Healthy Holiday Season

The holidays can be such a challenging time to try and stay on a healthy eating and living plan. I have included some links that have tips that might be helpful to participating families in the Healthy Weight Clinic.

The California Pacific Medical Center offers ten tips to avoid overeating and weight gain over the holidays, as well as a breakdown of specific foods and how to handle them such as gravies and dressings.
http://www.cpmc.org/about/e-health/11-05%20healthy-holidays.html

Alliance for a Healthier Generation has some advice on caring for ourselves in this busy season, from healthy eating tips to tips on getting enough rest.
http://www.healthiergeneration.org/parents.aspx?id=4181

The Mayo Clinic site offers many healthy recipes for all courses of holiday meals.
http://www.mayoclinic.com/health/holiday-recipes/NU00645

I hope these resources are helpful as you support your patients during this busy holiday season!

Unhealthiest Cereals Marketed to Children

Steering kids towards healthy eating is challenging in the best case scenario. A study from Yale recently identified one reason for this uphill battle. Cereal companies advertise their most unhealthy products to children ages 2 and up. Kid cereals have more sugar, more sodium, and less fiber than cereals marketed to adults. Please see the below articles that lay out the details of the study. Also included is an article that outlines what tactics companies use to target kids and concrete tips on how parents can combat advertising within their own home.



Cereal Companies Market Least Healthy Products to Children and Teens:


http://www.cbc.ca/consumer/story/2009/10/27/consumer-unhealthy-kids-cereals-yale.html


http://kidshealth.org/research/kids_marketing.html

Update in School Lunches and News Alert from the Center for Health and Health Care in Schools

We all know kids face an uphill battle when having to find healthy options at school and the corner store. Please see the below article on how a dietitian and students in LA improved school lunches as well as a CDC press release on school lunches. The Center for Health and Health Care in Schools looks at corner store purchases and how many calories kids are getting per dollar.

Kids excited by healthy lunch options and how they went about it:
School Lunches get Leafy in Los Angeles
http://www.wbur.org/news/npr/18948805

CDC press release on changes in what's for sale at school:
Fewer U.S. Schools Selling Less Nutritious Food and Beverages
http://www.cdc.gov/media/pressrel/2009/r091005.htm?s_cid=mediarel_r091005

Center for Health and Health Care in Schools Disseminate the following News Alert and aaaar– October 13, 2009
Purchases Made by Students in Corner Stores Near Urban Schools Contribute to Frequent Intake of High-Calorie, Low-Nutrition Foods:
"Purchases made in corner stores contribute significantly to energy intake among urban school children and may contribute to childhood obesity in minority and low-income communities, according to a study published in Pediatrics on October 12, 2009. Researchers surveyed more than 800 students in grades 4 through 6 from 10 schools who made purchases from 24 corner stores in Philadelphia, PA. More than half (53.3%) of the participants reported shopping at corners stores every day, and another 21.9% reported shopping 2 to 4 times per week."

The Center for Health and Health Care in Schools
202-466-3396
http://www.healthinschools.org/

Motivational Interviewing

At the live meeting November 4 we will be continuing our work in Motivational Interviewing. Please continue to record visits with patients with your digital voice recorders. Those of you who do not have a voice recorder will be receiving one at your health center for this purpose. We will be listening to patient visits in groups as we did at April's live meeting. It was so valuable to listen together to increase efficacy and share best practices in MI. The new article attached in your email by William Miller and Gary Rose shares recent research in Motivational Interviewing including how MI affects change talk and how that impacts behavior change. It also compares outcomes with interventions with or without MI.

I have also included a link below that helps identify stages of change. Included in this link are sample scripts to help MI practitioners at all stages of change, including pre-contemplation, to help patients move forward with behavior changes they want.

http://www.cellinteractive.com/ucla/physcian_ed/stages_change.html

Family Fun Day was a Blast!

