know more about schoolchildren’s nutritional needs understand the nutritional requirements for...

know more about schoolchildren’s nutritional needs

understand the nutritional requirements for school lunch / snacks guidelines

learn to make use of the ‘NutriAgent’ Handbook

understand how to use the monitor / assessment forms to keep check on the nutritional standard of school lunch / snacks

Before leaving for Before leaving for the day, you’ll…the day, you’ll…

‘‘You’-orientedYou’-oriented

Cross-sector synergistic Cross-sector synergistic cooperationcooperation

Continual supportContinual support

Appreciation and rewardAppreciation and reward

Assessment and reviewAssessment and review

Leaving a lasting Leaving a lasting reputationreputation

Stormy and perilousStormy and perilous

Completely exposed to Completely exposed to drawbacks from all sidesdrawbacks from all sides

Countless difficulties and Countless difficulties and barricadesbarricades

Strength-exhausting and Strength-exhausting and brain-rackingbrain-racking

Health and NutritionNutritional Guidelines on School Lunch for Primary Students and compliance monitorNutritional Guidelines on Snacks for Primary Students and compliance monitorOrganising projects promoting healthy eating at schoolSupport, record and rewardQ&A sharing

• The 3 major factors below count 60% on the death toll* in Hong Kong:– Cancer (33%)– Heart diseases (16.3%)– Cerebrovascular diseases (10.5%)

• Unhealthy dietary habitsincrease the risk of chronic illnessescause overweight and obesity

*Data of 2005 *

* Data Source: DH Student Health Service

• The percentage of primary schoolchildren with obesity*

Boys Girls Total

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06

男生女生總計

• rose from 16.4% in 1997/98

• to 19.4% in 2005/06

Energy Input

Energy Output

Obesity refers to the excessive storage of fat in the body, which may cause health impairment

ChildrenChildren

– Growth Charts

e.g. : Weight-for-Height Chart

Healthy eating habits built up in childhood are more likely to be carried on into adulthoodSchoolchildren generally fail to follow healthy eating principlesStudies abroad pointed out that school-based intervention programmes are found with proven effectiveness in promoting healthy dietary habits among schoolchildren

95.6% 95.9% 95.0% 97.7%

2.3%5.0%4.1%4.4%

Healthier

More unhealthy

Yoghurt Wheat bread with raisin

Chicken leg in Chinese ‘Lo Shui’ sauce

Pure orange juice

Ice cream Hot dog Deep-fried chicken leg

Soft drink

Healthier

More unhealthy

Yoghurt Wheat bread with raisin

Chicken leg in Chinese ‘Lo Shui’ sauce

Pure orange juice

Ice cream Hot dog Deep-fried chicken leg

Soft drink

51.9% 50.9%34.8% 35.1%

48.1% 49.1%65.2% 64.9%

Recipes with ‘less healthy ingredients’

63.2%

Recipes without ‘less

healthy ingredients’

36.8%

‘Snacks to choose more’

‘Snacks to choose in moderation’

‘Snacks to choose less’

Items soldat tuck shops

Items soldin vending machines

Items broughtto school from home

55.7% 61.3%35.6%

29.7% 28.8%

51.3%

14.6% 10.0% 13.1%

dietary habits and health are closely related

the existence of substantial gap between students’ knowledge and practice of healthy eating

teachers and parents have to be role models

To work together with us and give our next To work together with us and give our next generation a healthy eating environment!generation a healthy eating environment!

School ‘NutriAgent’ Project

Nutritional Training Workshop

Techniques of surveillance & negotiation

In this session, you’ll: Understand how to undertake surveillance of

the school eating environment

Know more about schoolchildren’s nutritional needs

Understand the qualitative and quantitative requirements in the Nutritional Guidelines on School Lunch / Snacks for Primary School Students

Learn to answer some FAQs about diet

Know how to use surveillance forms to keep the nutritional standard of school lunch / snacks in check

How to undertake surveillance of the

school eating environment?

What is Surveillance?

Data Collection

Data Collation

Data Analysis

Dissemination

Actions for Improvement

What we need for surveillance at school:

Basic knowledge of nutrition

Simple tools for lunch / snack surveillance

Items to be negotiated with lunch suppliers or tuck shop operators

School Lunch Surveillance

Nutritional Guidelines on School Lunch for Primary

School Students

With the guidelines, we hope to…

Achieve energy balance

Increase intake of fruit & vegetables

Reduce total intake of fat, sugar and salt

in students’ diet

About the guidelines:

(1) Guidelines on Quantity

(2) Guidelines on Quality

(1) Guidelines on Quantity

How much should a schoolchild eat?

