Combatting Childhood Obesity

in
Yazoo, Mississippi
Abstract
The grant of $10,000 will be used at McCoy Elementary School in Yazoo, Mississippi.
Mississippi has the highest rate of obesity in the United States, with Yazoo county having the
highest rate of obesity in the state. To combat the problem of childhood obesity in Yazoo, this
grant would fund classes incorporating nutrition-education lessons combined with cooking to
educate fourth grade students on recipe reading, portion sizes, MyPlate guidelines, and preparing
healthy meals. There will be a pretest and posttest after each marking period to assess what
students have learned from the program, as well as a pretest and posttest to assess physical
activity and eating behavioral changes in the students. An ASA-24 recall will be conducted six
months after the intervention has concluded to assess what healthy habits and portion control
habits the students have continued to use outside of the classroom.
Goals & Objectives
Socioecological Model Levels: Individual and Community
Goal #1: Intervene with schools in Yazoo, MS through educational, hands-on healthy cooking
classes.
● Students will receive an 80% average on the educational posttest at the end of each quarter.
● At least 80% of students will improve or maintain healthy eating and physical activity
habits, as evidenced by their responses to the behavioral posttest.
● By the end of each class, 80% of students will be able to demonstrate a knowledge of
MyPlate food groups and serving sizes by creating their own plate based on MyPlate
standards.
● By the end of the program, 80% of students will have incorporated at least 3 out of the 5
MyPlate food groups into at least one meal per day as shown by their 24 hour recall.
Goal #2: Find a downward trend in the student’s BMI scores.
● By the beginning of the following school year, 50% of the student’s BMI scores will have
decreased.

Introduction
Obesity rates in the United States of America in children ages six to seventeen have
nearly tripled since the 1980s; therefore, many would consider the USA to be in an epidemic.
This obesity epidemic may be due to the fact that over the last 2 years, nutrient dense foods, such
as fruits and vegetables have increased in price by almost twenty percent, while energy-dense
foods like sweets and fats have remained constant. High fast food and soft drink consumption
can also be traced back to the increase in childhood obesity rates. These poor eating habits in
overweight and obese children cause high BMIs and therefore an increased risk for many
cardiovascular risk factors such as hyperglycemia, dyslipidemia, inflammation and hypertension.
They may also experience sleep apnea, asthma, fatty liver, orthopedic problems, and chronic
kidney disease.​1​ It is therefore essential that action takes place in order to educate and help
children make healthier choices to decrease their risks of becoming overweight or obese.
Furthermore, the state of Mississippi has the highest rate of obesity in the country.
Obesity in children and adults continues to be a leading health concern for the state.​2​ More
specifically, the county of Yazoo has one of the worst rates of obesity in all of Mississippi, with
35.6% of adults and 21.7% of children aged ten to seventeen being obese.​2​ Therefore, Yazoo
would be an ideal spot to implement an intervention to help prevent and reduce the rates of
childhood obesity. In order to do so, a hands-on, education-based nutrition program would be
introduced in one of the elementary schools in Yazoo for children in grade four. This program
would consist of classes involving nutrition education related to MyPlate food groups and proper
portion sizes as well as cooking to allow students to implement their new nutrition knowledge
into cooking healthy recipes with their peers.
Both education and hands-on learning would be incorporated into the nutrition
intervention due to the fact that this has been proven an effective way to help prevent and reduce
obesity-related health risks in children, as evidenced by research. A review article on nutrition
education done by Isobel Contento, PhD, states that “an analysis of over 300 studies shows that
nutrition education is more likely to be effective when it focuses on behavior/action (rather than
knowledge only).”​ 3​ Therefore, nutrition-based education in conjunction with cooking food is
going to be a more beneficial intervention rather than nutrition education alone. Also, according
to one study conducted in Los Angeles, educating children on healthful food choices through
interactive classroom based education reduces obesity rates and teaching cooking education
classes helped reduce participant’s BMIs and lower diastolic blood pressures.​4​ Reducing BMI in
young children would be extremely beneficial to their health as they grow older, so evidence
supporting that cooking education classes can assist in doing this further supports this proposed
nutrition intervention. Another research article based on school-based nutrition education states
that “school-based nutrition education should focus not only on the provision of nutrition
information, but also on the development of skills and behaviors related to areas such as food
preparation, food preservation and storage….”​5​ In this proposed nutrition intervention to prevent
childhood obesity, children are going to be able to gain nutrition knowledge through classroom
lessons, and develop food preparation and cooking skills while preparing healthy meals. The
article states that “to be effective, nutrition promotion strategies must be creative, engaging,
inexpensive and widely disseminated.”​5​ This nutrition program would involve fun and creative
recipes that are cost-efficient, healthy, and catered to the desires of children. It would also
engage the students by allowing them to cook the meals themselves.
Along with the benefits of incorporating both nutrition-education and cooking classes in
this nutrition program, it would also benefit both individuals and the community in regards to the
socioecological model. This program would help individual students develop a greater
knowledge of healthy eating and proper portion sizes as well as cooking skills and use this
knowledge in their everyday life when they are making food choices or helping prepare a healthy
meal for themselves and/or family. This program also would benefit the community level of the
socioecological model because overall, the school community as a whole would have a greater
awareness and understanding of healthy food choices and cooking nutritious meals. An objective
of this intervention is for average BMI scores of the students to decrease, which would therefore
make the student community healthier.
This intervention targets the high prevalence of childhood obesity in Yazoo, Mississippi
related to a lack of standardized nutrition education by the Mississippi Department of Education​6
as evidenced by inadequate nutrition lesson plans for all grade levels.​7

