CHEO’s Centre for Healthy Active Living

The following is a formula we have for the families in our program. The formula contains important actions for a family to take together that can greatly help lay the foundation to a healthy lifestyle.

Formula for a start to Healthy Living

  1. Limit eating restaurant food to 1x/week
  1. Eat 3 meals per day – don’t skip meals!
  1. TV videogames, cell phones off during meals and snacks
  1. Eat in kitchen or dining room at table
  1. Limit sweetened beverages/fruit juice to 1 cup/day
  1. Limit screen time (TV, computer, videogame, ipod/cell phone) to 2 h per day
  1. Ensure teen is getting 9-10 h sleep per night

Motivating your patient to eat healthier everyday!

The media and research consistently bombards us with information about how to combat obesity. As an expert in the area of nutrition I understand that this can be very confusing for our pediatric population.

To improve the health of children it is important to take a family centered approach when making our recommendations.

Step 1: Ask and Listen

  1. Explore their day to day schedule with regards to what their usual intake is like. This should also be assessed for those who live in the household to gain a greater understanding of the dynamic of food and nutrition from the family perspective. These are the questions that are explored:
  • What types of food are they currently eating?
  • How much are they eating?
  • When are they eating?
  • Are they skipping meals?
  • Where are they eating?
  • Who are they eating with?
  • Why are they eating?
  • Who cooks at home?
  • Who puts lunches together?
  • Who plates the food?
  • Are there desserts in the house?
  • Is any food locked or hidden up in order to prevent certain people from eating it?

Exploring the ‘why’ behind many of these questions is also useful for determining obstacles

  1. What are your patient’s and family’s beliefs about food and nutrition? If your patient doesn’t fully understand how food and nutrition might positively impact their life, why would they be motivated to make any changes?
  • The goal is not necessarily weight loss or dieting, rather choosing healthier options as a way of life. Research indicates that dieting does not work and that it can cause increased weight gain once their habits revert back to their initial state. The goal is to make realistic and healthier changes that will stay with them for life. This is a great opportunity to clarify messages that they have heard in the media.
  • Food restriction is not recommended There may be religious or cultural reasons for this, however, most of the time many people listen to media. It is important to ‘debunk’ the myths that are associated with certain types of food and nutrition claims that are not evidence based.
  • Reading Food Labels may help people choose healthier choices. Many people are not educated on how to properly read food labels. It is important to clarify with the % Daily Value means and how to read what a serving is along with clarifying other questions that they may have.
  • Food provides nutrients beyond calories, carbohydrates, fat and protein. Explaining the role of various foods on the human body can help people understand why it is important to eat the various foods that are outline in Canada’s Food Guide. The importance of vitamins, minerals, antioxidants and phytochemicals should be discussed.
  • Cooking at home is very beneficial. This is an avenue that can be explored especially if people are struggling with their finances. Eating at restaurants can be VERY expensive and sometimes it is necessary to go over food budgeting with the families. Also, it is easier to make healthier choices at home since the family is in charge of adding the ingredients and how food is prepared.
  • Cooking and meal times can be…FUN! Research shows that when families cook and eat together they eat better. This is a time for families to bond, share ideas and have quality time. The theme for this year’s National Nutrition Month by Dietitians of Canada is using this idea as their campaign. Go to their website for ideas on how to help families work together to create fun meal times.

Step 2: How To Give Advice They Will Listen To

  • Good eating habits needs to be realistic. Small changes over time can have a dramatic impact.
  • With the information you gathered from Step 1:
  • Guide them through putting them on a healthy eating scale from 0 to 10 (0 = never choosing healthy options and 10 = always choosing a healthier option) – where do they put themselves? Why?
  • If they could improve their score by 1 point =, how would they do this? This is the basis of how they establish their own goals. It is important to allow them to do this so they are more motivated.
  • Encourage entire family to eat healthier and to establish positive behaviour change that impact their intake – it’s not just the patient who needs to improve with their food and nutrition.
  • Address fears they may have - Simply acknowledging that you heard and understood their fears can be helpful and empathize with how it is difficult to overcome obstacles.
  • Scared to try new food? Find ways to incorporate new and healthy foods gradually into their day to day routine.
  • Many people who have been bullied about their weight feel embarrassed to eat with others. Start small with a snack that is easy to eat.
  • Failing to eat ‘perfect’ all of the time – many people feel as though they need to eat ‘perfect’ or ‘optimal’ all of the time. This is not realistic. We want people to have healthy relationships with food and to make healthy choices most of the time.
  • Create a plan – review goals the patient and family will now work towards including and the strategies to help support the changes. Choose the top 3 for patients and families to work on. Providing to many goals may seem overwhelming.

Step 3: Check-In/Follow-Up

It is important to follow up with your patients in order to review their goals. Even if they have made the smallest changes, it is important to acknowledge this and to congratulate them on their achievement. It may have taken them a lot of courage and work to get to where they are. Focus on continuing to motivate them to progress with their healthy behaviours they have started to change. Empower them to believe they can do it… because they can. Sometimes they just need someone to believe in them.

Motivating your patient to move more and sit less!

Not everyone is a natural athlete, but everyone can be physically active and enjoy it! Help your patient understand the benefits of exercise for them, what activities might appeal to them and how they can fit it in their life’s schedule.

