kids n fitness 4all · – chronic overeating leading to obesity ... eating along child daily...

KIDS N FITNESS 4ALL(For All Learning Levels)

Brenda Manzanarez, MS, RDDiabetes & Obesity Program

Megan Lipton-Inga, MA, CCRP Ellen Iverson, MPHSamantha Garcia, MS

Disclosure

• Nothing to disclose

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Background• Kids N Fitness (KNF) was created in 2000 at Children’s

Hospital Los Angeles by a multidisciplinary team• Adaptations: original research regular classes (ages 8-16),

Junior (ages 3-7), church (Sunday school), afterschool with teens, summer camps.

• Key Program Elements:

Family-Centered Health Education

• Parent and child learn together

• Children learn from others in a social setting

• Parents have a support space

Physical Activity

•Dedicated time to be active

•Exercise with fun games

•Learn new ways of movement

Goal Setting & Self-Monitoring

• 5 weekly goals• Track daily

behaviors

Energy Intake

Energy Expenditure

Individual Factors

Environmental Settings

Social Norms and Values

Communities

Worksites

Health Care

Schools and Child Care

Home

Demographic Factors (e.g., age, sex, SES, race/ethnicity)

Psychosocial Factors

Genetics-Environment Interactions

Other Factors

Government

Public Health

Health Care

Agriculture

Education

Media

Land Use and Transportation

Communities

Foundations

IndustryFoodBeverageRetail

Leisure and Recreation

Entertainment

Physical Activity

Sectors of Influence

Food & Beverage Intake

Social Ecological Model

Community Partnership

Train Staff

•5 promotoras•1 lead KNF

coordinator•Volunteers

•Mock teachings•Program logistics

•Recruitment•Coordination•Volunteers•Staff debrief

Observe

•Lead CHLA Staff –main observer

•Noted:•Curriculum

adherence•Engagement with

audience•Program logistics•Questions by

audience

Provide Feedback

•Missed topics•Explanation of

topics

Follow-up & Reinforcement

•Routine check-ins• Increase confidence•Troubleshooting•Support

2015 – Partnership began- Regular Kids N Fitness2017 – 2018 - grant funding for ASD programming- KNF4ALL (All Learning Levels)

Needs in the Community

• South LA is one of the poorest in the county, and most under-resourced regions– Children:

• 68% Latino, 27% African American– Adults:

• 42% have less than a HS education, 52% not born in US– Families:

• 34% live below 100% of the Federal Poverty Level• St. John’s Well Children and Family Health

Center– Center for Autism and Developmental Disorders

• Comprehensive, interdisciplinary care• Serve over 275 children with ASD• Waitlist over 100 patients

ASD children stats

• 1 in 59 children• More common in boys

– 4x higher than girls

• DSM-V diagnosis

• ASD characteristics:– Issues with verbal and non-verbal communication– Impaired social interactions– Repetitive behaviors– Limitation in activities and interests

Co-occurring Physical & Mental Health Conditions

• Feeding issues– Selective eating (picky eating)– Pica (eating non-food items)– Chronic overeating leading to obesity

• Gastrointestinal (GI) problems– Limits food options nutritional deficiencies

• Attention-deficit/hyperactivity disorder (ADHD)• Obsessive compulsive disorder (OCD)• Anxiety - Depression• Disrupted sleep - Epilepsy• Schizophrenia - Bipolar Disorder

Social Ecological Model to Create Change

Why is it an issue?

LA children living with a special health care need

15%

Lack of early interventionLess than 1 in 3

receive timely developmental

screenings

Difficulty accessing

medical care12.9% Latino6% African American12.6% Asian (LAC-DPH, 2011, 2015)

Access?

