Home and Institutional Food Environment and Health Lecture Slides

HOME AND INSTITUTIONAL LEVEL FOOD ENVIRONMENT AND HEALTH  1 2 3 4 5 Outcome 1. Outcome 2. Outcome 3. Outcome 4. Outcome 5. Describe the...

HOME AND INSTITUTIONAL LEVEL FOOD ENVIRONMENT AND HEALTH  1 2 3 4 5 Outcome 1. Outcome 2. Outcome 3. Outcome 4. Outcome 5. Describe the Describe the food Describe school Describe the food Describe the home food environment in meals or school environment in objective measures environment schools lunch workplaces of the FE and gaps and how it affects programmes in food environment research in Malaysia health LEARNING OUTCOMES NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 2  HOME FOOD ENVIRONMENT (HFE) Environmental influences on health behaviours.  Home  Community The community FE includes food outlets in the community, which are associated with adults’ food purchasing and dietary behaviours. [1,2] 1. Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23-29. 2. Turrell G, Blakely T, Patterson C, Oldenburg B. A multilevel analysis of NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR socioeconomic (small area) differences in household food purchasing behaviour. J Epidemiol Community Health. 2004;58:208-215. 3  FAMILY AND HOME ENVIRONMENT  65-72% of children’s daily calories are consumed in the home 3  Home - Physical environment where children spend the majority of their time  Families – Primary social environment where children learn how, what, where and when to eat  Children’s knowledge, attitudes, values and behavioural preferences are formed at an early age 3. Smith LP, Ng SW, Popkin BM. (2013) Trends in US home food preparation and consumption: analysis of NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR national nutrition surveys and time use studies from 1965–1966 to 2007–2008. Nutr J, 12:45. 4  FAMILY AND HOME ENVIRONMENT (CON’T)  Children’s eating patterns are strongly influenced by environmental characteristics.4  Despite the growth of fast food, convenience foods, and trends toward increased eating away from home, about two-thirds of the foods children consume is from home.5  Home and family environments are essential in the development of food preferences and consumption habits, and families represent a promising avenue toward improvement of children’s eating habits and prevention of obesity. 5,6,7 4. Patrick H, Nicklas TA. A review of family and social determinants of children's eating patterns and diet quality. J Am Coll Nutr. 2005;24:83-92. 5. Adair LS, Popkin BM. Are child eating patterns being transformed globally? Obes Res. 2005;13:1281-1299. 6. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am. 2001;48:893-907. 7. Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annu Rev Public Health. 2001;22:337-353. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 5  HOME FOOD ENVIRONMENT (HFE)  Based on the ecological systems theory (7), the HFE is determined by parents and represents the child’s immediate food environment which acts to support or inhibit healthy eating (8).  It is likely that factors influencing child diet are unique at different age stages.  While it is acknowledged that in early childhood the child is most dependent on parents with dietary intake largely influenced by the HFE (9,10), the contributing influences of the HFE in primary-school children as age increases are unknown. Competing influences such as the media, peers and school environments can also come into play (7). 7. Bronfenbrenner U (1999) Environments in developmental perspective: theoretical and operational models. In Measuring Environment Across the Life Span: Emerging Methods and Concepts, pp. 3–17 [SL Friedman and TD Wachs, editors]. Washington DC: American Psychological Association. 8. Birch LL & Davison KK (2001) Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am 48, 893–907. 9. Wyse R, Campbell E, Nathan N et al. (2011) Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: a crosssectional study. BMC Public Health 11, 10. 10. Pearson N, Biddle SJ & Gorely T (2009) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR review. Public Health Nutr 12, 267–283. 6  HOME FOOD ENVIRONMENT (HFE)  A broad range of HFE components are related to child dietary intake.  availability and accessibility of fruit and vegetables, parental role modelling and parental intake were most consistently related to higher fruit and vegetable intake (10)  child feeding practices such as encouraging intake of healthy foods were related to lower BMI (11). 10. Pearson N, Biddle SJ & Gorely T (2009) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 12, 267–283. 11. Crawford DA, Ball K, Cleland VJ et al. (2012) Home and neighbourhood correlates of BMI among children living in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR socioeconomically disadvantaged neighbourhoods. Br J Nutr 107, 1028–1036. 