2012).

·         “Eight- to eighteen-year-olds spend more time with media than in any other activity besides sleeping—an average of more than 7½ hours a day, seven days a week” (Rideout, Foehr & Roberts, 2010).

SIDE NOTE: When I was a child I spent barely any time indoors. My days consisted of riding bikes, climbing trees, and playing at the playground until dark.  I grew up in Upstate New York and the winters were brutal, but on almost any given day I was outside playing.

Poor eating habits

Families are working longer hours, and more days to maintain their standard of living which leaves them with little time and energy to prepare home cooked meals.  Families today are also living in the world of extracurricular. Every minute of the day is consumed with some activity outside of school that leaves them little time to cook, so their options are quick meals and fast food. 

·         “There are over 25,000 fast food chains for Americans to choose from. The yearly total Americans spend on fast food is over $140 billion a year” (The healthy eating guide, 2011).

Increased portion sizes

Over the past few decades’ portion size have grown causing an increase in the calories we consume. We are bombarded daily with increased portions sizes at restaurants, grocery stores and special events, such as movies and sport games.

Portion sizes of less healthy foods and beverages have increased over time in restaurants, grocery stores, and vending machines.

·         “Research shows that children eat more without realizing it if they are served larger portions. This can mean they are consuming a lot of extra calories, especially when eating high-calorie foods” (CDC, 2012).

Portion Control:

There are many people who do not know what a healthy portion is, but who can blame them?  Over the past few decades, our portions have changed drastically. We have become accustomed to thinking larger portions are better and believe that what is served to us is normal.  Retraining our brains to understand that larger isn’t always better is not an easy task.  In order to have success when losing and managing weight we need to change our portions, which is a critical component to successful reducing childhood obesity (Kidshealth.org, n.d).

Our lesson today is learning how to develop "portion control."

Portion distortion is very real and many Americans suffer from this.  We believe that if we eat much junk food we will be overweight when in reality it is the size of the portions we eat of any type of food. We are living in a super-sized society which is contributing to our children growing up obese (KidsHealth.org, n.d.).

Questions we need to ask ourselves:

How do I plan for healthy eating?

How do I move my children away from the idea that "bigger is always better"?

Well, first we need to familiarize ourselves with portion size.

·         Show portion size chart (PowerPoint).

As children we develop eating habits, such as likes, aversions, and portion sizes.  Eating healthy not only calls for eating healthy foods but controlling the amount of food we eat, portion control. When preparing a meal for our children, the U.S. Department of Agriculture (USDA) provides portion guidelines for adults and children. An adult serving should be cut buy one half to a third when preparing a plate for a child. For example, a 3 oz. piece of chicken is the size of a deck of cards so a child’s serving should be 1 ½ ounces (WebMD, 2012).

It is challenging to understand portion sizes, but to make it easier equate food to the size of different objects.  Here are a few examples to help you visual the serving sizes of some foods. The palm of a women’s hand hold about 3oz which is a serving size of chicken. A cup of rice or pasta should be about the size of a tennis ball. I have a take-home handout titled “Portion size guide” to help you (WebMD, 2012).

Describe portion control

·         Show YouTube videos

o   How to Determine a Serving Size for Dummies (1.56) (PowerPoint)

o   How to Determine a Serving Size without Measuring For Dummies (.56) (PowerPoint)

·         Use visual aids to show portion size

o   Hand out portion size guide sheets/wallet

·         Discuss different portion sizes

o   Hand out portion size food containers

·         Hand out “What’s on your plate”  information

Talk about portion control tips

If anyone has bingo stop and review the key points.

Tips

Before Eating, Divide the Plate

Fruits and veggies should fill one side of your plate and the other side should have equal portions of protein and starch. For example, pork chops and rice or chicken and potatoes are not complete meals if fruits and vegetables are missing (Choosemyplate.gov, 2011).

Serve Good-For-You Foods Family-Style

Share your meals (Mayo Clinic, 2009).

Before placing food on your plate decide what you are going to eat and place appropriate size portions on your plate (Mayo Clinic, 2009).

Do not put all the food on the table, out of sight out of mind (Mayo Clinic, 2009).