??

Food Pyramid for Children

A healthy lunch should…

provide schoolchildren with of the nutrients

they need every dayone third

Tips on healthy lunch box

Grains & cereals, vegetables and meat should be in the ratio of 　：　：

by volume3 2 1

Recommended Quantity of Lunch for Junior and Senior Primary School Students

Food Group P.1 – P.3 Students P.4 – P.6 Students

Grains & Cereals At least 4 servings At least 5 servings

Vegetables At least 1 serving At least 1 serving

Meat, Poultry, Fish, Eggs, Legumes

1-2 servings 1½ - 2½ servings

Fruit At least ½ serving At least ½ serving

Fats and Oil Max. 2 servings Max. 2 servings

What is ‘serving’? unit of recommended serving

size helps maintain a balanced diet used for describing the

recommended quantity of food needed daily from the 5 food groups

One serving =Grains & cereals

Vegetables

Meat, Legumes,

Eggs ~1/5 bowl

~1/4 bowl of noodles

~1/3 bowl

~1/2 slice of bread

~ 1 as big as an egg

1 bowl of raw

　 1/2 bowl of cooked

4 slides of cooked

1/2 bowl of cooked

1/3 bowl

1

One serving =Fruit Fats and Oils

1 medium-sized (as big as a fist)

1/2

1 handful (about 10 grapes)

1 glass (150ml)

1/2 box of unsweetened dried fruit

1 tsp of plant oil

1 tbsp of salad dressing

(2) Guidelines On Quality

How to choose ‘quality’ healthy lunch

for children?

Quality Food 3 lows, 1 high:

Low-fat, low-sugar, low-salt and high-fibre

Types of food in lunch:

Encouraged food items Limited food items Strongly discouraged

food items

Natural and fresh

‘3 lows, 1 high’ food

Encouraged Food Items

Encouraged Food Items

Whole-wheat or high-fibre grains & cereals

Low-fat dairy products or other calcium-rich food

Limited Food Items

Processed / preserved food or food with added oil, salt or sugar

High-salt or high-fat sauce and gravy

≤ 2 days/week

Limited Food Items

Grains and cereals with added fat or oile.g. fried rice, fried noodles, fried rice noodles, baked rice with excess sauce

*Remark: It is recommended that sauce or gravy with high salt or fat content should be served sparingly and separately.

Limited Food Items

Fatty cut of meat and poultry with skine.g. chicken wings, spare ribs, chicken legs, ox belly, fatty minced meat cake

Whole-fat dairy productse.g. full-cream milk, regular cheese, full-cream yoghurt

Limited Food Items Processed or preserved meat,

eggs and vegetablese.g. sausages, ham, BBQ pork, preserved mustard green

Strongly Discouraged Food Items Food very high in fat, salt or

sugar

Food with added animal fat, plant saturated fat and trans fat

SayNO!

Strongly Discouraged Food Items

Deep-fried food

Deep-fried fish filletFrench

fries

Deep-fried chicken

leg

Deep-fried Tofu

Strongly Discouraged Food Items

Food with added animal fat, plant-based saturated fat and hydrogenated fate.g. lard, chicken oil, butter, coconut oil, palm oil, margarine

Strongly Discouraged Food Items Desserts or beverages containing

more than 10 grams or 2 tsp of added sugar in each serving

Strongly Discouraged Food Items Very salty food

e.g. preserved meat sausages, salted fish, salted eggs, etc.

FAQs on Children’s Diet

About lunch

FAQs on Children’s Diet

Is potato vegetable?

No, it belongs to the Grains & Cereals group.

Other plant foods in the grains and cereals group include corn, taro, sweet potato and carrot, yet they are also counted as vegetables.

Pumpkin is in the ‘Vegetables’ group only.

FAQs on Children’s Diet

How many calories should be provided in children’s lunch ？

About 650kcal

FAQs on Children’s DietIs the quantity in lunch for junior primary

students same as that for senior ones ？

No. As the daily nutritional needs of these 2 groups are not the same, their demand for grains & cereals and meat

are also different. Please refer to ‘Nutritional Guidelines on Lunch for

Primary Students’ for more information.

As for the recommended amount of vegetables and fruit, it is generally the

same for all students.

FAQs on Children’s Diet

Is margarine healthier than butter that we can feel free to use more for cooking?