7 Conceptual model of environmental factors related to childhood obesity risk Physical environment Access to and availability of foods Access to and availability of Child’s eating Energy activity and sedentary options Intra-individual environment behaviours intake Cue to behaviours Perception of social and physical environments Obesity Knowledge Risk Attitudes Values Social environment Skills Child’s Energy Preferences activity and expenditure Parenting style sedentary Family meal practices behaviours Affective/emotional environment Role modeling Social/cultural norms Moderators:  Family resources (time, money, skills)  Weight of adults in the home  Genetics NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Lytle LA. Healthy home food environment. IUNS 21st ICN International Congress of Nutrition 8 Conceptual model of environmental factors related to childhood obesity risk Physical environment Access to and availability of foods Access to and availability of Child’s eating Energy activity and sedentary options Intra-individual environment behaviours intake Cue to behaviours Perception of social and physical environments Obesity Knowledge Risk Attitudes Values Social environment Skills Child’s Energy Preferences activity and expenditure Parenting style sedentary Family meal practices behaviours Affective/emotional environment Role modeling Social/cultural norms Moderators:  Family resources (time, money, skills)  Weight of adults in the home  Genetics NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 9  ELEMENTS OF THE HOME ENVIRONMENT THAT IMPACT EATING AND ACTIVITY-RELATED BEHAVIOURS (ESPECIALLY CHILDREN’S)  Availability of foods, activity and sedentary options in the home  Accessibility of foods, activity and sedentary options in the home  Cues to eating, being active and being sedentary  Resources available to the family Smith LP, Ng SW, Popkin BM. (2013) Trends in US home food preparation and consumption: analysis of national NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR nutrition surveys and time use studies from 1965–1966 to 2007–2008. Nutr J, 12:45. 10  AVAILABILITY OF FOODS IN THE HOME  Children’s intake of fruits & vegetables (F&V)  availability of healthy foods in the home (Ding et al, 2012)  Children’s intake of high calorie and high sugary snacks/beverages  availability of less healthy foods in the home (Campbell et al, 2007)  The physical home food environment can be obesogenic or health-protective. Ding D, Sallis JF, Norman GJ, et al. (2012) Community food environment, home food environment, and fruit and vegetable intake of children and adolescents. J Nutr Educ Behav, 44(6):634–638. Campbell KJ, Crawford DA, Salmon J, et al. (2007) Associations between the home food environment and obesity- NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR promoting eating behaviors in adolescence. Obesity (Silver Spring), 15(3):719–730. 11  Model of the home food environment pertaining to childhood obesity Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR obesity. Nutrition Reviews® Vol. 66(3):123–140 12  MODEL OF THE HOME FOOD ENVIRONMENT PERTAINING TO CHILDHOOD OBESITY The domains Macro and Micro levels  Built and natural environments are those  Macro-level: at the larger community level, with composed of physical structures. potential carry-over into the child’s home life.  Political and economic environments are those  Micro-level: most proximal or nearest to a child’s composed of financial resources, policies, and laws. home life.  Sociocultural environments are those composed  Although micro-level components are contained of social interactions, demographic characteristics, within the macro-level, the collection of micro-level and secular trends. components across a population also shapes the macro-level environment.  Components may interact across domains. Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 13 pertaining to childhood obesity. Nutrition Reviews® Vol. 66(3):123–140  Model of the home food environment pertaining to childhood obesity Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR obesity. Nutrition Reviews® Vol. 66(3):123–140 14  POLITICAL & ECONOMIC ENVIRONMENT – MICRO-LEVEL Family socioeconomic status Family food insecurity  Well-established influence on dietary habits,  Food insecurity: limited or uncertain availability of nutritional outcomes and obesity nutritionally adequate foods;  Income, education, occupation, food programme - strongly related to financial insecurity and poverty eligibility, etc  Food insufficiency: is an inadequate amount of food intake due to a lack of money or resources. Food programmes participation  lack of participation have been offered: stigma, transactions costs, and lack of information NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 15  SOCIOCULTURAL ENVIRONMENT – MICRO-LEVEL Customs and traditions  impact of traditions, culture, religious practices, Parenting: practices, styles and rules ethnicity, race, and related social influences is  Parents can and should play the primary role in controlling the important to consider since many customs and obesogenic environment at home. traditions involve food as a central focus  Permissive parents: warm but not firm, allowing their children great freedoms in behavior and decision-making – less likely to  families who shared meals together more often had set limits or control food choices more similar dietary intakes.  Authoritarian; firm but not warm, set rigid limits, employ punitive and forceful actions of enforcement; negatively related to F&V availability/consumption Family structure, stress, and schedules  Authoritative: warm, firm and accepting of the child’s needs for autonomy; set limits based on reasoning & enforce limits  Dual-earner, single parent families, women in the through persuasion, provide better availability of F&V workforce, makeup and size of families  Using food as a reward – associated with nutritional problems  Family stress may be partially determined by socioeconomics, race, ethnicity, employment, and health. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 16  SOCIOCULTURAL ENVIRONMENT – MICRO-LEVEL Education and nutrition knowledge Parental eating/dieting  E.g., financial income, money management, priority  Parental dietary practices, such as dietary restraint for nutrition, nutritional knowledge, parenting skills, or dietary restrictive practices is a risk factor for general resources, or in other ways. children.  Better maternal nutritional knowledge was associated with better diets in children Family eating patterns Food preparation skills  The family mealtime affect eating behaviours  Limited skill may prevent adults from making improvements to the home food environment  Experts suggest factors such as cooking skill, food usage, motivations, and personality be included in interventions when targeting dietary change in the home NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 17  HOME FOOD ENVIRONMENT AND ASSOCIATIONS WITH DIETARY INTAKE AMONG ADOLESCENTS (WATTS ET AL, 2018)  It was hypothesized that an authoritative parenting style, parent modeling of healthful food choices (FV and low-fat snacks), more healthful family meal practices (fewer meals in front of the TV and at fast food restaurants), reduced availability of less healthful foods and drinks (availability of select high-fat foods or non-diet soft drinks in their home) and high SES (higher education or income level) would be associated with more healthful dietary habits among overweight/obese adolescents.  It was also hypothesized that social influences may indirectly influence adolescent dietary intake through associations with availability of less healthful foods in the home (Fig.). Watts et al. The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR intervention. BMC Nutrition 2018; 4:3 18  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Home availability and accessibility of foods  The better the availability and accessibility of nutrient-dense foods in the home environment, the more likely it is that children will choose to eat these obesity-protective foods  Less availability of obesity-protective foods such as fruits and vegetables predict lower consumption levels  More availability of obesity risk-factor foods predict higher consumption  Stockpiling of foods in the home may increase consumption for preferred and convenient products, and when the family is frequently reminded of the food via marketing  Parents are capable of manipulating the availability of foods in the home food environment through their purchases, which can influence children’s eating patterns. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 19  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Audiovisual media equipment  Irrespective of the advertising source, controlled studies have demonstrated the effectiveness of children’s advertising  resulting in the presence of advertised products at home.  Television  promote an obesogenic home food environment through the following three main avenues of influence: promotion of sedentary behavior, food advertising, and eating while watching TV  Beyond television, modern food marketing impacts the home food environment via internet websites, movie product placement, movie or TV character toy tie-ins, sponsorship of sports teams and icons, postal mail advertisements, newspaper and magazine advertisements and inserts, and even with coupons or vouchers from school programs.  Various public health policies have been proposed to protect children by regulating food marketing to children. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 20  CONCERNS ON HOME FOOD ENVIRONMENT  Having adequate food preparation supplies may also contribute to more frequent and convenient preparation of home meals that are usually more nutritious (Appelhans et al., 2012).  Stocking up on sales of nutritious foods may help save money but may also present pitfalls. Some studies show that having larger quantities of food on hand may lead to greater consumption. (Poelman et al., 2014). Appelhans, B. M., Waring, M. E., Schneider, K. L., Pagoto, S. L., DeBiasse, M. A., Whited, M. C., & Lynch, E. B. (2012). Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women. Appetite, 59(2), 576–584. https://doi.org/10.1016/j.appet.2012.07.009 Poelman, M. P., de Vet, E. W. M. L., Velema, E., Seidell, J. C., & Steenhuis, I. H. M. (2014). Behavioural strategies to control the NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR amount of food selected and consumed. Appetite, 72, 156-165. https://doi.org/10.1016/j.appet.2013.09.015 21  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Kitchenscapes, tablescapes, platescapes and Kitchen appliances and cooking equipment foodscapes  Food preparation and storage equipment such as  Rooms, furniture, containers, and the structure of food refrigerators, freezers, microwave ovens, ranges, and itself have been shown to modify consumption patterns. conventional ovens, cooking utensils, pots and pans,  Preferred foods that are prominently visible and and other such items accessible, along with larger plates, bowls, cups, and  influences eating behaviours in the home serving utensils  promote greater food consumption  Small kitchens with inefficient designs may discourage Home and community gardens the preparation and consumption of less convenient and more healthful meals  Garden-grown foods can positively impact the diet and budget of families  Structural changes to the micro-scale built environment may offer an effective means to change food intake.  