Although it was raining, that didn't dampen the spirits of the participants at CAVU Family Fun Day this past Saturday. Over 70 people including Healthy Weight Clinic patients, their family members, clinic staff, and peer leaders from Greater Lawrence Family Health Center, Holyoke Health Center, and Whittier Street Health Center were in attendance. The day was a hit with programs being run inside as well as outside. Archery went on despite the rain- the archery instructors and participants were troopers but the rain only seemed to add to the experience! In addition, folks were able to go to the Nature Center to see moose bones and bugs, play adventure games with WingSpeed, try their hand at boxing, plant seeds, and milk Milky, the milkable wooden cow!

After everyone had lunch and more fun time, kids from each clinic were recognized for their commitment to healthy living. It was great to honor all the kids and their families for the hard work that goes into making healthy choices. Awards were also given for the day's activities. Ask Kathy the nutritionist from Holyoke; she received one for her adventure leadership skills! The raffle items were a big hit with participants taking home a signed football from a New England Patriots linebacker, a mini-helmet signed by an NFL Quarterback, a fitness goodie bag, and a gift certificate from Hannaford Supermarket. Thank you so much to clinic staff who worked so hard to get folks to the event. Folks left damp but happy!

CDC Recommendations and Study on School Environment

The Center for Disease Control (CDC) has just released recommendations strategies for obesity prevention. Attached below are links that outline strategies and best practices to accomplish these goals as well as recommendations for changes on the policy level. Both documents are available for download.

CDC’s Recommended Strategies for Obesity Prevention:

1. Increase availability of healthier food and beverage choices in public service venues

2. Improve availability of affordable healthier food and beverage choices in public service venues

3. Improve geographic availability of supermarkets in under served areas

4. Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in under served areas

5. Improve availability of mechanisms for purchasing foods from farms

6. Provide incentives for the production, distribution, and procurement of foods from local farms

7. Restrict availability of less healthy foods and beverages in public service venues

8. Institute smaller portion size options in public service venues

9. Limit advertisements of less healthy foods and beverages

10. Discourage consumption of sugar-sweetened beverages

11. Increase support for breastfeeding

12. Require physical education in schools

13. Increase the amount of physical activity in physical education programs in schools

14. Increase opportunities for extracurricular physical activity

15. Reduce screen time in public service venues

16. Improve access to outdoor recreational facilities

17. Enhance infrastructure supporting bicycling

18. Enhance infrastructure supporting walking

19. Support locating schools within easy walking distance of residential areas

20. Improve access to public transportation

21. Zone for mixed-use development

22. Enhance personal safety in areas where persons are or could be physically active

23. Enhance traffic safety in areas where persons are or could be physically active

24. Participate in community coalitions or partnerships to address obesity

CDC is pleased to release the first set of comprehensive recommendations
to promote healthy eating and active living and reduce the prevalence of
obesity in the United States. The report contains 24 recommended
obesity prevention strategies focusing on environmental and policy level
change initiatives that can be implemented by local governments and
school districts. The MMWR report, Recommended Community Strategies and
Measurements to Prevent Obesity in the United States, is available at:


http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm


To assist local governments, states, and policy makers implement the CDC
recommended obesity prevention strategies and report on the associated
measurements a detailed Implementation and Measurement Guide was
developed. The guide includes measurement data protocols, a listing of
useful resources, and examples of communities that successfully
implemented each obesity prevention strategy. The Implementation and
Measurement Guide is available at:

http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

On the other end of the spectrum, according to a Center for Health and Health Care in Schools
News Alert -- July 29, 2009, many schools fail to provide a healthy school environment. Please see the below study.

Study of School District Wellness Policies Shows Many Fail to Provide A Healthy School Environment:

In school years 2006-2007 and 2007-2008, many school wellness policies were underdeveloped and fragmented, lacking sufficient plans for implementation and monitoring, according to a report released by the Robert Wood Johnson Foundation’s Bridging the Gap program.

