Nutrition Promotion: Improving Eating Behavior in Kindergartens

This article discusses the importance of promoting healthy eating behavior in kindergartens and provides evidence-based strategies for implementing a nutrition promotion program. It explores the link between eating behavior and children's health, particularly in low socioeconomic status populations. The article also outlines a session plan based on the Theory of Planned Behavior and the VARK learning model, and includes goals, objectives, and evaluation methods for the program. Overall, the article emphasizes the need for comprehensive and long-term interventions to address childhood obesity and improve nutrition in children.

Nutrition Promotion
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Introduction:
Brief outline:
Childhood is associated with rapid growth and development of children and this phase of life
is also important for choosing eating habits in the children. Choice of eating behaviours in the
kindergartens is important aspect because transmission of same eating behaviour occurs to
the adulthood. It is important to make correct food choices in the early childhood for proper
physical and mental growth. Parent’s eating behaviour have significant impact on the eating
behaviour of their children. Choice of eating pattern is an important issue in the children
because weight pattern in the childhood produce significant impact on the health issues in the
adulthood. There should be proper eating pattern for children because improper eating pattern
would lead to disturbed mealtimes and refusal of nutritious food by the children. Children
develop learning ability to make choices of their foods through taste, feel, smell and seeing.
Observation of eating behaviour of others also plays important role in making choices of
eating behaviour in children. It is evident that there is significant increase in the obesity of
kindergartens in Australia 1,2. This increase in the obesity mainly occurs due to alteration in
the eating behaviour of the kindergartens. Increase in the adiposity in the children can be
effectively controlled through the physical exercise and controlled food intake with the
reference to the energy requirements. Development of eating behaviour with high amount
vegetables proved useful in the prevention of different disease conditions like obesity, type 2
diabetes, cancer and cardiovascular disease. Vegetables proved ore useful in preventing these
diseases because these are with low sugar content as compared to the fruits 3.
Children belonging to the low socio-economic status (SES) are specifically prone to develop
obesity. Hence, health promotion programme will be implemented at local council in the
outer suburbs of Melbourne, Victoria. This region is low SES. Target population for this
health promotion programme for promoting healthy eating behaviour will be mothers of
preschool children.
Link between eating behaviour and health of children :
There are different types of eating behaviours like overeating, poor eating, feeding behaviour
problems and unusual choices. Different types of eating behaviour produce different health
effects and quality of life. Overeating produce health effects like obesity, diabetes mellitus,
hypertension, obstructive sleep apnea and orthopaedic problems. Overeating also produce
quality of health-related issues like poor self-esteem, social isolation, distressed body image
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and eating disorder. Poor eating behaviour lead to Failure to thrive (FTT) which results in the
impaired weight gain, height and head circumference. Feeding behaviour problem lead to
behavioural disorder like food phobias and post-traumatic feeding disorder4. Unusual choices
of food develop due to intake of non-food substances which lead to insufficient stimulation,
psychological disorders and mental retardation in children. However, more focus needs to be
given to the overeating because it led to development of obesity which is most significant
health issue in children. In Australia, approximately 25 % of the children develop obesity 1,2.
Evidence-based Session Plan:
Key influencers:
Parent’s eating behaviour have significant impact on the eating behaviour of their children. It
is evident that parents play an important role in improving fruit and vegetable consumption
by the children 5. Children of working parents are usually associated with the consumption of
energy rich foods and development of obesity. Financial aspects also plays important role in
eating behaviour of children. Families of the SES populations are usually with low socio-
economic status. Moreover, areas of SES population are usually associated with more number
of fast food shops. Food environment in the family and society also influence eating habits of
the children. Cultural aspects of the family and exposure to food advertising also influences
eating habits of the children 6,7.
In this programme, mothers of the children will be addressed. Mother’s will be addressed to
improve eating environment for their children to improve eating behaviour of their children.
Theory:
Session plan for addressing mothers of the children will be based on the Theory of Planned
Behaviour (TPB). TPB proved useful in linking individual’s beliefs and behaviour.