Methods
Cooking and nutrition education classes will be implemented in McCoy Elementary
School’s fourth grade classes and will take place for the duration of the 2017-2018 school year
during the student’s normal “special” time. Each fourth grade class, five in total, will have this
special once a week. These classes will take place in the school cafeteria before and after lunch
time, when it is not occupied. Using the budget and grant funding, the necessary materials and
appropriate recipes will be gathered in preparation for the classes. These materials include:
posters with MyPlate graphics, essential kitchen utensils and equipment, recipe ingredients, a
large refrigerator, as well as toaster ovens and portable skillets at each cooking station.
Two health science student volunteers will be contracted from Holmes Community
College for the duration of the school year. These students will be the cooking class teachers.
One will teach the lesson plan and how to prepare the recipe and the other will supervise the
students cooking their meals. A three hour orientation will be conducted by a hired Registered
Dietitian for these teachers to instruct how classes will run, what will be taught, and familiarize
them with MyPlate. More specifically, they will be taught that MyPlate focuses on variety,
amount, and nutrition. Fruit intake is recommended to be 1 ½ cups fruit per day, or ½ cup per
meal for both boys and girls ages nine to thirteen. Vegetable intake is recommended to be 2 cups
per day, or ⅔ cup per meal for girls and 2 ½ cups per day, or about ⅔ cup per meal for boys.
Grain intake is recommended to be 5 ounce equivalents, or 1.6 ounces per meal for girls and 6
ounce equivalents, or 2 oz. per meal for boys. Protein intake is recommended to be 5 ounces, or
1.6 ounces per meal for both boys and girls. Dairy intake is recommended to be 3 cups per day,
or 1 cup per meal for both boys and girls. Lastly, oil intake is recommended to be a maximum of
5 teaspoons per day, or 1.6 teaspoons per meal for both boys and girls. Teachers will use these
MyPlate guidelines for the age group of nine to thirteen in order to create meals that fulfill these
recommendations.

Cooking classes will be taught on a rotational schedule; the first week will be used to
teach the students a nutrition-based lesson. These lessons will consist of information about
MyPlate, proper serving sizes, and how to incorporate basic nutrition principles into a healthful
diet. In addition, simple math and reading concepts will be incorporated into class time as
students will learn how to read recipes and measure ingredients on their own. In class the
following week, students will use what they learned from their education class to cook a recipe
in groups of four students, five groups per class. Each group will make one meal to share. To
assess the students’ knowledge of serving sizes, they will be required to assemble a plate after
preparing the recipe using the appropriate proportions of each food group according to MyPlate
standards. For example, if each group prepares brown rice, broccoli and chicken, each group will
have to assemble a plate as a team with the correct serving sizes for each food item. The results
of each group’s assembled plates will be recorded for data collection.

In order to further measure this intervention's goals and objectives, students will be given
a pretest at the beginning of each marking period and and a posttest at the end in order to assess
each student’s individual learning and improvement. To evaluate whether students are
incorporating this knowledge into their own diets outside of school, an ASA-24 recall will be
conducted for each student six months after they complete the program, administered by the two
class teachers. Lastly, in order to measure changes in BMI, each student’s BMI score will be
collected from the school nurse at the beginning of the school year and will be measured against
their BMI score at the beginning of the following school year.