No. It’s because margarine contains trans fat which will also adversely affect our blood cholesterol level and increase

the risk of cardiovascular diseases or stroke. Moreover, margarine has the same calorie content as butter, which may also lead to obesity if consumed

excessively.

Tools for Lunch Surveillance in

Primary Schools

Nutritional Quality Evaluation Form of School Lunch

For whom to use? When to use?

Assign two teachers or parents

Once a month

Choose a week with 5 consecutive school days to be the assessment week

What you need:

(2) Nutritional Quality Evaluation Form of

School Lunch

(3) Lunches of the week

(1) Grouping list of food items for lunch

２ ３

１

5

４

How to observe changes in food quality?

E.g. Low-fat Curry Chicken with Vegetable Red Rice

Low-fat Curry Chicken with Vegetable Red Rice

23/9 362

Action Time!

Activity 1

Dissemination of Surveillance Results

School Executives, Headmasters / Teachers

Lunch Suppliers

Parents

Students

Negotiation with school lunch suppliers School and PTA may take the surveillance

results as an item for negotiation Should the surveillance results show the

followings:• fruit supply %

• vegetable supply %

• Encouraged Food Items %

• Limited or Strongly Discouraged Food Items %

communication with suppliers have to be promptly initiated for improvement.

Things to remind…• Always be positive• Gather and select comments or

suggestions in advance• Realize that meat is not the main part

of lunch, but grains and vegetables are

• Tasty = full-flavored / salty• Nutritional value should always be

the top priority when choosing a lunch supplier

Take Home Messages(on lunch)

Grains and cereals, vegetables and meat = 3 : 2 : 1

‘3 Lows, 1 High’ should be the rule for food

Cook with less oil

3 2 1 Healthy Lunch Suitable for Everyone

Let’s Take a Break!!!

School Snack Surveillance

Nutritional Guidelines on Snacks for Primary School Students

What is Snack?‘Snack’ means an amount of food

smaller than a meal eaten informally between meals.

Is snack a must? Snack is not main meal Just children eat adequately in a

balanced way and don’t feel hungry between main meals

Snack is not a must!

Snack is appropriate if children: feel hungry between main meals; eat snacks at the right time; and eat in small amount which does

not affect the appetite for the main meals

Parents may consider giving them some healthy snacks!

But in many cases…Children might feel hungry between meals

because of:

Small stomach, small capacity High energy output Imbalanced diet in the day

So we can have some snacks if that doesn’t

affect our appetite for the

main meals!

The right time for snacks…

There should be at least

between snacks and main mealsto avoid spoiling children’s appetite for

the next meal.

1.5 – 2 hours

Appropriate serving size for snacks…

e.g. : 1 slice of wheat bread +

1 glass of low-fat milk 1 apple + 1 glass of

water 2-3 plain biscuits + 1

glass of pure fruit juice

It is usually smaller than that for a main meal, and it does not mean

to replace the main one.

How to choose healthy snacks? Snacks to Choose More Snacks to Choose in

Moderation Snacks to Choose Less

Snacks to Choose More

Criteria for selection:

Containing at least one type of nutrients (e.g. dietary fibre, protein, calcium), and

‘3 Lows, 1 High’ Principle

Low in fat

Low in sugar

Low in salt

High in fibre

Bread and grains and cereals that are low in fat, salt & sugar

Snacks to Choose More

Fresh vegetables and fruit, and unsweetened dried fruit

Snacks to Choose More

Snacks to Choose More

Low-fat dairy products

Low-fat yoghurt

Low-fat milk

Snacks to Choose in Moderation

containing at least one type of nutrients (e.g. calcium and dietary fibre)

but also containing fat and added sugar or salt

Snacks to Choose in Moderation Bread and cereals

with added fat, sugar or salt

Processed and preserved vegetables

Snacks to Choose in Moderation

Fruit with added sugar

Whole-fat dairy products

Snacks to Choose in Moderation

Fatty, processed or preserved meat and its alternatives

Beverages with added sugar but also contain nutritional value

Snacks to Choose LessFood or beverages low in

nutritional value but high in fat, sugar and salt

Frequent consumption of these snacks may increase the risk of:

• Obesity• Heart diseases• Diabetes• High blood pressure

Snacks to Choose Less

Snacks high in fat, sugar and salt

Beverages

Choose More Water

Pure fruit juice

Low-fat milk

Choose in Moderation

Sweetened fruit juice

Sweetened soya milk, whole-fat milk, chocolate milk

Choose Less Soft drink, sweetened cartoned drink, cordials, black tea, coffee

Food Label Reading

Source of Information: Food and Environmental Hygiene Department

What can food labels do?