According to this theory; attitude of an individual toward behaviour, subjective norms ad
perceived behavioural control are helpful in shaping the behavioural intentions and
behaviours of the individuals 8. This programme will be based on the mother’s attitudes for
changing healthy behaviour of children through providing information about the importance
of healthy eating and good health. Families will address their subjective norms through
displaying it on noticeboard about the improved healthy habits of kindergarten. Instructions
for the procedural changes for eating behaviour change and addressing barriers like cost and
time will be helpful in understanding mother’s perceived ability 9,10.
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Learning principle:
This session will implement learning styles depends on VARK model. VARK model use
different media like visual (seeing), auditory (hearing), reading/writing or kinaesthetic
(doing) for providing learning 11. It is evident that people can adopt multiple learning styles;
however, most effective learning style need to be implemented. Since, females are more
introspective and self-critical; females are more inclined towards kinaesthetic learning.
Evidence based and problem solving approach will be helpful in the learning relevant
information. Though females are more inclined towards the kinaesthetic approach; other,
approaches will also be incorporated in Mother’s learning. These approaches will include
visual for displaying pictures of healthy food, auditory for demonstrating implementer speech
and role play speech, reading or witting for posting information and ideas in the form of
handouts and kinaesthetic for role playing and food preparation 12.
Goal of the programme :
Goal of this nutrition promotion programme is to reduce number of obese kindergarten form
SES outer suburbs of Melbourne, Victoria through implementation of the longstanding eating
behaviour programme.
Objectives :
Objective of this programme is to improve 40 % mothers of low SES kindergarten children to
serve their children with vegetables and fruits at the end of the implementation follow-up
which is 4 month.
Another objective of this programme is to reduce 15 % consumption of energy dense foods
like sugar sweetened beverages, cakes, biscuits and pastries and to increase 15 %
consumption of low energy dense foods like vegetables by kindergarten children of low SES.
Session plan :
From the previous studies it is evident that 2 hours intervention provided to the parents of the
preschool children proved helpful in reducing energy dense food consumption and improving
fruits and vegetables consumption. This intervention was based on the parents role-modelling
for healthy food consumption results in the availability of healthy food at home and improved
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timings of regular food consumption. Similar intervention will be implemented in the current
session 13.
Session: Healthy eating with kindergartens
Introduction:
1.Why kindergartens should follow healthy eating behaviour ? (15 minutes)
Note activity – Mothers mention significance of one incidence of healthy eating and one un-
healthy eating.
2.What should be target ? (10 minutes)
Food group provide information related to the recommended serves and serving size for
children of 4 – 5 yers.
3. Activity – What is the procedure for making food which fast, cheap and healthy which
whole family likes ? (30 minutes)
4. Activity – Role playing for different eating environments (30 minutes)
Give influential message of healthy eating behaviour through role play.
Positive influences for healthy eating
behaviour
Negative influences for unhealthy eating
behaviour
Parents eat vegetables Parents drink soft drinks and eat chocolates
Appraise healthy eating behaviour Forceful feeding to children
Scheduled mealtime for whole family Gifts for eating vegetables
Children exposure to new foods Disruptions during eating
Restrictions for food consumption other
than meal time
Watching TV while eating
Wrap up – What after the session ? (5 minutes)
Demonstration of success through pin-up board display. Display should mention that success
in improving healthy food habit of kindergarten. Display should also mention about
approaches used for improving food habits like scheduled mealtime, improved meal
environment, healthy food ideas and cheap food ideas. Each family should achieve at least
one goal. Number of participants would be improved through offering voucher gifts 14,15.
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Facilitator – Female from the similar background should be incorporated as session facilitator
because female can effectively influence female of the similar traits.
Handouts:
Provide information to the children about the importance of healthy eating habits for long and
healthy life.
Snack ideas – Vegetable snacks and healthy snacks ideas for kids.
Language – Prior to initiation of the session, kindergarten should be enquired about the
appropriate language for the preparation of handouts 14, 15.