CAVU Family Fun Day

We are so excited to be hosting an event to celebrate the achievements of both the patients in the Healthy Weight Clinic as well as those helping them to achieve their goals: clinic staff! CAVU Family Fun Day is going to be held at a Girl Scout camp property in Waltham. The day's program is going to be varied and fun. To make the most of the camp environment, many activities will be centered around the out of doors. Some activities will be drop in and ongoing throughout the day. A nature scavenger hunt, and outdoor games are great activities families can take as much time with as they would like. Folks will be able to drop in and plant seeds to take home so families can watch them grow. In addition, there will be a series of hour long programs that kids and their families will be able to choose from. Activities we are currently pursuing are archery, cooking class, dance, field day events and boxing! Activities will be an hour long and will be ongoing throughout the day so everyone will have an opportunity to participate. Lunch will be served as well as healthy snacks.

Please begin to think of patients your clinic would like to honor for the commitment they have made to healthy living so they can be honored during the ceremony.

We will be discussing the transportation on the collaborative call next week so we can get a sense of how many buses we might need and the location of pick-up points.

Interactive Website to Help Patients and Families Plan for Success

We are constantly on the lookout for resources that can help patients and their families reach their goals. The website Calorie Counter Database: Free Online Diet Program (http://caloriecount.about.com/) has a lot of features which could be helpful to Healthy Weight Clinic patients and their families. Additionally, members of the Healthy Weight teams might find other tools on the site to be helpful in their interactions with patients.

Users can create an account and then develop personalized plans for their caloric intake as well as utilizing tools like journals and exercise guides. Patients should use this in concert with their physician and other providers at the Healthy Weight Clinic to ensure consistency. The web site is broken down into topics including Food, Exercise, and Tools. Under Foods, there are not only healthy recipes but also a recipe analyzer where one can type in a favorite recipe and get an analysis of its nutritional value. There are also coupons for a variety of products and in addition users can enter their zip code for local coupons.

Under Exercise, specific activities that breaks how many calories are burned during different activities . The activities run the spectrum from traditional exercise such as running to other daily activities like playing a musical instrument or house cleaning to show users how many calories they are already burning in their current lifestyle, and how they could increase their physical activity.

The Tools section has features that tell folks roughly how many calories they are burning daily and how many calories they would need in order to maintain their weight, lose weight, etc. This seems especially beneficial as parents are typically trying to change their habits to support the child in the Healthy Weight Clinic.These features and others on the site could be a great resource for patients as they are looking to make all aspects of their lives healthier and would support the work done in clinic. Families might really find it helpful to have access to some of the tools and knowledge at this site, so please share it with them as you see fit.

Healthy Recipes

One of the things people find most difficult when starting to eat healthy is feeling as though one's favorite foods are no longer an option. Kathy the nutritionist from Holyoke Health Center has compiled some favorite recipes from Puerto Rico with a healthy twist!

Please see below recipes:

Sofrito

1 cup Italian pepper or green bell pepper. seeded and diced

1/4 cup sweet chili or Italian or green bell pepper, seeded and diced

1 cup diced onion

3 garlic cloves, cut in half

1/4 cup cilantro leaves, cut in pieces

1/2 cup recao or cilantro leaves, cut in pieces

Combine the pepper, sweet chili, onion, garlic, cilantro and recao in a food processor or blender. If using a blender, you will need to add a small amount of water to mix the ingredients.

MAKES 2 CUPS

Nutritional Information: 1 cup. 62 calories. 0% calories from fat. 14 grams from carbohydrate. 0 grams of fat. 2 grams of protein.

Note: Sofrito can be made in large quantities and frozen until needed.

