establishing a culture of early adoption of healthy eating habits and intuitive eating among ...

179 Pages·2017·2.55 MB·English

by  Carly Schott

ABSTRACT
ESTABLISHING A CULTURE OF EARLY ADOPTION OF
HEALTHY EATING HABITS AND INTUITIVE EATING
AMONG PRESCHOOLERS
Establishing healthy eating habits at a young age is essential for promoting
optimal health and wellbeing among children.1 Poor eating habits may increase
risk for the development of diet-related non-communicable diseases (DR-NCDs),
weight gain, and childhood obesity.2 Dieting is a common treatment for childhood
obesity, but dieting often results in weight regain within a few years and increased
risk for obesity later in life.3-10 As an alternative to dieting, this study explored
intuitive eating as a tool to positively influence eating patterns, encourage healthy
eating habits, and encourage early adoption of non-dieting eating behaviors among
preschoolers. Preschoolers participated in a 4-week study, including 2 weeks of
nutrition and intuitive eating education in the classroom that encouraged them to
accept new fruits and vegetables and to stop eating when they recognized feelings
of hunger satisfaction. Story books were sent home to reinforce education
provided in the classroom.11,12 This feasibility study found no significant changes
in the preschoolers’ fruit and vegetable intake and no significant changes in
hunger ratings reported after snack time. Despite the lack of significant changes in
eating habits, the valuable information gleaned from this feasibility study has laid
the foundation for future researchers to continue the work of developing
successful and sustainable childhood obesity prevention programs.
Carly R. Schott
May 2017

ESTABLISHING A CULTURE OF EARLY ADOPTION OF
HEALTHY EATING HABITS AND INTUITIVE EATING
AMONG PRESCHOOLERS

by
Carly R. Schott, RDN

A thesis
submitted in partial
fulfillment of the requirements for the degree of
Master of Science in Food and Nutritional Sciences
in the Jordan College of Agricultural Sciences and Technology
California State University, Fresno
May 2017
© 2017 Carly R. Schott
APPROVED
For the Department of Food Science and Nutrition:

We, the undersigned, certify that the thesis of the following student
meets the required standards of scholarship, format, and style of the
university and the student's graduate degree program for the
awarding of the master's degree.

Carly R. Schott, RDN
Thesis Author

Lisa Herzig (Chair) Food Science and Nutrition

Shabnam Pooya Food Science and Nutrition

Hala Madanat Health Promotion and Behavioral Science
San Diego State University

For the University Graduate Committee:

Dean, Division of Graduate Studies
AUTHORIZATION FOR REPRODUCTION
OF MASTER’S THESIS

I grant permission for the reproduction of this thesis in part or in
its entirety without further authorization from me, on the
condition that the person or agency requesting reproduction
absorbs the cost and provides proper acknowledgment of
authorship.

X Permission to reproduce this thesis in part or in its entirety must
be obtained from me.