Evaluation:
It is necessary to carry out programme evaluation to assess whether implemented programme
achieved goals and objectives set at the start of the programme. Hence, programme
evaluation will be carried out at the end of the programme. Evaluation will provide important
feedback about the efficiency of the programme in improving healthy habits of the children.
Evaluation will also provide validation for the future investment of time and money in the
same type of programme 16.
Effectiveness of the programme on improving eating behaviour of the children will be
evaluated after four months post implementation of the intervention. Improved knowledge of
the mother’s about healthy eating behaviour will be assessed by performing survey. In
survey, question like, how many vegetable serves are necessary for your children, will be
asked. Transformation of the mother’s towards healthy eating behaviour will be calculated in
percentage. Positive transformation of mothers will be considered if they provide correct
answers. Calculated percentage transformation will be compared to the 40 % improvement in
behavioural change for eating vegetables. If calculated percentage transformation will meet
40 %; it will considered that goal achieved for the implemented programme. Mother’s will
use validated food frequency questionnaire (FFQ) for estimating and providing dietary intake
for their children. Fried veg products will be excepted from calculating dietary intake because
these types of products are energy dense products. Percentage change in the energy
consumption will be calculated among vegetables and high energy dense products like
sweetened beverages, cakes, biscuits and pastries. Percentage change in the energy density
will be calculated for each individually and it will be compared with the target of 15 %. This
type of evaluation will be helpful in determining whether target has been achieved. The
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survey and FFQ will be kept in the local council prior to first session and after 4 months of
intervention implementation 17, 18.
Results obtained after the evaluation will be made available to all the team members,
different stakeholders and local council members and management. An evaluation copy will
be archived in the central archive of the local council. Report will be prepared based on the
results obtained through evaluation and this report will be used for publication in the central
council newsletter. Knowledge obtained through implemented programme will be used for
developing further improved programme 19.
Analysis and conclusion:
Programmes strengths:
Previous programmes implemented for the improvement of eating behaviour of children
through improving knowledge of parents were short term programmes. Hence, previous
programmes exhibited limited success in improving eating behaviour of the children in the
low SES families. Previous research demonstrated that knowledge of the parents in the food
preparation are helpful in improving eating behaviour of children. Hence, in this programme
along with information gathering; practical aspects like food preparation will be incorporated.
Parents have more control over children during kindergartens age. Hence, implementation of
this programme at this age will be more fruitful in comparison to the later age. Parents are
most influential for their children; hence, whole family approach of improving eating
behaviour will be helpful in controlling obesity in kindergartens as well among other family
members 20.
This programme is based on the TPB, which already demonstrated its role in changing
behaviours. This programme will consider different influencers for improving healthy
behaviour of the kindergartens. This programme will implement diverse learning styles
which will be helpful in improving knowledge of mothers. This programme will set specific
goals and objectives which will be helpful in demonstrating effectiveness of the programme
21.
Program limitations:
In the earlier interventions, it has been demonstrate that change in behaviours of parents are
not effective for the longer duration. This limitation of the study will be addressed through
providing exposure to children by displaying visuals on the notice board. Moreover school
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teachers will be engaged for improving eating behaviour in the children. Long term benefits
of the preparation of cheap, quick and healthy foods are not evident. Hence, probable
outcome of study related to these factors is questionable. This intervention will be
implemented in the group setting; hence, it will be difficult assess the impact of intervention
on the individual families 22.
In future, this intervention will be implemented in other low SES kindergartens and number
of sessions will be increased.
Conclusion:
Childhood obesity is one of the significant health issues in children of low SES in the
Australian population. Childhood obesity might carry forward in adulthood also. Obesity
produces significant physical, psychological and social issues in the families of obese
children. Recommendations made in this health promotion programme will be used as
guideline for implementing such programmes at national and international levels. This
programme will focus on both educational and practical aspects for the promotion of nutrition
in the children. Role of behavioural theory and learning techniques are the important aspects
in the implementation of educational health promotion programme. Nutrition promotion can
be effectively achieved through proper design of intervention programme for the target
population.
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