Help consumers: better understand the nutritional value

of food compare similar food products make healthier food choices or select

suitable food for disease management

Food labels can encourage food manufacturers to:

improve nutritional content of products

Content of food labels

Food labels

Nutrition labelling

Nutrition claims Function claimsHealth claims

Claims

Nutrient content claim

Nutrient comparative

claim

Types of nutrition labels

Types of nutrition labels

How to read nutrition labels?Step 1: Find out the serving size

Udon

How many grams are there in 1 serving of Udon?

4 servings

200 grams

How many servings are there in 1 pack of Udon?

How to use nutrition labels?

Step 2: Check out the calorie content

How many calories are there in 1 pack of Udon?

320kcal

1280kcal

How many calories are there in 1 serving of Udon?

How to use nutrition labels?

Step 3: Look for the nutritional valueWhat is the unit of

nutritional content?Per Serving

How to compare the nutritional value of food?

‘Per Serving’ The amount of

nutrient you consume

‘Per 100g’ For compare

the nutritional values of different food items using 100g as a unit

Which one is better?

Milk A Milk B

Calories

CalciumProtein

Dietary fibre

FAQs on children’s diet

About

snacks

FAQs on children’s dietThere are many beverages on the market coming with health claims.

Can these claims be trusted?

Not all beverages with health claims are healthy. Parents may refer to the ingredient list on the package to see where ‘sugar’ is put.

FAQs on children’s diet

Is it right for children to skip breakfast to avoid over-eating if they eat snacks during recesses?

No.

Breakfast is one of the main meals. It should not be skipped and should be

eaten at regular time. It should mainly consist of grains and cereals (e.g. bread, congee or oatmeal). Skipping breakfast may lead to over-eating at recesses or

lunch.

FAQs on children’s diet

Children love choosing fried and deep-fried snacks. How can we help

them to get rid of these food?

We can first reduce children’s weekly frequency of intake. Then gradually, we can use some fresh food such as vegetables or fruit to replace them.

FAQs on children’s diet

Would low-fat dairy products like milk, yoghurt or cheese be less nutritive

than full-fat ones?

No. All dairy food is rich in calcium, which is good for teeth and bone

growth. In fact, the nutritional content of low-fat dairy products are similar to those of the full-fat ones, especially in

terms of protein and calcium. In addition, low-fat dairy products are

lower in calories and fat, thus benefit our body more.

FAQs on children’s diet

Can sports drinks be provided for children instead of water?

Sports drinks or electrolyte-charging drinks are specially

designed for athletes. Children should not take sports drinks for

water to replenish water loss during study or exercise.

Rather, plain water is the best refill.

Tools for Snack Surveillance

School Snacks Monitoring Checklist

For whom to use? When to use? assign two teachers or

parents

use monthly

What you need:

(3) A list of snacks and beverages supplied at school tuck shop and/or vending machines

(2) School Snacks Monitoring Checklist

(1) Snack categorising list

１ ２

３ ４

How to observe changes in snack quality

Snacks to Choose Less

Snacks to Choose in Moderation

Snacks to Choose More

French fries Choose Less

Boiled corn

Choose in moderation / Choose more

Bean curd dessert

Chocolate milk Choose in moderation

Raisin puff Choose in Moderation

Orange-flavoured drink

Choose less

Cookies Choose less

Let’s group them up

Choose more

Action Time!

Activity 2

Dissemination of Surveillance Results

School Executives, Headmasters / Teachers

Tuck shop operators

Parents

Students

Negotiation with tuck shop operator

School and PTA may take the surveillance results as an item for negotiation

Should the surveillance results show the followings:

• ‘Snacks to Choose More’ %

• ‘Snacks to Choose in Moderation’ & ‘Snacks

to Choose Less’ %　 communication with operators have to be

promptly initiated for improvement.

Things to remind…

• Always be positive• Both ‘Snacks to Choose More’ &

‘Snacks to Choose in Moderation’ can be sold at school tuck shop

• Small, individual servings of snacks can be offered

• Avoid using food as reward• Encourage students not to bring

‘Snacks to Choose Less’ back to school so as to build up a healthy eating environment

Ways to encourage

children to eat more healthy food

Way 1:Make salad with colourful fruit and

vegetables, eggs and little low-fat salad dressing to attract children. This could be a dessert after meal or tea refreshment.