Perceived neighborhood

safety

77.8% vs 92.7%(LAC-DPH, 2015)

Children with ASD & Obesity

23.4%(2010 Natl Survey of Children’s Health)

Easy access to a park or

playground or other safe

place to play

85.8% vs. 89.3%(LAC-DPH, 2015)

Access to fresh fruit/vegetables as “excellent or

good”

69.4% vs. 88.3%(LAC-DPH, 2015)

Pilot Goals

1. Feasibility– Will families come?– Will children with

ASD be receptive to health topics?

– How easy will it be to make changes?

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2. Observations for future interventions

– Test simple modifications to ASD population

– What worked?– What didn’t work?

Program Stages

CHLA KNF Psychologist Case

Manager KNF

Coordinator Promotora

Multidisciplinary

meetings

Refe

rral

&

Enro

llmen

t

Surv

ey

Ori

enta

tion

Clas

ses

Feed

back

Psychologist &/or MD referral

Case Manager referral

KNF Coordinator Promotora

Planning phase

Implementation & Observations phase

KNF Coordinator 1 Promotora 1-2 Applied Behavioral

Therapists (ABA) 2-4 Volunteers Case Manager 1 CHLA KNF staff

Program Format

Structure-focused Agenda

poster Shorter didactics Story telling Tactile Arts & Crafts

Individual-based Smaller groups Activity stations Yoga videos

Exposure to familiar and non-familiar foods

Precut foods Self-selected

items Parent role-

modeling by eating along child

Daily logbooks Weekly goals

Continued nutrition education Space for sharing Brainstorm goal implementations Peer support & empowerment

Program Stats

32 families participated

3 Cohorts

18 families completed program (4+classes)

56% Retention Rate

During Nutrition Lessons…

• Well received:– Following an agenda– Repetition– Positive

reinforcement of behaviors (stickers, clapping, high-fives)

– Activities tied to nutrition

• My Plate collage• Coloring handouts

• Observations:– Children needed

increased wiggle breaks

– Parents became distracted with disruptive behaviors

– Engaged with children

During Physical Activity…

Observed Challenges:• Some games were

noisy• Too much

stimulation• Did not want to

separate from parent

• Crying; mostly younger kids

Adaptations:• 1:1 - 1:3

adult:child ratio• Focused on

stations and individual activities

• Calmer activities

Yoga is a success!

• Cosmic Kids Yoga• Dora the Explorer

Food

“He doesn’t like that. He is not going to eat it!”

Re-frame comments:

• What colors do you see?

• Let’s make this shape!

• You are doing such a good job at trying…!

Parent Feedback• “Thank you for the opportunity to help me

understand”• “A bit more time to learn”

Content

• “That my son got so involved in it”• “The excitement of my kids each class”• “My child tries new foods now”

Enjoyed aspects

• “It gave me ideas”• “It was a good way to get the kids to understand

things”Snacks

• “I want to learn more”• “My child is communicating with me more about

his food selections and he has motivation to play and do exercise more”

• “My child exercises more and is willing to eat more fruits”

• “Before eating my child will observe the food and critique it to make sure it is”

Other suggestions

or comments

Staff & Volunteer Feedback

Daily short debrief after

each class

Implement changes & observe

Debrief & get mini-training

from ABA

10-15 minutes What worked Challenges Parent perspective/

insight ABA feedback about

behaviors

Ease of adaptation Acceptability

Staff perspective Observer perspective ABA mini-training Weekly emails with

noted challenges and changes

Psychologist & Case Manager support

In Summary & Future Goals

• Despite low attendance, benefits can be seen by those who attended

• More programming and research are needed

• Incorporate a stronger social-behavioral therapy component into the curriculum

• Focus groups• Imbed into education/therapy after

initial diagnosis

For questions about the presentation:Brenda Manzanarez, MS, RD

Health Education Leader, Clinical Dietitian

bmanzanarez@chla.usc.edu

For questions about the Kids N Fitness Program:Megan Lipton-Inga, MA, CCRP

KNF Program DirectorMlipton@chla.usc.edu

(323) 361-5423

References