Childhood Obesity Media Project

1
Childhood Obesity Media Project
(University at Buffalo, 2006)

• By Lindsay Howard, Christine Achterholt, Amanda
  Radersma, and Jojo Agtarap

2
Table of Contents

• Purpose of Kit
• Childhood Obesity Defined
• Health Effects Diabetes Type II
• Hypertension
• Orthopedic Complications
• Psychosocial Effects and Stigma
• Respiratory
• Body Mass Index
• BMI-For-Age
• BMI-For-Age Charts
• At Risk Quiz
• Fast Food Facts

• Scary Fast Food Facts
• Fast Food Facts
• Tips
• Healthy Foods
• Canadas Food Guide
• Tips for Parents
• 5 Strategies for Healthy Eating
• Frequently Asked Questions
• Sample Letter
• Definitions
• Obesity Brochure
• References

3
Purpose of the Obesity Tool Kit

• This tool was developed for nurses with the
  intent that they (as well as other healthcare
  professionals) will use it as a tool for
  childhood obesity education in various settings.
• The entire tool kit or
• portions there of are
• accessible for viewing,
• printing, and other uses
• as necessary or
• when desired.

(Webweaver, 2006)
4
Childhood Obesity Defined

• The prevalence of obesity has been increasing
  at an alarming rate over the past two decades.
  The National Center for Health Statistics (2002)
  had estimated that sixteen percent of children
  ages six to nineteen years of age are overweight.
  With the increasing growth of childhood obesity
  in North America, the medical community is now
  paying attention to this epidemic since early
  2000. About 15.5 percent of adolescents (ages 12
  to 19) and 15.3 percent of children (ages 6 to
  11) are obese (National Center for Health
  Statistics, 2002). The increase in obesity among
  North American youths over the past two decades
  is dramatic, as shown in the tables below.

5
(American Obesity Association,
2002)
6
Health Effects Diabetes (Type 2)

• Type 2 diabetes accounted for two to four percent
  of all childhood diabetes before 1992, but
  skyrocketed to 16 percent by 1994. The parallel
  increase of obesity in children and adolescents
  is reported to be the most significant factor for
  the rise in diabetes. (American Obesity
  Association, 2002)
• Obese children and adolescents are reported to be
  12.6 times more likely than non-obese to have
  high fasting blood insulin levels, a risk factor
  for type 2 diabetes. (American Obesity
  Association, 2002)
• An inactive person risks a lipid profile
  consisting of raised concentrations of
  low-density lipoprotein (LDL) cholesterol and
  triglycerides, and reduced concentrations of
  protective high-density lipoprotein (HDL)
  cholesterol (Hambrecht Gielen, 2005)

(Childrens Physician, 2005)
7
Hypertension

• Persistently elevated blood pressure levels have
  been found to occur about nine times more
  frequently among obese children and adolescents
  (ages five to 18) than in non-obese.
• Obese children and adolescents are reported to be
  2.4 times more likely to have high diastolic
  blood pressure and 4.5 times more likely to have
  high systolic blood pressure than their non-obese
  peers (American Obesity Association, 2002).

(BBC Health, 2006)
8
Orthopedic Complications

• Engaging in little activity increases
  adolescents risk of developing both mechanical
  and metabolic health related issues. Obese teens
  are at risk for joint disease in their lower
  limbs due to the excess weight the body has to
  handle.
• Growing youth, bone and cartilage in the process
  of development are not strong enough to bear
  excess weight. As a result, a variety of
  orthopedic complications occur in children and
  adolescents with obesity. In young children,
  excess weight can lead to bowing and overgrowth
  of leg bones.
• Obese teens are at risk for joint disease in
  their lower limbs due to the excess weight the
  body has to handle. The associated diseases
  includes bilateral tibia vara, which results in
  knee pain, slipped upper femoral epiphyses, which
  causes hip pain, and pes planus, which is caused
  by poor foot arches.

(Seacoast Orthopedics Sports
Medicine, n.d.)
(Loke, 2002).
9
Psychosocial Effects Stigma

• Black, Goldstein, Mason (1992) note that 19.3
  of obese individuals had a depressive disorder,
  with 10 presenting with bipolar disorder.
• Obese adolescents have feelings of low
  self-esteem, social isolation, rejection and
  depression. They may also feel a strong sense of
  failure (Marmitt, 1991).

