Smart Snacking Central DuPage Hospital - New Directions Weight .

Smart Snacking Central DuPage Hospital – New Directions Weight Management Program January 19, 2015 Katie Keane ARAMARK Dietetic Internship 1

Overview The purpose of this project was to provide a nutrition intervention to the outpatient weight management community at Central DuPage Hospital in Winfield, Illinois. The Nutrition Care Process was utilized to assess, diagnose, intervene, monitor and evaluate the community. From this process, it was determined that the community would benefit from a class that provided knowledge about healthy snacking. The program taught participants how to choose a healthy snack and how to do so on-the-go as well. Utilizing evaluation tools, it is evident that the program was successful in meeting the program’s objectives. Nutrition Assessment Client History (CH) The population served by the Central DuPage Hospital Weight Management Center was assessed initially by utilizing the Central DuPage Hospital 2013 Community Health Needs Assessment.1 This document indicated that the primary race of the population served was white – 70.5% (Race: CH-1.1.4). The median age is 38.2 with the largest age group being between 18-44 years old (Age: CH-1.1.1). English is the predominant language in DuPage County at 89.9% (Language: CH-1.1.6). Literacy is 93.4% (Literacy factors: CH-1.1.7) and 92% of the population are at least high school graduates (Education: CH-1.1.8). The median household income for DuPage County was 72,470 which is 132% of the national average income (Socioeconomic factors: CH-3.1.1). It is important to note that the population for this project is a group of community members that signed up for the non-surgical weight loss program at Central DuPage 2

hospital. Therefore, the primary patient health history in this population is overweight or obesity (Patient/Client chief nutrition complaint- overweight, obesity: CH-2.1.1). Each participant enrolled in the program speaks English. The manager of the weight loss program did not express any cultural, language or religious (Religion: CH-3.1.7) requests in regards to delivering a community intervention program. Through the use of a pre-class questionnaire (see appendix A), the client history of participants was directly assessed. In total there were 55 participants. 40 of the participants were female and 15 were male (Gender: CH-1.1.2). 95% of participants were Caucasian/white, 1 participant was Asian, 1 participant was Hispanic and 1 was Native American. Food/Nutrition-Related History (FH) With the Central DuPage Hospital weight loss program, the dietitian provides a lesson to participants once a month. Each meeting the dietitian is responsible for, she provides weight management skills to participants with varying topics. The community project was implemented within this setting. The dietitian verbalized a need for a program that teaches participants healthy snacking patterns (Meal/Snack pattern: FH1.2.2.3). This topic had yet to be covered, and she felt this knowledge would benefit the participants’ progress towards weight loss. Ethnic and Religious Beliefs of Predominant Culture Prior to the development of this program, the dietitian manager was asked if any ethnic or religious beliefs should be considered. 95% of participants are white/Caucasian and the manager did not foresee any necessary considerations. White Americans, generally speaking, rely on western medicine. Being overweight or obese is 3

usually viewed negatively within this ethnicity. These factors and beliefs were kept in mind, but there weren’t any modifications made to the program. Nutrition Diagnosis – PES Statement Food- and Nutrition-related knowledge deficit (NB-1.1) related to lack of prior education as evidenced by self-reported undesirable snacks on participant questionnaire. Intervention For nutrition care intervention, education was utilized. A class was planned that provided participants with recommended modifications (E-1.5) to their snacking routines. Healthy People 2020 Based on the nutrition assessment that was performed on the population being served, it was determined that there is an overarching Healthy People Goal and Objective that would improve the nutrition status of this community. This overarching Healthy People goal would be to, “promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. The specific objective that could be achieved through the intervention of this program would be to “increase the proportion of adults who are at a healthy weight”. This objective meets all of the SMART criteria – the objective is aimed towards a specific target population, weight is a measurable indicator, it is achievable and realistic because of the nature of the setting of this community (weight loss program), 4

and the time frame is reasonable because a significant amount of weight loss can occur in five years, 2015-2020.2 Lesson Plan The title of this lesson is “Smart Snacking”. The target audience is the members of the Central DuPage Hospital outpatient weight loss group, New Directions. The lesson was provided to four different groups, 45 minutes each. The goal of the lesson is to provide content that will teach participants what is considered a healthy snack and where to find them. There are two learning objectives for this lesson. The first is: Participants will be able to plan a healthy snack using the “smart snacking” guidelines within a real life situation. This objective is specific in that it is directed towards the target population and it is one specific skill. It is measurable because of the discussion activity that will measure if participants obtained this skill. The objective is realistic and achievable in that it is limited to one skill that will be taught through the presentation. The objective can easily be met in the given time frame. The second objective is: Participants will be able to identify snack options on-thego. This objective is also specific to the target population and is a reasonably specific skill to acquire. The skill in this objective can also be measured by the discussion activity by seeing if participants can apply the content provided. It is a specific skill, which makes the objective realistic and achievable. This objective can also easily be met in the given time of 45 minutes. The program began with a pre-class questionnaire (appendix A). This questionnaire collected anthropometric information (to confirm assessment data) and had two open ended questions to assess prior knowledge and skills in relation to 5

