348
Answer: With this question, each student should approach the question from their own perspective and add
their own flavor and approach to the answer. Just saying we would like to do something is much easier than
actually putting a plan into action. Therefore, there might be some discussion of the challenges of how to put
4. Children from lower socioeconomic communities and families may fail to receive enough nutrient-rich foods to
support growth of a strong body. Families struggling to “make ends meet” often eat diets that are high in fat and
refined carbohydrates and low in high-quality protein. It is not uncommon for young children in very deprived
socioeconomic areas to display behaviors of “pica” or eating nonfood items such as dirt and old paint. Discuss
the problems with the diet described for a young, growing child (for both short– and long term-health) and
suggest how an RD might be able to help impoverished families.
Answer: A diet that is high in fat and carbohydrates and low in high-quality protein for a growing child can
have devastating effects on the child’s short– and long-term health. Children require protein for growth of
tissues and muscles. High-quality protein is very important for a child’s progress in growing, despite the fact
349
The family should take advantage of SNAP if they have not already done so. Call the county clerk’s office to
find out where the family can go to apply for SNAP and any other local, state, or federal assistance that may be
available to support the family in crisis.
There are also many church, county, and hospital programs that will support families in need and particularly
those with young children. Check with the local churches, hospitals, or youth groups to see if there are any local
options for this family.
The child may also have access to breakfast and lunches at their school that can provide proper nourishment.
This is quite valuable for a child in this situation and the RD should make sure that the child is signed up for all
meals and snacks that are available in that school district.
5. Adolescence is a time of tremendous change, not only within the body but also in the individual’s choices and
options in activities and diet. The adolescent is in the final stages of development and preparation prior to
becoming a “young adult” and going out on her/his own. Adolescents often challenge their parent’s choice of
music, lifestyle, and diet. What are nutritional/dietary issues that are prevalent or could be of concern during the
adolescent years, and how might they impact the individual physiologically? How can parents supervise these
challenging years, with regard to nutrition, and when should a parent be concerned and seek advice or help?
Answer: It is important to note that there are clearly many avenues to approach this question and that the more
students can add “to the mix” the more robust the answer will be for the entire class. In the final analysis, share
the summary of answers so that all students benefit from the exercise.
350
own eating pattern: some are vegetarians, some prefer hamburgers and fries, and others might choose all ethnic
foods. Whatever the case, family social roles are often disregarded in favor of the friends network.
Unfortunately, a growing number of individuals are moving into adolescence obese, not understanding what a
normal serving size is, choosing a fairly sedentary lifestyle, and after many years of ridicule about their weight,
not maintaining a strong sense of self. Food is often used as comfort for stress; therefore, during these stressful
years, further weight is added because the adolescent has not learned how to handle stress effectively. Peer
groups and peer acceptance can be hard to gain entrance into and food abusers can become drug abusers or turn
to smoking cigarettes or alcohol to avoid eating and to deal with stress.
For adolescents that require weight loss, a moderate approach is desirable. Consuming a diet that is nutrient rich
provides and 250-500 fewer kcal a day will provide a slow and desirable weight loss over time. During this high
growth period, if the adolescent is only slightly overweight, it is sometimes advisable to allow the child to
“grow into their height” by increasing exercise and improving their diet with less stress on cutting calories.
Whatever approach, it is very important to spend time with the adolescent, teaching them proper dietary habits
as well as appropriate serving sizes of all foods. This is a good “teachable time” in an individual’s life and
weight loss during this time period can often be very successful throughout the adult years.
Parents that can support their adolescent’s sense of discovery in these years will be more successful during this
period. It is important for parents to understand that the adolescent is trying to understand themselves as an
independent individual and prepare themselves for the day of separation. The parent’s job is to help them work
through this period without hurting themselves or others. Testing other dietary patterns is a normal and healthy
way to learn about other cultural and ethnic norms. Provide the adolescent with education and allow them to
make the choice based on their knowledge and family role models. Often, saying no will make the teenager do
just the opposite; therefore, allow them to make choices with some guidance on the part of the parents. In this
manner, both parents and adolescent are educated and can learn together. Parents may want to experiment with
some of the food choices with the adolescent. Such experimentation can be fun and a growing experience for
the adult.
Watch for signs that there is something different or “wrong” with the teenaged child that would indicate that the
adolescent is involved in drugs or alcohol or has an eating disorder. Parents should be alert for signs of drug
paraphernalia, loss of appetite, and unusual smells as well as the smell of alcohol on the teenager’s breath. Also
check pupil size and reaction. Pupils that are small and slow to react are indicative of drug use. When in doubt,
most pharmacies now carry drug urine testing kits that the parents can utilize. Don’t be afraid to ask or check; it
is the life and future of your child that are at stake.
6. The prevalence of obesity in children and adolescents is rising so dramatically in the United States that it is
frightening to consider the health of our adult population in fifty years. Consider the discussion in Highlight 16
regarding childhood obesity and its relationship to type 2 diabetes, atherosclerosis, high blood cholesterol and
blood pressure, and sedentary lifestyles. In your region (county and state), what is the prevalence of childhood
obesity? Compare your regional rate of childhood obesity with that of the national average. How does your
region compare?
