Spicing Up Healthy Snacks for Better Health

1. Spicing Up Healthy Snacks for Better Health Craig A. Johnston, Ph.D. Jennette L. Palcic, Ph.D. Baylor College of Medicine Department of Pediatrics-Nutrition Children’s Nutrition Research Center

2. Calories From Snacks Are Up • A Major Shift: • Steady increase over the last 3 decades • Approximately 100% increase in # of snacks • Almost 3 snacks per day • Prevalence of “snackers” increases • From 48% to 78% • More calories are coming from snacks • Up to 27% of caloric intake Source: Piernas & Popkin, 2010; Health Aff

3. Prevalence of Overweight & Obesity in Children (Ages 6-11) • 36.5% At risk of Overweight or Overweight • 19.9% Overweight • Obesity has quadrupled over 25 years • African American, Hispanic American & Native American children have highest obesity prevalence Source: Ogden et al., JAMA, 2006

4. Mixed Findings • No association between meal patterns and overweight status • Snacking frequency positively associated with rates of obesity • Overall, it is unclear the role that snacking plays. Source: Nicklas et al, 2003; Am J Prev Med Kerr et al, 2009: Br J Nutr

5. Elana’s study • The Following are slides that we received from Elana- Will need to be only shown on presentation day.

6. Number of Eating Occasions in a Day Source: NFCS, 1977-78; CSFII 1994-98; WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

7. Frequency of Eating Occasions Source: NFCS, 1977-78; CSFII 1994-98; WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

8. Percent Reporting Meals 1977-782005-06 Difference Breakfast93 84- 9 Lunch 85 85 Dinner 96 96 Snacks63 98 +35 Ate breakfast, lunch, and dinner . . . 77 70 - 7 Source: NFCS 1977-78; WWEIA, NHANES 2005-06; 1 day; 9-12 year olds

9. Frequency of Snacking x = 3 Source: NFCS, 1977-78; CSFII 1994-98; WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

10. Top 10 Foods Reported as Snacksby 9-12 year-old children soft drinks fruit drinks milk fruit juices Beverages Savory snacks from grains Candy Fruits Cookies & bars Ice cream Potato chips & French fries Cakes, doughnuts, pastries, pies Pizza, burritos, tacos Sandwiches apples bananas grapes oranges popcorn tortilla chips pretzels crackers chocolate chip cookies crème-filled choc. cookies sugar cookies brownies Source: WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

11. Characteristics of Our Sample • 6.5 eating episodes observed daily • 2.5 of these explained by meals • No difference in eating episodes based on weight status • No association between BMI percentile and number of eating episodes • Upon visual inspection • Information obtained from a “backpack raid”

12. Snack Intervention Substitution of nutritious snack foods Backpack Raid 1 oz portion of peanuts or ¾ oz PB given daily at school

13. Nutrient Adequacy • What We Know: • US children have inadequate intake of micronutrients (less than RDA) • Mexican American children have been shown to have the most nutritionally deficient diets • Obesity is increasingly becoming associated with poor nutrition = “Malnourished Obese” May 2008

14. Our Approach: Positive Messaging • Family Focused • A message for everyone • Find foods that are: • Closer in value to preferred foods • Readily acceptable • Not perceived as “diet food” • Healthy for all children

15. FLOW Methods and Main Goals Self Help (SH) Intensive Intervention (II) • Received a book • Spends “intervention time” • in study hall/health class • Daily contact (Mon- Fri) • 1 weekly nutrition education session • 4 weekly physical activity sessions • A daily snack intervention at school of • 1 oz peanuts or ¾ oz peanut butter • A way to improve eating patterns • Skipping/Adding meals • Reduce hunger • Improve snacking habits • Nutrient-rich for nutrient-poor • Proper portion • Satiety • Combination foods

16. Better Weights at 2 Years in Treatment Maintenance Effects: Change in BMI over time, 2 years; Cohorts 1+2 Remains above baseline Control SIGNIFICANT Treatment Source: Johnston et al., 2010; Obesity

17. Source: Johnston et al., 2010; Obesity

18. Important Biomarkers • Improved Lipids • Total cholesterol • “Bad” LDL cholesterol • Triglycerides - trending down • Improved Anthropometrics • ie. smaller waists • Improved Quality of Life Inflammatory Markers BASELINE hsC-RP

19. Spicing up Nutrition Education Jennette Palcic, PhD

20. Nutrition Education Simple and Positive • Categorizing foods • big bite • little bite • portion right • Satiety • Choosing “filling options” • Determining when you • have had “enough” • Addressing adolescent • dietary habits • (ie. Eating patterns, • meal skipping, snack • choices)

21. Peanut Eaters Have Better Bodies and Better Diets • RATIONALE for peanut snack intervention • WE SAW AT BASELINE: • Inflammatory markers higher in at • risk and overweight children • Peanut eaters less likely to be • overweight • Peanut eaters had better nutritional profile

22. Hunger Significantly Decreased after Snack Intervention Hunger ratings • Probable explanations: • Nutrient dense • Satiating • Acceptable • Affordable

23. Healthy Snacking We’ve also learned how to get kids to eat vegetables At baseline the majority ate veggies “zero” days per week

24. Eat Your Vegetables! • Randomized children to • Regular Exposure • Pairing with peanut butter • Significant differences at 3 months • Pairing group ate more (oz) • Pairing group ate a greater variety

25. Cooking with Kids

26. Recipe Ideas

27. Other Benefits • Kids excited about trying new foods • A hands-on approach helps • Shift from • These are the foods you need to stop eating • Moving towards • These are the foods (that you like) you need to start eating

28. The Motto of YES Charter Schools WHATEVER IT TAKES!

29. Nature vs. Nurture “The Current Epidemics of Chronic Diseases are a Result of Discordance Between Our Ancient Genes and Modern Lifestyle.” Eaton et al., The Paleolithic Prescription. 1988.