Fit & Fun Families

For Providers

Resources for the prevention of childhood obesity

CIGNA HealthCare and the Healthy Kids Challenge have teamed up to set the standard for the way health professionals, schools, and families work together to battle the childhood obesity crisis.

The Healthy Kids Challenge is a nationally recognized, award-winning program that addresses child nutrition and physical activity issues. Healthy Kids Challenge offers a multi-level approach of assistance to schools, organizations and communities.

Obesity is now at epidemic proportions. According to the U.S. Surgeon General, without significant effort to alter this problem, today's youth will be the first to fail outlive their parents. Through its unprecedented collaboration with the Healthy Kids Challenge, CIGNA HealthCare has produced the Fit & Fun Families Provider Tool kit, an information breakthrough to equip physicians and health care professionals in guiding families back to health.

This kit focuses on seven healthy habit concepts. It includes a series of Family Tip Sheets and fun Kids Activity Pages that work in conjunction to develop the foundation for healthy eating and activity. Physician talking points assist in conveying these tested concepts to patients and families.

• "5-A-Day the Tasty Way!"
• "Snack Attack!"  | Display Template 1  | Display Template 2
• "Breakfast GO POWER"  | Display Template 3
• "Active Play EVERY Day"  | Display Template 4
• "Healthy Meals...Fast"
• "Discovering Smart Servings"  | Display Template 5  | Display Template 6  | Display Template 7
• "Drink Think"  | Display Template 8

Each tip sheet provides:

• Links to studies and materials that support the message.
• Ideas for "a healthy message in a minute."
• Suggestions for simple actions, taken by staff, to connect kids and families with the healthy message.

Templates for artwork provide role-modeling and social marketing ideas for the office environment. These simple ideas interject appeal and fun into getting everyone involved in healthy eating and physical activity behavior change!

Click on any of the PDF files and print off as many as you need for each of your patients. Use in the waiting room, as discussion points during counseling, or as part of a complete lifestyle program.

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For Parents

Welcome to the Family Introduction section of Fit & Fun Families. This information provides the link that ties your message as a health care professional to the parents who play such a vital role in helping kids make healthy choices.

Family Guidelines: Setting Up for Success will help families create a foundation for healthy change. Use the following two guides to set the structure that helps make healthy eating and physical activity choices a habit.

"First Steps for Healthy Habits" (PDF)

"Happy Healthy You and Me!" (PDF)

The Family Tip Sheets offer practical tips, ideas, and activities to help families and kids of all shapes and sizes build healthy habits. These tips correspond with the information provided in the Health Care Professionals materials, and the kids activity pages.

Seven messages help families and kids build healthy habits!

• 5-A-Day the Tasty Way! * (PDF)
• Snack Attack! * (PDF)
• Breakfast GO POWER * (PDF)
• Active Play EVERY Day
* (PDF)
• Healthy Meals...Fast * (PDF)
• Discovering Smart Servings * (PDF)
• Drink Think * (PDF)

Next (For Kids) >

For Kids

Welcome to the Kids Activity Page section of Fit & Fun Families. Here you'll find fun healthy message activities for kids!

For each of the seven healthy messages, there is an activity page written two different age levels for younger (3 to 6 year-olds) and older (7 to 10 year-old) kids. The activities are directly linked to the messages, ideas, and display artwork suggested on the Health Care Professional and FamilyTip Sheets.

When Kids Activity Pages, Health Care Professional Tip Sheets, and Family Tip Sheets are combined, there is effective repetition, reinforcement, and support for each healthy message. (Not to mention HEALTHY FUN!)

The Seven Healthy Messages are:

• 5-A-Day the Tasty Way!
• Snack Attack!
• Breakfast GO POWER
• Active Play EVERY Day
• Healthy Meals...Fast
• Discovering Smart Servings
• Drink Think

Next (Using the Kit) >

Using the Kit

The Fit & Fun Families Tool Kit

An easy-to-use tool kit designed to help families and kids of all shapes and sizes develop healthy habits.

How to Use the Tool Kit
This tool kit is intended to address the health habits of all kids and families.

The tool kit is designed as an obesity prevention tool that provides pro-active ideas for addressing the obesity crisis.

Although the purpose and intent of this tool kit is for prevention, qualified health professionals such as dietitians, physicians, or nurse practitioners may want to incorporate tip sheets, goal setting and display and activity ideas to make them a part of a separate obesity treatment plan.

