Community Needs Assessment:

Overweight and Obesity

March 15, 2017

Prepared by Kristina Markovic, Queens College Dietetic Intern 1

 Table of Contents

Overview, Government...3
Facilities...4
Nutrition Assessment..5
Food/Nutrition-Related History....5
Food and Nutrient Intake.....5
Knowledge, Beliefs, and Attitudes.......7
Behavior..7
Factors Affecting Access To Food and Nutrition-related Supplies..8
Physical Activity and Function..9
Anthropometric Measurements...10
Biochemical Data, Medical Tests And Procedures....10
Nutrition Focused Physical Findings..8
Client History...11
Personal History...11
Social History.13
Nutrition Diagnosis....13
Nutrition Intervention.....14
Nutrition Monitoring and Evaluation.....18
Appendices
Appendix A......19
Appendix B......20
Appendix C......21
Appendix D......22
Appendix E...23
Appendix F......24
References.......25

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 Overview

is one school within the organization, located in the

Highbridge section of Bronx, NY. is dedicated to protecting, empowering,

and promoting independence for at-risk children and families and those with

developmental disabilities through quality community based services.

has 198 students currently enrolled in its pre-kindergaden and kindergarden

programs and accepts students aged 2-5 years old. The majority of childrens

families were born in the Dominican Republic, the United States, or Mexico. The

need for this assessment arose from the health statistics in the school, in which

38% of students were either overweight or obese.

Government

is located within State Assembly 84, State Senate 29, City Counsel

16, Congressional District 15, Community District 4, Zone R7-1, and Precinct 44

in the Bronx (NYC Planning).

State Assembly District 84 is represented by Assemblywoman Carmen E.

Arroyo who has co-sponsored legislation to increase minimum wage and paid

maternity leave (Assembly NY). State Senate District 29 is represented by Jos M.

Serrano, who has supported legislation to have recyclable trash collected within

New York City parks, and increasing funding for New York City parks (Assembly

NY). City Counsel District 16 is represented by Vanessa L. Gibson, who has

supported housing legislation (Council NYC). Congressional District 15 is

represented by Congrassman Jos E. Serrano who has co-sponsored legislation to

increase mental health accessibility, universal healthcare (Council NYC).

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 The District 4 chair is Kathleen Saunders and primary means of contact is

through email: bx04@cb.nyc.gov or telephone: 718-299-0800. District 4 general

board meetings occur every fourth Tuesday of the month, at 6:00pm.

Additionally, the Health and Human Services meeting occurs every second

Monday of the month (NYC.gov).

According to the 2016 District Needs Statement, District 4 indicated the need

for a new school and community center; increase in affordable housing; a

request for a new community park within newly vacated land; a greenway along

the Harlem river- complete with bike paths, seasonal programming; funding for

summer youth employement; and health issues. According to the District Needs

Statement, Health Risks section (which can be viewed in Appendix A) less than

94% of District 4 residents eat 5 or more fruits or vegetable per day. 25% have

not exercised in the past month, 32% are overweight, 33% are obese, and 22%

do not have health insurance. Additionally, this data notes notes severe health

problems within the district including: 14% of residents who have Diabetes, 33%

have Hypertension, 29% have high cholesterol, and 17% have Asthma.

Facilites

According to The Selected Facilities and Program Sites, as of 2015,

Community District 4 had eight gardens. None of these gardens had internet

presence, or clearly noted fees to participate in the garden. Pictures of a few of

these gardens can be found in Appendix B. There are four long-term care

facilities and only one hospital in Community District 4, but there are 14 hospital

extension clinics. There are 16 mental health services and 11 developmental

disability services. There are 12 homeless facilities and 16 soup kitchens/food

pantries within the district.

