healthy weights for children and teens...the qualitative research firm conducted a total of six...

Healthy Weights for Children and Teens

Consumer Message and Resource Development

MARCH 2013

www.dietitians.ca l www.dietetistes.ca

© Dietitians of Canada. 2013. All rights reserved.

http://www.dietitians.ca/

HEALTHY WEIGHTS FOR CHILDREN AND TEENS: CONSUMER MESSAGE AND RESOURCE DEVELOPMENT

DIETITIANS OF CANADA I PAGE i

Acknowledgements This project has been funded by the BC Ministry of Health.

Healthy Weights Advisory Committee Members: Julie Adams, Ministry of Health, Mental Health Promotion Heather Bretschneider, BC Ministry of Health, Communication Lynda Corby, Consultant - Ministry of Health Lisa Forster-Coull, Provincial Nutritionist, BC Ministry of Health Élaine De Grandpré, Health Canada Andrea Godfreyson, HealthLinkBC Claudia Gorenko, Health Canada Toby Green, BC Ministry of Health, Physical Activity Melanie Kurrein, BC Ministry of Health & Committee Liaison for Action Schools Ellen Lo, Provincial Health Services Authority Debbie Reid, Mental Health Metabolic Program, BC Children and Women’s Hospital Cathy Richards, Regional Health Authority Group Dr. Tom Warshawski, Pediatrician

Dietitians of Canada Consultants: Sonya Kupka Sue Mah

The following members of the Public and Consumer Information Technical Group, Provincial Healthy Eating Strategy are acknowledged for their input into the fact sheet development:

Cindy Bossio – Interior Health Authority Maria Burglehaus – Vancouver Coastal Health Authority Holly Christian – Northern Health Authority Jasmina Egeler – Vancouver Coastal Health Authority Carol Gulliford – Interior Health Anthea Kennelly – Vancouver Island Health Authority Barb Leslie – HealthLink BC Dietitian Services Ellen Lo – Provincial Services Health Authority Dorthy Rosenberg – Vancouver Island Health Authority Jennifer Scarr – Vancouver Coastal Health Authority Lori Smart – HealthLink BC Dietitian Services Jane Wark – Fraser Health Authority Kitty Yung – Vancouver Coastal Health Authority

Ministry of Health Consultants: Lynda Corby Sue Ross Zena Simces


DIETITIANS OF CANADA I PAGE ii

Table of Contents Acknowledgements .............................................................................................................................................................................. i 1. Background .................................................................................................................................................................................... 1 2. Project Objectives .......................................................................................................................................................................... 1 3. Process ............................................................................................................................................................................................ 1

Advisory Committee .......................................................................................................................................................................... 1

Consumer Focus Groups .................................................................................................................................................................. 2 Message Development ..................................................................................................................................................................... 3

4. Results ............................................................................................................................................................................................. 3

Key Findings from Focus Testing ..................................................................................................................................................... 4

Final Key Messages ........................................................................................................................................................................... 5 5. Conclusions ................................................................................................................................................................................... 6 APPENDICES Appendix A: Healthy Weights Key Messages and Supporting Messages for Teens and Parents ........................................... 7

Teen Key Messages ........................................................................................................................................................................... 7 Teen Supporting Messages .............................................................................................................................................................. 8

Parent Key Messages ...................................................................................................................................................................... 10 Parent Supporting Messages ......................................................................................................................................................... 11

Appendix B: Evidence Summary – Healthy Weights Key Messages and Supporting Messages for Teens and Parents ....................................................................................................................................................................................... 13

Healthy Bodies: Tips for Teens .................................................................................................................................................. 13 Healthy for EveryBODY: Parents ............................................................................................................................................... 20

Appendix C: Terms of Reference .................................................................................................................................................... 27


DIETITIANS OF CANADA I PAGE 1

1. Background A strategic initiative for the British Columbia Ministry of Health is to support healthy eating practices that contribute to

reducing the risk and the incidence of chronic disease through public awareness and education. Accordingly, the BC Ministry of Health and the Provincial Health Services Authority provided a grant to Dietitians of Canada to support the development of evidence based, consumer-tested messages for parents and teens on healthy weights with

customizable factsheets for both target audiences. See Appendix A for the final key and supporting messages and Appendix B for the evidence summary.

2. Project Objectives 1. To develop a series of evidence-based motivational messages for English speaking parents with school

aged children and teens and teens them selves (ages 14 to 17), regarding the promotion of healthy weights for children and teens.

2. To develop the resulting messages into customizable factsheets that are generated from the previously created web-based tool, the Factsheet Generator (http://bcfsg.dietitians.ca/) .

3. Process The Ministry of Health established a multidisciplinary Advisory Committee to provide strategic direction throughout the

process. Dietitians of Canada appointed a project manager (Sonya Kupka, SJK Services) to oversee the initiative, recruited a nutrition communications contractor (Sue Mah, Nutrition Solutions) to develop evidence-based messages

and engaged a qualitative research firm (MD Analytics) to focus test the messages and factsheets.

Advisory Committee

The Healthy Weights Advisory Committee included representatives from the BC Ministry of Health, Provincial Health Services Authority, Dietitians of Canada, BC Pediatric Society, HealthLink BC, the Regional Health Authority Group,

Mental Health, and Health Canada. The Terms of Reference were reviewed and approved by the Advisory Committee (see Appendix C).

Nine meetings were held by teleconference with some work between meetings to review and provide feedback on circulated documents. Throughout the process, the Advisory Committee members consulted with their organizations and, where appropriate, external stakeholders. All feedback on the messages was collated, summarized and re-

circulated to the Advisory Committee members to inform discussions and ensure transparency. A consensus building approach was used to guide the message development, with final approval resting with the BC Ministry of Health.

http://bcfsg.dietitians.ca/



Consumer Focus Groups

The qualitative research firm conducted a total of six focus groups with English speaking consumers, three with teens (aged 14 to 17) and three with adults with school aged children and teens. The purpose of the consumer testing was

to test the messages with the intended audience for acceptance as well to gather feedback for message refinement. The research firm recruited participants using a database maintained for conducting qualitative research. The

research firm, with input and approval by the Advisory Committee, developed a screening tool to ensure appropriate representation. Consideration was given to age, gender, geographic distribution, and for parents, employment and income. Due to the sample size, the special recruitment methods used, and the study objectives themselves, the

information obtained was exploratory in nature. All focus groups took place in Vancouver at a purpose build facility. Each focus group lasted 2 hours. A financial

incentive was provided to participants. To help direct the moderator in leading the focus groups, the research firm drafted a discussion guide with input and approval by the Advisory Committee.

Four of the six focus groups were held in August 2012 to conduct the initial message testing, and the remaining

two in January 2013 to follow up after further message refinement and factsheet design had taken place. A total of 15 parents participated in the initial focus testing and an additional eight (8) parents participated in the final testing.

Slightly more females (13) participated than males (10). A profile of the adult focus group is summarized in Table 1.

Table 1: Parent Focus Groups

Age Their ages ranged from 30 to 59 years, with an average of 45 years in the first two focus groups and 40

years in the final testing

Employment Most parents (16, n=23) were working full or part time in addition to household responsibilities.

Level of Education Most parents (19, n=23) had some form of post secondary education.

Marital Status Most parents (18, n=23) were married or common law.

Household income

Household income ranged from less than $35,000 to over $120,000. Almost half of the parents (9, n=19)

had a household income of less than $49,000, with four of these parents having had a household income of less than $35,000.

Geographic Distribution

All parents lived in the lower mainland with just over half (13, n=23) living in Vancouver. The remaining

parents resided in Burnaby, Richmond, Surrey and Coquitlam.

