Nutrition in Health

Promotion
DR.MASHAEL HUWAIKEM
APR 26TH , 2023
 What is health education?

Health
(Health) education – the process of assisting individuals,
acting separately or collectively to make informed
decisions about matters affecting their personal health

Education
and that of others (National Task Force on the Preparation
and Practice of Health Educators, 1985).

Today, health education is delivered in almost every

conceivable setting.
Nutrition Education

What is (nutrition) education?

“Any combination of educational strategies, accompanied by

environmental supports, designed to facilitate the voluntary adoption
of food choices and other food and nutrition related behaviors
conducive to health and well-being” ~ Contento, 2011
 Our health
needs
Why is improvement
Nutrition
Education Dietary and
Needed? physical activity
patterns are not
optimal
Obesity Trends* Among U.S. Adults
BRFSS 1990, 1999, and 2008
1990 1999

2008

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

(*BMI ³30, or about 30 lbs. overweight for a 5’4” person)

http://www.floridacharts.com/Charts/documents/Healthiest_Weight_State_Profile_FINAL.pdf

Miami-Dade County Charts: http://www.floridacharts.com/charts/HealthiestWeightProfile.aspx?county=13&profileyear=2012&tn=31

High Costs
u Obesity
u Link between excess body weight and type

of Chronic 2 diabetes; cancers of the breast,

endometrium, ovaries, colon, rectum, and
kidneys; hypertension; coronary artery
Disease disease; stroke; asthma; gallbladder disease;
and osteoarthritis
u Cost: $147 billion per year
u 1 in 10 modifiable deaths are attributed to
overweight/obesity
u For a 1% decline from anticipated obesity
trajectories, obesity-related medical costs
would drop by $84.9 billion by 2030
High Costs of Chronic Disease

u Cardiovascular and Cerebrovascular

Disease
u Leading cause of death in the United
States
u Cost: $297.7 billion in 2008
u More than any other disease

u <1% of US adults have a diet

considered ideal when compared
with the American Heart Association
2020 goals
High Costs of Chronic Disease

u Diabetes Mellitus
u More than 18 million US adults (8%)
were diagnosed with diabetes in
2008, and diabetes prevalence is
projected to reach 33% by 2050.
u Being seen more frequently in
children
u Based on the 2005-2006 National
Health and Nutrition Examination
Survey data, approximately 40% of
those with diabetes were
undiagnosed cases
High Costs of Chronic Disease
u Cancer u Osteoporosis

u Incidence rates have decreased u Prevalence is estimated at 8%

from 2000 to 2010 among US women 20 years of age
and older
u Obesity/overweight is implicated
in 14% of cancer deaths in men u Prevention of fractures is strongly
and 20% of cancer deaths in related to calcium and vitamin D
women intake as well as regular weight
bearing exercises
Healthy People 2020

Serve as a guiding framework for improving health outcomes

Goals:
1. Attain high quality, longer lives free of preventable disease, disability, injury,
and premature death
2. Achieve health equity, eliminate disparities, and improve the health of all
groups
3. Create social and physical environments that promote good health for all
4. Promote quality of life, healthy development, and healthy behaviors across all
life stages
http://www.healthypeople.gov/2020/default.aspx
Are you
on a diet?
DIET: THE FOOD AND BEVERAGES A
PERSON EATS OR DRINKS
Meet Fred

u Fred is a 25 year old graduate student. Fred is hungry for lunch.

What types of things might affect what he chooses to eat for lunch?
 Choices are highly personal
What affect
u
u Social or behavioral motives

Food u Many choices:

u 1928 – 900 items in grocery stores

Choices? u 1980 – 12,000 food items in grocery stores

taken from a supply of 60,000 items
u Personal preference
u Taste
u Sweet and salty
u Genetics
u Habit
u Ethnic Heritage or Tradition
Food Choices

u Social interactions
u Availability, convenience, and economy
u Benefits of home-cooked meals
u Positive and negative associations
u Emotions
u Boredom, depression, anxiety
u Stress
Food Choices