Options for Using Tool Kit Content
Use the content in whatever way works best for your practice. Each Tip Sheet can stand alone to deliver a healthy message, so you may choose to make the Family Tip Sheets and Kids Activity Pages available with other information in the waiting area of your office.

For more effective outcomes, however, an integrated approach is suggested:

• In the waiting area or exam room, have a family member complete the Family Habit Inventory.
• Use the Family Habit Inventory to assess and discuss current family habits and readiness for change. The Family Habit Inventory asks questions that are directly linked to information provided on each Family Tip Sheet so that you can easily identify which Family Tips will be most helpful.
• Provide Family Tip Sheets and Kids Activity Pages as appropriate. Use ideas on the Health Care Professional Tip Sheets to reinforce the message.
• Follow-up by repeating the Family Habit Inventory at intervals you deem appropriate.
• Set-up a supportive office environment. Use ideas in the Health Care Professional Tip Sheets to reinforce the healthy messages. To create a strong emphasis on one healthy behavior at a time, alternate the use of suggested displays and interactive ideas throughout the year.

Get everyone involved and show families and kids that healthy choices CAN be appealing!

Tool Kit Content	Description
Tool Kit Overview	A page-at-a-glance view for how to connect 7 Healthy Messages to the Health Care Professional, Family, and Kids
Tool Kit Concepts, References and Additional Resources	Guidelines, concepts, references and additional resources used to support Tool Kit content
Family Habit Inventory	A Health Care Professional tool to assess a family's current habits, readiness for change, and educational needs

Tip Sheets	Description
Health Care Professional	7 Healthy Message Tip Sheets 8 Office Display Templates Provide easy to implement ideas for role modeling and a supportive office environment Use talking tips to reinforce messaging Identify studies and data that create cause for action Emphasize the importance of the provider leadership role
Families	2 guideline pieces to develop a supportive family structure Add structure to the home environment Encourage positive attitudes and concepts 7 Healthy Message Tip Sheets Create dialogue amongst families, kids, and health professionals Emphasize role modeling Connect healthy eating and physical activity Provide a means of goal setting and measuring progress Identify helpful resources
Younger Kids (3-6 year-olds)	7 Kids Activity Pages – Healthy messages presented in rhymes, riddles, drawings, colorings, or active play ideas
Older Kids (7-10 year-olds)	7 Kids Activity Pages – Ideas for exploring healthy choices and goal setting

Next (Background Info) >

Background Info

The foundation of this toolkit is built on guidelines recommended in the AMERICAN ACADEMY OF PEDIATRICS, POLICY STATEMENT: Prevention of Pediatric Overweight and Obesity, 2003 (2)

• Families should be educated and empowered through anticipatory guidance to recognize the impact they have on their children's development of lifelong habits of physical activity and nutritious eating.
• Dietary practices should be fostered that encourage moderation rather than over consumption, emphasizing healthful choices rather than restrictive eating patterns.
• Regular physical activity should be consciously promoted, prioritized, and protected within families, schools, and communities.
• Optimal approaches to prevention need to combine dietary and physical activity interventions.

Rationale for the Seven Healthy Messages

5-A-Day the Tasty Way – Snack Attack – Breakfast GO POWER – Active Play EVERY DAY – Healthy Meals…Fast – Discovering Smart Servings – Drink Think

A sampling of studies and references that demonstrate the need for messages is provided on each of the seven Health Care Professional Tip Sheets. Additional supporting studies and references (identified by subject below) include:

Prevention Programs: Centers for Disease Control recommends targeting specific health habits: "To make the best use of scarce resources for prevention, public health agencies attempting to prevent chronic disease should use strategies that focus on highly prevalent risk factors that are modifiable through behavior change. Following are four behavior change strategies that meet this criterion. Each strategy can target one or more Healthy People 2010 objectives.

• Promote increases in physical activity. Exercise provides numerous health benefits and should be promoted to the most sedentary subgroups of the population.
• Promote breastfeeding. Breastfed children have less risk for acute diseases of infancy and early childhood and a reduced risk of developing childhood obesity.
• Increase fruit and vegetable consumption. Higher consumption of fruits and vegetables is associated with lower incidence of several chronic diseases, including cardiovascular disease and some cancers.
• Reduce television-viewing time. A reduction in the length of time that children and adolescents watch television may reduce the risk for obesity among young people."

CDC: Promoting Healthy Eating and Physical activity for a Healthier Nation; Promising Practices in Chronic Disease Prevention and Control: A Public Health Framework for Action, accessed 2/22/05
http://www.cdc.gov/nccdphp/promising_practices/promoting_health/opportunities.htm

Overall Health Behavior Goals: The Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). Dietary Guidelines for Americans 2005, accessed 2/22/05
www.healthierus.gov/dietaryguidelines/index.html

National Center for Chronic Disease and Health Promotion. Nutrition and Physical Activity: Are there recommendations for young people? Accessed 2/22/05
http://www.cdc.gov/nccdphp/dnpa/physical/recommendations/ young.htm

5-A-Day: Limited data exist on the fruit and vegetable consumption of preschoolers and children. In other age categories, only 20.4% 18-24 year-olds and 19.7% of 25-34 year-olds eat 5+ servings of fruits and vegetables per day (Centers for Disease Control, Behavior Risk Factor Surveillance System, 2003).

Snacks and TV Viewing: Serving snacks to children while they are engaged in other activities such as watching television is associated with increased intake of high energy, low nutrient foods which may lead to unconscious overeating and unwanted weight gain. (Coon, K.A., J. Goldberg, B.L. Rogers, et al. Relationships between use of television during meals and children's food consumption patterns, Pediatrics 107: E7, 2001)

Breakfast: "Breakfast: Waking Up to a Healthy Start" September 1998 Archives of Pediatric and Adolescent Medicine, Massachusetts General Hospital

• Children who increase their participation in school breakfast programs tend to show improvement on a wide range of measures of social and academic functioning.
• Increased school breakfast participation correlated with less tardiness and absence, higher math grades, and reductions in problems like depression, anxiety and hyperactivity.

Active Play: Overall, 26% of US children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). Boys and girls who watch 4 or more hours of television each day had greater body fat (P .001) and had a greater body mass index (P .001) than those who watched less than 2 hours per day. National Health and Nutrition Examination Survey III

A study of individuals aged 15 and older without physical limitations found that the average annual direct medical costs were $1,019 for those who are regularly physically active and $1,349 for those who reported being inactive. "Higher Direct Medical Costs Associated With Physical Inactivity." The Physician and Sportsmedicine 28(10). Oct 2000

Fast Meals at Home vs. Fast Food: Eating at Fast-food Restaurants More than Twice Per Week is Associated with More Weight Gain and Insulin Resistance in Otherwise Healthy Young Adults. National Heart, Blood, and Lung Institute Press Release, Thursday, December 30, 2004, accessed 2/22/05
http://www.nih.gov/news/pr/dec2004/nhlbi-30.htm

Food Portions and Body Weight: McConahy KL, Smiciklas-Wright H, Birch LL, Mitchell DC, Picciano MF. Food portions are positively related to energy intake and body weight in early childhood. J Pediatr 2002;140:340-347.

Beverage Consumption: Frequent beverage and snack consumption are likely contributors to the increasing obesity epidemic. Energy density and beverage consumption in American Adults 1999-2001. Nielsen, S., and B. Popkin. Obesity Research. 719-P, 12(supplement): A183, 2004

Concepts and Guidelines Used in Message Development

Division of Responsibility in Feeding: Parents are responsible for what is presented to eat and the manner in which it is presented. Children are responsible for how much and even whether they eat. (3)

Eating Preferences: Children's food preferences are learned through repeated exposure to foods. With a minimum of eight to 10 exposures to a food, children will develop an increased preference for that food. (4)

Hunger Cues: When parents assume control of meal size or coerce children to eat rather than allowing them to focus on their internal cues of hunger, children's ability to regulate meal size in response to energy density is diminished. (4)

All Foods Fit: It is the position of the American Dietetic Association that all foods can fit into a healthful eating style. The ADA strives to communicate healthful eating messages to the public that emphasize the total diet, or overall pattern of food eaten, rather than any one food or meal. If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. (5)

Moderation, appropriate portion size, balance and dietary adequacy are fundamental and interrelated principles that can be used as indicators of whether and how the typical food pattern of a person or group may be improved. (5)

Television Viewing: The American Academy of Pediatrics recommends: Limit children's total media time (with entertainment media) to no more than 1 to 2 hours of quality programming per day. (6)