healthy snacking. Next, the speaker, Katie Keane, introduced herself. The body of the program is the power point presentation. Specific content of the power point can be seen in the lesson plan template (appendix B) and the power point itself (see document submitted with report). After the power point, a discussion activity (appendix C) explored different snacking scenarios and was used to assess the success of the intervention. This activity measured if the objectives were met. A handout was provided (appendix D) to participants that summarized the content of the program as well as a copy of the power point slides.3 The program concluded with answering any questions that participants had. The materials needed were a USB with the PowerPoint, a computer connected to a projector, a projector screen, 55 copies of the printed out power point, 55 copies of the smart snacking handout and 55 pre-class questionnaires. There were not any costs associated with the implementation of this project to the project leader. The printed out materials were provided by Central DuPage Hospital. The conference room is rented out by the weight loss program. Marketing Marketing for this community project was not applicable due to the setting of the education intervention – a weight loss program where participants come to weekly classes. There are marketing regulations set in place for this program at Central DuPage Hospital. However, if the education intervention were implemented to a different target audience, hypothetically the following marketing plan could be used to gain interest. The “product” being marketed would be the class itself. “Promotion” could be accomplished through flyers posted around the hospital. This would reach both 6

employees, patients and their families. The “place” would be marketed as where the program is taking place – in this case, Central DuPage Hospital. The “price” of the class would be included within the New Directions Weight Loss Program. Nutrition Monitoring & Evaluation To measure the success of learning objectives, a discussion activity was used to measure against the pre-program questionnaire. In the pre-program questionnaire, participants were asked two questions to gauge knowledge and skills prior to the intervention. These questions included: 1. Prior to the New Directions Program, what would your typical snack be? Please include serving size. Feel free to give more than one example. 2. Is it difficult to find healthy snacks outside the home (while traveling, at work, etc.)? Please explain. Responses to the first question is summarized in the chart below. In general, participants snacked on high calorie unhealthy snack options. Snack Choices Prior to Class 25 20 15 10 5 Chips Ice Cream Candy Fruit Crackers Popcorn Pretzels Vegetables Fast Food Cookies Cupcakes Milkshake Brownie Regular Latte Cheese Peanuts Cereal Desserts Protein Drinks Soda Peanut Butter Slim Jim Yogurt Pudding Lunch meat Granola Bar 0 7

This chart indicates the top five snack choices prior to the program were chips, ice cream, candy, cookies and popcorn. When consumed as a regular snack without controlling portion sizes, these snacks contribute greatly to excessive calorie intake. Participant’s responses to the second question are summarized in the chart below. The majority found it difficult to find healthy snack options while on-the-go. IS IT DIFFICULT TO FIND HEALTHY SNACKS OUTSIDE THE HOME (TRAVELING, AT WORK, ETC.) ? no 35% yes 65% The pre-class questionnaire established that the majority of participants, prior to the education intervention, were choosing unhealthy snacks and had difficulty in finding healthy snacks choices while outside the home. The snacking scenario discussion activity determined that both objectives were successfully met. Each group of participants verbalized healthy snack options that fell within the healthy snack guidelines taught in the class. Each scenario was an “on-the- 8

go” snacking situation and participants were able to state how and where they could find healthy choices. Plans for future monitoring and evaluating are limited due to the setting of this intervention. It would be difficult to determine if successful weight loss was a result of the “Smart Snacking” class or if it was a result of the weight loss program in general. The ultimate Healthy People 2020 Goal can be monitored by assessing the weight loss progress of the group. In regards to the healthy snacking intervention – the monitoring and evaluation ended after the class. Seeing as both objectives were met, the overall goal of teaching participants what a healthy snack is and where to find healthy options was achieved. 9

Appendix A Name: Date Height Current Weight Weight When Starting the Program Gender Race/Ethnicity Estimated Start Day of New Directions Program 1. Prior to the New Directions Program, what would your typical snack be? Please include serving size. Feel free to give more than one example. 2. Is it difficult to find healthy snacks outside the home (while traveling, at work, etc.)? Please explain. 10