(Care for Kids, 2006)
10
Respiratory
(Mount Sinai School of
Medicine, n.d)
(Sleeplabs, n.d)

• Prevalence of obesity is reported to be
  significantly higher in children and adolescents
  with moderate to severe asthma compared to their
  peer group.
• Sleep apnea, the absence of breathing during
  sleep, occurs in about seven percent of children
  with obesity. For obese children, obstructive
  sleep apnea makes sleeping difficult, since the
  excessive fat in the neck causes the partial
  obstruction of the upper airways during sleep.
  The poor quality of sleep often results in lapses
  in concentration and memory, as well as daytime
  somnolence.

(Loke, 2002)
11
Body Mass Index (BMI)

• Body Mass Index
• (BMI) is a mathematical
• formula used to assess
• relative body weight.
• The measure correlates
• highly with body fat. It
• is calculated as weight in
• kilograms divided by the
• square of the height in
• meters (kg/m2) (American
• Heart Association AHA,
• 2006).
• BMI weight (kg) / height2
• (meters2) (AHA, 2006)
• To convert pounds to kilograms, divide
• the amount in pounds by 2.2 to give
• you the amount in kilograms.

(Health Network, 2005)
12
BMI-for-Age

• BMI for Children and Teens is sometimes referred
  to as "BMI-for-age (Center For Disease Control
  and Prevention CDCP, 2005).
• BMI is used differently with children than it is
  with adults. In children and teens, body mass
  index is used to assess underweight, overweight,
  and risk for overweight. Children's body fatness
  changes over the years as they grow (CDCP, 2005).
  

• BMI-for-age is plotted on gender specific growth
  charts. These charts are used for children and
  teens two to 20 years of age (CDCP, 2005).
• Healthcare professionals use the following
  established percentile cutoff points to identify
  underweight and overweight in children (CDCP,
  2005)
• Underweight is BMI-for-age Normal is BMI-for-age 5th percentile to percentileAt risk of overweight is BMI-for-age
  85th percentile to is BMI-for-age 95th percentile (CDCP, 2005).
• The same calculation that is used with adults is
  used with, but the age of the child is also taken
  into consideration. (See following slide for age
  and sex specific charts)

(RuthK, 2006)
13
BMI-For-Age Charts
Boys
Girls
(CDCP, 2005)
14
At Risk for Obesity Quiz

• 1) How much "screen time" (TV, video, computer
  games) does your child get each day?
• Less than one hour -1 point
• One to two hours 0 points
• Two to three hours 1 point
• More than three hours 2 points
• 2) How many servings of fruits and vegetables
  (excluding fruit juice) does your child consume
  each day?
• Five or more servings 0 points
• Three to five servings 1 point
• Less than three servings 2 points
• 3) How much physical activity does your child get
  each day?
• Less than 30 minutes 2 points
• 30 to 60 minutes 0 points
• More than 60 minutes -1 point

• 5) Is water your child's primary beverage
  throughout the day, with low-fat or skim milk at
  meal times?
• Most occasions 0 points
• Sometimes 1 point
• Hardly ever 2 points
• 6) My child snacks predominantly on high-fat
  foods.
• Most of the time 2 points
• Some of the time 1 point
• Hardly ever 0 points
• 7) Food is not used to reward positive behavior
  in our family.
• True 0 points
• False 1 point
• 8) My child participates on community or school
  sports teams or is involved in activities such as
  dance classes or tennis lessons.

(USA Today, 2003)
15
Quiz Continued.

• 9) Regular physical activities are part of our
  family life.
• True 0 points
• False 1 point
• 10) Do the child's parents maintain a healthy
  weight?
• Yes, both parents maintain a healthy weight 0
  points
• No, either the mother or father is overweight
  1 point
• No, both parents are overweight 2 points
• Scoring
• -2 to 2 points Your child is at low risk of
  becoming overweight or obese. Continue to
  encourage your child to be active and eat
  healthy.

• 3 to 7 points Your child is at moderate risk.
  Look for ways to increase opportunities for
  physical activity and focus on providing a
  balanced and healthy diet for your child.
• 8 to 12 points Your child is at moderately high
  risk. Limit his or her screen time and help your
  child achieve the national guideline of one hour
  of physical activity each day. Look for ways to
  incorporate physical activity into your family
  life or identify organizations that your child
  can join that will provide opportunities for
  regular physical activity. In addition, examine
  your family's meal and snack patterns. Try
  replacing high-fat snacks with servings of fruits
  and vegetables.
• 13 to 16 points Your child is at high risk.
  Carefully examine your child's eating and
  exercise habits.