Step 1: Ask and Listen

  1. What activities are they currently doing? This not only lets you know what they’re doing, but it allows them to assess themselves!
  • Transportation to school/work
  • Walking their dog/Chores at home
  • Are they taking gym at school?
  • Organized physical activity at school (clubs, teams)
  • Organized physical activity outside of school
  • How much time do they spend in sedentary pursuits (TV, computer, video games)
  1. What are your patient’s beliefs about the benefits of exercise? If your patient doesn’t fully understand how exercise might positively impact their life, why would they be motivated to do it?
  • Exercise helps manage weight – while exercise alone is not the key to weight loss, it appears to be key to managing any weight loss achieved.
  • Exercise promotes better sleep – a good night’s sleep can improve concentration, productivity and mood (at school, work and at play) and physical activity helps you fall asleep faster and deepen your sleep. And better sleep can lead to improved weight management.
  • Exercise improves your mood – Physical activity stimulates various brain chemicals that leave you feeling happier and more relaxed than you were before you did your activity. Feeling better can boost your confidence and boost your self-esteem.
  • Exercise helps prevent and manage chronic disease – regular physical activity can help you prevent or manage diseases like high blood pressure, type 2 diabetes, high cholesterol and their complications.
  • Exercise can be…FUN! Physical activity is a great way to get the entire family doing something together as you can find an activity that suits everyone! Remember: Exercise can be play and Play can be exercise!
  1. What activities does your patient wish they could participate in and which ones do they not enjoy participating in?
  • This can open dialogue between parent and child
  • Allows patient to express, and you learn, what they feel would be fun and realistic exercise for them and which ones they struggle with

Step 2: How To Give Advice They Will Listen To

  • Work with what you’ve got – physical activity needs to almost seamlessly fit in their day’s schedule. With the information you gathered from Step 1:
  • Let them come up with ideas and strategies to be more active
  • If they have a dog – can they commit to walking it 2-3x/week?
  • If they take gym class – encourage them to move lots in it
  • If they’re interested in joining a school team or club – encourage it!
  • If they want to participate in an organized activity outside of school – help parents support this
  • Encourage entire family to be active – it’s not just the patient who needs to become more active
  • Address fears they may have - Simply acknowledging that you heard and understood their fears can helpful
  • Embarrassed to do exercise? Find ways to be active at home and with family
  • Have had bad experiences (bullying, failing gym class) – explain that exercise should not be something we dread and we should all have the chance to find something we enjoy
  • Fearful of “failing” – it’s important to realize you can’t fail at physical activity. If the specific activity you’re doing, despite your best attempts, is not working for you, then try something new!
  • Create a plan – review activities the family will work towards including the strategies to help support the changes. Let them know you look forward to following up with them at their next visit.

Step 3: Check-In/Follow-Up

Accountability and the knowledge that someone is interested in helping them achieve their goals is motivating. Be sure to congratulate them on changes made and address any hurdles they encountered and re-formulate the physical activity care plan and goals.

Physical & Sedentary Activity Assessment Form

  1. Do you take gym at school? Do you enjoy it? Which activities do you enjoy the most? Which do you enjoy the least?
  1. Are you a member of any clubs or teams at school?
  1. Do you participate in any organized activities outside of school?
  1. Do you have any pets? Do you have any chores at home you’re responsible for?
  1. Are there any activities you wish you could participate in or what to learn how to do?
  1. What are the benefits to our body of doing exercise?
  1. When do you watch TV, play on the computer or play video games?

Discussion/Recommendations:

Centre for Healthy Active Living

Resources for Parents

Healthy Eating
Canada’s Food Guide

EATracker

Eat Right Ontario

Dietitians of Canada

The Ottawa Good Food Box

Helping your overweight child(NIH, U.S. Dept of Health and Human Services)

City of Ottawa Nutrition Information

Physical Activity
Healthy Active Kids Canada

City of OttawaParks and Recreation Guide

Paths and Trails in Ontario

Resources for Kids & Teens

Healthy Eating
Virtual Grocery Store- An online grocery shopping game! Make healthy choices for you and your family.

Kid’s Health- A website that tells you everything you need to know about your health. Sections for parents, kids, and teens!

Getting Physically Active!
Canada’s Physical Activity Guide to Healthy Active Living

Physical Activity Chart- A fun way to keep track of all of your activities.

Gotta Move- A cool interactive magazine for kids 6-9 years old.

Let’s Get Active- A cool interactive magazine for teens 10-14 years old

Kidnetic- Kidnetic.com lets you tap into your own energy so you can feel great all day long.

Kid’s Health- A website that tells you everything you need to know about your health. Sections for parents, kids, and teens!

More copies available for download at:

Other Programs in the Community…

Name / Location & Contact Info / Program Information – provided by each site
The CHANGE Weight Management Program
- Rideau Family Health Team / Riverside Court Medical Clinic
3635 Rivergate Way
Unit 1 & 5
Ottawa, On K1V 2A4
Tel: 613-739-3700
Fax: 613-739-7043
Web:
Lancaster Medical Clinic
2450 Lancaster Rd
Suites 11 & 12
Ottawa, ONK1B 5N3
Tel: 613-738-9119
Fax: 613-738-2736
You need to be referred by your family doctor; we work as a team.
There is a registration fee of $150 that covers the cost for all three phases of the CHANGE.
3 Ways to register:
Call: (613) 739-3700 ext. 243
Email:
In Person: Ask to speak with Erika / What is the CHANGE?
The CHANGE weight management program works with you, your family doctor and a dedicated team of health professionals to help you meet your weight-management goals.
The CHANGE program
  1. Welcome to the CHANGE:
  2. A welcome session to see if this is the right program for you.
  3. You will get an introduction package, medical and lifestyle assessment and lab requisition.
  1. Building the CHANGE:
  2. 12 weekly skill-building sessions focusing on diet, exercise, cravings, support and motivation.
  3. Sessions taught by a team including a dietitian, social worker, nurse, and exercise specialist.
  4. Weekly opportunity to talk to a doctor.
  1. Maintaining the Change:
  2. Monthly check-in and problem solving sessions to help you keep the change going.
  3. Continues for 6 months.
  4. Focuses on learning to deal with “setbacks” or “slip-ups”.

More copies available for download at: