1. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Children’s Healthy Eating from research to practice Tony Worsley and David Crawford Centre for Physical Activity and Nutrition Research Deakin University

2. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Acknowledgement The Department of Human Services Victoria funded the review of the children’s healthy eating literature on which this presentation is based.

3. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Overview  Interventions on Children’s eating  Lessons from intervention research  Issues facing Australian families  Experimental and Practice examples  From interventions to action research  System change – food policies & monitoring

4. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Children’s Eating Interventions Most interventions:  Not evaluated  Mainly primary children and peri natal mothers and babies  < 3 months duration  Many effective in short term (1/3) - some long term  Not clear which method is best

5. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Lessons from interventions  EVALUATE - document all activities  Interventions often “work”  Parents are targets, like children  Sustainability a big problem - system management, policy, resource issues

6. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Gaps in Intervention Research

7. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Gaps: Healthy eating poorly defined & measured  Focus on biomedical & nutrient outcomes  Food and eating underemphasised  Whole diet studies absent  Meals and timing ignored  Physical activity often absent

8. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Gaps: Limited theoretical basis Baranowski review Psychophysiology  Timing of food consumption - de Castro  Satiety and appetite regulation - Blundell  Food, mood & cognition systems - Benton  Food choice motivation – Steptoe, Grunert Learning & cybernetic theory – Birch, Rozin, Carver, Powers Social theory – family theory

9. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Gaps: Few evaluated studies of:  Parental behaviours and family influence  Preschoolers  Teenagers  Child oriented community programs  Long term interventions  Food consumption vs biomedical outcomes  Integrated broad health outcomes  Effects of local food policies

10. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Many interventions have failed to take account of economic, organisational, and social contexts

11. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Issues facing Australian Families AE Griffiths, 2003  Resources – finance, housing  Behavioural problems – physical, substance abuse, etc  Parental expertise & knowledge  Support structures – internal & external  External pressures - govt policies, employment, unemployment, technology & transport

12. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Experimental Research & Practice Work of non-interventionists is crucial Rozin & Birch - food exposure, modelling, reward important Tapper et al – Food Dudes Practitioners’ experiences crucial Social environment Food policies Green – PRECEDE/PROCEED

13. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Practice Examples  Food Dudes – show parents how to feed children  Start Right Eat Right – healthy eating education for child care workers  FoodCent$ - inexpensive eating for low income families

14. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Practice Examples  Tooty Fruity – school policy based program  Maribyrnong Fruit breaks & and Water bottles – classroom food policies – restructure the school day  Colac and Barwon community development programs

15. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research A clash of paradigms: From Interventions to Action Research & System Change

16. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Children’s health and education systems Several “systems” responsible for children:  Families  Pre-school day care  Schools  Health facilities  Communities & local government Are they responsible for food and nutrition?

17. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Action research for system change Formative evaluation  What’s the problem?  Who are the stakeholders?  What are the influences on children’s eating?  What are our goals?  How are changes made & institutionalised? >> Food policies

18. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Action research for system change Process evaluation  What are the barriers to our goals?  How do we get around them?  Do we alter our goals?  How do we know if the system is helping children eat more healthily?

19. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Monitoring - Process & Impact Evaluation What do we monitor?  Food consumption, preferences, knowledge, skills, eating behaviour, nutrient status, body mass, growth, social interactions? Who monitors and who is monitored?  Children, teachers, parents, food services? How often do we monitor? How extensively/intensively do we monitor?  Food bought during each quarter?  Lunch content, consumption for a day or a week?

20. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research FEEDBACK How is monitored information used?  By child  By teacher/ day carer  By parent  By institution  By education and health systems

21. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research How to influence children’s healthy eating  Make food policies – set expectations State & Federal govt systems Local govt Institution Family  Partnerships – make environments and organisations supportive  Inform, demonstrate, motivate, feedback, reward, monitor

22. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research New DHS materials  Review of Children’s Healthy Eating Interventions  Data base of publications  Practitioners’ Guide to the Promotion of Children’s Healthy Eating

23. C-PAN Centre for Physical Activity and Nutrition Research Centre for Physical Activity and Nutrition Research Thank you! tonyw@deakin.edu.au