(USA Today, 2003)
16
Fast Food Facts
(McDonalds, 2006)
(My Campus Dining, n.d.)

• In a recent study, children who ate fast food
  (compared to those who
• did not) were found to have the following
  intakes
• Higher level of calorie intake
• More fat and saturated fat
• More total carbohydrates
• More added sugars
• More sweetened beverages
• Less milk, fiber, vegetables
• Eating fast food on a frequent basis does not
  provide the
• recommended nutrient intake for optimal growth
  and development of
• children. An increase in the reliance on fast
  food restaurants may be
• contributing to the increased prevalence of
  overweight children.
• (Asche, 2005)

17
Scary Fast Food Facts

• McDonald's feeds more than 46 million people a
  day - more than the entire population of Spain.
• French fries are the most eaten vegetable in
  America.
• The average child sees 10,000 TV advertisements
  per year.
• McDonald's operates more than 30,000 restaurants
  in more then 100 countries on 6 continents.
• Only seven items on McDonald's entire menu
  contain no sugar.
• McDonald's distributes more toys per year than
  Toys-R-Us.
• (Supersize Me, n.d.)

18
Fast Food Facts

• Due to increases in drive-thru restaurants and
  the demands of everyday life parents are more
  likely to buy meals for their children from fast
  food restaurants (Statistics Canada, 2003)
• According to Statistics Canada (2004), 1/3 of
  children aged 14-18 interview in a study had
  consumed something prepared by a fast-food outlet
  the day before their interview.
• The food prepared in the fast-food outlets ranged
  from pizza, hamburgers to hot dogs and 25 had a
  regular soda.
• Harrison Marske report that with an average of
  10.65 food advertisements an hour being shown on
  TV children aged 6-11 see about 11000 food
  advertisements every year (University of
  Michigan, n.d.)

(University of Michigan, n.d.)
19
Tips on How to Reduce Reliance on Fast Foods

• Be aware of the negative health effects of
  regular use of fast foods.
• Make informed decisions about fast food by asking
  for nutrition information about menu offerings.
• Value good nutrition and make it a family
  priority.
• Plan ahead. Plan simple meals for week nights.
  Always include a fruit and a vegetable.
• Prepare main dish items on the weekend that can
  be frozen for a quick meal later in the week.
• Utilize a crock pot to start a meal before you go
  to work so it will be ready when you get home.
• Visit the following websites for nutritional
  information and tips on healthier eating,
• http//www.bddiabetes.com/us/download/13a_fastfo
  odguide.pdf
• or
• http//www.fraserhealth.ca/NR/rdonlyres/etq23spst
  vxkh4bjfyhbglgru6zfhmkmdi6ohoykjsgrofgn2z7s4izripm
  dletbjj6sdznsjietwn/HealthierFoods.pdf
• (Asche, 2005)

20
Fast Food Facts Nutritional Information Sheets

• http//www.wendys.com/food/pdf/us/nutrition.pdf
• http//www.mcdonalds.ca/pdfs/Food_FactsNutrition_e
  n.pdf
• http//www.bk.com/Nutrition/PDFs/brochure.pdf
• http//www.arbys.com/nutrition/printable.php?type
  nutrition
• http//www.yum.com/nutrition/documents/kfc_nutriti
  on.pdf

21
Are Healthy Foods Affordable?

• The average monthly cost to feed the average
  family of four in 2005 is 654, up from last
  year by 3.5.
• The largest barrier for healthy eating is
  inadequate income. Poverty is associated with
  lower food expenditures and lower quality diets.
  Low income families consume fewer fruits,
  vegetables and milk products than higher income
  families in Canada.
• Families on income assistance living and buying
  food in BC would need to spend 31 to 44 of
  their income on food, compared to the average
  B.C. family that spends 15 of their income on
  food.

(Swiss Info, 2006)
(The Cost of Eating in BC, 2005)
22
Are Healthy Foods Affordable?

• Low income families are more likely to eat an
  unbalanced diet, be physically inactive and
  overweight or obese. Unless the root cause of
  food insecurity is addressed povertyit will be
  difficult to achieve the provincial governments
  2010 health targets.
• 36 of children use the food bank.