The initial two teen focus groups were divided by gender and had eight teens in each group. The final focus testing

was with eight teens, with an equal number of males and females participating. The average age of the teens was 16 years old, with only three (3, n=24) 14-year-old participants. All but two teens were attending school. As with the

adults, just over half of the teens (13, n=24) lived in Vancouver, with the remaining teens coming from Surrey, Coquitlam, North Vancouver, Burnaby, and Richmond.

The research firm produced a transcript of the focus groups and prepared a top-line report with observations and recommendations following both the initial and the final focus testing. These reports and recommendations were used to inform the message development.



Message Development

The nutrition communications consultant developed key and supporting messages for two target groups: teens; and parents of school-aged children and teens. A number of resources were used to inform the message development:

documents provided by the BC Ministry of Health; a review of key literature on the topic of healthy weight promotion in children and teens; feedback and suggestions from members of the Advisory Committee, including the Public and Consumer

Information Technical Group, Provincial Healthy Eating Strategy; reports and recommendations from the consumer focus groups, provided by the research firm; and consultation with the project manager.

The project manager facilitated a series of teleconferences with the Advisory Committee and the communications

consultant to discuss feedback and changes to the messages. The Ministry of Health representative, with input by the project manager, identified corresponding images for all

messages from the Ministry of Health and Dietitians of Canada image data banks. The Advisory Committee and communications consultant provided feedback and recommendations to the images

Upon approval by the Advisory Committee and Ministry of Health, the messages were submitted to Practice-based

Evidence in Nutrition (PEN) www.pennutrition.com for PEN approval. PEN is a global online nutrition knowledge translation service developed and hosted by Dietitians of Canada. PEN approval on the factsheets indicates that the key

and supporting messages are under-pinned by supporting evidence from the recent literature and best practice approaches (See Appendix B).

4. Results Unlike previously developed factsheets, healthy eating is not the main focus in promoting healthy weights. The

Advisory Committee agreed that it was essential to have three equally important threads in the messages: healthy body image, physical activity and healthy eating. Also, given the increasing evidence linking healthy weights and sleep, they felt there is value in including some messaging relating to the importance of sleep for teens.

Also, although the topic of the factsheets is to promote healthy weights, the Advisory Committee agreed that terminology such as “obesity”, “overweight”, “underweight” and even “healthy weight” and “the right weight for you” is

best avoided. They acknowledged that these terms could contribute to body dissatisfaction or possible even disordered eating, and further more, this terminology would negate the message that healthy bodies come in all shapes and sizes. Another key issue discussed by the Advisory Committee was the importance of emphasizing the pleasure of healthy

eating, without generating guilt when less nutritious foods are consumed.

http://www.pennutrition.com/



Key Findings from Focus Testing

Several recommendations emerged from the focus testing:

1. Focus on the positive messages. Options and guidelines should be presented, rather than prescribing limits on activities. Participants preferred messages that focused on what they could be doing, rather what they should not be

doing. Specifically, parents rejected the notion of establishing taboo topics that their children may eventually cross. Teenagers preferred being encouraged on what they could do, rather than being discouraged from undesired activities.

Parents readily used guidelines as points of comparison to evaluate how well they are doing. Detailed guidelines, such as the prescribed amount of exercise, were well-received because they provide a concrete measure. On the other hand, parents usually rejected strictly worded guidelines such as “no more than 2 hours of screen time”, as they shirked at imposing strict limitations, especially on teenagers.

Similarly, teenagers reacted negatively to tips phrased in a commanding way when they go against their beliefs. However, when they were presented with options and the likely outcomes of these options, they felt free to pick what is convenient for them.

2. Provide clear suggestions – unless they know what to do already. Regarding physical activities, teenagers know best which activities are appealing to them, and therefore

disliked being told what specific activities they should do. When participants were recommended a certain activity that did not fit into their lifestyle, the overall recommendation lost some of its value. However, suggestions on healthy snacks and nutrition were usually welcomed, as teenagers expressed the desire to know more about this topic.

3. Provide new information to make messages stand out from background noise. Both parents and teenagers were interested in learning new things, particularly the latter group. Messages

that included relevant and interesting information about the effects or results of certain actions were greeted with greater interest, which in turn increases the likelihood of adoption of those measures.

1

4. Consider that electronics have become an inherent part of family life. Parents of teenagers, as well as the teenagers themselves, used screens and electronics as part of their way

of functioning. As such, while they understood the value of not being idle in front of a screen for too long, they were hesitant about adopting any strict recommendation that prescribed or suggested reducing screen time in general. Messages may benefit by focusing on the lack of activity associated with spending too much time in front of a screen, rather than trying to define some types of screen time (e.g. doing homework on the computer) as better than other (e.g. sitting and playing video games).

5. Suggest easy ways of getting involved in the community. Statements that called for full-blown leadership in the community did not garner much enthusiasm, as the

task appeared overly daunting. Caught between being too busy, not having the right personality, and cynicism towards existing institutions, parents and teenagers may more likely adopt activities that are small in scope, easy to adopt, and involve a small amount of effort. To this effect, participants specifically mentioned that they are more comfortable acting at a micro-level than at a macro-level.



6. Backup counter-intuitive or controversial points with facts and references. Parents and teenagers were most sensitive to the information’s source if it was unfamiliar or novel, such as

letting children determine the amount of food to eat, or setting a time limit to physical activity and sleep. Providing credible online sources along with these claims would more likely lead to its acceptance and adoption.

7. Pictures in teenagers’ factsheets need to represent realistic impromptu moments, rather than people posing for the camera. Teenagers described pictures of people posing, staring and smiling at the camera as a “perfect” moment,

and therefore unrealistic. In such cases, the pictures undermined the message that perfection is unrealistic.

8. Pictures in the parents’ factsheets should not appear on a stage, and should be mindful to not appear exclusionary. Unlike teenagers, parents did not react negatively to pictures in which people stared and smiled at the

camera. However, pictures that lacked a real-life background were perceived as unrealistic. Moreover, parents tended to react negatively to pictures in which the age range of children was limited, or pictures of food ingredients that excluded particular food groups.

9. Information can become more relevant to teenagers if it is presented as a learning experience. Teens often reacted less than enthusiastically to message where the reasons behind the statement were

not clearly laid out. Some wanted to know the specific consequences if they do not follow on the recommendations provided.

10. Caution should be taken in how the factsheets are provided to teenagers.

Many teenagers reacted negatively to the idea of receiving these factsheets from their doctor or primary health care provider, as they may interpret it as a criticism about their lifestyle. Moreover, teen indicated a need for at least some of the tips provided to be instilled by their parents, particularly on the family getting together for meals.

Final Key Messages

The final key and supporting messages defined by this research are included in the Appendix A of this report. The

Advisory Committee ensured that these messages were supported by the current evidence and written in plain language, appropriate for a range of socio-economic and educational backgrounds. The focus testing gave insights on

how to frame the messages so that they would be realistic and well accepted by parents and teenagers.



5. Conclusions This initiative demonstrated the important role of consumer focus testing as a best practice approach to

developing nutrition messages. There was a stark improvement in the reactions by consumers to the messages between the initial phase of testing and the final testing.

Consumers’ feedback indicated a clear need for greater education on the promotion of healthy weights, both among parents and teenagers. The overall reaction among the parents to the factsheets was very positive, and there are signs that they would be open to adopting many of the recommendations provided. The teens indicated they had seen similar messages in the past, so there is a concern that they may not stand out from previous communications. The Advisory Committee felt that the repetition of key messages would be valuable in helping to reinforce information about these issues.

The Advisory Committee was an important element in the message development process. The multidisciplinary nature of the Advisory Committee provided differing professional perspectives and insights.