The more frequently a family uses products from gardens, the less obesogenic their home food environment should be. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 22   Class Activity: Home Food Inventory (HFI) checklist  Determining what foods an individual or family usually has on hand  Validated, self-administered  Try this at home! Check your fridge, freezer, shelves, cupboards, tabletop, and any areas.  Check “no” only if the food is not present in your home. Fulkerson JA, Nelson MC, Lytle LA, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. International Journal of Behavioral Nutrition and Physical Activity, 2008, 5;55. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 23  HFI: OBESOGENIC FOOD AVAILABILITY SCORE (RANGE 0 – 71)  Regular fat dairy What are your  Frozen and prepared desserts scores for  Candy obesogenic food  Savoury snacks availability in the  Sugar sweetened beverages home?  Processed meats  High fat microwavable foods  Added fats  Access to unhealthy food in the kitchen and refrigerator NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 24  HFI items are listed in a checklist type format with yes/no (1/0) response options. Higher scores represent greater availability. In addition, participants were instructed to check whether the vegetable, fruit, and bread items were fresh, frozen, dried or canned, as appropriate. The category order was set up to facilitate ease of completion, beginning with the refrigerated items, followed by frozen items, and non-perishable items. Participants are instructed to look for these foods in all areas of the home where food is stored, including the refrigerator, freezer, pantry, cupboard, and other areas (e.g., basement). Participants were informed that lower fat products may be labeled as "reduced-fat," "low-fat," "light," "nonfat," or "skim." Foods in the dairy, added fats, frozen desserts, prepared desserts, and savory snacks were categorized into regular-fat or reduced-fat groupings; beverages were categorized into regular sugar and low sugar categories; and foods in the two ready- access categories were further subgrouped into healthful and less healthful categories. Although the categorization of foods into healthful and less healthful categories may not be entirely straightforward, we assessed each food by its typical fat and sugar content when determining its category. To assess the overall obesogenic home food availability, a summative score was created that includes regular-fat versions of cheese, milk, yogurt, other dairy, frozen desserts, prepared desserts, savory snacks, added fats; regular-sugar beverages; processed meat; high-fat quick, microwavable foods; candy; access to unhealthy foods in refrigerator and kitchen. The obesogenic home food availability score potential range was from 0–71. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 25  SUMMARY – HOME FOOD ENVIRONMENT  The home food environment can be conceptualized as overlapping interactive domains.  Each type and level of environment uniquely contributes influence in a mosaic of determinants depicting the home food environment as a major behavior setting for child dietary behavior and the development of weight status.  Although we did not address energy expenditure or physical activity here, consideration of both sides of the energy balance equation is essential for the study of obesogenic environments and the development of obesity. Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood obesity. Nutrition Reviews® Vol. 66(3):123–140 NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 26  SCHOOL FOOD ENVIRONMENT NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 27  INTRODUCTION  Health promotion efforts in schools could have a broader impact on eating behaviors and future disease risk.  Youth consume between one-third to one-half of meals at school, making this a crucial setting for interventions that alter the food environment.  Promising school food environment policies include  direct provision of healthful foods/beverages such as fruits and vegetables (F&V),  quality standards for competitive foods and beverages (foods and beverages sold outside of school meal programs),  quality standards (targets for foods, nutrients/energy) for school meals (lunch, breakfast) Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, et al. (2012) Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 126: 1514–1563. pmid:22907934 Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. (2018) Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis. PLoS ONE 13(3): e0194555. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 28 https://doi.org/10.1371/journal.pone.0194555  PROMOTING DIET AND NUTRITION IN SCHOOLS  Food and Agricultural Organization (FAO): Schools  ideal setting  Reach children at an age when food and health habits are being formed.  