(Health Canada, 2002)
(The Cost of Eating in BC, 2005)
23
Canadas Food Guide
(Funny and Jokes, 2005)
24
Canadas Food Guide
(Red Apple, 2006)

• The amount of food your body needs every day from
  each of the four food groups depends on your age,
  body size, activity level, whether you are male
  or female and if you are pregnant or
  breast-feeding. The Food Guide gives a lower and
  higher number of servings for each food group.
  Children would require a smaller serving size
  than a teenager or adult. (Health Canada, 2006)
• View a printable version of Health Canadas Food
  Guide at
• http//www.hc-sc.gc.ca/fn-an/food-guide-aliment/f
  g_rainbow-arc_en_ciel_ga_e.html

(Health Canada, 2006)
25
Tips for Parents

• Children cant obtain all the nutrients a day
  through three meals alone, they need smaller
  portions of food more frequently.
• Dont ban childrens snacks, plan them most
  children snack on prepackaged food which are high
  in calories and low in nutrients. provide healthy
  snack choices so children will learn to make
  healthy food choices in the future.
• Children will typically grab whatever is close
  and easy. Try to have vegetables and fruits cut
  up and ready to eat.
• Fruit juice is not a healthy choice, although
  they may contain nutrients, they are often high
  in calories and lead to weight gain and tooth
  decay. Juice also lacks the fiber that actual
  fruit has.
• Children should drink no more than two 6 ounce
  servings of fruit juice a day .
• Healthy snack choices include microwave popcorn,
  low or fat free milk, cheese and yogurt, low
  sugar/ whole grain breads and cereals.
• Read nutrition labels. Sometimes foods that say
  low fat are high in sugar.
• Limit the amount of television your children
  watch. This will help your child be more active
  and lessen the number of advertisements featuring
  unhealthy high-calorie foods.
• Be a role model for your kids! If you are eating
  healthy so will they.

(Yolo, 2006)
(NAAR, 2005)
(Clerccenter, n.d.)
(Mayo Clinic, 2006)
26
Five Strategies for Healthy Eating
(Eton Digital, 2005)

• Eat meals as a family.
• Stock up on a variety of healthy foods and
  snacks This makes it easy for children to make
  healthy choices.
• Be a role model to your children by eating
  healthy this is the best way to encourage
  healthy eating.

(Kids Health, 2006)
(Parisi, n.d.)
27
Five Strategies for Healthy Eating
(Eton Digital, 2005)

• 4) Do not battle over foods do not bribe,
  bargain, reward or use food to show your love. Do
  not force your children to clean their plate as
  doing so teaches children to ignore their
  feelings of fullness.
• 5) Get your children involved Children will
  enjoy making decisions about what to make for
  dinner etctalk to them about how to make a
  healthy meal and allow them to shop with you. You
  can help them create healthy habits.

(Kids Health, 2006)
(Health Care for Child Care, 2006)
28
Frequently Asked Questions
(The Chicago Book, 2006)
(Dakota Flax,2005)
(Frequently Asked Questions, n.d.)
29

• 1) My child is overweight. What treatment options
  are available?
• Children may have a genetic predisposition to
  obesity, being more common in children when one
  parent is obese and much more common when both
  parents are obese. Decreased activity levels in
  children, combined with the availability of
  palatable, high fat foods, is leading to the
  increase in childhood obesity. Currently, the
  treatment of childhood obesity primarily involves
  attempts at increasing exercise, decreasing the
  fat content of childrens diets, and behavioral
  changes.

(Galeria Karola Krenskiego, n.d)
(Abacus Design, n.d.)
30

• 2) What are some of the factors that contribute
  to childhood obesity?
• There are many factors that contribute to
  childhood obesity including technological
  advancement, lack of parental oversight,
  decreased physical activity, inadequate school
  lunch programs and easy access to fast-food.
• A) Physical Inactivity and Safety Concerns
• Kids today, in general, exercise less than kids
  from previous generations. With increasing levels
  of violence in society, parents have greater
  safety concerns about letting children play
  outside. Parents are reluctant to let their
  children even walk alone to play with their
  friends. Many children go straight from school
  to home, where they must stay inside until their
  parents get home. They have time to watch TV,
  play video games and snack.
• B) Easy Access of High-Calorie Foods
• In addition to physical inactivity, easy access
  to high-calorie foods significantly contributes
  to children gaining weight. Many school lunch
  programs offer unhealthy choices, but even the
  programs that offer healthy foods are not helping
  kids stay at a healthy weight kids often refuse
  to eat the healthy food. Additionally, the
  availability of vending machine snacks can easily
  undo any benefits healthy school lunch programs
  promote. Schools are reluctant to remove vending
  machines because of the revenue they generate.