Signature of thesis author:
ACKNOWLEDGMENTS
First and foremost, I would like to thank Dr. Lisa Herzig, without whom
this feasibility study would not have been possible. I cannot thank you enough for
sharing your advice and expertise, and for your time and dedication to this project.
I would also like to express my gratitude to Dr. Hala Madanat, Dr. Steven Pao,
and Dr. Shabnam Pooya for your guidance throughout this process and for
contributing your expertise to this research. To my research assistants, Cassie
Kandarian, Linda Larsen, Karly McNabb, and Carla Munoz Rocha; to the staff at
the Huggins Center; and to my story book illustrator, Hank Nunes; I would like to
express my sincere appreciation for volunteering your time to assist me with this
feasibility study. I am so grateful for your commitment to this project.
To Dr. Andrew Cook and the staff at Vital Health Institute, thank you for
ensuring my health and wellbeing along this journey, and for helping me conquer
the many obstacles that threatened the completion of this project. Without you all,
I never would have made it this far.
To my family, thank you for your continuous support and love throughout
this entire process. Mom, Dad, Clayton, Monica, Crystina, Danica, and Jared,
thank you for always cheering me on, even during the toughest of times. To
Wally, thank you for bringing joy and sweetness to my life when I needed it most
to help me complete my graduate school journey. Most importantly, I would like
to express my deepest gratitude to my husband, James. Thank you for your never-
ending encouragement and absolute loyalty. Your unconditional love and support
have given me the strength I needed to succeed in this venture. I share this
accomplishment with each of you who supported me along the way.
TABLE OF CONTENTS
Page
LIST OF TABLES .................................................................................................. ix
LIST OF FIGURES .................................................................................................. x
CHAPTER 1: INTRODUCTION ............................................................................ 1
Establishing Healthy Eating Habits at a Young Age ........................................ 1
An Introduction to Childhood Obesity .............................................................. 3
Prevention Strategies ......................................................................................... 6
An Introduction to Intuitive Eating ................................................................... 8
Intuitive Eating among Preschoolers .............................................................. 11
Food Acceptance among Preschoolers ........................................................... 14
The Purpose of this Feasibility Study ............................................................. 14
Justification for this Feasibility Study ............................................................ 17
Hypotheses ...................................................................................................... 17
Definition of Terms ......................................................................................... 18
CHAPTER 2: LITERATURE REVIEW ............................................................... 22
Current Treatment Strategies for Childhood Obesity ..................................... 22
Problems with Current Treatment Strategies .................................................. 24
Intuitive Eating: A Proposed Alternative ........................................................ 29
Hunger and Satiety Picture Rating Scale ........................................................ 35
Use of Nutrition Education and Storytelling to Encourage Healthy Eating
Habits ................................................................................................... 37
Use of Established Relationships with Teachers and Family to Encourage
Preschoolers to Eat Intuitively ............................................................. 38
CHAPTER 3: METHODOLOGY .......................................................................... 40
Target Population, Sample, and Setting .......................................................... 40
vii vii
Page
Research Strategy ............................................................................................ 46
Food Handling Protocol .................................................................................. 56
Data Analysis .................................................................................................. 59
CHAPTER 4: RESULTS ....................................................................................... 60
Differences Between Treatment Groups ......................................................... 60
Changes in Fruit and Vegetable Intake ........................................................... 60
Changes in Reported Hunger Ratings After Eating ........................................ 65
Summary of Key Findings .............................................................................. 66
CHAPTER 5: DISCUSSION ................................................................................. 67
Differences Between Treatment Groups ......................................................... 67
Changes in Fruit and Vegetable Intake ........................................................... 68
Changes in Hunger Ratings After Eating ........................................................ 69
Feasibility Study Limitations .......................................................................... 70
Recommendations for Future Research .......................................................... 79
Significance of this Feasibility Study ............................................................. 80
Conclusion ....................................................................................................... 82
REFERENCES ....................................................................................................... 84
APPENDICES ........................................................................................................ 96
APPENDIX A: INFORMED CONSENT FORM ................................................. 97
APPENDIX B: WEEK 1 LESSON PLAN ............................................................ 99
APPENDIX C: WEEK 2 LESSON PLAN .......................................................... 108
APPENDIX D: WEEK 3 LESSON PLAN .......................................................... 118
APPENDIX E: WEEK 4 LESSON PLAN........................................................... 127
APPENDIX F: WEEK 2 STORY BOOK ............................................................ 137
APPENDIX G: WEEK 4 STORY BOOK ........................................................... 142
viii viii
Page
APPENDIX H: STORY TO FAMILIARIZE PRESCHOOLERS WITH THE
HUNGER AND SATIETY PICTURE RATING SCALE ....................... 147
APPENDIX I: TEMPERATURE MONITORING .............................................. 149
APPENDIX J: F.A.R.E. FOOD ALLERGY PROTOCOL .................................. 154
APPENDIX K: TESTING THE USABILITY OF THE HUNGER AND
SATIETY PICTURE RATING SCALE WITH PRESCHOOLERS ........ 156
APPENDIX L: E-MAIL CORRESPONDENCE WITH DR. CARMEL
BENNETT ................................................................................................. 163
APPENDIX M: RAW DATA .............................................................................. 165