ADA FoundationKnowledge Networks Family Nutrition and Physical Activity Survey

1

• ADA Foundation/Knowledge Networks Family
  Nutrition and Physical Activity Survey

Funded by a grant in memory of Allene Vaden
2
Study Purpose

• Expand knowledge of childrens attitudes and
  behavior patterns regarding weight, food
  selection, eating and physical activity patterns
• Assess parents awareness of childrens behaviors
  that influence weight
• Gain a deeper understanding of how parents and
  children relate to the topic of weight, eating
  and physical activity

3
Methodology

• Conducted three focus groups, children and
  parents, to learn best approach for topics
• Completed telephone interviews with (N144)
  younger children (ages 8 - 2)
• Completed online survey with (N471) older
  children (ages 13 17)
• Completed parallel online surveys with (N615)
  parents (of younger and older children)
• due to FCC regulations, children under age 13
  are not permitted to participate in Internet
  surveys or online data collection of any kind.

4

KN Panel Mirrors US Population
US Census
5
Survey Content Areas

• Body size and satisfaction self and family
  assessment
• Parental interaction opportunities for modeling
  parents eating and physical activity
• Nutrition and body size communication
• Family habits relative to meal and bedtimes

• Why and when kids eat
• Childrens meal and snack purchase habits
• School lunch participation and barriers to
  participation
• Childrens involvement in physical activity
• Childrens role models
• Nutritional value of foods eaten, self-assessment

6
Selected Survey Findings
7
Why Kids Eat

• Parents (78.5) overestimated younger childrens
  (61.8) hunger
• Parents (35) underestimated the extent to which
  children (43) eat because they are bored or
  because they are depressed at least some of the
  time
• Parents (8.5) also underestimated that children
  (16) eat because they are angry, sad, or
  depressed at least some of the time

8
Why Kids Eat

• Older children eat more frequently than younger
  children all or most of the time because
• Bored 15.9 vs. 7.7
• Angry, sad, or depressed 6.2 vs. 4.3
• Friends are eating 15.1 vs. 5.6
• Younger children ( 13.2) eat more than older
  children ( 7) all or most of the time
  because parents/adults made them
• Boys ate more than girls because they were hungry
  (80.8 vs. 70.8) all or most
• Girls ate more than boys all or most of the
  time because of being angry, sad or depressed
  (7.2 vs. 6.2)

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When Kids Eat
10
Eat While I am Watching TV, Playing Computer Games
All Kids All Parents
2.9
All of the time
7.2
10.7
Most of the time
16.1
42.0
Some of the time
45.2
34.7
Every once and a while
22.0
9.3
Never
9.6
0.2
Don't know
0.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Statistical Significance p 11
Eat in the Evening, After Dinner
3.2
All of the time
5.8
All Kids
12.8
All Parents
Most of the time
17.5
34.6
Some of the time
32.0
40.6
Every once and a while
31.8
7.8
Never
12.8
0.6
Don't know
0.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Statistical Significance p 12
Where Kids Buy Meals and Snack

• The majority of children purchase meals and
  snacks more frequently and from a wider array of
  venues than parents may realize
• With the exception of school lunch lines, parents
  under-predict this frequency

13
Food Purchase Habits Reported by Children and
Parents Perceptions
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School Lunch Participation

• More than 55 of children reported eating school
  lunch daily
• 21 reported sometimes taking a lunch from home
  and sometimes eating school lunch
• When asked how often children purchased from
  school lunch line, only 36 reported daily or
  most days
• Significantly more parents (49) believed
  children purchased from lunch line daily or most
  days

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Barriers to School Lunch Participation

• For those that did not eat school lunch, reasons
  given included
• Do not like what is offered (38)
• Parent prefers take lunch from home (25.9)
• Not cool (22)
• Friends do not eat it (22)
• Prefer vending options (18.3)
• Younger childrens decision not to eat school
  lunch appears to be driven more by friends
  decision not to eat school lunch
• Girls are more likely than boys to strongly agree
  that they do not eat a school lunch because they
  do not like the food served

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Body Satisfaction/Size

• Parents are likely to inflate childs body
  satisfaction
• Parents of boys report 8.07, boys own score 6.92
• Parents of girls report 7.51, girls own score
  6.43
• Girls body satisfaction is slightly lower than
  boys
• Many more parents than children believe that
  their childs body size is fine as is, and that
  their child need not gain or lose weight

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How Kids Describe Their Body Size

• Significantly more girls (33) describe their
  bodies as slightly overweight compared to boys
  (24), although slightly more boys (4.5 than
  girls (2.0) described their bodies as very
  overweight/heavy
• More older children (50.7) reported being
  slightly overweight than younger children
  (40.3) more younger (38.2) children felt they
  were about the right weight than older (24.4)