(Abacus Design, n.d)
(State Transit Authority, n.d.)
(Abacus Design, n.d.)
31

• 3) What methods do you recommend for weight
  reduction?
• The general recommendations are usually dietary
  alterations with behavior modification and
  exercise. Methods such as, weight reduction
  programs and treatment and screening of
  underlying eating disorders are interventions
  that can be utilized. 
• 4) How do I figure out what a healthy weight is
  for my child?
• It is difficult to figure out the ideal weight
  for a child, because children grow so quickly.
  One way to estimate a healthy weight is to
  consult a doctor. Comparing your childs weight
  to standard weights of other children by age is
  another alternative measure that can be used.
• 5) At what age should I start monitoring my
  childs weight?
• Although it is usually not recommended to
  closely monitor your childs weight, it is a good
  idea to monitor for signs and symptoms that your
  child could become overweight as early as age 2.
  Children may show signs of being overweight by
  late infancy.

(Small Indulgence,2006)
(Engineering Electronics, 2003)
(Abacus Design, n.d.)
32
Sample Letter

• Dear Community Leaders,
• The issue of childhood obesity has risen in
  recent years to become one of the greatest health
  crises impacting the future of our children.
  Childhood obesity is now considered an epidemic
  that affects one in three children, and the
  crisis is growing (Cowley, 2000). According a
  recent statistic the health crisis affects ten to
  fifteen percent of youth today with the numbers
  tripling in the past twenty years (Childhood
  Obesity Foundation, 2006). Childhood obesity is
  known to be caused by such factors as sedentary
  lifestyles and poor eating habits. Obesity is
  linked to problems such as depression, social
  isolation and decreased self-esteem as well as an
  increased risk for the development of chronic
  illnesses such as type II diabetes and heart
  disease.
• As a community we must take a stand to prevent
  and change the way obesity is affecting our
  children and their future. We need to work
  together to increase peoples awareness of the
  magnitude of the problem and join forces to
  develop strategies for change. Prevention,
  promotion, and management are key to our
  childrens health and their future. Families,
  parents, teachers, health professionals and
  governments must join together to fight the
  obesity epidemic.
• For more information on how you can help..(add
  contact information)
• Sincerely,

Letter Click on Letter to left to download
a printable copy of this letter
33
Definitions

• Body Mass Index a mathematical formula used to
  assess relative body weight. The measure
  correlates highly with body fat. It is calculated
  as weight in kilograms divided by the square of
  the height in meters (kg/m2) (American Heart
  Association, 2006).
• Chronic Illness a long-lasting or recurrent
  condition that usually lasts longer than three
  months (Wikipedia, 2006). Examples related to
  childhood obesity include heart disease, type 2
  diabetes and hypertension.
• Epidemic a disease that appears as new cases in
  a given human population, during a given period,
  at a rate that substantially exceeds what is
  "expected", based on recent experience
  (Wikipedia, n.d.)
• Health According to the World Health
  Organization "health is a state of complete
  physical, mental and social well-being and not
  merely the absence of disease or infirmity. It
  also ncludes the ability to lead a "socially and
  economically productive life" (Wikipedia, n.d.,
  para. 2).

34
Definitions

• Overweight having more body fat than is typical
  or required for the normal functioning of the
  body (Wikipedia, n.d.)
• Physical Exercise is the performance of some
  activity in order to develop or maintain physical
  fitness and overall health. Frequent and regular
  physical exercise is an important component in
  the prevention of some of the diseases of
  affluence such as heart disease, cardiovascular
  disease, Type 2 diabetes and obesity (Wikipedia,
  n.d., para 1).
• Prevalence can be defined by either of the
  following
• the total number of cases of a given disease in
  a specified population at a specified time and/or
  
• the ratio of the number of cases of a disease
  present in a statistical population at a
  specified time and the number of individuals in
  the population at that specified time(Wikipedia,
  n.d., para 1).
• Sedentary Lifestyle a type of lifestyle most
  commonly found in modern (particularly Western)
  cultures. It is characterized by sitting or
  remaining inactive for most of the day (for
  example, in an office or at home). It is believed
  to be a factor in obesity and other disorders,
  primarily heart disease (Wikipedia, n.d., para.
  2).

