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Take Off 4-Health Nutrition Education Curriculum for a Healthy Lifestyle Camp for Overweight Youth

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Take Off 4-Health Nutrition Education Curriculum for a Healthy Lifestyle Camp for Overweight Youth Top Clin Nutr Vol. 25, No. 2, pp. 151–159 Copyright c 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins APPROACHES TO OVERWEIGHT AND OBESITY Take Off 4-Health Nutrition Education Curriculum for a Healthy Lifestyle Camp for Overweight Youth Carolyn Dunn, PhD; Kathryn M. Kolasa, PhD, RD, LDN; Nancy Harris, MS, RD, LDN; Yancey Crawford, MPH; Sarah Henes, MA, RD, LDN; Stephanie Kinner, BA; Virginia Sutton, MPH; Sarah Colby, PhD, RD, LDN; David N. Collier, PhD, MD Evidence exists about the effectiveness of residential summer weight-loss camps for initiating or supporting small changes in childhood obesity. This report describes the development and eval- uation of a nutrition-education program for overweight adolescents attending a 3-week healthy lifestyle camp. Campers were given a diet prescription based on MyPyramid and then self-selected their meals and snacks in a family-style service format. The curriculum included eating strategies known to contribute to healthy weights in youth. Campers demonstrated an improved ability to estimate portion sizes. Thirty-four campers completed the 3-week experience with a weight loss considered to be safe. Key words: 4 H camp, nutrition-education curriculum, overweight youth ESIDENTIAL weight-loss and fitness healthy-food selections, nutrition education, Rcamps are popular in the United weight-loss tips, self-esteem building, and States.1,2 They typically feature exercise, recreational activities. In the short-term, resi- dential weight-loss programs, especially those that restrict calories, appear effective across a range of health indicators.2–4 Unfortunately, Author Affiliations: Department of 4H Youth Development and Family & Consumer Sciences, NC there are no reports of long-term successes Cooperative Extension, NC State University, Raleigh in treating childhood obesity through big (Dr Dunn), Pediatric Healthy Weight Research and changes in diet and physical activity. This Treatment Center at East Carolina University (Drs Kolasa and Collier and Mss Crawford and Henes) article describes the nutrition-education and Departments of Nutrition and Dietetics (Mss Harris and Kinner and Dr Colby), Pediatrics (Ms Henes), Public Health (Ms Sutton), East Carolina University, Greenville, North Carolina. The authors thank the leadership of the TO4H advisory Conflict of Interest Disclosure: Kathryn Kolasa, PhD, team members from both North Carolina State Univer- RD, LDN has a potential conflict of interest disclosure. sity and East Carolina University, especially the teach- None of the other authors do so. ing and evaluation provided by Family and Consumer Kathy Kolasa is a member of the Nutrition Advisory Science agents Amanda McDanel and Dee Furlough, Panel for Burger King’s Positive Steps Program. Since and the assistance of the foodservice staff of the East- 2008, ten nutrition experts have served to advise Burger ern 4-H Center, especially Becky Ingalls. We appreciate King on their corporate, ongoing efforts to promote bal- the support of Kathy Cable, Health Sciences librarian at anced diets and active lifestyle choices. the Laupus Library, East Carolina University and the re- view of the manuscript by Dr Carolyn Lackey, Professor Corresponding Author: Kathryn M. Kolasa, PhD, RD, Emeritus, North Carolina State University. LDN, Pediatric Healthy Weight Research and Treatment Center at East Carolina University, 4N70 Brody Medi- Scholarships for campers were provided by the Pitt cal Sciences Bldg, 600 Moye Blvd, Greenville, NC 27834 Memorial Hospital Foundation. ([email protected]). 151 152 TOPICS IN CLINICAL NUTRITION/APRIL–JUNE 2010 curriculum designed for Take Off 4-Health Table 1. Camper demographics, N = 34 (TO4H), a healthy-lifestyle camp for over- weight youth. We have adopted the small- No. % change approach,5 immersing overweight adolescents in an environment that allows Agea,y them to learn how to make small changes in 12–15 27 79 their energy intake and increase their physical 16–18 7 21 activity. Lessons learned from implementing Race the nutrition curriculum may benefit other Black 24 70 healthcare professionals as they develop White 10 30 Gender summer camp programs. Female 26 76 Male 8 24 PROCEDURES aMean age = 14.1 y. The camp The TO4H was a 3-week residential camp olina University and Medical Center Institu- experience for overweight youth. At camp, tional Review Board. At the beginning of youth initiated weight loss, built self-esteem, camp, anthropometric data (height, weight, and learned multiple strategies for leading a and waist circumference) and assessments healthy lifestyle. The rationale and descrip- of quality of life, depression, health behav- tion of a similar, earlier effort from this group iors, and body image were collected from to provide this type of camp are reported the campers. Parents also completed the as- 6 elsewhere. The TO4H was a collaborative ef- sessments (results reported elsewhere).8 The fort of the Pediatric Healthy Weight