Learn Serving Sizes

Weigh out your food to make sure you have the correct portions. Once you’re comfortable you will be able to measure out food without the assistance of a scale (Mayo Clinic, 2009).

Learn to identify serving sizes this allows for better control over the portions of food you eat (WebMD, n.d.).

Don’t clean your plate

Let children decide when they’re finished; don’t make them clean their plates; let them stop when they are full (NIDDK, 2012).

Eating out

Split a meal (Choosemyplate.gov, 2011).

Substitute vegetables for french fries and order off the kid’s menu for children they do not need an adult size meal (NIDDK, 2012).

Before you start eating, request a to go carton and put half immediately into the carton (Mayo Clinic, 2009).

At home

Make an effort to get everyone at the table to eat together (NIDDK, 2012).

Use a small plate for your meals, using a large plate can encourage a person to fill their plate causing them to eat more than what they would have if they used a small plate (NIDDK, 2012).

Repackage goodies like cookies and chips into small bags to control overeating. This way you can control portion size (Mayo Clinic, 2009).

Television can cause a distraction during mealtime so turn off the television to control mindless eating (NIDDK, 2012).

Use an individual bowl to snack from instead of snaking out of the bag this way you can keep track of how many portions you are eating (Mayo Clinic, 2009).

Think Before You Drink

Stock your house with liquid options, such as water, low or fat free milk, or 100% juice. Children can have ½ to 1 cup of 100% fruit or vegetable each day.  Eliminate your home of sugary and high calories drinks (Choosemyplate.org, 2011).

Evaluation

I will check for understanding of my lesson and to evaluate the participant’s progress during the lesson and after I will use class observation, answer & question session, and class discussion (bingo review) and a questionnaire.

Anticipated Problem(s) and Solution(s)

·         Additional participants attend the lesson then what were anticipated.

o   Have additional copies of bingo cards, worksheets, handouts and additional chairs.

·         Forget flash drive with PowerPoint information, videos, and graphics.

o   Send PowerPoint to e-mail account and make a hardcopy of notes.

·         Conference room is locked.

o   Call ahead to make sure door is unlocked and that night staff (janitors) know we will be holding a class.

·         Parents many bring children with them if they have no other option.

o   Have another person on hand to help with children. Bring books and a few toys to have a play area set up for the children.

Objectives

Process Objectives

Participants will be able to list during the lesson the main causes contributing to childhood obesity to the members at their table (Cognitive).

Participants will show a willingness to take personal action to improve portion control habits at home by following guidelines presented in class in a post evaluation questionnaire a month later (Affective).

Participants will engage in conversation with class and teacher during the lesson showing an understanding of the material presented by listing the key points of the lesson (Psychomotor).

Outcome Objectives

80% of the participants will be able to identify the cause of childhood obesity (Cognitive).

75% of the participants will agree to use portion control guidelines when preparing their children’s meals (Affective).

80% of participants will be able to demonstrate their understanding of portion size through a question and answer period (psychomotor).

Goal

The goal of the program is to provide families with background knowledge of obesity and how portion control can help them and their children can live health lives through eating appropriate sized meals.

·         Increase knowledge of obesity.

·         Change attitudes towards potion size and eating healthy.

·         Encourage healthy eating behaviors.

·         Increase self-efficacy in order to develop portion control habits.

Guiding Health Education Theory or Model

Health Behavior Model

The Health Behavior Model was developed as a guiding framework to explain why a person decides not to change or maintain a health habit , as well as, what makes a person decide to change and maintain their new health behaviors. The constructs of the model include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. In order for people to change their behavior they need to understand how where they fit among these constructs. Once they have knowledge of how each of these constructs affects them they can begin to change their behaviors and have the confidence to maintain these health behaviors (Glanz, Rimer & Viswanath, 2008). Obtaining and preparing the proper foods can be a perceived barrier creating a potential negative effect on their health action. According to John & Ziebland (2004) there are external and internal factors which create food barriers for families. A few examples of external food barriers are high prices of fruits and vegetable and time to properly grocery shop. A few internal barriers are health habits and food preference. A strong predictor of whether or not food will be eaten is the taste of a food (John & Ziebland, 2004).

            The main purpose of  this lesson is to change eating behaviors which will include breaking down food barriers, such as food selection, as well as, increasing their self-efficacy to shop and prepare for foods that will create a well-balanced meal.

Setting 8 round tables

•   Nighttime 6:30 -7:00

•   Thursday night

•   Conference room

•   Two display tables

•   Overhead projector and computer

•   8 Tables and Chairs

Estimated Time

•   Introduction (5min)

•   Explanation and handout of game (5min)

•   Background information (5min)

•   Discussion of visual aids (pass them around) (5 min)

•   Question and answer (10 min)

•   Review (5min)

Materials Needed

•   Computer

•   Handouts (what does a serving size look like)

•   Visual aids (portion control items, my plate handout, bingo game)

•   8 tables, 32 chairs

•   Bingo chips

•   Plastic containers

•   Food portions

•   Take home kids coloring sheet

Reference page

Center for Disease Control and Prevention. (2011a). Childhood obesity facts. Retrieved from http://www.cdc.gov/ healthyyouth/ obesity/facts.htm

Center for Disease Control and Prevention. (2011b). Obesity rates among all children in the United States. Retrieved from http://www.cdc.gov/obesity/ childhood/data.html

Center for Disease Control and Prevention. (2012). Overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood/basics.html

Choosemyplate.gov. (2011). Build a health meal. Retrieved from http://www.choosemy plate.gov/food-groups/downloads/TenTips/DGTipsheet7 BuildAHealthyMeal.pdf

Glanz, K., Rimer, B., & Viswanath, K. (2008). The health belief model. In Champion, V., & Skinner, C. (Eds.), Health Behavior and Health Education: Theory, research, and practice (pp. 45-62). San Francisco, CA: Jossey-Bass

Jeyanthi, J., & Ziebland, S. (2004). Reported barriers to eating more fruit and vegetables before and after participation in a randomized controlled trial: a qualitative study. Health Education Research, 19(2), 165-174.  doi: 10.1093/her/cyg016 Retrieved from http://her.oxford journals.org/content/19/2/165.full.pdf+html

Kidshealth.org (n.d.).Portion distortion. Retrieved from http://kidshealth.org/parent/ nutrition_center/healthy_eating/portions.html#

Mayo Clinic. (2009). Nutrition and healthy eating. Retrieved from http://www.mayoclinic.com/ health/portion-control/MY01101

National Insititute of Diabetes and Digestive and Kidney Diseases [NIDDK]. (2012). How can I control portions at home. Retrieved from http://win.niddk.nih.gov/publications /just_enough.htm#f

Rideout, V., Foehr, U., & Roberts, D. (2010). Generation M2 media in the lives of 8to18year olds. A Kaiser family foundation study. Retrieved from http://www.kff.org/entmedia/ upload/8010.pdf

The Healthy Eating Guide. (2011). Health eating statistics: American’s obesity crisis. Retrieved from http://www.thehealthyeatingguide.com/healthyeatingstatistics.html

WebMD. (2012). Portion size guide. Retrieved from http://www.webmd.com/diet/printable/ portion-control-size-guide

Brochure

Click on the image to see the full image of my childhood obesity brochure.

Childhood Obesity Brochure

SMOG - Readability


For materials containing  < 30 sentences
1. Count the number of sentences: ___15_____
2. Count the number of words with 3 or more
syllables in the sample: ___21_____
3. Divide the number of sentences in the sample
into 30 (i.e., 30/25) and multiply this number by
the number of words from step 2.
Answer:_____42____
4. Use the answer to step 3 to look up the reading
grade level in the chart.

“SMOG” Conversion chart number 

Number of Words        Grade

in a sample

0 – 2                                  4 

3 – 6                                  5

7 – 12                                6

13 – 20                              7

21 – 30                              8

31 – 42                              9

43 – 56                             10

57 –  72                            11

73 –   90                           12

91 –   110                         13

111 – 132                         14

133 – 156                         15

157 – 182                         16

Reading level of this material: ______9____ th Grade  (plus or minus 1.5 grades)

Brochure References

Center for Disease Control and Prevention [CDC]. (2011a). Childhood obesity facts. Retrieved from http://www.cdc.gov/ healthyyouth/ obesity/facts.htm

Center for Disease Control and Prevention [CDC]. (2011b). Obesity rates among all children in the United States. Retrieved from http://www.cdc.gov/obesity/ childhood/data.html

Center for Disease Control and Prevention [CDC]. (2012). Overweight and obesity. Retrieved from http://www.cdc.gov/ obesity/childhood/problem.html

Choosemyplate.org, (

Healthmad. (n.d.).  Facts about obesity. Retrieved from http://healthmad.com/conditions-and-diseases/facts-about-obesity-3/

Hive. (2011). Slimming the future. Retrieved from http://hive.slate.com/hive/time-to-trim/article/slimming-the-future

Livestrong. (2010). Emotional effects of obesity in children. Retrieved from http://www.livestrong.com/article/108268-emotional-effects-obesity-children/

Mayo Clinic. (2012). Social and emotional complications.  Retrieved from http://www.mayoclinic.com/ health/childhood-obesity/DS00698/DSECTION=complications

The Davis Enterprise. (2012). Statewide, county childhood obesity rates remain high. http://www.davisenterprise.com/local-news/statewide-county-childhood-obesity-rates-remain-high/

The Discovery Channel. (2002). Prevalence of overweight in children and adolescents. Retrieved http://www.discoverychannelcme.com/childhoodobesity/charts/charts.html

Wordpress. (n.d.) Impact of Obesity on Children. Retrieved from http://childrensobesity 101.wordpress.com/100-2/

Prevention

Prevention

What is disease prevention?

"Disease prevention incorporates preventative care, medicine and therapy to prevent the occurrence of disease, reduce risk factors, and understand the progression of the disease in order to reduce the consequences of the disease" (Definition of Wellness, n.d.).

There area three levels of disease prevention which are primary, secondary and tertiary.  Primary is directed towards prevention of a disease, secondary prevention is directed towards the treatment of the disease and tertiary is directed towards therapies and maintaining the disease (Healy, & Zimmerman, 2010).

Obesity disease prevention

My Examples

Below are ideas that, I believe, fall under each area of prevention. If there are any that you may feel I have chosen to be in the wrong category please leave me your reasoning in the comment box.

Primary Prevention: "Activities taken to prevent disease in the future" (Healy, & Zimmerman, 2010). 

1. Yearly health checkups at the doctor for weight assessment.
2. Breastfeeding has been associated with reducing obesity risk in children
3. Exercise
4. Eat a healthy breakfast every morning
5. Limit sugary drinks
6. Limit high fatty processed foods
7. Avoid snacks that are high in fat,salt and sugar

A supporting website of my examples can be found at Medical Home Patrol a website for parents, families, and physicians who are advocating for child safety and special health care needs (Medical Home Patrol, 2012).

Secondary Prevention: "Early detection and treatment of disease" (Healy, & Zimmerman, 2010).

1. Increase exercise to control weight
2. Increase outdoor activities and lessen indoor activities (television)
3. Lifestyle coaching
4. Incorporate portion control


Tertiary Prevention: "Rehabilitation therapies to prevent complications or further illness" (Healy, & Zimmerman, 2010).

1. Weight management program
2. Weight surgery
3. Medical care for diseases caused by obesity

I found supporting information for my ideas on secondary and tertiary prevention on the website for the National Heart, lung and blood institute (National, Heart, Lung and Blood Institute, 2008).

Reference


Definition of Wellness. (n.d.). Definition of disease prevention. Retrieved from http://www.definitionofwellness.com/dictionary/disease-prevention.html

Healy, B., & Zimmerman, R. (2010). The New World of Health Promotion, New Program Development, Implementation, and Evaluation. In Healy, B., & Zimmerman, R (Eds.), Epidemiology as the catalyst in the  development of health promotion programs (pp. 23-40). Sudbury, MA: Jones and Bartlett publishers.


Medical Home Patrol. (2012). Childhood Obesity. Retrieved from http://www.medicalhomeportal.org/ clinical-practice/screening-and-prevention/childhood-obesity

National, Heart, Lung and Blood Institute. (2008). Working group report on future research directions in childhood obesity prevention and treatment. Retrieved from http://www.nhlbi.nih.gov/meetings/ workshops/child-obesity/index.htm#summarytreatmentpanel