Focus on Healthy Choices Instead of Weight. The Society for Nutrition Education (SNE) recognizes that obesity, eating disorders, hazardous weight loss, nutrient deficiencies, size discrimination, and body hatred are all interrelated and need to be addressed in comprehensive ways that do no harm. SNE recommends: A comprehensive, successful program will focus on promoting and supporting healthy lifestyles for all children at home, in school, and in the community as integral to the well being of children of all sizes. It will develop and implement activities that a) create a nurturing environment, b) provide education on healthful eating, and c) promote and support opportunities for enjoyable physical activity. (7)

Behavior Change Strategies Used in Tip Sheet Development

The tool kit combines key messages with behavioral strategies that help enhance self-efficacy and self-esteem in children. Activities help children develop confidence that they can successfully change their eating and physical activity patterns. The Health Care Professional and Family Tip Sheets help educate parents and other caregivers on mealtime behaviors that promote the adoption of healthier eating behaviors early in life. (4)

The artwork templates and ideas suggested on the Health Care Professional's Tip Sheets create a "social marketing" approach, a behaviorally focused process that adapts commercial marketing technologies to programs designed to influence the behavior of target audiences to improve their well-being. (5)

Kids Activity pages help develop appeal for making healthy choices by engaging kids in play. When possible, there is a connection made between healthy eating choices and physical activity. (8, 9)

1. Institute of Medicine of the National Academies. Preventing Childhood Obesity: Health in the Balance, 2005. accessed 2/22/05 www.iom.edu
2. POLICY STATEMENT: American Academy of Pediatrics: Prevention of Pediatric Overweight and Obesity, PEDIATRICS Vol. 112 No. 2 August 2003, pp. 424-430
3. Satter, Ellyn, R.D., A.C.S.W., "Child of Mine: Feeding with Love and Good Sense, ", Bull Publishing Company, Palo Alto California, 2000
4. Position Paper: Dietary guidance for healthy children aged 2 to 11 years, J Am Diet Assoc. 2004; 104:660-677.
5. Position Paper: Total Diet Approach to Communicating Food and Nutrition Information ,J Am Diet Assoc 2002;102:100
6. POLICY STATEMENT: American Academy of Pediatrics: Children, Adolescents, and Television, PEDIATRICS Vol. 107 No. 2 February 2001, pp. 423-426.
7. Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Cholumn 142 - Warning: trimming empty

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8. Matheson D., Spranger K., & Saxe A., Preschool children's perceptions of food and their food experiences. Journal of Nutrition Educ Behav, 34, 85-92, 2002.
9. Roths B, Fees BS, Bailey G, Fitzgerald, K Let's Move, Learn, and Have Fun!, J Nutr Educ Behav,34:343-344, 2002

Additional Suggested Resources to Enhance the Office Environment

Videos and Kids' Books Appropriate for the Patient Waiting Area:

Wellness Incorporated, The OrganWise^™ Guys Wellness Education Materials

The OrganWise^™ Guys characters – Hardy Heart, Calci M. Bone, the Kidney Brothers, etc. – are ideal vehicles for communicating health issues, inciting behavior change, and enlivening the education process for any age group.
Web Site: www.organwiseguys.com
E-mail: organwise@aol.com
Phone: 1-800-786-1730
Mailing Address: 3838 Song River Circle
Duluth, Georgia 30097

Ideas for Literature that Links to Nutrition

Michigan TEAM Nutrition has developed a downloadable pdf file with a listing of over 300 books for kids about healthy eating and physical activity – Preschool through 3rd grade
tn.fcs.msue.msu.edu/booklist.html

Posters or Display Materials for Purchase

Produce for Better Health Foundation 5-A-Day Catalog
Posters, teaching aids, brochures and more

Web Site: www.shop5aday.org
Phone: 1-888-391-2100

Mailing Address:
Produce for Better Health Foundation, Catalog Sales
5341 Limestone Rd., Wilmington, DE 19808

NASCO

Posters, food models and other teaching aids
Web Site: www.eNASCO.com
E-mail: info@eNASCO.com
Phone: 1-800-558-9595
FAX: 1-920-563-8296
Mailing Address: 901 Janesville Ave
Fort Atkinson, Wisconsin 53538

NCES
Teaching aids

Web Site: www.ncescatalog.com
Phone: 1-877-623-7266
FAX: 1-800-251-9349
Mailing Address: 1904 East 123rd Street
Olathe, Kansas 66061-5886

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