Influence families and can be a channel for wider community participation  Promoting better diets and nutrition through schools  increase the health and well-being of students and families  FAO works with governments and schools in supporting the Sustainable Development Goals. Food and Agricultural Organization (FAO), 2019 http://www.fao.org/school- NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 29 food/areas-work/food-environment/en/  HEALTHY FOOD ENVIRONMENT AND SCHOOL FOOD  Refers to all the spaces, infrastructure and conditions inside and round the school premises where food is available, obtained, purchased and/or consumed. √ Nutritional content of these foods √ All information available, promotion (marketing, advertisements, branding, food labels, packages, promotions) and the pricing of foods and food products.  A healthy food environment allows and encourage the school community to make choices for better diets and improved wellbeing. Food and Agricultural Organization (FAO), 2019 http://www.fao.org/school- food/areas-work/food-environment/en/ NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 30  HEALTHY FOOD ENVIRONMENT AND SCHOOL FOOD  How governments can shape healthier school food environments: (FAO) o setting and enforcing nutrition standards for school food, meals and snacks; o making nutritious foods more affordable o restricting the sale and advertisement of food products rich in fat, sugar or salt.  Efforts from public and private sectors: o voluntary adoption of standards for sale of foods, o reformulation of food products o creation of codes of conduct for marketing & advertisement  FAO provides technical support, develops guidance and strengthens the capacities of government institutions and other stakeholders to implement nutrition standards for school food and meals and to develop policies for healthier school food environments. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 31  SCHOOL-BASED FOOD AND NUTRITION EDUCATION (SFNE)  Consists of educational strategies and learning activities, which supported by a healthy food environment, help the school community to improve their diets and food choices.  Promotes a “whole school” approach to SFNE, actively involving all people that interact in the school setting.  Schools settings - one of structured learning, a place where those who influence children’s food perceptions, practices and habits interact.  SFNE capitalizes on this and creates learning opportunities and experiences that can shape healthier food patterns. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 32  INCLUSIVE PROCUREMENT AND VALUE CHAINS  The Home-Grown School Feeding approach  Connects the need for safe, diverse and nutritious food with the production of local farmers and community businesses.  Improve the economic development of small-scale famers and local communities and to strengthen the connection between nutrition, agriculture and social protection through schools.  offers local farmers a regular market (schools) for their production. This can boost local agriculture, create business opportunities for smallholder farmers and other vulnerable producers (including women, youth, and members of traditional communities), and contribute to community socioeconomic development.  It can also increase the value of traditional foods NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 33  INCLUSIVE PROCUREMENT AND VALUE CHAINS  FAO supports governments on building these linkages, and on providing technical assistance, information and policy support on inclusive food procurement to schools.  It also promotes ways and opportunities to enhance the nutrition quality and safety along the school food chain,  These “nutrition-sensitive value chains” can play an important role in shaping healthier and more sustainable local and national food systems. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 34  ENABLING POLICY, LEGAL AND INSTITUTIONAL ENVIRONMENT  Coordination, enabling policies, legislation and institutional capacities are need for programmes to be successful.  Benefits for programmes maximized if  aligned with other related programmes and policies in the areas of social protection, nutrition, health, education, agriculture, rural development and urban food planning.  Regulatory frameworks relevant to human rights, food safety and quality, public procurement  a relevant part of a supportive enabling environment and have an important effect on the design and effective implementation of these multicomponent school food and nutrition programmes. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 35  SCHOOL FEEDING PROGRAMMES School Meals/School Lunch NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 36  SCHOOL FEEDING PROGRAMMES – GENERAL INFORMATION  Provision of healthy food and nutrition to children in schools (KRI report)  Two ways: ‘on-site’ school meals or snacks, or ‘take-home’ rations conditional on school attendance  Some interventions may involve on-site programmes with take-home rations targeted at specific groups of vulnerable children.  Four main on-site feeding options in terms of timing and size of meal: breakfast, mid-morning snack, lunch and dinner (for boarding schools).  To support classroom learning and address classroom hunger, meals may have to be provided early in the school day, especially for those unable to have some food at home before going to school.  