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 Nutrition Assessment

Food/Nutrition-Related History (FH)

Food and Nutrient Intake (1)

In terms of dietary guidance, the Organizacin de

Panamericana de la Salud of the Dominican Republic

released The Piln De La Alimentacin y Nutricin,

which is similar to MyPlate. The Piln is a mortar and

pestle, which is the basis of the dietary guidance of the

country (see right). A zoomed-in version can be found in

Appendix C. The mortars base indicates that this dietary

guideline is for children over 2 years old (the second and third children in the

picture). The following components in ascending order, show pictures of: water,

grains (which the organization stated should be the main source of energy),

beans and legumes, complex carbohydrates, fruits and vegetables, and

complete proteins. The pestle includes: sugar, salt, and fats.

Similarly, Mexico has El Plato de Bien

Comer from Contacyt which resembles

MyPlate more closely. El Plato de Bien Comer

stemmed from Mexicos desire to combat

overweight and obesity in the country (Guas

Alimentarias, 2014). The guideline includes

grains, fruits and vegetables, and proteins

(legumes and animal based). It may be more beneficial to structure lesson plans

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for Sacred Heart families based on the familiar foods listed in the dietary

guidelines of each country.

Food Intake (1.2.2). The Healthy People 2020 objectives for children aged 2

and older include: an increase in fruit and vegetable, whole grain, and calcium

intake; and a decrease in saturated and solid fats and added sugar (Brown,

2010).

According to the 2005-2010 NHANES, school aged children within the United

States had high intakes of: grains, dairy, protein and low intakes for: certain

vegetables. Within New York City Child-Care Centers, children have high intakes

of: dairy and fruits/fruit juices and low intakes of: grains, protein, vegetables,

and oils (Dixon, Breck, Khan, 2016).

The highest reported intakes of food children eat in is dairy,

followed by protein, fruits and vegetables, and grains. Childrens lowest intake is

sweets and oils. The full chart can be seen below:

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Knowledge, Beliefs, and Attitudes (4)

Food and Nutrition Knowledge/Skill (4.1). According to the Global

Nutrition Report, 2015 Nutrition Country Profile for the

Dominican Republic, 8% of children under 5 years old

were overweight in 2013

(see right). As of 2014, 9.4% of children aged 2-5

were obese (CDC) According to the 2013-2014

NHANES, ~10% of respondants had a health

professional tell them their child (aged 0-15 years) was overweight. According to

the Global Nutrition Report, 2015 Nutrition Country Profile for Mexico, 9% of

children are overweight (see left).

Beliefs and Attitudes (4.2). According to the Pew Hispanic Center, Latinos

born outside of the United States are less likely to have a health care provider.

The majority of Latinos believe in obtaining health care from medical

professionals, but some believe in Curanderismo which relies on a combination of

the patients faith along with use of herbs, fruits, eggs, and oils as healing tools

(Gurung, 2013). Unfortunately, if unlikely to seek help by a medical doctor, it

seems unlikely that they will seek out hep by an RD.

Behavior (5)

Mealtime Behavior (5.4). In terms of limited food acceptance, four children

within do not eat pork for either religious or personal preference. Seven

children have allergies or lactose intolerance. Three children were described as

picky eaters.

In the study by Weisberg-Shapiro and Devine (2015), food routines for

Dominican women oftentimes involve daily shopping for the meals of the day

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due to frequent electricity blackouts and unreliable refrigeration, along with lack

of money. Lunch is the main meal of the day which generally includes rice, with a

protein and a salad. Breakfast is also a larger meal than dinner in many

Dominican households (Weisberg-Shapiro and Devine, 2015).

Traditionally in Mexico, familes eat four to five meals per day but after

acculturation into the United States, many eat three meals per day (Ohio State

University). Similarly to practices within the Dominican Republic, lunch is the

main meal of the day, and dinner is the smallest meal of the day. Lunch typically

consists of a meat dish, along with rice, tortillas, coffee, and dessert (Ohio State

University).

Factors Affecting Access To Food And Nutrition-Related Supplies (6)

Food/Nutrition Program Participation (6.1). As of 2015, 16.6% of

households with children under eighteen are food insecure in the United States;

a similar percentage was found for New York state (ERS).

According to the USDA, as of 2016, 50,807,872 people in the United States

participate in either the Supplemental Nutrition Assistance Program (SNAP) or

Women, Infants, and Children (WIC).

In New York, SNAP and WIC had a total of 3,393,411 participants in 2016

(USDA).

In , only forty three parents (21.7%) had received either WIC or

SNAP, despite one hundred eighty one parents (91%) meeting baseline eligibility

levels for SNAP. Unfortunately, not all childrens charts were complete in terms

of food assistance, so this number is not an updated one.

Safe food/meal availability (6.2). Within walking distance ( mile)

of , there are seventeen restaurants which mainly serve protein,

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specifically chicken and beef (Google Maps). Of these seventeen restaurants, six

are classified as fast food. There are eleven supermarkets within walking

distance of Sacred Heart. The closest supermarket, Pioneer, had only five fruit

and/or vegetable deals on the first page of its weekly ad (week of

02/26/2017-03/04/2017) along with ten protein products, five refined grain

products, one water and one juice product. The remainder of fruit and vegetable

deals were displayed on the last page of the weekly ad. The weekly ad can be

found on their website (pioneersupermarkets.com).

Physical Activity and Function (7)

Physical activity (7.3). A

pre-school aged child should have at

least sixty minutes of physical

activity per day (Brown, 2010).

78.4% of children in the United

States are not meeting this guideline

(Katzmarzyk, et al., 2016). According

to a study ~70% of the 486 children did not participate in any organized

recreational activities and average time in gym class was one hour per week.

46.7% of children in the study had more than two hours of screen time per day.

Physical activity data within was not available but data on mode of

transportation was. Families were more likely to take public transportation or

drive than walk, reducing the amount of physical activity the child participates

in.

Factors affecting access to physical activity (7.4). The Walk Score of

zipcode 10452 is 94/100, meaning most daily errands can be walked to

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 Nutrition Diagnosis

PES Statement

1. Overweight and Obesity (NC-3.3) related to excessive energy intake as

evidenced by BMI in the 85th to more than the 95th percentile.

2. Food and Nutrition Related Knowledge Deficit (NB-1.1) related to parents

unsupported beliefs/attitudes about food, nutrition, and nutrition-related

topics as evidenced by the Nutrition Assessments in childrens charts as well

as Nutrition Consultations.

Nutrition Intervention

Nutrition Prescription (NP-1.1): Encouraged through nutrition education and

counseling.

Recommended general, healthful diet

Recommended food intake: Increase fruit and vegetable intake to five

servings of fruits and vegetables per day.

Nutrition Education- Content (1): Through the use of workshops and

presentations by Interns and Nutrition Team.

Nutrition relationship to health/disease (E-1.4)

Physical activity guidance (E-1.8)

Nutrition Counseling (C):

Goal Setting (C-2.2): Related to cooking at home, cooking more healthful

foods, increasing intake of healthful foods, increasing physical activity

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 Stress Management (C-2.6): Tools given to both parents and children in

regards to stress management techniques. Can be done during nutrition

education, or preferably, nutrition counseling. The purpose of stress

management in Sacred Heart will be to give parents an increased ability

to prepare and eat healthy foods with their children.

Healthy People 2020 Objectives

Reduce the proportion of children aged 2 to 5 years who are considered

obese (NWS-10.1): Through nutrition education and counseling at the

site, obesity and overweight statistics will decrease due to parent

compliance of the nutrition prescription of a general healthful diet and

an increase in fruit and vegetable intake.

Increase the contribution of fruits to the diets of the population aged 2

years and older (NWS-14): Through nutrition prescription listed above,

fruit and vegetable intake in children of Sacred Heart will increase.