Sofrito

1 taza de pimiento italiano o verde sin semillas, cortado en pedazos

1/4 taza de ají dulce o pimiento italiano o verde sin semillas, cortado en pedazos

1 taza de cebolla cortada en pedozas

3 dientes de ajo, cortados por la mitad

1/4 taza de hojas de cilantro, cortadas en pedazos

1/2 taza de hojas de recao o cilantro, cortadas en pedozas

Mezcle el pimiento, el ají, la cebolla, el ajo, el cilantro y el recao en un procesador de alimentos o una licuadora. Si usa la licuadora debe añadir un poco de agua para mezclar los ingredientes.

RINDE 2 YAZAS

Información Nutritiva: 1 taza. 62 calorías de grasa. 14 gramos de carbohidrato. 0 gramos de grasa. 2 gramos de proteína

Nota: Se puede hacer el sofrito en grandes cantidades y congelarlo para usar luego.

Stewed Red Beans

1 pound of dried small red beans

6 cups water

1/2 large green pepper, seeded and chopped

1/2 medium onion, chopped

2 garlic cloves, ground or chopped

1/2 cup chopped cilantro leaves

1/4 cup recao or cilantro leaves, chopped

1 teaspoon olive oil

1 cup tomato sauce

1 cup calabaza or butternut squash, peeled and cut into chunks

1/4 teaspoon badia (yellow coloring)

Sort and rinse the beans with cold water until clean. Soak in 3 cups of the water for 6-8 hours or overnight. Do not drain. Bring the beans to a boil in a large saucepan. Reduce the heat, cover and simmer for 1 hour or until tender.

Combine the pepper, onion and garlic, cilantro, recao, and oil in skillet and saute over medium heat for 4 minutes. Add the tomato sauce and badia and cook for 5 more minutes. Add this mixture to the saucepan. Add 3 cups of cold water and bring to a boil. Add the squash. Reduce the heat, cover with the lid slightly open and simmer for 20 minutes or until the sauce thickens.

MAKES 8 SERVINGS of 1 cup each.

Nutritional information: 1 cup. 217 calories: 5% calories from fat. 40 grams of carbohydrate. 1 gram of fat. 14 grams of fat.

Habichuelas Coloradas Guisadas

1 libra de habichuelas coloradas pequeñas secas

6 tazaz de agua

1/2 pimiento verde grande sin semillas, picado

1/2 cebolla mediana o picados

2 dientes de ajo, molidos o picadas

1/2 taza de hojas de cilantro, picadas

1/4 taza de hojas de recao o cilantro, picada

1 cucharadita de aceite de oliva

1 taza de salsa de tomate

1 taza de calabaza, pelada y cortada en trozos

1/4 cucharadita de badia (colorante)

Limpie y lave las habichuelas secas con agua fría y póngolas a remojar en 3 tazas de agua por 6 a 8 horas o toda la noche. No las escurra. Póngolas a hervir en una olla grande. Reduzca el fuego tápela y hierva a fuego lento por una hora o hasta que estén blandas.

Mezcle el pimiento, le cebolla, el ajo, el cilantro, el recao, y el aceite en una cacerola o sartén y sofría a fuego moderado por 4 minutos. Añada la salsa de tomate y badia y cocine por 5 minutos más. Añada esta mezcla a la olla. Añada 3 tazas de agua y póngolas a hervir. Añada la calabaza. Reduzca el fuego y hierva a fuego lento con la tapa un poco abierta por 20 minutos o hasta que el liquido esté espeso.

RINDE 8 RACIONES de 1 taza cada una.

Información Nutritiva: 1 taza. 217 calorías. 5% calorías de la grasa. 40 gramos de carbohidrato. 1 gramo de grasa. 14 gramos de proteína

Kathy also provided recipes for additional dishes in English and Spanish. They are:

• Chicken Asopao
• Rice with Pigeon Beans
• Sancocho

Please contact me for copies.