Take home rations provide direct, higher value transfers in kind to families which are worth more than school meals, providing a strong incentive for increasing school attendance. Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Kuala Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0. 37  SCHOOL FEEDING PROGRAMMES Objectives:  Ensuring food security and food safety  Addressing malnutrition in the nation  Improving student academic and physical development, achievements and productivity  A successful school feeding programme requires appropriate strategies to improve the education, health, nutrition and agriculture aspects.  Universal - providing for all students and sensitive to the school environment. Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. Kuala NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0. 38  SCHOOL FEEDING PROGRAMMES  Serve as a type of social protection for school children.  Improving child nutrition  an investment to enhance their physical and cognitive development.  Sustainable food supplies from local producers and processors will also strengthen such food production, especially with procurement arrangements designed to strengthen farmer cooperatives and associations as well as parental oversight.  Parental involvement  help improve safety and health in agricultural production and food preparation, as well as minimise abuses through such ‘peer-monitoring’ or stigma. Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. Kuala NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0. 39  UNITED STATES : NATIONAL SCHOOL LUNCH PROGRAM (NSLP) NSLP - offered for free or at reduced cost to low- income students Schools participating - receive federal reimbursements for all school lunches served that meet the NSLP nutrient requirements School food service programmes must ensure their meals meet the nutrition requirements,  freedom to decide which specific foods to serve and how to prepare Each lunch must include a meat or meat alternative, a grain, low-fat of fat-free milk, a fruit and a vegetable Current standards - whole grain requirements, limits on sodium and saturated fats, restriction on trans fats, NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR and acceptable calorie ranges Stein N. (2015). Public Health Nutrition: Principles and Practice in 40 Community and Global Health. Jones & Bartlett Learning, USA.  INDIA - MID-DAY MEAL SCHEME Objectives are to reduce malnutrition, increase enrollment and attendance, reduce dropouts, and improve learning Regulated by the federal government Subsidy is provided to transport grains from local federal depots to schools – hard to reach regions are often the poorest and most in need of nutrition assistance Meals must be provided during the summer drought season, when the risk for malnutrition is higher Provides 100g of rice or wheat flour, or the cooked equivalent, such as 200 to 300 grams of unleavened flat https://www.theguardian.com/global-development/2014/aug/11/india-midday-meal-scheme-schoolchildren bread (chappattis) daily Largest meal programme in the world with more than A typical meal includes pulses (legumes) or soybeans, 140 million children participating seasonal vegetables, cooking oil, a condiment and drinking Established in 1995; made mandatory in 2002 in all water government-run primary schools and at rural education guarantee scheme sites Stein N. (2015). Public Health Nutrition: Principles and Practice in 41 NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Community and Global Health. Jones & Bartlett Learning, USA.  INDIA - MID-DAY MEAL SCHEME (CON’T) Has been effective when combined with fortification and other interventions such as deworming Boosted school attendance of girls and improved nutrition among children, especially in poor areas. Has a non-discrimination policy with the objective of reducing socioeconomic disparities by allowing low-income children, especially low-income girls, who are traditionally most likely to stop attending school when food is scarce, to continue attending school School programs may not discriminate based on student caste or gender Also promotes women’s employment through policies encouraging the employment of women to cook meals Stein N. (2015). Public Health Nutrition: Principles and Practice in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 42 Community and Global Health. Jones & Bartlett Learning, USA. THE SHOKUIKU PROGRAM IN JAPAN  A long history, dating back to 1889 when monks provided lunches of rice balls, grilled fish and pickles for poor children.  During the Meiji (1868-1912) and Taisho (1912-1926) eras, school lunches were served to impoverished children, incentivising them to attend school.  Reinstated in 1946 in response to the need to reduce widespread malnutrition in children after the World War 2  Program is universal in elementary schools by 1952, secondary schools in 1954 with the passage of the School Lunch Law by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)  2005 “Basic Law of Shokuiku” established a school lunch programme that address the nutritional concerns of Japanese children while including features that reflect the nation’s culture  Besides providing supplementary food - includes nutrition and health education, with an emphasis on adapting healthy behaviours such as serving appropriate quantities of food, eating breakfast, increasing PA, and reducing sedentary time.  