Based on the climate, geography, culture, prevalence of chronic disease, and target area needs for childhood
obesity education and programming, develop an integrated obesity program for children in a local target area.
Discuss why you chose the particular target region, how you will develop an integrated program and with
whom, what specific selected outcomes over what period of time would be pursued, and why and how this
would impact long-term risk nationwide for chronic disease.
Answer: There are many types of approaches and programs available to solve the problem of childhood
obesity. It appears that few are successful with the continued increase in childhood obesity and its co–
IM Worksheet Answer Key
Worksheet 16-1: How to Rate Your Food Behaviors
Instructor memo: The likelihood that your students will answer “True” to all of the questions is unrealistic. If you
look at questions 1 thought 9, all of them are concerned with food behaviors that are influenced by multiple factors,
352
both internal and external. However, question number 10 is solely based on one’s evaluation of caloric intake for
which the probability is exceedingly high that individuals are NOT aware of their daily caloric intake.
Worksheet 16-2: Chapter 16 Crossword Puzzle
Worksheet 16-3: Infant Feeding Review (Internet Exercise)
Canadian Information9
16.1 Nutrition Guidelines for Healthy Term Infants
The current guidelines for infant feeding—prepared and approved by a joint working group of the Canadian
Paediatric Society, Dietitians of Canada, and Health Canada—are found in the 2005 document, Nutrition for
Healthy Term Infants.10 The complete report includes an Executive Summary that provides an excellent overview of
issues involved with infant feeding and is useful as a framework for teaching this topic. Important updates from
previous guidelines include:
16.2 Infant Formulas in Canada
The nutrient composition of infant formulas in Canada is regulated by the Food and Drug Regulations11 and varies
slightly from those in the United States. The nutrient content of iron-fortified infant formulas is designed to meet the
nutritional needs of healthy term infants until 9 to 12 months of age. Both Canadian and American consumers who
live close to the border may buy infant formula in the other country. Parents who are buying infant formulas in the
other country should read the labels carefully, especially for iron content, which may be labelled differently.
In 2002, Canada joined other countries when Health Canada approved fortification of infant formulas with
arachidonic acid (ARA), a long-chain omega-6 fatty acid, and docosahexaenoic acid (DHA), a long-chain omega-3
fatty acid. Both fatty acids support normal growth and development in healthy term and pre-term infants. Students
should be aware of the large array of infant formulas that are available, each one with a specific nutrient profile that
will suit specific dietary preferences or needs.
16.3 Iron Status of Canadian Infants
Iron status continues to be a concern for Canadian infants, due to its association with depressed mental and motor
development.12 This is of special concern in low-income communities and in First Nations and Inuit populations,
16.4 Infant Nutrition Links
Complementing the infant feeding guidelines found in Nutrition Guidelines for Healthy Term Infants (see Section
16.1 above), the Public Health Agency of Canada (www.phac-aspc.gc.ca/dca-dea/prenatal/index-eng.php) provides
16.5 Canada’s Food Guidance for Preschoolers and Children
Eating Well with Canada’s Food Guide provides food guidance for all Canadians aged 2 years and older. More
specifically for children, Canada’s Food Guide recommends serving small and nutritious meals and snacks every
day, not restricting nutritious foods because of their fat content, offering a variety of foods from the four food
groups, and being a good role model.
Table 16.1 presents the food group servings suggested in Eating Well with Canada’s Food Guide for children 2-3
and 4-8 years of age. The background document, Eating Well with Canada’s Food Guide: A Resource for Educators
and Communicators15 provides many ideas for encouraging healthy eating patterns in children. Appendix A of the
background document offers a one-day menu for a three-year-old girl.
354
Table 16.1 Eating Well with Canada’s Food Guide
Food Group
Number of Servings
Girls and Boys
2-3 years
4-8 years
Vegetables and Fruit
4
5
16.6 Assessing Growth in Infants and Children
In 2004, a collaborative public policy statement released from Dietitians of Canada, Canadian Paediatric Society,
The College of Family Physicians of Canada, and Community Health Nurses Association of Canada, and titled, The
Use of Growth Charts for Assessing and Monitoring Growth in Canadian Infants and Children, provided practice
guidelines for use by health care professionals when measuring and assessing linear growth and weight gain in
16.7 Canada’s Food Guidance for Older Children and Adolescents
As noted in Section 16.5 above, Eating Well with Canada’s Food Guide provides food guidance for all Canadians
aged 2 years and older. Table 16.2 presents the number of food group servings suggested in Eating Well with
Canada’s Food Guide for children 9-13 years of age and for female and male teens. Appendix A of the background
document, Eating Well with Canada’s Food Guide: A Resource for Educators and Communicators,15 provides a
sample one-day menu for a twelve-year-old boy and a sixteen-year-old female.
Table 16.2 Eating Well with Canada’s Food Guide
Number of Servings
9-13 years
14-18 years
Girls and Boys
Females
Males
6
7
8
6
6
7
3-4
3-4
3-4
1-2
2
3
Grain Products
3
4
Milk and Alternatives
2
2
Meat and Alternatives
1
1
16.8 Overweight and Obesity Among Canadian Children
Overweight and obesity among children are important public health issues in Canada. The Canadian Community
Health Survey (CCHS), Cycle 2.2: Nutrition, conducted in 2004, used trained interviewers to collect measured
heights and weights from a nationally representative sample of over 35,0000 Canadians of all ages from across the
nation. The last time heights and weights of Canadians were measured was in 1978 as part of the Canada Health
Survey. In 1978/79, 12% of 2– to 17-year-olds were overweight, and 3% were obese—a combined
overweight/obesity rate of 15%.20 By 2004, the overweight rate for this age group was 18%, and 8% were obese—a
combined rate of 26%.20 Over the past quarter century, the prevalence of overweight and obesity combined has more
than doubled among youth aged 12 to 17, while the prevalence of obesity alone has tripled.21 These results are based
on provincial, but not territorial, data.
Body Mass Index (BMI) rose for 12– to 17-year-old Canadian adolescents from 20.8 in 1978 to 22.1 in 2004, with
the most pronounced increase occurring for adolescents whose BMI exceeded 25 or 30.22 The overweight and
obesity rates used in the CCHS analysis are based on sex– and age-specific BMI cut-off points established by the
International Obesity Task Force criteria.23 Combined overweight/obesity rates for 2-17 year olds in Canada (using
2004 CCHS data) are similar to those in the United States (using 1999-2002 NHANES data); however, the rate of
obesity in the United States is slightly higher (10%) than in Canada (8%).24
Physical and Health Education Canada provides links to facts and statistics associated with nutrition and physical
activities for children and youth in school and community settings, and to many organizations involved in
supporting healthy environments for young Canadians.25
Recent research conducted with 5200 grade 5 students and their parents in Nova Scotia showed evidence for a
positive association between diet quality and academic performance, in particular with increased fruit and vegetable
intake and moderate consumption of fat.26
356
16.9 School Food Policy
Canada has no national child nutrition program. Most provinces, and many local boards of education in
collaboration with pubic health departments, have developed school food policies to address the availability and
quality of food in schools supported by nutrition curricula.27 Teacher associations are showing concern for hungry
children in classrooms and many schools have developed some type of feeding program. In 2007, Dietitians of
The Canadian Living Foundation’s Breakfast for Learning (BFL) program is the nation’s lead advocate for quality
nutrition in schools. The BFL vision is to ensure that every child in Canada attends school well nourished and ready
to learn, and their mission is to help empower communities to start and sustain child nutrition programs to enhance
learning and healthy development of children and youth. 2008-09 figures indicate BFL funding supported over
2,200 nutrition programs that served millions of healthy breakfasts, lunches, and snacks to more than 222,350
In the Food for Thought: Schools and Nutrition resource,29 Health Canada, the Canadian Association of Principals,
and the Canadian Association for School Health collaborated to generate a checklist of school–community actions
that promote healthy eating to students.
Provincial governments across Canada have formed partnerships with local and regional associations to establish
healthy eating environments for students. For example, in British Columbia, the Knowledge Network in partnership
with BC Dairy Foundation and Act Now BC have a web site that provides tools and resources for supporting healthy
357
Worksheet 16-1: How to Rate Your Food Behaviors
Fill out the following table with respect to your own observations about food behaviors.
Question
True
False
1. I only eat when I am hungry.
5. When I am reading a magazine and view a food advertisement,
I think about eating that food item.
7. I snack on food in between and after meal times.
8. I prepare all of the food that I eat during the week.
9. I purchase foods from a vending machine during the week.
6. When I go to the supermarket I become hungry as I walk up
and down the aisles.
10. I am aware of the amount of food that I eat in terms of the
amount of kcalories consumed on a daily basis.
2. When I go into a restaurant, I have a definite idea of what I
want to eat.
3. When I am watching television and a food commercial comes
on, I think about eating the food item advertised.
4. I can remember everything that I ate yesterday in terms of
amounts and food products.
358
Worksheet 16-2: Chapter 16 Crossword Puzzle
Across:
Down:
1. decay of the teeth
5. an adverse reaction to foods that involves an
immune response
8. iron-deficiency anemia that develops when an
excessive milk intake displaces iron-rich foods from
the diet
2. unusual responses to food, including intolerances
and allergies
3. allergies with produced antibodies and symptoms
4. with respect to nutrition, key people who control
other people’s access to foods and thereby exert
profound impacts on their nutrition
1 2 3
4
5
6
7
8
9
10
359
Worksheet 16-3: Infant Feeding Review (Internet Exercise)
Click on Solid Food: Ready or Not? to answer questions 1-4.
1. Which of the following behaviors is a reliable indicator that your baby is ready to eat solid foods?
2. You should use a bottle to provide juice to infants after 6 months of age.
a. True
b. False
3. Salt should not be added to an infant’s food.
4. The amount of fat in a baby‘s diet should be limited.
a. True
b. False
Click on Nourishing the Newborn: Birth to Four Months to answer questions 5-6.
5. By the end of a year, the average baby triples his/her birth weight.
6. If a woman experiences the let-down reflex at the onset of breastfeeding, this is considered to be an