As a result of the comprehensive process, the Advisory Committee felt confident the factsheets captured their feedback and are reflective of the target audience's needs. They appreciated having sufficient time to review the messages with their colleagues and to reflect on the proposed changes. They valued the multidisciplinary approach and learned from each other.

The key messages have been integrated into the Factsheet Generator http://bcfsg.dietitians.ca/. Using this tool, health intermediaries in a variety of settings [e.g. health authorities, NGOs, schools, recreation centres] can customize their own fact sheets for different audiences. In addition, these messages can be used as the basis for other educational tools and resources including, but not limited to websites, factsheets, display posters, power point presentations and videos. While it is important to retain the wording of the messages for consistency, it is not necessary to use all messages in every communication.

http://bcfsg.dietitians.ca/



Appendix A: Healthy Weights Key Messages and Supporting Messages for Teens and Parents (from Final Key Messages - Healthy Weights: Feb 24, 2013)

Healthy Bodies: Tips for Teens

TEEN KEY MESSAGES

Teen Key Message #A:

Focus on the positive in yourself and others We are not all meant to look the same. Respect all body shapes and sizes. You are more than just your physical appearance. Appreciate who you are both inside and out. There is no one else like you! Reflect on the images of people you see in the media. Real people aren’t perfect, and perfect people aren’t

real.

TIP BUBBLE: It’s normal to not like some things about yourself. Focus on your strengths and passions – you have a lot going for you!

Teen Key Message #B:

Enjoy healthy food and drinks most of the time Choose a variety of foods from all four food groups in Canada’s Food Guide. Visit

www.healthcanada.gc.ca/foodguide for more information. Satisfy your thirst with water. Limit sugary drinks like slushies, sports drinks and pop. A typical 355 mL can of pop has 10 teaspoons of

sugar! Eat with family members as often as possible. You’ll make healthier choices together. Explore food and cooking. Try a new food or recipe. Help prepare a meal.

TIP BUBBLE: It’s OK if you don’t choose healthy food and drinks all of the time. What counts is that you choose healthy food and drinks most of the time.

http://www.healthcanada.gc.ca/foodguide



Teen Key Message #C:

Have fun: Be active and keep moving Move more, sit less. Limit screen time to no more than two hours a day. Find moderate to vigorous intensity activities that you like to do - indoors and outdoors. Aim to be active for

at least 60 minutes every day. Swap sedentary time with active time. Go to www.csep.ca/guidelines for ideas.

TIP BUBBLE: Teens need more sleep than adults. Aim for nine to ten hours of sleep every night. Being active helps you sleep better. You’ll be in a better mood too! For tips on how to get enough sleep, go to http://www.caringforkids.cps.ca/handouts/teens_and_sleep

TEEN SUPPORTING MESSAGES

Teen Supporting Message #1:

Healthy bodies come in all shapes and sizes. Everyone’s body develops differently and at different ages. Don’t judge yourself or other people based on

physical appearance. Practice positive self-talk by focusing on things you really like about yourself which are not related to the

way you look.


The way you treat others is important. Teasing someone about the way they look can be hurtful. Take action against bullying. Check out www.erasebullying.ca Treat each other well. Hang out with friends who treat you well and who help you feel good about yourself.


Enjoy regular meals to feel and be your best. Try not to skip meals and snacks – they give you energy, help you concentrate and put you in a better

mood. Use Canada’s Food Guide to help you choose the types and amounts of food you need.

Visit www.healthcanada.gc.ca/foodguide for more information.

Need a healthy snack? Try: yogurt and fruit hummus with pita whole wheat crackers and cheese veggies and dip milk and nuts

http://www.csep.ca/guidelines

http://www.caringforkids.cps.ca/handouts/teens_and_sleep

http://www.erasebullying.ca/





Eat with your family and have fun with food. Eat with your family whenever you can. It helps you stay connected and you’ll make healthier choices

together. Help with the grocery shopping. Try new ingredients and foods from different cultures. Take cooking lessons or make a recipe with your family and friends. Knowing how to cook is an important

skill.


Pay attention to your food and feelings. Focus on enjoying your food. Turn off electronics when you’re eating. Ask yourself why you’re eating - are you hungry or thirsty? Or are you bored, sad or upset? When you eat, do you stop when you feel full?


Find fun activities that get you moving. If you’re not already active, start with ten minutes of moderate to vigorous intensity activity at a time and

work up to 60 minutes a day. Go to www.csep.ca/guidelines for ideas. Try jogging, join a sports club at school, or go for a bike ride. Check out your community recreation guide for new activity ideas.


Look for realistic and inspirational images in the media. Ever notice how people in the media often look “flawless”? It can be the magic of make-up, hair styling and

photo editing. Males in the media are usually very muscular and females are often underweight. Don’t compare yourself to

these unrealistic images or put pressure on yourself to look like them.




Health for EveryBODY: Parents PARENT KEY MESSAGES

Parent Key Message #A:

You are a powerful role model. Feeling good about yourself matters. The way you think, feel and talk about yourself and others will affect

how your kids think, feel and talk about themselves and others. Model the habits and attitudes that you want your kids to have. Compliment others more often for who they are as a person, not for how they look.

TIP BUBBLE: Focus on the positive and how you enjoy healthy eating, being active and feeling good about yourself. Going on a crash diet, skipping meals, or making comments such as “These pants make me look fat” all send negative messages about yourself.

Parent Key Message #B:

Cook, eat and explore food together. Get everyone involved in meal planning, shopping and cooking. These are important life skills for everyone. Eat together as often as possible. It can be at breakfast, lunch, dinner or snack time. Eating together is a

great way to connect and catch up on the day’s events.

TIP BUBBLE: Start with small steps. Schedule a time to have one meal or snack together and then build from there. Go to www.bettertogetherbc.ca or www.dietitians.ca for shopping and cooking ideas.

Parent Key Message #C:

Encourage kids to have fun and keep moving. Kids and teens need at least 60 minutes of moderate to vigorous intensity physical activity every day. Encourage more active forms of entertainment. Limit screen time to no more than two hours a day. Start a family challenge to be active every day. Look for fun activities to do with your kids – indoors and

outdoors. Get some ideas from www.csep.ca/guidelines

TIP BUBBLE: Build physical activity into your family’s everyday routine. Take the stairs instead of the elevator. Walk or cycle all or part of the way to school, work or your destination. Walk the dog together.

http://www.bettertogetherbc.ca/





Parent Key Message #D:

Help your kids feel good about themselves. Remind your kids of how special and unique they are. Celebrate your child’s achievements. Connect with your kids and help them work through challenges and

disappointments. Teach your kids that people come in all shapes and sizes. It can be hurtful and disrespectful to make

comments about anyone’s weight or physical features.

TIP BUBBLE: Kids often compare themselves to the images and messages they see in the media. Talk to your kids about this and encourage them to look for realistic and inspirational images.

PARENT SUPPORTING MESSAGES

Parent Supporting Message #1:

Focus on your health and wellbeing instead of your weight. Role model healthy habits and actions. Avoid going on short term “diets” or talking about “good” and “bad”

foods. Talk about healthy choices instead. Show your kids that you enjoy healthy food and drinks, and pay attention to when you are hungry and when

you are full. Build activity into your everyday routine.


Food brings everyone together. Involve your kids in meal planning and grocery shopping. Use the Nutrition Facts Table on food labels to

teach your kids to make healthy choices. Find out more information about nutrition labelling at www.healthycanadians.gc.ca/dailyvalue.

Cook together and explore new foods, flavours and recipes from different cultures. Eat together to help build strong connections with your kids and hear about their day.

Get cooking and meal planning tips at http://bettertogetherbc.ca/.


Trust that kids will eat the amount of food they need. Trying to control how much your child eats can lead to over-eating or under-eating. Sharing responsibility

for healthy eating can be challenging but it helps children and teens develop a healthy relationship with food.