Research mean baseline body mass index was 41.9. and Treatment Center at East Carolina Univer- sity’s Brody School of Medicine, the staff of Nutrition curriculum the Eastern 4-H center, a rural 4-H camp facil- Six hours were allocated by the camp’s ity, and Family & Consumer Sciences agents medical director for nutrition-education with the North Carolina Cooperative Exten- classes. An additional hour was used to sion. The camp was priced about $1000 less explain the individualized diet prescription than other weight-loss camps described and on the basis of MyPyramid.9 The objective 7 advertised on the Web. The daily schedule in- was to provide the knowledge and skills that cluded physical activities, nutrition-education campers would need to achieve a healthy classes, cognitive behavior therapy, and tra- weight when they returned home. ditional camp activities. Rather than plated, For curriculum development a literature calorie-controlled meals typically found in review was conducted, exploring relevant weight-loss camps, TO4H followed the 4-H Web sites and professional listservs for camp- camp tradition of providing family-style meals. related menus and curricula and reviewing the 4-H camp’s menu. The theory of planned Participants behavior change guided the curriculum devel- Conducted in 2008, camp participants in- opment. Nutrition-education lessons focused cluded 26 girls and 8 boys, aged 12 to 18 on food choices that participants would prac- years (Table 1). Most of the participants (70%) tice while at camp and continue upon their re- were African American and economically dis- turn home. The camp’s menus reflected foods advantaged. If Medicaid eligible, they quali- found in school meal programs and at home fied for scholarships provided by a local hos- with familiar items from the grocery store. pital’s foundation. Institutional review board The nutrition-education curriculum included approval was obtained from the East Car- a modified camp menu, “camper meal cards” Take Off 4-Health 153 with a 1-hour introduction to the use of the ular “Rethink Your Drink” graphic from the card and portion size education, six 1-hour in- ESMM-WL was changed to reflect the tim- teractive nutrition classes, counselor training, ing and beverages consumed by teenagers and a family take-home packet. (Fig 2). The interactive lessons matched the key messages and included a Power- Menu and meal camper cards Point presentation, instructor guide, handout The camp’s standard menu was modified and hands-on activities. The materials (avail- by the researchers in cooperation with the able at http://www.takeoff4health.org) were camp’s food service manager while ensuring branded as TO4H with the logos of the part- that the nutrient needs of growing adoles- nering groups. cents were met. The 2005 Dietary Guidelines One author reviewed the menus and pro- for Americans10 were followed. Meals were vided technical assistance so that the food- low in fat and sugar and whole grains and service staff could provide the appropriate- fiber were adequately supplied. Some of the sized portions of food and ensure that the changes made to the menu were adding a daily Dietary Guidelines10 were followed. Camp salad bar and fresh fruits, specifying the size of counselors and campers received training on meat portions, using skinless poultry, and low use of camper meal cards. Camp counselors fat and sugar food preparation techniques. also received a 2-hour overview on childhood Modifications were made within the camp’s obesity that included a review of evidence- budgetary constraints and no “diet” or spe- based physical activity and nutrition and be- cialty products were included. Two small daily havioral strategies for the prevention and snacks were served in addition to 3 meals. treatment of childhood obesity from a physi- Each camper received a personalized nutri- cian and a registered dietitian. A registered tion prescription, presented as a camper meal dietitian prepared the personal dietary pre- card (Fig 1) to guide food choices and portion scription and instructed the campers on its sizes at meal and snack times. To promote a use. The lessons were delivered by Family safe weight loss while at camp, the MyPyra- and Consumer Sciences agents, previously mid calorie levels9 for age and gender were trained in providing weight-management pro- chosen at the sedentary level of activity. The gramming, and a dietitian who works exclu- daily amount of food from each food group sively with overweight youth. was based on the MyPyramid food intake pat- Formative evaluation of the entire terns for each calorie level.9 A family take- nutrition-education curriculum described home packet was given to campers. Each fam- above was completed by professionals in- ily received a magnet with healthy living tips, volved in TO4H through interviews (VS), tear-off shopping lists, an Eat Smart Move written reports, and conference-call dis- More Weigh Less (ESMM-WL) magazine, an in- cussions, and at a postcamp debriefing teractive CD to aid teens making healthy food meeting. The effectiveness of the portion-size choices, a meal-planning white board, and a education was assessed through pre- and scale to monitor weight.
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