u Values
u Religious beliefs, political views,
environmental concerns
u Body weight and image
u Nutrition and health benefits
u Functional foods – foods that
contain bioactive components
that provide health benefits
beyond their nutrient contributions
u Example: Orange juice fortified
with calcium
 Social/environmental
Person-related factors
Physical/food
determinants environment
Intraperson •Food availability
Experience with food factors •Built environment
Associative conditioning •Perceptions Social
Physiological •Attitudes environment
Biologically conditioning •Beliefs •Social relations
determined •Motivations and •Cultural practices
behavioral •Familiarity: values
learned safety •Social structures
predispositions •Personal
meanings •Public policy
•Conditioned food
•Taste/pleasure preferences •Knowledge
•Sweet, sour, salt2, bitter • Food Neophobia and skills
•Hunger/satiety mechanisms Economic
•Social norms environment
•Sensory specific satiety •Conditioned satiety •Cultural
Social conditioning •Resources
norms
•Social affective •Price
Interperson •Time
context (Modeling)
factors
•Parenting Practices
•Family & social
(pressure/restriction) Informational
networks environment
•Food as Reward •Advertising
•Media
FOOD CHOICE AND
DIET-RELATED
BEHAVIORS
Sensory-affective Beliefs, attitudes, Social environmental
factors norms, and skills influences
 Why Nutrition Education
Is Exciting and Challenging
What people want What professionals
Tasty foods recommend
Familiar More fruits and vegetables
Easy (to buy, prepare, and eat) More whole and less-processed grains
Good value for money (cheap) Variety
Healthy Less fat, sugar, sodium
Balance food intake and physical activity

What the food

system supplies
All the basic foods in abundance
Fast foods high in fat, sugar, and salt
Sweetened beverages
Remember: Although many Americans say
Large portions their diets need improvement, they also
Low prices indicate that they are knowledgeable
about nutrition and are just unable to
change or are uninterested in changing.
Implications for Nutrition Education

Role of nutrition education is to address:

u Food-related determinants: preferences and sensory-affective
factors
u Person-related factors: perception, attitudes, beliefs, meanings,
social norms, etc.

u Environmental determinants: availability, accessibility,

economic environment, time
How Nutrition
Education as
Translational Practice
u Nutrition education can be
viewed as translational
practice and nutrition education
research as translational
research because nutrition
education translates findings from
nutritional science into guidelines
and messages to alter behavior.
Implications
for Nutrition
Education
When Is Nutrition Education
Effective?
Reviews show that nutrition education can be a significant factor in
improving dietary practices when behavior change is set as a goal
and the educational strategies used are based on theory and
appropriate to the goal.

- Whitehead, 1970; Johnson & Johnson, 1985; Contento et

al., 1995; Lytle & Achterberg, 1995; Ammerman et al., 2001;
Pomerleau 2005, Howerton, 2007.
 Compares the economic
benefits of a nutrition
education program for
participants to the actual
costs of delivering a program

Cost-Benefit
May prevent tens of
thousands of cases of heart
disease
A national study by the USDA

Analysis
found that educational
interventions to encourage
Americans to improve their
diets:
Save between $4 billion and
$12 billion in health care
expenditures and lost earnings
over 10 years
 Communities

Nutrition
u

u Women, Infants, and Children (WIC) programs

u Expanded Food and Nutrition Education Program (EFNEP)

Education u designed to assist limited-resource audiences in

acquiring the knowledge, skills, attitudes, and
changed behavior necessary for nutritionally sound

Settings
diets
u http://www.nifa.usda.gov/nea/food/efnep/about.ht
ml
u Supplemental Nutrition Assistance Program Education
(SNAP-Ed)
u The goal of SNAP-Ed is to improve the likelihood that
persons eligible for SNAP will make healthy food
choices within a limited budget and choose
physically active lifestyles consistent with the current
Dietary Guidelines for Americans and MyPlate.
u http://www.fns.usda.gov/snap/supplemental-
nutrition-assistance-program-snap
u Head Start program
 Nutrition
Emergency food organizations
Education
Farm-to-institution programs
Settings
Schools

Workplaces

Healthcare settings
Overlapping
Roles of
Nutrition
Education
Competenci
es and Skills 1 2 3
for Nutrition Food and nutrition
content: nutrition
science, food
Eating behavior:
understanding food
choice and food
Behavior and
educational theory:
apply learning

Education
science, and clinical system impacts. theory, instructional
nutrition. theory and behavior
change theories.

Specialists
 Research methods and program
evaluation: Design methods to
conduct research and program
Research evaluations. ( I want to see what
Competencies people had done to make it
successful)

and Skills for

Nutrition
Education Design and delivery of nutrition
Specialists Design
education:
•Design nutrition education programs, curricula,
and materials;
•Deliver programs;
•Implement and administer programs.
SNE is an international organization of nutrition education professionals who are
dedicated to promoting effective nutrition education and communication to support
and improve healthful behaviors with a vision of healthy communities through nutrition
education and advocacy.
http://www.sneb.org/
Additional Resources

Identifying and evidence based interventions:

Cochrane Collaboration www.cochrane.org

CDC’s Guide to Community

www.thecommunityguide.org
Preventive Services
Questions ?