A Slimmer Tomorrow

A Slimmer Tomorrow

Students at Sunshine High School attend a health fair (Kimberly Bissell).
Students at Sunshine High School attend a health fair (Kimberly Bissell).

There is not a single, simple solution to fix the nation’s obesity problem. That’s why University of Alabama researchers take multi-disciplinary approaches to the challenge – approaches that frequently focus on children.

“As a country, we’ve become more and more obese over the last several decades, and Alabama is one of the more obese states,” says Dr. John Higginbotham, a UA epidemiologist.  “Obesity strikes all kinds of people, but it seems to be more prevalent in rural areas. It also seems to be more difficult to address such health-related conditions in rural areas.”

The National Institutes of Health recently awarded one set of UA researchers a three-year, $1.1 million grant to help communities find ways to help themselves overcome their weight challenges. The collaborative effort involves the College of Community Health Sciences’ Institute for Rural Health Research, the College of Communication and Information Sciences’ Institute for Communication and Information Research and the Black Belt Community Foundation.

An early planning phase brought together community members and academic researchers to work on obesity and obesity-related diseases in the rural Black Belt, a region named for its rich, dark soil. The group developed research ideas and helped communities create ways to implement them.

They also conducted a health fair for children and adults at a high school in Newbern. The school was part of a pilot study with the Druid City Garden Project, where the children learned about nutrition through the hands-on experience of planting gardens and harvesting the produce.

“We wanted to help communities so they can have a voice in coming up with interventions that will work in those areas,” Higginbotham says. “Who better than they to come up with a plan that will work for them?”

It’s all about portions

And, what better way to reach children than through a mobile app?

Seeing parents eat fruits and vegetables impacts children's eating habits, UA researchers say (Zach Riggins).
Seeing parents eat fruits and vegetables impacts children’s eating habits, UA researchers say (Zach Riggins).

The Association for Education in Journalism and Mass Communication recently awarded Dr. Kim Bissell, founder of UA’s new Health Communication Lab, a grant to develop a mobile application to teach children about healthy eating habits.

“One of the things we know in health communication research is that adults and children aren’t aware of the portion sizes they are eating,” Bissell says.  “They aren’t really aware of the amount of food they are consuming.”

Bissell says an app like the new “Track My Plate,” designed to be user friendly for any school-age child, empowers children to take their health into their own hands and make better decisions.

Available for free in the Apple app store, Track My Plate allows children to scroll through a list of choices to select a visual representation of what they ate for each meal throughout the day.

Seeing the items and portion sizes on a plate can help children understand, Bissell says, when they have overdone it on certain food items or eaten an unbalanced meal.

The app is kid-tested, as Bissell went through three stages of beta testing with children in local elementary schools and also hosted a child nutrition camp during summer 2014 where children used the app before it was made available to the general public.

“It all comes down to awareness,” Bissell says. “If you are aware of what you are eating or doing, it’s easier to make a change or to say, ‘Well, maybe that’s not the best choice for me, but this is a better choice.’”

Accurate measurements a must

Public health and public policy officials can make better choices when they have accurate and complete data. As chair of an Alabama Obesity Task Force subcommittee, Dr. Linda Knol, a UA nutrition expert, recently helped fill the data gap in statewide obesity statistics for children between kindergarten and third grade.

In a year-long collaborative effort with divisions of the Alabama Public Health Department, the researchers found that rates of overweight and obesity among kindergarteners in Alabama were 14.2 percent and 15.1 percent, respectively. Those rates jumped to 16.6 percent and 21.7 among third graders. And the rates of childhood obesity in Alabama differ significantly, Knol says, by race/ethnicity and geographic location.

“As childhood obesity prevention efforts within Alabama increase, surveillance efforts must capture obesity data for all age groups,” Knol says. “Obesity data are captured in a systematic way for toddlers, preschoolers, teens and adults. However, statewide data on the young school-age child are limited and needed. “

The Alabama Public Health Association presented Knol and a department of public health collaborator with an award of excellence for the effort.

Parents fearful of being ‘bad guy’

Soda and sweetened beverage consumption, though ingrained as staple drinks in American culture, are one of the culprits of childhood obesity. Nearly 63 percent of children studied between the ages of 3 and 5 consume sodas, and 94 percent consume sweetened milk products, according to a study co-authored by Dr. Jen Nickelson, in the Journal of School and Health’s March 2014 edition.

Parents can sometimes be barriers to healthy eating habits, UA research shows (Zach Riggins).
Parents can sometimes be barriers to healthy eating habits, UA research shows (Zach Riggins).

The study revealed that more children drink these sweetened beverages as they age, so interventions should occur early, she says, before children reach preschool age.

In other research, Nickelson found that parents face significant barriers in limiting consumption of these drinks, including fear of embarrassment; fear of losing a child’s affection; not wanting to change their own habits; and the actions of grandparents and other caregivers.

“Parents were concerned that they would be viewed as ‘the bad guy’ if they didn’t allow sweetened beverages when the child wanted them,” Nickelson says. “Parents want to be fair.  If everyone else on the team is getting a sweet drink, they want their child to be able to indulge with the team.

“Knowing what the barriers are to limiting sweetened beverage intake can help us design health promotion programs directed toward minimizing its consumption,” she says. “We should create strategies for overcoming these barriers.  Children would not be embarrassed to drink only healthier beverages like water and milk if all of their friends were doing so, as well.”

Nickelson says it’s best for parents to model the behavior they desire from their child, but if this isn’t an option, parents can, and should, still encourage their children to adopt healthy behaviors – even at the risk of being viewed as hypocritical.

Nickelson recommends children drink milk and water, almost exclusively. If  fruit juice is liked, she recommends children between the ages of 1 and 6 have no more than 4-6 ounces per day of 100 percent fruit juice, based on American Academy of Pediatrics’ guidelines.

Parenting Style Impacts Children’s Health Behaviors

Dr. Adam Knowlden, a UA health science researcher, says few things influence child obesity like home life.

Proportion sizes are a key to maintaining healthy diets (Kimberly Bissell).
Proportion sizes are a key to maintaining healthy diets (Kimberly Bissell).

“The family and home environment is one of the most influential environments for targeting child obesity, but it’s also one of the most difficult to access for researchers and practitioners. One of the things we’re starting to realize is that parenting style has a long-lasting impact on child heath behaviors.”

When it comes to food issues, as with other issues, an authoritative parenting style, rather than an authoritarian or a passive approach, is encouraged, Knowlden says.

“Children learn to become independent, through food, at young ages,” Knowlden says.  Giving children food choices, within boundaries set by the parents, is optimal, he says. For example, allowing young children to select from among green beans, broccoli or cauliflower is an example of an authoritative style of parenting that could lead to healthy eating habits among children.

Modeling healthy eating habits is also vital, he says.

“Seeing your mom eating fruits and vegetables every day influences the child.”

A few of UA's researchers with interest and expertise in obesity research stand on the Quad. From left are: Drs. Jen Nickelson, John Higginbotham, Linda Knol, Adam Knowlden and Kim Bissell (Zach Riggins).
A few of UA’s researchers with interest and expertise in obesity research stand on the Quad. From left are: Drs. Jen Nickelson, John Higginbotham, Linda Knol, Adam Knowlden and Kim Bissell (Zach Riggins).

As a doctoral student, Knowlden developed an online program, known as EMPOWER, or Enabling Mothers to Prevent pediatric Obesity through Web-based learning and Reciprocal determinism.

He developed a series of YouTube videos and online discussion boards to help parents develop plans for improving their children’s behavior in four categories: physical activity, fruit and vegetable consumption, amount of video screen time and consumption levels of sugary beverages.

In an eight-week study that also involved a control group who received only information about childhood obesity behaviors, the research showed that behaviors improved for both groups in three of the categories, but only the group receiving the skill-building activities showed improvements in the consumption of fruits and vegetables. And, a year following the exposure, improvements remained measurable.

When it comes to improving childhood obesity, giving parents facts, alone, is not enough, Knowlden says. An intervention effort that helps parents develop nutritional plans and build skills is more effective.

“Knowledge is necessary,” Knowlden says, “but not sufficient for behavior change.”

Dr. Bissell is associate dean for research in the College of Communication and Information Sciences and director of the Institute for Communication and Information Research. Dr. Higginbotham is director of the Institute of Rural Health Research and chair of the department of community and rural medicine in UA’s College of Community Health Sciences. Dr. Knol is an associate professor in the department of human nutrition and hospitality management, Dr. Knowlden is an assistant professor in the department of health science and Dr. Nickelson is an associate professor in the department of health science, all within UA’s College of Human Environmental Sciences. 

Chris Bryant, Kim Eaton, Misty Mathews and David Miller contributed to this report.