Offer a variety of healthy foods in a pleasant setting at regular times. Then let your children or teens decide how much to eat, whether they want more, and when they have had enough even if they leave food on their plate.

http://www.healthycanadians.gc.ca/dailyvalue

http://bettertogetherbc.ca/




Enjoy active family time - everybody benefits from moving more and sitting less. Walk the dog or go for a bike ride together. Start a game of street hockey, soccer or basketball

– kids versus adults! Swap sedentary time with active time. Limit screen time to no more than two hours a day. Go to www.csep.ca/guidelines for ideas.


Let your child know that it’s normal to gain weight as they are growing. Everyone’s body develops differently and at different ages. Teach your kids that health is more important

than weight. Ask if your child is being teased or bullied. Take notice if they start losing interest in their friends or eating

– these may be signs of body dissatisfaction. If you are worried, visit www.erasebullying.ca for more information.


Talk with your kids about images and ads in the media. Teach your kids that images in the media are often touched up, photo-edited and not realistic. Break down commercials and ads together. Talk about how ads are designed to persuade people to buy

the product.





Appendix B: Evidence Summary – Healthy Weights Key Messages and Supporting Messages for Teens and Parents

Healthy Bodies: Tips for Teens

Teen Messages Supporting Evidence

Key Messages and Tips Teen Key Message #A: Focus on the positive in yourself and others.

We are not all meant to look the same. Respect all body shapes and sizes.

You are more than just your physical appearance.

Appreciate who you are both inside and out. There is no one else like you!

Reflect on the images of people you see in the media. Real people aren’t perfect, and perfect people aren’t real.


Being Me: Promoting Positive Body Image http://healthyschoosbc.ca/rpogram/242/being-me-promoting-positive-body-image. A Teacher’s Support Resource for Elementary and Middle Schools. British Columbia 2012. “Being Me” module developed to support existing physical activity and healthy eating frameworks while supporting the Ministry of Educations’ prescribed learning outcomes across the curriculum. “Everybody is different. Students will learn that every body develops at an individual rate and this is a normal part of growing up. There are many ways we are unique and it is important to respect, accept and celebrate these differences.” Martin JB. Development of Ideal Body Image Perceptions in the United States. Nutrition Today 2012; 45(3): 98-110. http://journals.lww.com/nutritiontodayonline/Abstract/2010/05000/The_Development_of_Ideal_Body_Image_Perceptions_in.4.aspx Misperceptions of the perfect body size and thus the ideal body image, the role airbrushing, digital image enhancement, breast augmentation, plastic surgery, liposuction and so on, in the fashion industry are revealed in the documentary America the Beautiful. Expert Opinion: Aug 8, 2012 – Suggested text from external reviewer Pam Narang, Psy.D., R.Psych. B.C. Children's Hospital, Vancouver, B.C.: “It is also pretty normal not to like everything about yourself. Nobody likes everything about themselves! But focusing on the positive can help you accept those things you’re not happy with much better.” This suggested text was modified by the writer and Advisory Committee, and included the use of the term “normal”.

http://healthyschoosbc.ca/rpogram/242/being-me-promoting-positive-body-image

http://journals.lww.com/nutritiontodayonline/Abstract/2010/05000/The_Development_of_Ideal_Body_Image_Perceptions_in.4.aspx




Teen Messages Supporting Evidence Teen Key Message #B: Enjoy healthy food and drinks most of the time.

Choose a variety of foods from all four food groups in Canada’s Food Guide. Visit www.healthcanada.gc.ca/foodguide for more information.

Satisfy your thirst with water. Limit sugary drinks like

slushies, sports drinks and pop. A typical 355 mL can of pop has 10 teaspoons of sugar!

Eat with family members as

often as possible. You’ll make healthier choices together.

Explore food and cooking.

Try a new food or recipe. Help prepare a meal.

Eating Well with Canada’s Food Guide – www.healthcanada.gc.ca/foodguide Eating Well with Canada’s Food Guide www.healthcanada.gc.ca/foodguide – Satisfy your thirst with water. Drink water regularly. It’s a calorie free way to quench your thirst. PEN: Sugary Drink Sense Factsheets –Factsheet Generator Eating Well with Canada’s food Guide. A Resource for Educators and Communicators – Pg 28 – Limit beverages that are high in calories and low in nutrients. These include…soft drinks, sports and energy drinks and sweetened hot or cold beverages. PEN Background – Healthy Lifestyle: Eating Together - Research from around the world consistently shows a nutritional benefit of family meals. Benefits with school-aged or adolescent populations typically include an increased intake in vegetables, fruit, and calcium-rich foods or dairy, and a decreased intake of soft drinks. A lower risk for overweight is associated with increased frequency of family meals, although this might vary by race or ethnicity. Eating together as a family also seems to offer protection from eating disorders especially in girls. PEN Key Practice Point - Reduced risk of overweight among children and teens is associated with increased frequency of family meals. PEN Practice Guidance Summary on Eating Together indicates that getting older children to help, working on food preparation skills and focusing on quick-to-prepare healthful meals are all ways to relieve the time pressure families face and make eating together more frequently a possibility. Recent research with families with younger children reinforce the importance of cooking together as a first step towards eating together more frequently.

Improving Cooking and Food Preparation Skills: A synthesis of the Evidence to Inform Program and Policy Development. http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/cfps-acc-synthes-eng.php#a43 Introduction & Purpose: “There is a growing body of research supporting the relationship between food preparation and cooking skills and food choices of children and adolescents within the family context.”





http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/cfps-acc-synthes-eng.php#a43



Teen Messages Supporting Evidence TIP BUBBLE: Start with small steps. Schedule a time to have one meal or snack together and then build from there. Go to www.bettertogetherbc.ca or www.dietitians.ca for shopping and cooking ideas.

The Student Body: Promoting Health at Every Size – Healthy Eating Teacher Background: What does normal eating involve? http://thestudentbody.aboutkidshealth.ca/module_healthyEating_step2.asp Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index. Journal of Adolescent Health, Volume 50, Issue 1 , Pages 80-86, January 2012 http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X11001765.pdf Eating very little and skipping meals were by far the most commonly reported behaviors, and both behaviors predicted statistically significant larger increases in BMI in females and males.

Teen Key Message #C: Have fun: Be active and keep moving.

Move more, sit less. Limit screen time to no more than two hours a day.

Find moderate to vigorous intensity activities that you like to do - indoors and outdoors. Aim to be active for at least 60 minutes every day.

Swap sedentary time with active time. Go to www.csep.ca/guidelines for ideas.


Canadian Physical Activity Guidelines from CSEP http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf For health benefits children should accumulate at least 60 minutes of moderate to vigorous intensity physical activity daily. http://www.csep.ca/english/view.asp?x=949 Limit recreational screen time to no more than 2 hours per day; lower levels are associated with additional health benefits. Physical Activity Tips for Youth – 12-17 years. Public Health Agency of Canada http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/06paap-eng.php PEN Media Literacy Practice Guidance Summary Recommend restriction of television and video viewing to two hours or less daily, with no television or video use for children under the age of two years. http://www.pennutrition.com/KnowledgePathway.aspx?kpid=7549&trcatid=43&trid=7600 Canadian Pediatric Society – Teens and Sleep – Why You Need it and How to Get Enough – Caring for Kids: Canadian Pediatric Society. January 2008. http://www.caringforkids.cps.ca/handouts/teens_and_sleep Scientific research shows that to function at your best, you need between 9 and 10 hours of sleep every day.

Medical research shows that teens who usually get too little sleep are more likely to struggle in school. Why? Being tired affects your memory, your concentration and, most seriously, your motivation (the desire to accomplish a goal). Mental Health Canada- How Much Sleep Do We Need? http://www.mentalhealthcanada.com/article_detail.asp?lang=e&id=28 The amount of sleep each person needs depends on many factors, including age. Infants generally require about 16 hours a day, while teenagers need about 9 hours on average.

Too little sleep leaves us drowsy and unable to concentrate the next day. It also leads to impaired memory and physical performance and reduced ability to carry out math calculations.



http://thestudentbody.aboutkidshealth.ca/module_healthyEating_step2.asp

http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X11001765.pdf


http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf

http://www.csep.ca/english/view.asp?x=949

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/06paap-eng.php

http://www.pennutrition.com/KnowledgePathway.aspx?kpid=7549&trcatid=43&trid=7600

http://www.caringforkids.cps.ca/handouts/teens_and_sleep

http://www.mentalhealthcanada.com/article_detail.asp?lang=e&id=28



Teen Messages Supporting Evidence National Sleep Foundation – Why Teens need their sleep http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep Consequences of not enough sleep:

Limit your ability to learn, listen, concentrate and solve problems. You may even forget important information like names, numbers, your homework or a date with a special person in your life;

Lead to aggressive or inappropriate behavior such as yelling at your friends or being impatient with your teachers or family members;

Cause you to eat too much or eat unhealthy foods like sweets and fried foods that lead to weight gain. Supporting Messages

Teen Supporting Message #1: Healthy bodies come in all shapes and sizes.

Everyone’s body develops differently and at different ages. Don’t judge yourself or other people based on physical appearance.

Practice positive self-talk by focusing on things you really like about yourself which are not related to the way you look.

The Student Body: Promoting Health at Every Size – developed by Gail McVey, Sick Kids Hospital http://thestudentbody.aboutkidshealth.ca/module_teasing_step2.asp

Teen Supporting Message #2: The way you treat others is important.

Teasing someone about the way they look can be hurtful.

Take action against bullying. Check out www.erasebullying.ca

Treat each other well. Hang out with friends who treat you well and who help you feel good about yourself.

Yale Rudd Centre for Food Policy and & Obesity: Weight Bias at Home and School – video http://www.yaleruddcenter.org/what_we_do.aspx?id=200 Peiican S and Vanden Heed F. The Power of Others. Recommendations to help create environments in which every body can be healthier and happier. Yale Rudd Centre for Food Policy and Obesity. May 2005. http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf Appreciate that teasing, criticism, or negative actions related to a person’s body and/or physical abilities can be deeply hurtful, and the resulting negative view of one’s body and/or physical abilities can last many years – even a lifetime. The Student Body: Promoting Health at Every Size – developed by Gail McVey, Sick Kids Hospital http://thestudentbody.aboutkidshealth.ca/module_teasing_step2.asp

http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep

http://thestudentbody.aboutkidshealth.ca/module_teasing_step2.asp


http://www.yaleruddcenter.org/what_we_do.aspx?id=200

http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf

http://thestudentbody.aboutkidshealth.ca/module_teasing_step2.asp



Teen Messages Supporting Evidence Teen Supporting Message #3: Enjoy regular meals to feel and be your best.

Try not to skip meals and snacks – they give you energy, help you concentrate and put you in a better mood.

Use Canada’s Food Guide to help you choose the types and amounts of food you need. For more information visit www.healthcanada.gc.ca/foodguide

Need a healthy snack? Try: yogurt and fruit hummus with pita whole wheat crackers and

cheese veggies and dip milk and nuts

Eating Well with Canada’s Food Guide www.healthcanada.gc.ca/foodguide

Teen Supporting Message #4: Eat with your family and have fun with food.

Eat with your family whenever you can. It helps you stay connected and you’ll make healthier choices together.

Help with the grocery shopping. Try new ingredients and foods from different cultures.

Take cooking lessons or make a recipe with your family and friends. Knowing how to cook is an important skill.

Improving Cooking and Food Preparation Skills: A synthesis of the Evidence to Inform Program and Policy Development. http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/cfps-acc-synthes-eng.php#a43 Introduction & Purpose: “There is a growing body of research supporting the relationship between food preparation and cooking skills and food choices of children and adolescents within the family context.” PEN Background – Healthy Lifestyle: Eating Together - Research from around the world consistently shows a nutritional benefit of family meals. Benefits with school-aged or adolescent populations typically include an increased intake in vegetables, fruit, and calcium-rich foods or dairy, and a decreased intake of soft drinks. A lower risk for overweight is associated with increased frequency of family meals, although this might vary by race or ethnicity. Eating together as a family also seems to offer protection from eating disorders especially in girls.







Teen Messages Supporting Evidence Teen Supporting Message #5: Pay attention to your food and feelings.

Focus on enjoying your food. Turn off electronics when you’re eating.

Ask yourself why you’re eating - are you hungry or thirsty? Or are you bored, sad or upset?

When you eat, do you stop when you feel full?

Centre for Mindful Eating http://www.tcme.org/ Mindful eating involves many components such as:

learning to make choices in beginning or ending a meal based on awareness of hunger and satiety cues; learning to identify personal triggers for mindless eating, such as emotions, social pressures, or certain foods; valuing quality over quantity of what you’re eating; appreciating the sensual, as well as the nourishing, capacity of food; feeling deep gratitude that may come from appreciating and experiencing food

Oregon Dairy Council http://www.oregondairycouncil.org/what_is_normal/qa_nutrition/ What is 'mindful eating' Mindful eating is the practice of using all your senses to be aware of your eating and food choices: what the food looks and tastes like, how it satisfies hunger, and what emotions have been involved in your choices. Mindful eating means understanding and being in charge of the food choices made. It is non-judgmental about choices but with practice, hunger and satiety cues will play an important part of eating.

Teen Supporting Message #6: Find fun activities that get you moving.

If you’re not already active, start with ten minutes of moderate to vigorous intensity activity at a time and work up to 60 minutes a day. Go to www.csep.ca/guidelines for ideas.

Try jogging, join a sports club at school, or go for a bike ride.

Check out your community recreation guide for new activity ideas.

Canadian Society of Exercise Physiologists Physical Activity and Sedentary Behaviour Guidelines www.csep.ca/guidelines

http://www.tcme.org/

http://www.oregondairycouncil.org/what_is_normal/qa_nutrition/

http://www.oregondairycouncil.org/what_is_normal/qa_nutrition/





Teen Messages Supporting Evidence Teen Supporting Message #7: Look for realistic and inspirational images in the media.

Ever notice how people in the media often look “flawless”? It can be the magic of make-up, hair styling and photo editing.

Males in the media are usually very muscular and females are often underweight. Don’t compare yourself to these unrealistic images or put pressure on yourself to look like them.

Martin JB. Development of Ideal Body Image Perceptions in the United States. Nutrition Today 2012; 45(3): 98-110. http://journals.lww.com/nutritiontodayonline/Abstract/2010/05000/The_Development_of_Ideal_Body_Image_Perceptions_in.4.aspx Misperceptions of the perfect body size and thus the ideal body image, the role airbrushing, digital image enhancement, breast augmentation, plastic surgery, liposuction and so on, in the fashion industry are revealed in the documentary America the Beautiful.





Healthy for EveryBODY: Parents

Parent Messages Supporting Evidence

Key Messages and Tips Parent Key Message #A: You are a powerful role model.

Feeling good about yourself matters. The way you think, feel and talk about yourself and others will affect how your kids think, feel and talk about themselves and others.

Model the habits and attitudes that you want your kids to have.

Compliment others more often for who they are as a person, not for how they look.


Eating Well with Canada’s Food Guide. A Resource for Educators and Communicators. – Pg 2 – Family and peers influence the way people eat. Parents are role models in helping children to develop a taste for healthy food. Peiican S and Vanden Heed F. The Power of Others. Recommendations to help create environments in which every body can be healthier and happier. Yale Rudd Centre for Food Policy and Obesity. May 2005. http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf Be a positive role model. Praise young people in ways that help them value their body regardless of size or shape. This praise can help protect, shield, or buffer them against negative influences later in life. Improving the Health of Canadians: Promoting Healthy Weights. CIHI. 2006. Pg 55. http://publications.gc.ca/collections/Collection/H118-36-2006E.pdf Research suggests that parents can play key roles in children’s eating behaviours and physical activity patterns, which can develop into behaviours that promote good health or contribute to poor health. Analyses of 2001 CCHS data indicate that parental obesity was strongly associated with youth obesity. Adolescents with a parent who was inactive in his or her leisure time were also themselves more likely to be inactive. Key Highlights from: Mental Health, Wellness and Childhood Overweight/Obesity: A Complex Relationship. Literature Review by: Shelly Russell-Mayhew, R. Psych. Feb 2012, Public Health Agency of Canada Innovation Strategy Knowledge Product http://www.hindawi.com/journals/jobes/2012/281801/ – Stop focusing on weight (weight is not a behaviour, thus should not be the object of behaviour modification); create a more inclusive context which focuses on health and wellness for all body sizes; promote healthy body image – helps to prevent weight and shape concerns thus improve psychological outcomes for children of all ages; target adult role models – parents are role models for influencing children’s attitudes and behavours towards their bodies; shift adult’s focus from weight and shape to a focus on health, wellness and resiliency so that parents can enhance the well-being of children and teens regardless of their weight status.

Parent Key Message #B: Cook, eat and explore food together.

Get everyone involved in meal planning, shopping and cooking. These are important life skills for everyone.



http://publications.gc.ca/collections/Collection/H118-36-2006E.pdf

http://www.hindawi.com/journals/jobes/2012/281801/




Parent Messages Supporting Evidence Eat together as often as

possible. It can be at breakfast, lunch, dinner or snack time. Eating together is a great way to connect and catch up on the day’s events.

TIP BUBBLE: Start with small steps. Schedule a time to have one meal or snack together and then build from there. Go to www.bettertogetherbc.ca or www.dietitians.ca for shopping and cooking ideas.

PEN Background – Healthy Lifestyle: Eating Together - Research from around the world consistently shows a nutritional benefit of family meals. Benefits with school-aged or adolescent populations typically include an increased intake in vegetables, fruit, and calcium-rich foods or dairy, and a decreased intake of soft drinks. A lower risk for overweight is associated with increased frequency of family meals, although this might vary by race or ethnicity. Eating together as a family also seems to offer protection from eating disorders especially in girls.

Parent Key Message #C: Encourage kids to have fun and keep moving.

Kids and teens need at least 60 minutes of moderate to vigorous intensity physical activity every day.

Encourage more active forms of entertainment. Limit screen time to no more than two hours a day.

Start a family challenge to be active every day. Look for fun activities to do with your kids – indoors and outdoors. Get some ideas from www.csep.ca/guidelines


Peiican S and Vanden Heed F. The Power of Others. Recommendations to help create environments in which every body can be healthier and happier. Yale Rudd Centre for Food Policy and Obesity. May 2005. http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf Foster and support physical activities that include all youths and that help them enjoy physical activity. Canadian Physical Activity Guidelines from CSEP http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf For health benefits children should accumulate at least 60 minutes of moderate to vigorous intensity physical activity daily. http://www.csep.ca/english/view.asp?x=949 Limit recreational screen time to no more than 2 hours per day; lower levels are associated with additional health benefits.





http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf

http://www.csep.ca/english/view.asp?x=949



Parent Messages Supporting Evidence Parent Key Message #D: Help your kids feel good about themselves.

Remind your kids of how special and unique they are.

Celebrate your child’s achievements. Connect with your kids and help them work through challenges and disappointments.

Teach your kids that people come in all shapes and sizes. It can be hurtful and disrespectful to make comments about anyone’s weight or physical features.

TIP BUBBLE: Kids often compare themselves to the images and messages they see in the media. Talk to your kids about this and encourage them to look for realistic and inspirational images.

Yale Rudd Centre for Food Policy and & Obesity: Weight Bias at Home and School – video http://www.yaleruddcenter.org/what_we_do.aspx?id=200 Peiican S and Vanden Heed F. The Power of Others. Recommendations to help create environments in which every body can be healthier and happier. Yale rudd Centre for Food Policy and Obesity. May 2005. http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf Create an environment that nurtures young people’s sense of self-worth and respect for the body sizes and shapes of other youths and adults. Key Highlights from: Mental Health, Wellness and Childhood Overweight/Obesity: A Complex Relationship. Literature Review by: Shelly Russell-Mayhew, R. Psych. Feb 2012, Public Health Agency of Canada Innovation Strategy Knowledge Product http://www.hindawi.com/journals/jobes/2012/281801/ – create a more inclusive context which focuses on health and wellness for all body sizes; reduce and prevent bias against overweight people of all ages to build psychosocial RESILIENCY and reduce/prevent weight related disorders; promote healthy body image – helps to prevent weight and shape concerns thus improve psychological outcomes for children of all ages; Expert opinion: Aug 8, 2012 – Insights from external reviewer Pam Narang, Psy.D., R.Psych. B.C. Children's Hospital, Vancouver, B.C.: “You never know when the teachable moments will be, but spending time together generates an environment where communication is more likely.” Martin JB. Development of Ideal Body Image Perceptions in the United States. Nutrition Today 2012; 45(3): 98-110. http://journals.lww.com/nutritiontodayonline/Abstract/2010/05000/The_Development_of_Ideal_Body_Image_Perceptions_in.4.aspx Misperceptions of the perfect body size and thus the ideal body image, the role airbrushing, digital image enhancement, breast augmentation, plastic surgery, liposuction and so on, in the fashion industry are revealed in the documentary America the Beautiful.

http://www.yaleruddcenter.org/what_we_do.aspx?id=200







Parent Messages Supporting Evidence

Supporting Messages

Parent Supporting Message #1: Focus on your health and wellbeing instead of your weight.

Role model healthy habits and actions. Avoid going on short term “diets” or talking about “good” and “bad” foods. Talk about healthy choices instead.

Show your kids that you enjoy healthy food and drinks, and pay attention to when you are hungry and when you are full.

Build activity into your everyday routine.

Eating Well with Canada’s Food Guide. A Resource for Educators and Communicators. – Pg 2 – Family and peers influence the way people eat. Parents are role models in helping children to develop a taste for healthy food.

Peiican S and Vanden Heed F. The Power of Others. Recommendations to help create environments in which every body can be healthier and happier. Yale Rudd Centre for Food Policy and Obesity. May 2005. http://www.yaleruddcenter.org/resources/upload/docs/what/bias/educators/Educators-NASBEBullyingArticle.pdf Be a positive role model. Praise young people in ways that help them value their body regardless of size or shape. This praise can help protect, shield, or buffer them against negative influences later in life

Key Highlights from: Mental Health, Wellness and Childhood Overweight/Obesity: A Complex Relationship. Literature Review by: Shelly Russell-Mayhew, R. Psych. Feb 2012, Public Health Agency of Canada Innovation Strategy Knowledge Product http://www.hindawi.com/journals/jobes/2012/281801/ – target adult role models – parents are role models for influencing children’s attitudes and behavours towards their bodies; shift adult’s focus from weight and shape to a focus on health, wellness and resiliency so that parents can enhance the well-being of children and teens regardless of their weight status

Improving the Health of Canadians: Promoting Healthy Weights. CIHI. 2006. Pg 55. http://publications.gc.ca/collections/Collection/H118-36-2006E.pdf Research suggests that parents can play key roles in children’s eating behaviours and physical activity patterns, which can develop into behaviours that promote good health or contribute to poor health. Analyses of 2001 CCHS data indicate that parental obesity was strongly associated with youth obesity. Adolescents with a parent who was inactive in his or her leisure time were also themselves more likely to be inactive.

Canadian Physical Activity Guidelines for Adults 18-64 http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-adults-ENG.pdf – to achieve health benefits adults aged 18-64 years should accumulate at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week in bouts of 10 minutes or more.

Parent Supporting Message #2: Food brings everyone together.

Involve your kids in meal planning and grocery shopping. Use the Nutrition Facts Table on food labels to teach your kids to make healthy choices.


PEN Background – Healthy Lifestyle: Eating Together - Research from around the world consistently shows a nutritional benefit of family meals. Benefits with school-aged or adolescent populations typically include an increased intake in vegetables, fruit, and calcium-rich foods or dairy, and a decreased intake of soft drinks. A lower risk for overweight is associated with increased frequency of family meals, although this might vary by race or ethnicity. Eating together as a family also seems to offer protection from eating disorders especially in girls.



http://publications.gc.ca/collections/Collection/H118-36-2006E.pdf

http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-adults-ENG.pdf




Parent Messages Supporting Evidence Find out more information about nutrition labelling at www.healthycanadians.gc.ca/dailyvalue.

Cook together and explore new foods, flavours and recipes from different cultures. Eat together to help build strong connections with your kids and hear about their day.

Get cooking and meal planning tips at http://bettertogetherbc.ca/.

Parent Supporting Message #3: Trust that kids will eat the amount of food they need.

Trying to control how much your child eats can lead to over-eating or under-eating. Sharing responsibility for healthy eating can be challenging but it helps children and teens develop a healthy relationship with food.

Offer a variety of healthy foods in a pleasant setting at regular times. Then let your children or teens decide how much to eat, whether they want more, and when they have had enough even if they leave food on their plate.

PEN Client Handout – Healthy Eating for Children 5-11 Trust your child’s appetite – As a parent, you should offer your children a range of healthy foods at their meals and snack times. Your kids can then decide which foods and how much they want to eat. Curbing Childhood Obesity. A federal, provincial and territorial framework for action to promote healthy weights. http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/2011/assets/pdf/co-os-2011-eng.pdf CREATE SUPPORTIVE ENVIRONMENT in which healthy choices are value and give kids the knowledge, skills, self confidence, opportunities to practise healthy eating habits. From Pg 16 of A Review of Better Practices for The Prevention of Obesity and Overweight and The Maintenance of Healthy Weights. By BC Provincial Health Services Authority, July 2005 http://www.phabc.org/pdf/PHSA_Healthy_Weights_Report_July-05.pdf Allow children to determine their own portions at meals. Encourage children to pay attention to their own internal signals of fullness, do not insist on them having to clean their plate. Avoid using food as a reward. Ellyn Satter eating competency philosophy – From The Student Body video series http://research.aboutkidshealth.ca/thestudentbody/module_healthyEating_step2.asp – if the joy goes out of eating, nutrition suffers. Imposing rules about weight can undermine children’s internal regulation. Developing a healthy relationship with food is just as important as eating healthy food to support healthy growth and development. Parents play a key role in helping young children develop a healthy relationship with food. Children are born knowing when they are hungry and when they are full. By teaching children to listen to their bodies, you are supporting them to have the skills that they need for healthy eating as they get older. Let your child decide how much and if they want to eat during meals and snacks. Trust that your child knows how much or how little to eat. Serve healthy foods. Adults decide what, when and where food is offered to children.



http://bettertogetherbc.ca/

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/2011/assets/pdf/co-os-2011-eng.pdf

http://www.phabc.org/pdf/PHSA_Healthy_Weights_Report_July-05.pdf

http://research.aboutkidshealth.ca/thestudentbody/module_healthyEating_step2.asp



Parent Messages Supporting Evidence Parent Supporting Message #4: Enjoy active family time - everybody benefits from moving more and sitting less.

Walk the dog or go for a bike ride together. Start a game of street hockey, soccer or basketball – kids versus adults!

Swap sedentary time with active time. Limit screen time to no more than two hours a day.

Go to www.csep.ca/guidelines for ideas.

PEN Media Literacy Practice Guidance Summary Recommend restriction of television and video viewing to two hours or less daily, with no television or video use for children under the age of two years. http://www.pennutrition.com/KnowledgePathway.aspx?kpid=7549&trcatid=43&trid=7600

Parent Supporting Message #5: Let your child know that it’s normal to gain weight as they are growing.

Everyone’s body develops differently and at different ages. Teach your kids that health is more important than weight.

Ask if your child is being teased or bullied. Take notice if they start losing interest in their friends or eating – these may be signs of body dissatisfaction. If you are worried, visit www.erasebullying.ca for more information.

Key Highlights from: Mental Health, Wellness and Childhood Overweight/Obesity: A Complex Relationship. Literature Review by: Shelly Russell-Mayhew, R. Psych. Feb 2012, Public Health Agency of Canada Innovation Strategy Knowledge Product http://www.hindawi.com/journals/jobes/2012/281801/ – Stop focusing on weight (weight is not a behaviour, thus should not be the object of behaviour modification); create a more inclusive context which focuses on health and wellness for all body sizes; promote healthy body image – helps to prevent weight and shape concerns thus improve psychological outcomes for children of all ages. Expert Opinion: Aug 8, 2012 – Suggested text from external reviewer Pam Narang, Psy.D., R.Psych. B.C. Children's Hospital, Vancouver, B.C.: “Explicitly ask about teasing or bullying. Many parents fear that talking about teasing/bullying will make the child feel worse, but it helps to alleviate some stress and stimulate discussion re problem solving.”


http://www.pennutrition.com/KnowledgePathway.aspx?kpid=7549&trcatid=43&trid=7600




Parent Messages Supporting Evidence Parent Supporting Message #6: Talk with your kids about images and ads in the media.

Teach your kids that images in the media are often touched up, photo-edited and not realistic.

Break down commercials and ads together. Talk about how ads are designed to persuade people to buy the product.

Martin JB. Development of Ideal Body Image Perceptions in the United States. Nutrition Today 2012; 45(3): 98-110. http://journals.lww.com/nutritiontodayonline/Abstract/2010/05000/The_Development_of_Ideal_Body_Image_Perceptions_in.4.aspx Misperceptions of the perfect body size and thus the ideal body image, the role airbrushing, digital image enhancement, breast augmentation, plastic surgery, liposuction and so on, in the fashion industry are revealed in the documentary America the Beautiful.





Appendix C: Terms of Reference

TERMS OF REFERENCE

ADVISORY COMMITTEE

HEALTHY WEIGHTS FOR CHILDREN AND TEENS – CONSUMER MESSAGE & RESOURCE DEVELOPMENT Approved: June 27, 2012

BACKGROUND A strategic initiative for the British Columbia Ministry of Health is to support healthy eating practices that

contribute to reducing the risk and the incidence of chronic disease through public awareness and education.

Accordingly, the BC Ministry of Health and the Provincial Health Services Authority have provided a grant to Dietitians of Canada to support the development of consumer-tested messages for parents and teens on healthy weights with customizable factsheets for both target audiences.

The factsheets will be accessible on the same platform as the factsheets previously created for the Ministry of Health on

sodium reduction and sugary drinks, with some minor redesign and technology updates Messages will be drafted by a health professional with public communications expertise and validated with two

English- speaking parent-focus groups and two teen groups (male group and female group) in Vancouver using a marketing research firm. The suitability of messages integrated into factsheets will be confirmed by two focus groups –

one parent and one teen group. The final messages will be delivered by September 30, 2012 and the educational factsheet tools that integrate the

messages and tips for two audiences – parents and teens - by March 31, 2013.



OBJECTIVES OF INITIATIVE 1. To develop a series of six to eight evidence-based common/core motivational messages, including sub

messages and supporting tips regarding the promotion of healthy weights for children and teens that will: Be relevant to teenagers with a range of BMI for Age Support parents and teenagers in understanding the role of active living and healthy eating (including

family meals and eating competence) for physical and social health and development. Inspire parents of children (school-age to teenage) and teenagers themselves, to make positive

changes in their family and individual practices within a number of settings that could include at home, school, recreation and social settings, eating out and grocery shopping.

Inspire parents, teenagers, and teachers to promote positive body image and respect for self and others (including finding activities they enjoy) during peri-pubertal development (male focus, female focus).

Inspire teenagers to adapt to their increasing independence with positive food and activity choices. Will be supported by the current evidence and consistent with the BC provincial definitions of healthy

eating, healthy weights and mental health (see appendix). Are written in plain language, English-only, appropriate for a range of socio-economic and educational

backgrounds. Messages will be short and focused; be practical, inspirational, action-oriented, do-able and within the control of the target groups.

Messages will be focus tested for comprehension and likelihood of the message to motivate/inspire action in parents of school-age children and teens and teens themselves (ages 14-17 years).

2. To develop a series of English-only factsheets based on the tested messages appropriate for parents with children and teens themselves, that are generated from the same factsheet generator technology and design created for the previous BC Ministry of Health project on customizable factsheets on sodium reduction and

sugary drinks. A maximum of eight (8) factsheets with related tips for two audiences will be developed.

PURPOSE The Healthy Weights (HW) Advisory Committee is advisory to the Dietitians of Canada Project Manager and the BC

Ministry of Health Nutrition Consultant responsible for core message development to ensure the fulfillment of the project objectives within the defined timelines.



MEMBERSHIP AND EXPERTISE The members of the HW Advisory Committee have been selected to reflect the major stakeholders (staff and volunteers)

who will use the resulting messages. The membership includes representatives from:

BC Ministry of Health – Public Health Nutrition, Physical Activity, Health Promotion Supports & Engagement

Portfolios and Mental Health Promotion Provincial Health Services Authority

Dietitians of Canada – Media Relations and Communications BC Pediatric Society HealthLink BC

Actions Schools BC Eating Disorder Representative

Regional Health Authority Group Mental Health Nutrition consultant designated by BC Ministry of Health

Health Canada representatives will play an observational role in the development of the Healthy Weights messages.

RESPONSIBILITIES Advise on the focus testing screening criteria, and discussion guide for the parent and adolescent focus groups Advise on the focus and content of the core/common messages on healthy weights for children and teens,

including sub messages and related tips.

Advise on the text and imagery of eight Factsheets. (Note: the same design template will be used as for the Sugary Drinks and Sodium factsheets.)

Participate in regularly scheduled teleconference meetings of the committee in accordance with the Work Plan in order to provide timely feedback

Representatives will provide updates on progress to their organization as appropriate.

Ensure review by relevant stakeholders when appropriate.

TERM The term of appointment will be for the duration of the project; anticipated completion date is March 31st, 2013.

NUMBER OF MEETINGS Meetings will be held primarily by teleconference – 8 are anticipated during the course of the project. Meeting dates will be set well in advance to accommodate members’ schedules. There will be some work entailed between meetings

to review and provide feedback on circulated documents.



DECISION MAKING A consensus building approach will be used to guide direction to the Project Manager and Nutrition Consultant for

message development. Where consensus cannot be reached, the final decision will rest with BC Ministry of Health since the messages are largely being designed to support public education and awareness for the province.

ACCOUNTABILITY The Project Manager is accountable to Dietitians of Canada to ensure the project stays on track within the committed

budget and deliverables, financial management, contract hiring and oversight, preparation of meeting agendas, recording and disseminating meeting notes and key decisions.



The Meaning of Healthy Eating in

British Columbia is intended to provide a consistent definition of

healthy eating for the purpose of developing policy and strategies for

healthy eating in British Columbia. The Meaning of Healthy Eating in

British Columbia background

document has been developed to

support and expand upon this definition.

TERMS OF REFERENCE APPENDIX

Working Draft of the Meaning of Healthy Eating in British Columbia

January 23, 2012 Working Draft – Copied with Permission for Discussion Purposes

What is healthy eating?

Healthy eating is a way of eating that meets the body’s needs for nutrients and energy and is characterized by diversity and balance. Healthy eating includes positive relationships with food, the enjoyment of food and positive social interactions around food and meals.

Why is healthy eating important?

Healthy eating promotes and supports social, physical, and mental

wellbeing at all ages and stages of life and contributes to the overall health of individuals, families, and communities. Healthy eating helps to minimize the risk and supports the management of disease.

What helps us to eat healthy?

A basic understanding of food and nutrition as well as food preparation

skills enables people to eat healthy. Healthy eating is supported by a food system that ensures food security by providing enough nutritious food and water that is available, accessible, affordable,

acceptable, and safe to all people, at all times. Who is responsible for healthy eating?

The collaboration and commitment of government, industry, and non-government (NGO) organizations, through policies and practice, is pivotal to the creation and maintenance of healthy eating environments. All of society shares in the responsibility of supporting and contributing to environments

that foster healthy eating. These environments provide opportunity for individuals, families and communities to practice healthy eating behaviours.



The Meaning of Healthy Weight in British Columbia

March 2013 – Copied with Permission for Discussion Purposes

What is Healthy Weight?

A healthy weight is defined by a body composition that positively contributes to an individual’s overall health,

wellbeing and quality of life over their lifespan. Weight is one marker of health. A healthy weight is different for each individual.

Why is Healthy Weight Important?

Healthy weight, at all ages and stages of life, promotes and supports the physical, mental and social health and

wellbeing of individuals, families, and communities. Healthy weight reduces the risk and occurrence of and supports the management of weight related diseases and health problems.

How is Healthy Weight Supported?

Supporting healthy weight requires an integrated and comprehensive approach that includes supporting environments, health and social services and policies that address inequities and facilitate healthy eating, active living and mental

well-being where people live, learn, work and play. Features of this approach include: access to healthy food, opportunities for physical activity, and knowledge and skill development for healthy living. Healthy weight is supported

by individuals, families and communities that hold beliefs, attitudes and values, and engage in behaviours that facilitate health and well-being. This approach acknowledges social, economic and cultural diversity, respects all body sizes and is free from weight-related bias, stigma and discrimination.

Who is Responsible for Healthy Weight?

All of society shares in the individual and collective responsibility of supporting and fostering healthy weight. Action is

needed at the local, regional, national and global level. The collaboration and commitment of government at all levels, industry, and non-government (NGO) organizations, education, research, communities, and the media through

programs, services, policies, practices and products built upon the values of health equity, diversity and autonomy, are pivotal to the promotion and maintenance of healthy weights.



Policy Direction for a Definition of Mental Health in British Columbia

Source: Healthy Minds, Healthy People: A Ten Year Plan to Address Mental Health and Substance Use in British Columbia (Ministry of Health Services Ministry of Children and Family Development. November 1, 2010, p. 13)

“Positive mental health and mental fitness are the foundation for optimal overall health and wellbeing. From early childhood on, positive mental health is the springboard for thinking, learning,

emotional growth, resilience and self esteem – ingredients that combine to support healthy choices across the lifespan. As a dimension of overall mental health, mental fitness endows individuals with

the capacity to plan, act and reflect on decisions that in turn make a positive contribution to their social, emotional, and physical development and their well-being”.

healthy weights for children and teens...the qualitative research firm conducted a total of six...

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