Evaluation

At the beginning of each marking period of the 2017-2018 school year, students will be
given a pretest to evaluate their knowledge of the nutrition curriculum that will be taught during
that marking period. An identical post-test will be administered at the end of each marking
period. The health science students from Holmes Community College will administer the tests
and help students if they have questions. These tests will be multiple choice and be different for
each of the 3 marking periods. Listed below is a sample of questions that will be included to
assess the students knowledge of portion sizes and MyPlate:

1. Marking Period 1; Pretest and Posttest Questions

a. Which of the following foods belongs to the fruit group?
i. Answer: Watermelon
b. Circle the picture that correctly identifies the serving size for roasted
carrots.
c. How confident are you in following directions in a recipe?​8

2. Marking Period 2; Pretest and Posttest Questions

a. Circle the picture that correctly identifies the serving size for grapes.
b. Which food group does zucchini belong in?
i. Answer: Vegetable
c. How confident are you in following directions in a recipe?​8

3. Marking Period 3; Pretest and Posttest Questions

a. Circle the picture that correctly identifies the size of an individual pizza.
b. Which food group does cheese belong in?
i. Answer: Dairy
c. How confident are you in following directions in a recipe?​8

To answer question labeled c on the above tests, students will choose a number 1-4 representing
the following answers respectively; Not confident, Somewhat confident, Confident, Totally
confident.
To evaluate their current food consumption and physical activity habits, students will be
given a test at the beginning of the 2017-2018 school year, at 19 weeks into the curriculum, and
at the beginning of the 2018-2019 school year. This behavioral test will consist of the following
questions:​9
1. I eat vegetables..
2. I eat fruit..
3. I choose healthy snacks..
4. I do physical activities…
5. Being active is fun…
6. Being active is good for me…
7. How confident are you in following directions in a recipe?
For the first 4 questions, students will choose a number 1-4 representing the following
answers, respectively; Never or Almost Never, Some Days, Most Days and Every Day. For
questions 5-6, students will choose a number 1-3 representing the following answers
respectively; I do not agree, I’m not sure and I agree. Data from the behavioral surveys will be
analyzed for percentage of students who engaged in healthier habits.
In order to address the student’s BMI scores, data will be collected from the nurse at the
beginning of the 2017-2018 school year and at the beginning of the 2018-2019 school year.
After analyzing the BMI scores and comparing them from 2018 to 2017, there is expected to be a
decrease in at least half of the student’s scores. This is an indication that students have
maintained or increased their physical activity level and/or incorporated healthy eating habits as
taught in the classes. The BMI scores will be evaluated in accordance with each individual
student’s responses to the behavioral post-test. It is expected that students who respond and
either maintain or increase their physical activity level and/or healthy food consumption will
have a lower BMI score in August 2018 compared to August 2017.

Future Funding

The purpose of this program is to observe a correlation between nutrition education and
cooking classes and student’s health. The goal is to see a decrease in the BMIs of at least fifty
percent of students over the course of a full year. If this goal is met, then it can be concluded that
the nutrition classes are positively benefiting the student’s health and overall helping to lower
childhood obesity rates in Yazoo. If the program can be proven successful, then the school will
be asked for funding to further invest in the cooking classes and hopefully expand to other
schools in the area. Future funding can also be used to incorporate cooking classes permanently
by building a full kitchen in the school. By funding a full kitchen, students will have more
options for complex recipes that require ovens and stoves, which will help them learn different
ways to cook foods and how to use different kitchen equipment.

Budget

Category Amount

Personnel      2 health sciences students from Holmes Community College,

Goodman, MS: free, as volunteer    
Registered Dietitian to teach orientation for teachers: $28.69 x 3
hours = $86.07
Supplies      Groceries - average: $68.33 per recipe x 18 weeks= $1,229.94
*For specific recipes that will be used and prices see Appendix B.

Toaster oven $39.92 x 5 (1 at each cooking station) = $199.6​10​  

Utensils (17 piece tool and gadget set): $14.77 x 5=$73.85​11
Plastic dinner plates (set of 20): $9.97​12
Silverware: 12.97 set of 4 x 5 (1 at each cooking station) =$64.85​13
Equipment      Refrigerator (22.1 cu ft.): $1099​14
Portable skillets: $23.90 x 5 (1 at each station)= $117.45​15
Travel      Mileage for Holmes Community College Students
36.9 miles away​16​ x 15 cents per mile (average gas price per mile)
$5.35 x 2 ways = $11.07 per day x 180 days = $1,992.60 total   
Computer Costs      ASA-24 hour recall: free when used for research​17
Other     Printing: 0.05 per page

18 recipes (pages) x ~100 students= 1800 x .05= $90.00

Behavioral: 3 tests per student x 100= 300 x 0.05= $15.00
Curriculum: 6 tests per student x 100 =600 x 0.05= $30.00
5 MyPlate Posters x .05= $0.25
Total $3,015.98 food/supplies + $1,992.60 gas= $5,008.58

*For timeline covering grant funding period, see Appendix A.