Another goal is to promote regional produce and rice consumption. Stein N. (2015). Public Health Nutrition: Principles and Practice in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Community and Global Health. Jones & Bartlett Learning, USA. The Hinomaru bento 43  THE SHOKUIKU PROGRAM IN JAPAN (CONTINUED)  Diet and Nutrition Teacher System – established in 2007 – responsible for menu planning and health promotion - Counsel nutritionally at-risk individuals (students with obesity or allergy) - Develop educational materials for students, train teachers on nutrition and health, communicate with parents - MEXT encourages schools to make a Diet and Nutrition Teacher available nearly every day  The Lunch Environment – students are engaged:  setting up meals to cleaning up after;  students learn about appropriate portion sizes by serving themselves and having the option to return for second helpings;  learn about food safety from the Diet and Nutrition Teachers  Objective of the D&N Teacher System – to increase “interest in dietary education: to 90% from a baseline of 70% Stein N. (2015). Public Health Nutrition: Principles and Practice in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Community and Global Health. Jones & Bartlett Learning, USA. 44 NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 45 TEACH A COURSE 46  MALAYSIA: SCHOOL SUPPLEMENTARY FEEDING PROGRAM (SSFP) 1980 – Education Ministry implement the SSFP independently; associated with the New Economic Policy, the national 5-year plans and the community development programme 1989 – extended to all schools Geared to the needs of the vulnerable, poorer socioeconomic groups, reduce imbalances among groups differentiated by geography (urban vs. rural), ethnicity, and socioeconomic status SSFP meals were expected to contribute 25–35% of schoolchildren’s daily recommended nutrient intake (RNI) requirements, as stipulated by the MOE Rancangan Makanan Tambahan Sekolah (RMTS) – an integrated effort carried out in conjunction with primary expected to provide 350–400kcals of energy and 5-40g schools’ nutrition and healthy programmes of protein daily Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. Kuala Lumpur: NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 47 Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0.  MALAYSIA: SCHOOL SUPPLEMENTARY FEEDING PROGRAM (SSFP)  The aims of the SSFP in primary schools were to: a) provide part of the daily protein-energy and other nutrition requirements of needy children b) create opportunities for formal and informal nutrition education c) create a focal point for school-community cooperation by involving parent-teacher associations and community groups. d) provide informal community education on health and nutrition.  At the school level, effective school feeding programmes will require: o Involvement of parents, via Parent-Teacher Associations o Effective monitoring of food preparation; Ensure that food suppliers are responsible for quality and safety of their supplies Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Kuala Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0. 48  MALAYSIA: SCHOOL SUPPLEMENTARY FEEDING PROGRAM (SSFP)  Effective school feeding programmes will require an ‘all-of-government’ approach. Ministry Role(s) Ministry of Education Ensure effective overall management of the feeding programme and nutrition education Ministry of Health - Design food menus to ensure healthy diets and good nutrition - Ensure high quality, safety and nutrition standards to ensure compliance with appropriate minimal standards and procedural guidelines Ministry of Agriculture and Agro-based Ensure safe and nutritious food sources, preferably from smallholder Industries farmers, through their cooperatives and associations Ministry of Entrepreneur Development Mobilise farmer cooperatives as part of this effort by MOA Ministry of Family, Women and Community Ensure that school feeding programmes complement their other Development efforts to improve the welfare of children and families Ministry of Domestic Trade and Consumer Help ensure reasonable food prices and healthy, safe food supplies. Affairs NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 49  MALAYSIA: SCHOOL SUPPLEMENTARY FEEDING PROGRAM (SSFP)  Success/Impact: Reducing protein-energy malnutrition among children; increased school attendance, particularly by children from low SES families (Kandiah & Tee, 1990). A study of 129 schools in Peninsular Malaysia found that 97.0% of the children liked and were happy with the food served, 88.6% reported that they ate all the food served, while only 3.0% disliked the food given. The parents surveyed also appreciated the programme and wanted SSF to continue. (Mohd Shahril, et al. 2000) Protein-energy malnutrition had declined significantly after two years of SSF (Chen, 1989).  Gaps: Of micronutrients, only vitamins A and C were in the SSFP meals provided (Arop, et al., 2003). Foods that was made available in schools can be unhealthy due to high fat and calorie content. (Wan Nudri & Abdullah, 1996; Nik Rosmawatiet al., 2014) There were limited options available for dairy products, fruits and vegetables (Nik Rosmawati, et al., 2014) due to reduced ingredients used to prepare certain meals and beverages (Jabatan Audit Negara, 2009). Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 50 Malaysia. Kuala Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0.  FOOD ENVIRONMENT IN WORKPLACES NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 51  INTRODUCTION  Workplaces represent an important venue for influencing dietary patterns.  Worksites offer an important venue to reach large numbers of workers in order to provide on-going education as well as healthy food options.  It may be possible to support behavior changes long-term through co-worker support, changes in the foods available at work, and consideration of other work-related factors associated with workers’ dietary patterns. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Quintiliani L et al (2010). Healthy Eating Strategies in the Workplace. Int J Workplace Health Manag.; 3(3): 182–196. 52  Food environments nearby to workplaces are associated with some eating behaviours. Food environment policies need to also consider non-residential environments.  Workplace practices and policies that support health can:  make it much easier and more convenient for employees to choose healthier foods  engage in physical activity throughout their work day  Easy access to healthier foods, beverages, and physical activity at work encourages healthier lifestyles among employees. Thornton et al (2013). Employment status, residential and workplace food environments: Associations with women's eating NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR behaviours. Health Place 24: 80-89. https://doi.org/10.1016/j.healthplace.2013.08.006 53  The Centers for Disease Control and Prevention (CDC) of the US – Tips for Offering Healthier Options and Physical Activity at Workplaces Meetings and Events 1. Offer a colorful variety of fruit and vegetables. 2. Offer 100% whole-grain products in a variety of forms. 3. Offer smaller portion sizes and prepare food in ways that reduce added calories. 4. Do not offer foods that contain industrially produced (or artificial) trans-fatty acids. 5. Offer foods that are reduced or low in salt and sodium. 6. Offer healthier condiments served on the side in small portions. 7. Offer snacks that are low in calories and high in nutrients. 8. Limit sweet treats. 9. Discourage the practice of “Dumping” or leaving leftovers of less healthy foods (like birthday cake) in common areas. 10. Offer water and low-calorie beverages. *Active Workplace Practices  Physical Activity (Sem 3) NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 54 References:  Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23-29.  Turrell G, Blakely T, Patterson C, Oldenburg B.A multilevel analysis of  socioeconomic (small area) differences in household food purchasing behaviour. 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Br J Nutr 107, 1028–1036  Ding D, Sallis JF, Norman GJ, et al. (2012) Community food environment, home food environment, and fruit and vegetable intake of children and adolescents. J Nutr Educ Behav, 44(6):634–638.  Campbell KJ, Crawford DA, Salmon J, et al. (2007) Associations between the home food environment and obesity- promoting eating behaviors in adolescence. Obesity (Silver Spring), 15(3):719–730.  Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood obesity. Nutrition Reviews® Vol. 66(3):123–140  Watts et al. The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention. BMC Nutrition 2018; 4:3  Appelhans, B. M., Waring, M. E., Schneider, K. L., Pagoto, S. L., DeBiasse, M. A., Whited, M. C., & Lynch, E. B. (2012). Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women. Appetite, 59(2), 576–584. https://doi.org/10.1016/j.appet.2012.07.009  Poelman, M. P., de Vet, E. W. M. L., Velema, E., Seidell, J. C., & Steenhuis, I. H. M. (2014). Behavioural strategies to control the amount of food selected and consumed. Appetite, 72, 156-165. https://doi.org/10.1016/j.appet.2013.09.015  Fulkerson JA, Nelson MC, Lytle LA, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. International Journal of Behavioral Nutrition and Physical Activity, 2008, 5;55.  Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, et al. (2012) Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 126: 1514–1563. pmid:22907934  Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. (2018) Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis. PLoS ONE 13(3): e0194555. https://doi.org/10.1371/journal.pone.0194555  Food and Agricultural Organization (FAO), 2019 http://www.fao.org/school-food/areas-work/food-environment/en/  Wan Manan Wan Muda, Jomo Kwame Sundaram and Tan Zhai Gen. 2019. Addressing Malnutrition in Malaysia. Kuala Lumpur: Khazanah Research Institute. License: Creative Commons Attribution CC BY 3.0.  Stein N. (2015). Public Health Nutrition: Principles and Practice in Community and Global Health. Jones & Bartlett Learning, USA.  Quintiliani L et al (2010). Healthy Eating Strategies in the Workplace. Int J Workplace Health Manag.; 3(3): 182–196.  Centers for Disease Control and Prevention. Smart Food Choices: How to Implement Food Service Guidelines in Public Facilities.Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2018.  THANK YOU! QUESTIONS? NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR