Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 2

How to use this toolkit:

This toolkit has been created to make it easy for a variety of organizations interested in adolescent

health to participate in Global Teen Health Week. You are free to use and adapt any of the materials

herein for your Teen Health Week activities; however, use of these materials is not required in order to

promote adolescent health during Teen Health Week. Participating organizations are at liberty to

celebrate Teen Health Week in any manner they wish, and are encouraged to be creative in adapting

these ideas to meet the needs of the adolescents you wish to reach. Approval for activities or

educational materials is not required.

Background:

Nutrition and physical fitness play a major role in the health of adolescents. Teens can be a healthy

weight but consume too few nutrients through their diets. For instance, iron deficiency anemia is a

major cause of death and disability worldwidei. Malnutrition is not only associated with underweight.

Obese teens too can suffer from malnutrition, especially if their caloric intake is from foods with poor

nutritional quality. Time spent performing sedentary activities, such as computer use, increases as teens

age, and physical activity declines with age.

Objective: Today, the objective is to provide facts and resources for teens to learn accurate

information about nutritious diet and the importance and benefits of physical activity, but also to

provide ample opportunities to demonstrate physical activity can be fun, and nutrition can be tasty.

Teens also can be encouraged to inspire healthy behaviors in their families as setting an example.

Worldwide, the number of obese adolescents and children has been increasing steadily over the past 40

years: rates of obesity in children ages 5-19 has increased 10-fold over this period of time. If these rates

continue, obesity will take over underweight by 2022 among young people as a major nutritional health

issueii. Obesity is well known to be associated with an increased risk of variety of health issues, both in

teens themselves, as well as later in life as teens develop into adults. For instance, obesity is associated

with diabetes, numerous types of cancer (which comprise almost half of cancers diagnosed): thyroid,

breast, kidney, liver, colon and othersiii.

Dietary choices and physical inactivity contribute to these problems:

• Fewer than 1 in 4 adolescents gets the World Health Organization (WHO)iv recommended 60

minutes of moderate to vigorous physical activity each day.v While physical activity levels are

low for young people, then tend to be especially low for girls.vi

• The WHOvii also recommends that free sugars should constitute less than 10% of total energy

intake. Recent evidence from the United Kingdom suggests that adolescents are consuming 15%

of their daily calorie intake in the form of sugars.viii

• Among US high school students, rates of soda consumption are decreasing but still about 1 in 5

drank soda at least once a day in 2015.ix

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 3

• A significant percent of US high school students does not regularly eat fruits (~5%) and

vegetables (~7%).x Diets low in fruit and vegetable consumption are amongst the leading causes

of dietary risk factors in a person’s life.xi

• Slightly fewer than half of US high school students attend physical education classes once a

week.xii

• Young people spend approximately 60% of their waking time sitting, making sedentary

behaviour the most common behavior (besides sleep) in children and adolescents.xiii

• “Screens” play a big role in sedentary behavior of teens. Although television viewing is

decreasing, for instance more than 4 in 10 US high school students spend 3 or more hours a day

at a computer for fun outside of school during their free time.xiv

Many public health experts are concerned about the impacts of marketing directly to teens, as well as

limited access to healthier foods amongst the poor. Professor Majid Ezzati, of The Imperial College of

London states:

“These worrying trends reflect the impact of food marketing and policies across the globe, with

healthy nutritious foods too expensive for poor families and communities. The trend predicts a

generation of children and adolescents growing up obese and at greater risk of diseases, like

diabetes.”

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 4

Activities and Resources

Setting or Outlet Suggested activities or ideas

Medical Practice Ideas • Have staff wear Teen Health Week t-shirts or lime green to celebrate the week.

• Submit a letter to the editor to local press about importance of nutrition and fitness in teens.

• Partner with a local school to share educational materials about healthy diet and exercise. A good starting point is reaching out to gym and health teachers.

• Plan a local event – a community yoga class, a healthy food fair, etc. Promote your event (and your practice / expertise) with local newspapers, television and radio media. If you can be interviewed by local media / morning news use the opportunity to share information about how communities can support teens in making healthy diet and exercise choices.

School-wide ideas • Post nutritional information in cafeteria along with food selections.

• Encourage students to take a fruit or vegetable with their lunch.

• Offer granny smith apples (lime green!) as a healthy snack favor.