 APPENDIX A
Timeline Covering Grant Funding Period**

Week: Plan Cost

Before Nutrition students’ orientation, taught $86.07

school by Registered Dietitian
year
begins-
August
2017

1 Lesson, Curriculum Pretest #1, $10.00 for printing

Behavioral Test #1, BMI Information
Gathered

2 Cooking Class $68.33 for Recipe + $5.00 for printing

3 Lesson No cost

4 Cooking Class $68.33 for Recipe + $5.00 for printing

5 Lesson No cost

6 Cooking Class $68.33 for Recipe + $5.00 for printing

7 Lesson No cost

8 Cooking Class $68.33 for Recipe + $5.00 for printing

9 Lesson No cost

10 Cooking Class $68.33 for Recipe + $5.00 for printing

11 Lesson No cost

12 Cooking Class, Curriculum Posttest $68.33 for Recipe + $5.00 for printing
#1

13 Lesson, Curriculum Pretest #2 $5.00 for printing

14 Cooking Class $68.33 for Recipe + $5.00 for printing

15 Lesson No cost

16 Cooking Class $68.33 for Recipe + $5.00 for printing

 17 Lesson No cost

18 Cooking Class $68.33 for Recipe + $5.00 for printing

19 Lesson, Behavioral Test #2 $5.00 for printing

20 Cooking Class $68.33 for Recipe + $5.00 for printing

21 Lesson No cost

22 Cooking Class $68.33 for Recipe + $5.00 for printing

23 Lesson No cost

24 Cooking Class, Curriculum Posttest $68.33 for Recipe + $5.00 for printing
#2

25 Lesson, Curriculum Pretest #3 $5.00 for printing

26 Cooking Class $68.33 for Recipe + $5.00 for printing

27 Lesson No cost

28 Cooking Class $68.33 for Recipe + $5.00 for printing

29 Lesson No cost

30 Cooking Class $68.33 for Recipe + $5.00 for printing

31 Lesson No cost

32 Cooking Class $68.33 for Recipe + $5.00 for printing

33 Lesson No cost

34 Cooking Class $68.33 for Recipe + $5.00 for printing

35 Lesson No cost

36 Cooking Class, Curriculum Posttest $68.33 for Recipe + $5.00 for printing
#3

August BMI Information Gathered, $5.00 for printing

2018 Behavioral Test #3
*Timeline subject to change based on academic school year calendar
 APPENDIX B
Recipes;
90 days cooking x 5 meals/groups per class= 450 meals (each group makes 1 plate)
1. Turkey Hotdog, Whole Wheat Bun, Side of Roasted Carrots w/seasoning & Watermelon
2. Toasted Ham & Cheese on Whole Wheat Bread, Side of Grilled Zucchini & Grapes
3. Pizza: Whole Wheat Pizza Crust Tomato Sauce, Cheese side of Apple

PRICES FOR EACH RECIPE

HOTDOG RECIPE GRILLED CHEESE RECIPE PIZZA RECIPE

Turkey Hotdog Ham Whole Wheat Pizza Crust

Jennie-o ​Turkey Franks with Oscar mayer turkey/ham Mama Mary’s Whole Wheat
Natural Smoke Flavoring (10 lunch meat (28 oz)​24 Individual Pizza Crusts (2
ct)​18 $6.98 x 2 =$13.96 ct)​30​ $3.48 x 13= $45.24
$1.24 x 3 =3.72

Whole Wheat Bun Cheese Tomato Sauce

Great value hot dog buns (8 Great value american cheese Kirkland Signature Tomato
ct)​19 (32 ct)​25 Sauce (12 ct)​31
$2.49 x 4 = 9.96 $4.48 $10.39

Carrots Whole Wheat Bread Cheese

80 oz grimmway carrots= Country pride split top wheat 2 x 24 oz bags mozzarella

$3.52​20 bread (24 oz 2 pk.)​26 cheese (48 oz)​32
.044 per oz x 100oz=$4.40 $3.73 $6.74 x 2= $13.48

Watermelon Zucchini Apple

$5.48 x 5 = $27.40​21 1 medium zucchini yields 1 Ambrosia apples (1 lb)​33

cup​27​ → need 2.5 medium $2.47 x 9lb=$22.23
zucchini/day →
13 x $1.38 = $17.94​28

Salt/Pepper Grapes

Morton Iodized Salt; $0.89​22 $2.48 x 8.3 lb​29​ = $20.58

Ground Black Pepper; $6.59​23
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32. Kraft Natural Cheese Shredded Mozzarella Cheese Family Size, 24.0 OZ. Walmart
Website.
https://www.walmart.com/ip/Kraft-Shredded-Mozzarella-Cheese-24-oz/52483956​.
Accessed May 7, 2017.
33. Ambrosia Apples. Walmart Website.
https://www.walmart.com/ip/Ambrosia-Apples-Bulk/44391093​. Accessed May 7, 2017.