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What Should the Child Do About His/Her Weight?
57.3
60.00
60.0
Girls
Parents of Girls
54.4
Boys
Parents of Boys
50.00
50.0
42.9
40.00
40.0
39.5
33.4
28.1
30.00
24.8
30.0
21.2
20.9
20.00
19.2
20.0
10.7
10.7
7.8
7.5
5.9
10.00
10.0
3.9
0.6
0.0
1.3
0.7
0.00
0.0
Lose a little
Lose a lot of
Not do
Gain a little
Gain a lot of
Lose a little
Lose a lot of
Not do
Gain a little
Gain a lot of
weight
weight
anything--is
weight
weight
weight
weight
anything--is
weight
weight
fine as he/she
fine as he/she
is
is
All differences are statistically significant at
p
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Overweight v. Non-Overweight
Overweight Kids (Self-Report) N196
Non-Overweight Kids (Self-Report) N414

• Gender 45.7 boys, 54.3 girls
• Mean Nutrition Rating
• 5.75 (SD 1.86)
• Child Body Satisfaction Rating
• 4.73 (SD 2.42)
• Been on a Diet
• 67.7 Yes, 32.3 No
• Kids Report of Moms Body
• 60.6 Overweight
• 39.4 Not Overweight
• Kids Report of Dads Body
• 56.1 Overweight
• 43.9 Not Overweight
• Parent avg. BMI (from profile)
• Mean30.41, SD7.81

• Gender 53.4 boys, 46.6 girls
• Mean Nutrition Rating
• 6.43 (SD 1.85)
• Child Body Satisfaction Rating
• 7.60 (SD 2.04)
• Been on a Diet
• 29.1 Yes, 70.6 No
• Kids Report of Moms Body
• 44.1 Overweight
• 55.9 Not Overweight
• Kids Report of Dads Body
• 40.3 Overweight
• 59.7 Not Overweight
• Parent avg. BMI (from profile)
• Mean27.81, SD6.70

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Physical Activity Habits

• Most children report participating in a team
  sport or group physical activity, although
  significantly more younger (81.3) than older
  children (56.7) reported these activities
• Girls (31.3) are significantly more likely than
  boys (21.25) to prefer sedentary, indoor
  activities
• Parents over-predicted extent that children
  preferred outdoor activities (37.3 vs. 26.2)
• Parents of boys (14.9) more than of girls (7.8)
  predicted their children preferred spending time
  being active vs. sedentary

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Parent-Child Interaction

• Nearly 80 of children eat with parent/adult
  daily or most days, while only 15 play a sport,
  bike ride, or other activities
• On a daily basis, boys are significantly more
  likely than girls to report eating a meal (54.7
  vs. 47.9) or engaging in physical activity (21.4
  vs. 9.1) with their parent/adult
• 42 of children reported going to fast food
  restaurants or food courts with parent/adult one
  of more times a week and 47 reported grocery
  shopping one or more days

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Parents Are Role Models

• Children, regardless of age, report that a parent
  serves as a role model, or the person s/he would
  like to be like most.
• As a child grows older, however, the degree to
  which a parent is a role model lessens, however
  mother is still top choice
• Boys are more likely to select a father as a role
  model, while girls more often select their mother

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Children's Top Choices for Role Models

• Boys Top Responses
• Father (19.3)
• Sports celebrity (18)
• Unsure/No one (13.8)
• Mother (8.3)

• Girls Top Responses
• Mother (25.3)
• Unsure/No one (12.8)
• Music celebrity (11.8)
• Actor/Actress (6.9)

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Factors Related to Body Satisfaction

• Variables significantly related to childs body
  satisfaction
• Nutrition of foods consumed (self-report)
• Child ever being on a diet
• Describing body as overweight
• Family member telling child to do something about
  weight
• Age of child (as age increases body satisfaction
  decreases)
• Physical activity with parent (as activity
  increases, so does body satisfaction)
• Parent physical activity
• (Weakly related) Body size of mother
• (Weakly related) Ethnicity

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Factors Related to Self-Reported Nutrition

• Variables significantly related to self-reported
  nutrition of foods child consumes
• Gender of child (girls report lower
  nutrition/consumption ratings)
• Age of child (as child grows older, self-reported
  nutrition decreases)
• As regular meal times decrease, nutrition
  self-report decreases
• (To a lesser extent) as regular bed times
  decrease, nutrition self-report decreases
• As eating meals with parent decreases, nutrition
  self-report decreases
• Number of hours primary shopper works outside the
  home is negatively related to self-reported
  nutrition

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Factors Related to Belief in Need for Weight Loss

• Variables significantly related to child
  believing s/he should lose weight
• Gender of child (girls)
• Mom being overweight
• Physical activity with parent (as increases,
  prob. of child believing s/he should do something
  about weight decreases)
• Age of child
• Self-report nutrition of foods child consumes
• Parent communicating to child about need to do
  something about body size

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Application of Study Findings
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What can the RD do with this information?