• Have a dance-a-thon.

• Have a free-throw contest.

• Publish a student-written article in the school newspaper or blog about nutrition and fitness and how it can benefit students.

• Student Government can make a statement, facilitate a discussion between students and administrators, or host an event about improving the diet and activity levels of their peers.

Health Class activities • Use the class time for yoga, dancing, or other physical activity.

• Cook or prepare a healthy snack to enjoy in the class.

• Have students bring in health recipes and put together a “cook-book” or a blog or share via social media. Include pictures!

• Create “advertisements” to “sell” healthy foods. Teens can use the tricks they see in all sorts of advertising. Ads can be images, announcements, skits, videos.

• Discuss sports nutrition – healthy ways to gain weight for certain sports, as well as caution when trying to “make weight” for others.

• Student can use pedometers (either their own, or download an app on their phones) and have a “most steps taken over the week” contest. Sample free apps for iPhone and Android: www.mypacer.com

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 5

Setting or Outlet • Suggested activities or ideas

Social Media ideas (#2018teenhealth)

• Post pictures of activities to students’ social media or to dedicated Teen Health Week social media pages using #2018teenhealth.

• Post pictures of healthy snack creations to social media.

• Create a SnapChat story showing healthy food choices or activities over the course of a day, or a story about cooking a healthy recipe with funny cooking messes, etc.

• Help students identify accurate social media accounts that inspire health nutrition and fitness decisions. Examples: @healthymonday; @fruits_veggies, @RTwithDrOffutt

Tweets • Shocker: 2 - 20oz sugar sweetened drinks a day seriously increases your risk of diabetes. And who like shots?! #2018teenhealth

• Problems: Stress, anxiety, feeling tired. What helps: Exercise, exercise, exercise. #GetUpAndMove #2018teenhealth

• Ever heard of "Eating the Rainbow"? Orange carrots, red tomatoes, blueberries, green lettuce. Colors=nutrients. #2018teenhealth

• A can of soda has 10 + teaspoons of sugar?!? So do juice drinks! Pick water first to quench your thirst. #2018teenhealth

• Hate working out? Love music? Know you should exercise? Turn up the tunes and dance! C'mon, no one's looking! #2018teenhealth

Facebook posts • What’s exercise good for? Well: o Problem: Stress - What helps: Exercise o Problem: Anxiety - What helps: Exercise o Problem: Fatigue - What helps: Exercise o Problem: Back pain - What helps: Exercise

• The scale doesn't measure your value as a person; but your BMI helps you know if you are in a healthy range. Check yours: https://nccd.cdc.gov/dnpabmi/Calculator.aspx #2018teenhealth

• A picture is worth a thousand words! Look at this to compare how much sugar is in your favorite beverages! https://www.hsph.harvard.edu/nutritionsource/how-sweet-is-it/ #2018teenhealth

• It’s #2018teenhealth! Get a pedometer app and track those steps! Goals: More than 10,000 a day! Compete with your friends! 2 free apps for iPhone and Android: www.mypacer.com

• What’s YOUR favorite fruit or vegetable? Share your fruit or vegetable emoji for #2018teenhealth

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 6

Selected additional resources and links:

• Perils of “making weight and other sports nutrition problems: http://realtalkwithdroffutt.org/13/post/2014/04/coach-says-do-it-i-gotta-do-it.html

• Healthy meals and snack ideas for teens: https://www.niddk.nih.gov/health-information/diet-nutrition/healthy-meals-snacks-teens#b

• Exactly how much sugar is in certain foods: https://www.hsph.harvard.edu/nutritionsource/how-sweet-is-it/

• General health and nutrition information blog posts written specifically for teens: http://realtalkwithdroffutt.org/nutrition-and-fitness.html

• Sample free pedometer apps for iPhone and Android: http://www.mypacer.com/ and

http://www.azumio.com/s/argus/index.html

• Top tips for a campaign on healthier lifestyles for young people:

http://www.eyto.org.uk/media/1041/top-tips-final.pdf

• Healthy Lifestyles Campaign Development Tool for professionals:

http://www.eyto.org.uk/media/1042/eyto-replication-tool.pdf

• Numerous resources for teens about healthy diet and fitness:

http://www.eatright.org/resources/for-teen

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 7

Poster / Handout Appendix

The following materials may be reproduced and shared freely.

In a hurry in the morning? Not quite into a cereal and milk breakfast?

Try these power-packed Grab ‘n Go breakfasts to give you an energy-filled start to your day!

• Peanut or almond butter and bananas on raisin toast

• Quesadilla snack wrap with scrambled egg and grated low fat

cheese. Add salsa for a flavor boost!

• Frozen french toast or waffle and juice-box style vanilla or chocolate

flavored milk.

• Trail mix made with Cheerios® or Rice Chex®, almonds, walnuts,

dried cranberries or raisins and bagged to go.

• Tortilla spread with peanut butter and jelly

• Smoothies made with 1 cup low fat milk (can subsitute almond or soy

milk), ½ cup rolled oats, 1 banana, 1 cup strawberries (frozen works

well!), 1 tsp sugar or honey and ½ teaspoon vanilla extract. For flavor

and color change, try spinach and kiwi

• Cheese cuts or string cheese, fruit, and whole wheat crackers

• Bagel with light cream cheese or peanut butter with drinkable yogurt

• Peel banana. Spread with peanut butter and roll in breakfast cereal.

Freeze in zip loc bag.

• Soup is not just for lunch and dinner! Try cream or tomato soup in a

travel mug

• To make scrambled eggs, simply add 2 eggs, 2 tbsp milk and

salt/pepper to taste to a microwavable mug. Stir briskly until well

mixed. Microwave on high for 45 seconds. Stir. Return to microwave

and cook on high for 30-45 seconds until set.

• Like oatmeal cookies? Try baked oatmeal. Easy recipes found online.

Cut into squares. Tasty and portable. Easily frozen for later.

Fast food doesn’t have to sabotage your healthy eating plans. Try these tips the next time you visit a fast food restaurant.

1. Check out the chicken. Grilled chicken sandwiches with lettuce,

tomato and pickles can beat out burgers in taste and nutrition. A

couple of tips….choose grilled (not breaded or fried) chicken and skip

the bacon, mayo and creamy sauces. Add ketchup or barbecue

sauce to add some pizazz.

2. Keep your eye on the size. Keep your eye on portion size. Choose

plain cheese or hamburger, and small fries instead of large ones. You

can still enjoy the taste without the extra fat and calories. Choose kid-

size meals to help you control portion sizes.

3. Add fruit and veggies to the team. Most fast food restaurants have

fruit and veggie options to select from in place of high fat sides. Try

apple slices, mandarin oranges, fruit cup or a side salad in place of

fries.

4. Are you chili? A small chili, glass of low fat milk and fruit on the side

can be a tasty and healthy choice.

5. Be wise about sides. Not all side dishes are healthy. Cole slaw, onion

rings, macaroni and cheese, biscuits, mashed potatoes and gravy

can be chock full of calories and unhealthy fats. Instead, choose a

side salad with light dressing, fruit cup, or baked potato (light on the

toppings).

6. Speak up. Have it your way and ask for sauces and toppings to be

served on the side (or skip them) so you can control the amount that

is used.

7. Compare and Choose. Most fast food restaurants post nutrition

information on line or through an app. Compare nutrition facts of

different menu items. You may be surprised.

8. Rethink Your Drink. Choose beverages such as low-fat milk or water

to avoid extra sugar and calories.

7 Quick Fix Snacks for Teen Athletes

Along with the challenges on the field, eating healthy presents a challenge

off the field. The extra energy needed to fuel sports often comes in the form

of sugary snacks that are downed in seconds. To fuel exhausting practices

and games, simple snacks containing protein and carbohydrates give the

best one-two punch.

With a little planning, snacks can easily be planned into a teen athlete’s

routine.

Check out the options below. Which ones would you be willing to try?

• Homemade trail mix. Mix your favorite nuts, along with dried cranberries

or raisins, pretzels or low sugar additions such as Rice Chex, Cheerios

or pretzel bites. For a bit of sweetness, throw in a few chocolate chips,

yogurt covered raisins or coconut flakes. Make a large batch and store

in an airtight container. Pack in 5 plastic bags, one for each day of the

week.

• In a rush? Try peanut butter-filled pretzel nuggets and a banana for a

boost of protein, along with potassium and a bit of sodium for electrolyte

replenishment.

• Apple or pear with string cheese stick, handful of almonds, or a “to go”

size pack of peanut butter.

• Low fat chocolate milk. A great pre-game snack or post game recovery

fuel. No refrigeration? No problem! Bring a shelf stable box of chocolate

milk from home, and take it with you in your back pack.

• Snack size portable packs of hummus and whole grain crackers.

• Peanut butter on a mini bagel or raisin bread.

• Homemade baked oatmeal bars. Many recipes are available online. Add

walnuts, or dried fruit if desired. Prepare ahead, cut into bars,

individually wrap. May be frozen.

What are you drinking? Sports Drinks. Sports drinks offer a quick and easy way to replenish electrolytes, fluid and sugar during or following a long bout of exercise, such as playing a basketball or soccer game where you are on the field most of the time running hard and sweating hard. But for teen athletes who find themselves playing for just a few minutes at a time, water is the best option. Even though sports drinks may provide less sugar than soda, the calories can add up and provide little return on investment from a nutrition perspective. Providing sports drinks on a regular basis may keep that “sweet tooth” revved up, resulting in a preference for sweet beverages over plain water. Save these drinks for use on active game days, not lunch bags and afterschool snacks. Energy Drinks. Sometimes "sports drinks" can be confused with caffeine containing "energy drinks." These energy drinks really have no place in a healthy diet especially for teens because they provide excessive caffeine and sugar, providing an expensive "jolt" of energy in liquid form and causing rapid heartbeat and stomach distress for some teens. A brisk walk and plenty of water can be much more energizing, clearing the brain and allowing for better focus. Juices. It’s hard to beat the nutritional punch of a fresh piece of fruit, such as an orange. When faced with a choice between fresh fruit or juice, opt for the whole fruit, and skip the juice. The fiber can help promote a sense of fullness and may prevent overeating and benefits of the whole fruit cannot be entirely replicated in liquid form. While it might take 10 minutes to eat a fresh orange, it takes only seconds to down a cup of orange juice. Savor your fruit calories by eating them, not drinking them, and stock up on seasonal fresh fruit for snacks and meal time. Teens and Milk. Getting teen girls to drink more milk can be a challenge and yet getting enough calcium is critically important especially in teen years when bones are still forming. But getting enough calcium doesn’t have to mean drinking milk. Yogurt, smoothies, low fat cheese, calcium fortified breakfast cereals and almonds can also provide a calcium boost. Flavored milk, such as strawberry and chocolate provide an excellent source of calcium and vitamin D, but control sugar content by making your own version, by using 1% or skim milk and adding a teaspoon or two of chocolate or strawberry syrup or powder rather than purchasing the store bought varieties, which may contain twice as much sugar.

Tuesday, 20 March 2018

_____________________________________________________________________________________

Healthy Diet and Exercise

Toolkit created by Real Talk with Dr. Offutt, LLC Page | 12

Special Thanks and Acknowledgments

• Aixa Aleman-Diaz, Policy Advisor, WHO Collaborative Centre for International Child and

Adolescent Health, School of Medicine, University of St Andrews

• The Teen Health Week Fellows Working Group at The College of Physicians of Philadelphia

References

i http://www.who.int/mediacentre/factsheets/fs345/en/ ii http://www.who.int/mediacentre/news/releases/2017/increase-childhood-obesity/en/ iii https://www.cdc.gov/vitalsigns/obesity-cancer/index.html iv http://www.who.int/dietphysicalactivity/publications/physical-activity-recommendations-5-17years.pdf?ua=1 v http://www.who.int/mediacentre/factsheets/fs345/en/ vi Inchley J et al. eds. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002–2014. Observations from the Health Behaviour in School-aged Children (HBSC) WHO collaborative cross-national study. Copenhagen, WHO Regional Office for Europe, 2017. vii http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/ viii https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf ix https://stateofobesity.org/high-school-nutrition/ x https://stateofobesity.org/high-school-nutrition/ xi https://ec.europa.eu/jrc/en/health-knowledge-gateway/promotion-prevention/nutrition/fruit-vegetables#_Tocsc61 xii https://stateofobesity.org/high-school-physical-activity/ xiii Owen N, Salmon J, Koohsari MJ, Turrell G, Giles-Corti B. Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention. Br J Sports Med. 2014;48(3):174–7 xiv https://stateofobesity.org/high-school-physical-activity/