How do you teach nutrition?Jaclyn Munge

University of Sunshine Coast

What will be covered

• Background

• Support for school-based nutrition education

• Teachers’ role in nutrition education

• Teaching approaches/strategies for effective nutrition education

• Conclusion

BackgroundImportance of nutrition education in secondary schools

Poor nutritional habits

Linked to all major lifestyle

diseases

Accounts for majority of health costs

Poor nutritional habits a result of…

• Rapid urbanisation

• Changing lifestyles

• Increased production and ready availability of highly processed foods

(Sadegholvad et al., 2017)

Adolescent nutritional habits are transitory because…

Adolescence represents:

- stage of increased growth and development

in body size

- increased demand for energy and nutritional

requirements

- growing independence to make own

decisions about food choices

(Lyttle, 2002; Savige et al., 2016)

Example

• Adolescents nutritional habits don’t meet national dietary guidelines:

- low consumption of fruits, vegetables,

wholegrains, and dairy

- high consumption of energy-dense foods

• Increased frequency of food consumed out of home in last three decades

- increased undesirable foods

- decreased desirable foods

(Brady et al., 2000; Deithelm et al., 2012; French et al., 2000; Nicklas et al., 2001; St-Onge et al., 2003)

Long-term effects

• Health-related outcomes show tracking through adolescence into adulthood

• May have long-term consequences for health (medical and psychosocial) (Gracey et al., 1996)

• Medical consequences: physical health

• Psychosocial consequences: social emotional and mental health risks

Health consequences

• Medical

- Obesity

- Type 2 diabetes

- Certain cancers

- Atherosclerosis

• Psychosocial

- Low self-esteem

- Depression

- Behavioural and learning problems

Importance of nutrition education in adolescent years

Potentially reduce risk of

• Long-term health (medical and psychosocial) consequences

• Health costs associated with poor overall health

Schools as the primary target

• Ability to reach varied and large numbers of young people (Dudley et al., 2018)

• Offer continuous intensive teacher-student contact (Dudley et al., 2018)

• Opportunity for cross-curricular integration of health messages (Baranowski & Stables, 2000; Dudley et al., 2018)

• Whole school approach involving students, staff, parents and wider community (O’Dea & Malony, 2000; Smolak et al., 1998)

Teachers are best placed to teach nutrition

• Teachers yield more positive results in changing nutrition behaviours compared to nutrition guest speakers (Abood et al., 2008; Dunton et al., 2009; Fahlman et al., 2008; Hall et al., 2016)

• Teachers have the potential to positively influence expected outcomes of nutrition behaviour interventions

- increased fruit and vegetable intake

- increased behavioural intentions for

healthy eating

- increased physical activity

- increased nutrition knowledge

- increased efficacy expectations

regarding health eating

- decreased sedentary activity

- decreased consumption of refined

sugar

• Teachers spend a significant amount of time with students

• Teachers position as role models in students’ lives

• Opportunity for vicarious learning

(Hall et al., 2016)

However, school-based nutrition education has been neglected, contributing to poor nutritional habits in adolescence

- low degree of implementation

- low program fidelity

School-based nutrition education

2006 School Health Policies and Programs Study

• Median 3.4 hr/yr spent on nutrition and dietary behaviour instruction in elementary schools in USA

- 10-15hr/yr necessary to elicit change in

knowledge

- 50hr/yr to elicit lasting changes in

attitudes and behaviours

NSW Education Standards Authority (NESA)

• Recommended 1.5-2.5hr/wk on all 8 strands in the PDHPE syllabus

• Nutrition is 1 of 6 topics in the ‘Personal Health Choices’ strand

• 3min/wk or 2hr/yr spent on teaching nutrition

Barriers to teaching

• Availability and accessibility to resources

• Already crowded curricula

• Limitations in nutrition education programs

• Lack of explicit curriculum and support by staff

• Teachers’ self-efficacy

• Teachers’ knowledge of the subject matter

(Baranowski & Stables, 2000; Fahlman et al., 2011; Jones & Zidenbeg-Cherr, 2015)

Teachers will remain the key agent of promoting health and nutrition

within schools post-2015

What can we do?

Are there examples to follow?

Systematic review and meta-analysis (Dudley. Cotton and Peralta, 2015)

Aim of study

• Systematically review the evidence related to interventions designed to improve healthy eating habits and patterns of primary school students

Objectives

• Describe the nature of the interventions that had been conducted

• Conduct meta-analyses to determine the effectiveness of these interventions

Outcomes of interest

• Healthy eating outcomes

- reduced food consumption or energy intake

- increased fruit and vegetable consumption or preference

- reduced sugar consumption or preference (not from whole fruit)

- increased nutritional knowledge

• Teaching strategies or articulated approaches to teaching that has a known effect on student learning and behaviour

Results

• Final 49 studies selected

• Data captured from 38, 001 primary school children

• Data capable for inclusion from 20, 234 participants

• 13 different countries (12 OECD, 1 Trinidad & Tobago)

• 8 dominant effective teaching strategies/approaches

8 effective teaching strategies/approaches

• Enhanced curriculum approaches

• Cross-curricular approaches

• Parental involvement

• Experiential learning approaches

• Contingent reinforcement approaches

• Literary abstraction approaches

• Games-based approaches

• Web-based approaches

Curriculum approach/web-based approach/parental involvementEffects of a comprehensive fruit-and vegetable-promoting school-based intervention in three European countries: the Pro Children Study (te Velde et al.,2008)

Objective:

To evaluate the effects of the Pro Children Intervention on school children’s FV intake after 1 and 2 years of follow-up, compared to control schools

Participants:

1472 10-11yo from 62 schools in Norway, Spain and the Netherlands

Methods:

FV curriculum combined with web-based computer-tailored tool for personalised feedback on FV intake

Questionnaires completed before intervention, , immediately after 1st intervention, and 1 year later as follow-up

Results:

Significant increase in FV intake at first follow-up for all three countries, both at school and at home

1 year later, Norway showed significant increase in FV in school; Spain and the Netherlands showed significant increase in FV outside school

Cross-curricular approachReducing overweight through a multidisciplinary school-based intervention (Spiegl & Foulk, 2006)

Objective:

To evaluate the effectiveness of a multidisciplinary elementary school-based intervention on BMI, FV, PA (Wellness, Academics & You - WAY)

Participants:

1013 students in 4th and 5th grades, 69 classes from 16 schools in 4 states (Delaware, Kansas, Florida, North Carolina)

Methods:

10 mths intervention - Pre-post Height & Weight; BMI; survey;

teachers administer the WAY program in multidisciplinary activities involving language, arts, math, science, and health; reflective journaling; 10 minute aerobic activity every day

Results:

Significant decrease in BMI; increased FV consumption; increased physical activity levels, in intervention group compared with control group

Contingent reinforcement/parental involvement

Kid’s Choice Program improves weight management behaviors and weight status in school children (Hendy, Williams & Camise, 2011)

Objective:

To examine the effectiveness of the KCP for increasing children’s weight management behaviors, and decreasing BMI% for overweight and average-weight children

Participants:

382 children (1st to 4th grade)from one Pennsylvanian elementary school

Methods:

2 groups: KCP ‘Lions’ (rewards for 3 ‘Good Health Behaviors’); control group ‘Tigers ( rewards for 3 ‘Good Citizenship Behaviors’); lunch observations and pedometer records completed for one month under baseline and three months under reward conditions

BMI% calculated one year before baseline, at baseline and end of KCP application, and 6 months later

Results:

KCP increased FVFIRST, HDRINK, and EXERCISE from baseline through reward conditions, due to rewards;

Overweight and average-weight children showed drops in BMI% after 3 months KCP;

Parent volunteers effectively delivered KCP and endorsed as best personnel to deliver KCP

Experiential learning, curriculum/cross-curricular approachThe impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students (Morgan et al., 2010)

Objective:

To investigate the impact of school garden-enhanced NE on children’s FV consumption, vegetable preferences, FV knowledge and quality of school life (QoSL)

Participants:

127 grade 5 and 6 students from 2 NSW primary schools in Hunter Region

Methods:

10-wks intervention with NE&G, NE only and control groups. FV knowledge, vegetable preferences, FV consumption (24hr recall x 2) and QoSL measured at baseline and 4 –mth follow-up

Results:

NE&G and NE groups had higher willingness to taste and taste ratings for vegetables compared to control

NE&G group: increased ability to identify vegetables, willingness to taste vegetables, and student preference to eat vegetables as snack , compared to NE and control group

Game-based approachKaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion (Amaro et al., 2015)

Objective:

To promote nutrition education and improve dietary behaviour using the board game, Kaledo ((i) score on ‘Adolescent Food Habits Checklist’ (AFHC); (ii) score on a dietary questionnaire, (iii) BMI z-score

Participants:

3,110 students (9-19yo) from 20 schools in Campania, Italy

Methods:

2 group design, one pre-treatment and two post-treatment assessments

Treatment group: Kaledo introduced each week over 20 weeks; Control group: no intervention

Results:

Kaledo improved nutrition knowledge and healthy behaviour over 6 months and had a sustained effect on BMI z-score

Treated group had significantly higher scores on AFHC, 4 sections of dietary questionnaire (physical activity, food habits, nutrition knowledge, and health and unhealthy diet and food’, lower BMI z-score, compared to control group. At second post-assessment (18 mths), BMI z-scores lower

Literary abstraction

Piloting a cooperative Extension service nutrition education program on first-grade children’s willingness to try foods containing legumes (Edwards & Hermann, 2015)

Objective:

To pilot the effect of an Extension nutrition education program on 1st grade children’s willingness to try foods containing legumes

Participants:

14 1st grade children from a rural elementary school in Oklahoma

Methods:

3 weeks program using a pre-, post-, follow-up design during school term, with one meeting/wk over 3 wks.

1st & 3rd wk – snack tasting; 2nd wk – children were read The Story of Benny the Traveling Bean, then participated in snack tasting

Each wk, trained observers recorded number of snacks containing legumes children took and number they tasted

Results:

Increase in number of children who tasted snacks containing legumes across the 3 time periods (pre, post, follow-up)

Conclusion

What can you do to teach nutrition in your class/school? classrooms?

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Interested to find out how your professional identity and self-efficacy to teach nutrition impact on your experiences teaching nutrition?

If you:• Are a secondary HPE teacher with full

registration, AND• Have at least five years of experience

teaching HPE in secondary schools in Queensland,

WE INVITE YOU FOR THE RESEARCH SURVEY!

To participate, please go to https://www.surveymonkey.com/r/Z7F3Y83to access the Research Project Information Sheet (RPIS) and the online survey.