35
Obesity Brochure

• Childhood Obesity
• A Growing Epidemic
• obesitybrochure.pdf

(University at Buffalo, 2006)
Designed By Kwantlen University College Nursing
Students 2006
Brochure Click on Brochure to left to
download a printable copy
36
References

• Abacus Design. (n.d.) Frequently Asked Questions.
  Retrieved November 3, 2006, from
  www.abacusdesign.com.au/frequently-asked-ques...
• American Heart Association. (2006). Glossary.
  Retrieved Match 16, 2006, from http//www.american
  heart.org/presenter.jhtml?identifier1158
• American Obesity Association (2002) Childhood
  Obesity. Retrieved November 3, 2006, from
  http//obesity1.tempdomainname.com/subs/childhood/
  prevalence.shtml
• http//obesity1.tempdomainname.com/subs/fast
  facts/obesity_youth.shtml
• Asche, K. (2005). Fast foods may increase
  childhood obesity rates. Retrieved November 3,
  2006, from http//www.extension.umn.edu/
  extension news/2005/fast food.html
• BBC Health. (2006). Condition Hypertension.
  Retrieved November 3, 2006, from
  www.bbc.co.uk/.../conditions/hypertension1.shtml
• BC Community Nutritionist Council School
  Advisory Committee. (n.d.). Healthier foods How
  to make fun-fast-food healthier for students.
  Retrieved November 5, 2006, from
  http//www.fraserhealth.ca/NR/rdonlyres/etq23spstv
  xkh 4bjfyhbglgru6zfhmkmdi6ohoykjsgrofgn2z7s4izripm
  dletbjj6sdznsjietwn/HealthierFoods.pdf
• Black, D.W., Goldstein, R.B., Mason, E.E.
  (1992). Prevalence of mental disorder in 88
  morbidly obese bariatric clinic patients. America
  Journal of Psychiatry, 149, 227-234.

37
References

• Canadian Institutes of Health Research. (2003).
  Obesity in Canada identifying policy priorities.
  Institute of Nutrition, Metabolism and Diabetes
  (INMD) http//www.cihrirsc.gc.ca/e/21597.html14
• Center for Disease Control and Prevention.
  (2005). BMI-Body Mass Index BMI for Children and
  Teens. Retrieved March 16, 2006, from
  http//www.cdc.gov/ nccdphp/dnpa/bmi/bmi-for-age.h
  tm
• Childhood Obesity Foundation. (2006).
  Identifying, evaluating and promoting best
  practices for childhood obesity. Retrieved
  September 24, 2006, from http//www.cofbc.ca
• Clerccenter. (n.d.). Retrieved November 6, 2006,
  from http//clerccenter.gallau det.edu/products/im
  ages/otherphotos/ODY_5.gif
• Cowley, G. (2000). Generation XXL Childhood
  obesity now threatens one in three kids with
  long-term health problems and the crisis is
  growing. Newsweek, 136(1), 40-44. Retrieved
  September 25, 2006, from CINAHL database.
• Dairy Queen. (2006). Nutrition facts. Retrieved
  November 3, 2006, from http//www.dairyqueen.com/N
  R/rdonlyres/F4C25FBA-C782-4E3B-8D18-F30A041B3BF0/0
  /DQLtdBrzrGrllChllNtrtnFcts2006.pdf

38
References

• Dakota Flax. (2005). Frequently asked questions
  and answers. Retrieved, November 3, 2006, from
  www.dakotaflax.com/faq.html
• Demasi, B. Keith, R. (2006). Timely
  information Human nutrition, diet health.
  Department of Nutrition and Food Science. Auburn
  University, Alabama.
• Eton Digital. (2005). Checkmark. Retrieved
  November 6, 2006, from http//www.etondigital.com/
  img/checkmark.gif
• First Call BC. (2002). The cost of eating in BC
  2005. Retrieved September 24, 2006, from
  http//www.dietitians.ca/resources/resourcesearch.
  asp?fnvi ew contentid1944
• Fittante, A. Haven, S. (n.d.). BD getting
  started fast food guide. Retrieved November 5,
  2006, from http//www.bddiabetes.com/
  us/download/13a fastfoodguide.pdf
• Frequently Asked Question jpeg image (n.d.)
  Retrieved November 3, 2006, from
• www.e-dem.info/.../colour/jpg/
• Funny and Jokes. (2005). Food pyramid. Retrieved
  November 3, 2006, from http//www.funnyandjokes.
  com/comics/dieting/food-pyramid.gif
• Galeria Karola Krenskiego (n.d), Retrieved
  November 3, 2006, from
  www.inf.sgsp.edu.pl/pub/MALUNKI/PLD/

39
References

• Hambrect, R. Gielen, S. (2005). Essay
  hunter-gatherer to sedentary lifestyle. Medicine
  and sport. The Lancet. 366, S60-S61.
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