• All dietetic professionals are equipped with
  knowledge and resources to guide families to
  better eating activity habits
• Utilize data by breaking into messages
• One-on-one counseling
• Group lectures
• Written articles

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Utilize Data to Communicate Key Messages

• One-on-one counseling
• A recent survey of children ages 8-17years and
  their families showed. Insert a key finding
  from the survey pertinent to the topic you are
  discussing.What do you make out of this
  information?
• Let the family/child digest the information and
  tell you how they interpret it and what it means
  to them in terms of potential change

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Breaking down the data into key messages

• Group setting
• Take a message or a set of messages and share at
  a community gathering, PTA meeting, religious
  group, work-site lunch-and-learn, professional
  group meeting
• Written form
• Take a message or group of messages and write a
  short article for a newsletter (neighborhood,
  community, school, work, professional) for a
  newspaper, or create handouts for your clients

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Key Findings to Communicate

• Children pick parents as their number one role
  model
• Parents spend little time being physically active
  with their child however most parents do eat
  and watch TV with children almost daily
• Children have multiple opportunities away from
  parents to purchase meals and snacks
• Parents do not realize all the times during the
  day children are eating
• Childrens degree of body satisfaction is
  influenced by parents attitudes, nutrition and
  exercise-related factors and many children
  perceive themselves as overweight and/or needing
  to lose some weight

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Message to Parents About Being a Role Model

• Although parents of young children may be acutely
  aware of this, as the child ages, they may or may
  not perceive themselves as an important role
  model
• Parents can model
• Healthy eating habits
• A commitment to being physically active

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Message to Parents Regarding Physical Activity

• A recent survey of children ages 8-17 years, and
  their parents, showed that many parents spend
  time engaging in some activities with their
  children, like eating, watching TV or movies, and
  playing video games. But, most parents did not
  play sports or engage in any physical activity
  with their children on a regular basis. What do
  you make out of this?

34
Encourage Parents to Be Active with Their Children

• Message to parents
• Be a role model by finding activities or sports
  that your family can enjoy
• Find ways to be active in even the little things
  in life like daily routines
• Make activity a priority for you personally
• Message to children
• Everyone needs to be more physically active
• Any type of activity is good, not just sports
• Get your parents involved being active with you -
  they need it, and you do too!

35
Message About Purchasing Meals and Snacks

• Message to parents
• Be aware that this happens often
• Be aware of when and where it happens
• Talk to your child about food choices outside the
  home
• Message to children
• Keep healthy eating in mind when purchasing
  food. Making healthier food selections does not
  mean you are not cool
• Balance, variety and moderation - make snacks
  count

36
Message About When Children Are Eating

• Message to parents
• Be aware that children are eating at multiple
  times during the day
• Be aware that children eat while doing other
  activities like homework, watching TV, playing on
  the computer
• Talk to your child about being aware of when they
  eat and take time out of activity to enjoy a
  snack
• Message to children
• Take a break from your computer game to have a
  snack and really enjoy it
• Try to limit snacking while watching television

37
Message to Parents About Food Selection

• Plan menus together, let them pick some of their
  favorite meals
• Take children to the store and have them help by
  reading labels and selecting produce
• Get them involved in food preparation
• Let them learn on their own by purchasing
  magazines and books that have sound nutrition
  information
• Consider discuss how they use their allowance and
  if they are buying too many snack items
• Be a positive role model

38
Message About Determinants of Body Satisfaction

• A recent survey of children ages 8-17 years
  showed that children had a tendency to be less
  satisfied with their body when they felt their
  diet was less nutritious, they spent less time
  being physically active, had dieted, or had
  someone in their family be negative about their
  weight. Tell me your thoughts about this.

39
Message About Increasing Children's Body
Satisfaction

• Discuss that parents and children MAY feel better
  about themselves if they eat a more nutritious
  diet and become more physically active
• Discourage dieting behaviors among children and
  teens, particularly any diet that is unsupervised
  or a fad diet
• Encourage parents to not comment negatively about
  childrens weights -- even if a child is
  overweight, all children need good self-esteem to
  face the challenges ahead of them

40
Message about Childrens Perception of their
Weight

• A recent survey of children ages 8-17 years
  showed that about half of all the girls and a
  third of all the boys felt that they needed to
  lose weight. When they had described their body,
  however, less of them had described themselves as
  overweight. What do you make out of this?

41
Message about Childrens Perception of their
Weight

• Message for parents
• Children may feel as if they need to be a certain
  size or shape in order to feel OK
• Parents should talk to their children about how
  they feel about their body size and positive and
  encouraging, regardless of body size avoid
  negative remarks about their own weight or size
• Message to children
• We all come in different shapes and sizes, we are
  unique and not cut out from the same
  cookie-cutter
• Eating a healthy diet and being active are the
  best ways to keep our bodies strong, healthy and
  toned

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Summary

• Stress a family focus for healthy weight
• Parents have multiple opportunities to influence
  children
• Children name their parents as leading role model
• Parents are spending time each day with children
  eating and watching TV could use this time to
  promote healthy lifestyle choices and include fun
  physical activities
• Children said they will talk to parents about
  weight and nutrition another great opportunity
  for parents to be positive
• If parent suggests child should lose weight,
  child is influenced so parents need to be careful
  with approach, be supportive no matter what
  childs weight/body shape

43

• This presentation was developed for the American
  Dietetic Association Foundation by
• Alicia M. Moag-Stahlberg, MS, RD
• Aida Miles, MMSc, RD, CSP, CNSD