Lesson Plan

A workshop series of nine presentations will be provided to parents

within , twice per month. The focus of the lesson plans will be healthful

eating (including fruit and vegetable intake, various recipes, concentration on

different diet components, etc.), picky eating, applying for SNAP, etc. All

presentations will be interactive and encourage parents to participate through

conversation. The presentations will also provide social support between

parents. All lesson plans will include components of previous lesson plans along

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with checking in with parents on their success with incorporating previous

topics into their daily lives. The objective of each lesson plan is for parents to

incorporate one component of the presentation into their daily life. All lesson

plans will consist of one handout, a powerpoint presentation, and props. All

handouts will be in English and Spanish and all presenters will present in English

and Spanish or have a Spanish translator.

1. Healthy Eating with MyPlate: This lesson plan will focus on MyPlate

and the various components of it, with a concentration of substitutions similar to

those that parents currently make for their family. It will also include portion

size component using hands as indicators. As a introductory lesson plan, plenty

of time will be included for questions and introductions. It will also include a

pre-test on general healthful diet components in families daily lives.

2. Childhood Overweight and Obesity: This lesson plan will discuss the

effects of overweight and obese status on children, as well as build on MyPlate

topics from the previous lesson plan. At the end of the previous lesson, parents

will have been asked to write out a healthy dinner they had with their family in

the last week using a MyPlate blank handout. These will be posted onto an easle

and brought in for the remainder of the workshop series. Physical activity will be

touched upon during this presentation as well. The lesson plan, handout, and

powerpoint presentation slides are available to view in Appendix D-F.

3. Sugar and Salt: This lesson plan will focus on the effects of sugar and

salt on a childs body and substitutes in cooking.

4. SNAP, How to Make it Work for Your Family: This lesson plan will

focus on steps to apply for SNAP, as well as how to shop on SNAP. This lesson

plan will also feature buying healthy foods on a budget.

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 5. Help! My Child is a Picky Eater: This lesson plan will focus on parents

who are worried about their childs picky eating. Interns and staff will provide

parents with tips on how to combat picky eating such as plate decoration.

6. Cooking in No Time: This lesson plan will focus on cooking in a rush

and will include how to include children in cooking.

7. Physically Active Families: This lesson plan will focus on making

children and their families more physically active. It will include dancing clips

that can be danced to in class.

8. Healthy Desserts: Because dessert is such a large focus in both

Dominican and Mexican culture, a lesson plan will be devoted on healthy

desserts.

9. Potluck: This final lesson will be a potluck from various cultures using

tips learned from the lesson plans. This lesson plan will also include a post test,

which will be a replica of the pre-test along with a comment section on how to

make the workshop series better.

Marketing

Product. Fliers will be made by interns or nutrition team staff to entice

parents to join the workshop series. Emphasis will be placed on healthy eating

and picky eating as these are hot topics for parents at the site. Emphasis will

also be placed on the potluck at the end of the workshop series.

Place. Placement of fliers for the workshop series will be given to teachers to

distribute to parents as well as placed in areas within with high levels of

foot traffic such as the parent room, the main office, and outside of classrooms.

Price. Emphasis on the fliers will include that the workshop series is free but

reservations need to be made.

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 Promotion. The main promotion will be the fliers given to parents and

posted around the site. The workshop series can also be promoted on social

media or on the schools website. Phone calls will also be placed to parents who

did not RSVP for the series up to a week before the first presentation.

Resources

Resources include: access to a laptop and projector, handouts that can be printed

on site, and materials for the parfait recipe. When this lesson plan was conducted

on February 28, 2017 by Kristina Markovic, the total cost was $24.85 for the

recipe materials (yogurt, granola, fruit, cups, and spoons) and $1.85 to print all

handouts from home (Costco).

Nutrition Monitoring and Evaluation

A pre and post test will be included in the workshop series in order for staff

to judge the success of the series and evaluate the participants understanding of

each component of the series. The pre-test will be given to parents to complete

on the day of the first lesson plan, and the post-test will be given to parents on

the last day of the series along with a section for comments.

Verbal Q&A will be utilized throughout the workshop series as a means of

evaluating participants knowledge and application of the series topics.

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