David Collier, MD, PhD ECU Pediatric Healthy Weight

David Collier, MD, PhD ECU Pediatric Healthy Weight

David Collier, MD, PhD
ECU Pediatric Healthy Weight Research
and Treatment Center
[email protected]

Take Off 4-Health Healthy Lifestyle Camp
Nutrition Education Curriculum
Carolyn Dunn PhD, Nancy Harris MS RD LDN, Yancey Crawford MPH, Sarah Henes MA RD LDN,
Stephanie Kinner BA, Virginia Sutton MPH, Kathryn Kolasa PhD RD LDN & David Collier MD PhD

Nutrition Curriculum Development

Obesity is now widely recognized as one of the most pressing public
health challenges in the United States. Eastern North Carolina (ENC)
has particularly high rates of obesity due in part to poverty, lack of
education and a large African American population which is
disproportionately affected. To address obesity in ENC, a healthy
lifestyle camp, Take Off 4-Health, was developed for overweight
adolescents. This poster describes the nutrition curriculum for the camp.

Camp Partnership
Take Off 4-Health is a collaboration between East Carolina University
(ECU), Brody School of Medicines Pediatric Healthy Weight Research
and Treatment Center, NC 4-H, North Carolina Cooperative Extension
(NCCE) and Pitt County Memorial Hospitals Pediatric Healthy Weight
Case Management Program.
East Carolina University
Medical Support
Nutrition & Physical Activity Programming
Development of Menus
Recruitment of Scholarship Campers

NC Cooperative Extension
Development of Nutrition Curriculum
Printing of Nutrition Materials
Materials for Family Packets
Staff to provide Nutrition Instruction

NC 4-H
Camp Facility
Hiring & Training of Counselors
Camp Programming
Recruitment & Enrollment of Campers
Day to Day Operation of Camp

Collaborative team from ECU and NCCE reviewed literature & relevant
web sites and contacted professional list serves for camp-related
Since few are published, modified two existing
NCCE curricula:
Eat Smart Move More Weigh Less
Families Eating Smart and Moving More

Camp Demographics & Outcomes
N=34; 26 girls, 8 boys; majority African American (70%); mean age:14
Mean BMI pre camp: 41.9
Mean weight loss: 6.7 pounds or 2.5% of initial weight over 3 weeks
Mean post camp BMI: 40.8 (Mean BMI change: > 1 BMI unit)
Mean waist circumference decrease: 2+ inches
Four-five month follow-up data is available for 19 campers; 17
completed all 3 weeks of camp

Take Off 4-Health curriculum included:
Camper cards
Six, hour-long interactive nutrition lessons
Training for camp counselors
Take-home packet for campers & their families

Campers attending nutrition class

Lessons were taught by two Family & Consumer Science agents and ECU dietitians
Nutrition handouts are available at www.ecu.edu/pedsweightcenter (click on
Programs & Activities and then Healthy Lifestyle Camps)

Attending camp was associated with a 3 unit decline in BMI for
these 17 youth (Figure 1)
The average BMI z-score (indicates the number of standard deviations
above the mean BMI for gender and age) for the 17 campers has
continued to decline following camp
Figure 1: Mean BMI & Z-scores Over Time for 17 Campers

Camper Cards





Each camper received a personalized nutrition prescription based on the MyPyramid
calorie levels for age, gender and sedentary activity level.








Held at the Eastern 4-H Center in rural eastern NC
Youth participated in:
Traditional camp activities such as hiking, boating & swimming
Confidence and team building activities including a challenge
course & climbing wall

Sample Handout

Campers received nutrition handouts corresponding to each
lesson, a pedometer & a take-home packet at the end of camp


Interactive Lessons

The camp provided sufficient education in a real life environment
for most campers to lose weight at a safe rate.

Key Messages of Lessons

The menu and recipe modifications improved the nutrient value and
energy density of the meals and were acceptable, affordable and
have the potential for use in all 4-H camps.


Key Message

Key Skills



Your Drink

Calorie Beverages:
-can contribute lots of calories to the
overall diet
-may not provide satiety
-can be replaced with calorie-free
beverages to decrease total calories.

*Strategies to choose caloriefree or lower calorie
*beverage clocks illustrated
how to substitute (Figure 1)

How can you
make better
choices to
achieve a
healthy weight?

-analyzed labels of
common drinks.
-made drinks from
fruit juice and seltzer.

Enjoy More
Fruits and

Fruit and vegetables:
-in their natural state, are low in
calories and fat.
-are KEY to a weight loss/weight
*for snacks and meals.

strategies to make fruits and
vegetables more available for
meals/ snacks.
Snack clocks illustrated how
to make healthier snack
choices throughout the day.

How can you
make better
choices to
achieve a
healthy weight?

-analyzed food labels
with fruit in the
name; asked to Find
the Fruit. -taste tests.

Food Labels

Food labels useful to:
-compare different foods
-help control portions
-identify food lower in fat and

use the nutrition facts panel to
compare two foods and use
ingredient list to see food
Use common label terms (i.e.,
fat-free, low-fat)

How can you
make better
choices to
achieve a
healthy weight?

-presented with 5
snack and 5 beverage
choices; used
information on the
package to make the
healthier choice.

Eat Smart
When You
Eat Out

Eating out:
-is related to increased weight due to
serving sizes and food preparation
-make healthy choices when you eat
-might not be as healthy as choosing
to prepare and eat meals at home

Strategies to eat more meals
at home.
Strategies to choose healthier
options when eating out
including choosing smaller

How can you
make better
choices to
achieve a
healthy weight?

-used an interactive
multimedia CD to
choose from 6 fast
food restaurants; tote
board indicated
nutrients for the
foods chosen.

-sizes have increased over the years
-control is a key factor in achieving a
healthy weight.
-that are large can lead to consuming
more calories than you need.
-selection needs to be mindful

*Demonstrations to use hand
to estimate portion sizes and
strategies to right-size
*Use stoplight method (rarely,
sometimes, anytime) to teach
variety and moderation.

How can you
make better
choices to
achieve a
healthy weight?

Nutrition, group counseling and physical activity classes
Campers were served 3 family-style meals and two snacks
daily based on standard camp menus that were modified by
pediatric dietitians to ensure nutrient needs, reduce fats & sugars
and increase whole grains & fiber.



Camp Overview
3-week residential camp for obese 12-18 year old boys and girls

Z score



Pediatric Healthy Weight Case Management Program
Bridge Program for Parents during Camp to Prepare Home Environment
Monthly Meetings for Campers & Families after Camp
Case Management Services for Scholarship Campers



-participated in a
mindful eating
exercise and activity
with the stop light
food to budget what
they eat.

Re-Think Your Drink Graphic

Campers used, though not consistently, the personalized camper
cards. Use may be improved if campers, counselors and food
service staff had more intensive training.
Campers improved their ability to recognize appropriate portion
sizes. This skill may be strengthened through a 2-5 minute
demonstration of nutrition tips to reinforce topics taught in classes.
The topics selected were appropriate for the age group; however it
was recommended that campers have additional opportunities
to practice newly learned skills (i.e. role play and skits) and the
materials include popular media such as videos and You Tube
clips to keep campers engaged.

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