Additionally, the Center for Disease Control has a website that provides nutritional information and recipes that might be very helpful for patients. One is able to select recipes by food groups (for example, dessert, finger food etc.) as well as by fruit or vegetable. It also has featured fruits and vegetables each month and other interactive tools to help people make healthy choices.
http://apps.nccd.cdc.gov/dnparecipe/recipesearch.aspx

Kathy from Holyoke also sent the following link that has other recipes and their nutritional information. http://www.kraftfoods.com/

Thanks, Kathy for all your help!

Policy Update and Helpful Tools

The MA Public Health Council has approved two policies outlined in MASS in Motion, a wide ranging statewide initiative to promote a range of wellness activities for MA residents.

On April 8 , the statewide regulations to require public schools to regularly measure BMI on all students and to provide parents with the information passed unanimously. The results will be mailed to the parents along with information to help them understand the results and tips for helping children eat better and become more active. Kids will be screened in grades 1st, 4th, 7th and 10th. Parents can opt out of the screening process at any time. Aggregate data will be shared with the Department of Public Health to analyze trends in weight status for school-age children. (1)

On May 13, the DPH Commission also approved rules requiring major chain restaurants to provide calorie information on their food. Information must be at the point of purchase. Fifty chains with over 5000 locations will be affected. Both policies have an 18 month roll-out timeline. (2) Please see www.mass.gov/MassInMotion for more information.

The Robert Wood Johnson Foundation (RWJF) also utilizes a multi-faceted strong community approach to combating pediatric obesity. RWJF developed a toolkit for obesity advocacy to assist local and state leaders to help promote healthy active communities. Suggestions run the gamut from how leaders can provide incentives for farmer's markets to how they can support laws that encourage mixed-use development.
http://www.rwjf.org/childhoodobesity/product.jsp?id=42514

The Center for Disease Control has an article on portion size that might be very helpful to Healthy Weight Clinic patients. It outlines tips for managing portion control as well as popular misconceptions folks might have around how much to eat how often. Included on the page is a game that can be printed out for use in the Healthy Weight Clinic that kids might find fun and helpful.
http://www.cdc.gov/healthyweight/healthy_eating/portion_size.html


(1) Manley, J. (2009, April 8). Public Health Council Approves New Regulations Requiring BMI Measurements for Schoolchildren, [Press Release]. Boston. Office of Health and Human Services.

(2) Lyons, T. (2009, May 13). Massachusetts Approves Calorie Labeling Measure for Major Chain Restaurants, [Press Release]. Boston. Office of Health and Human Services.

Congrats to OCHS and Summer Camp Guides

CAVU would like to recognize Outer Cape Health Services as they prepare to move from the planning phase of their Healthy Weight Clinic to operations with the newly added clinics. Their willingness to participate in collaborative activities this past year speaks to OCHS's commitment to the collaborative and the health of the children they serve.

I also wanted to pass along some summer camp guides (see links below). While some camps may already be full, most camps have financial assistance set aside to help children who would otherwise be unable to access their facility. Please feel free to pass this information on to parents or follow up with any local camps directly.

http://www.acane-camps.org/

http://www.gocamps.com/

http://www.summer-daycamps.com/

http://www.campresource.com/

I am looking forward to seeing you all on Tuesday!

Penny

Congratulations to the New Healthy Weight Clinics

We would like to congratulate the new additions to the Healthy Weight Initiative!

• Bowdoin Street Health Center
  
• Greater New Bedford Community Health Center
  
• Lowell Community Health Center

We look forward to meeting the HWC teams at the live meeting on April 28, 2009 and working together!

Helpful Information

Evan passed this along for the team to read:
http://www.commercialexploitation.org/news/2008/12/childrenmediahealth.htm

Other articles of interest:

Trimming youth obesity at Healthy Kids Day:
http://www.hcnonline.com/articles/2009/04/03/north_channel_sentinel/news/040209_healthy_kids_day_nc.txt

Rapid Infant Weight Gain Linked to Childhood Obesity:
http://news.yahoo.com/s/hsn/20090330/hl_hsn/rapidinfantweightgainlinkedtochildhoodobesity