Way 2:Parents may go shopping with children

and buy their favourite fruit. Children are encouraged to take part in the preparation, so as to increase their

interest in eating fruit and vegetables.

Way 3: Food substitution

Luncheon meat and ham sandwich

Wholewheat bread with fresh tomato & boiled egg

Full-fat dairy products

Low-fat dairy products

French fries Baked mashed potato / Baked potato wedges

Potato chips Cornflakes or fruit chips

Deep-fried chicken leg and wing

Baked chicken leg or breast (skinned)

Way 4:

Try mixing food that children have never tried or dislike with those they like. Start with a small amount and gradually increase the portion.

Take Home Messages(on snacks)

1. Snacks could not replace main meals

2. Better to have a time lag of 1.5-2 hours between snacks and main meal

3. Choose ‘3 Lows, 1 High’ Snacks

‘1 High, 3 Lows’ Snacks

Healthy and Tasty

• To provide teaching resources and templates for reference

• To assist teachers and parents in running healthy eating activities

• To simplify the procedure of organising activities for saving teachers’ and parents’ time

1. How to formulate ‘School Healthy Eating Policy’?2. Undertaking surveillance of school eating

environment (lunch and snacks)3. Methods of planning and procedures of running

activities4. Proposals on projects / programmes promoting

healthy eating5. Support, record and reward

We have developed We have developed 26 26 proposals of promotional proposals of promotional activity in activity in TWOTWO categories: categories:

1. Policy, surveillance, environment and behaviour

2. Knowledge, attitude and awareness

(1) Formulating healthy eating policy(2) Healthy eating surveillance in action – lunch(3) Healthy eating surveillance in action – snacks(4) DIY surveys of healthy eating environment and students’ dietary habits(5) Work together to promote lunch guideline policy(6) Tuck shop of health and nutrition(7) Red-yellow-green snacks zoning system(8) Give tuck shop a new face(9) Teacher-Student Fruit Day(10) ‘Choose the Smart and Healthy Lunch’ Campaign(11) Lunchtime broadcast on nutritional analysis of meal(12) A Lunchtime for Parents and Students

Policy, surveillance, environment and behaviourPolicy, surveillance, environment and behaviour

Knowledge, Attitude and AwarenessKnowledge, Attitude and Awareness(13) Visit to kitchens of school lunch suppliers(14) Parent-child Snacks Campaign(15) Healthy Eating Ambassadors(16) Healthy Eating Carnival(17) Healthy Eating Garden(18) Healthy Eating Quiz(19) Publishing in-school healthy eating quarterly by students(20) Healthy eating API making competition(21) Healthy Eating poster design competition(22) Healthy Eating story competition(23) Model making competition of Healthy food teaching aid(24) Healthy lunch / snacks comic strip competition(25) Healthy Snacks Catwalk Show(26) Healthy gourmet’s dish paper plate drawing competition

** No less than two activities are to be conducted for the academic year 2006-2007

• Specially recommended activitiesSpecially recommended activities (2) Healthy eating surveillance in action -- Lunch (3) Healthy eating surveillance in action -- Snacks

• Optional activitiesOptional activities Activities suggested in the Handbook and other school-

based activities designed for healthy eating promotion

School ‘NutriAgent’ Project School ‘NutriAgent’ Project RequirementsRequirements

Professional adviceProfessional advice– Through our enquiry hotline, our Through our enquiry hotline, our

professional team provide professional team provide consultancy on:consultancy on:

• the process of organising eventsthe process of organising events• problem solvingproblem solving• resources availableresources available• recommendation of community recommendation of community

resourcesresources• the progress follow-up of the the progress follow-up of the

programme organisation for the programme organisation for the yearyear

Resources availableResources available

– Health education Health education resourcesresources

– Community Community resourcesresources

Volunteers’ supportVolunteers’ support

AppreciationRecord and Reward

AppreciationRecord and Reward

Appreciation and commendation to the Appreciation and commendation to the ‘NutriAgents’ who are cordially devoted to ‘NutriAgents’ who are cordially devoted to

proactive running of events promoting proactive running of events promoting healthy eating in schoolhealthy eating in school

• ProposalsProposals

• Evaluation ReportsEvaluation Reports

Evaluation ReportsEvaluation Reports

• Photographs, promotion posters, Photographs, promotion posters, questionnaires and results of evaluation studyquestionnaires and results of evaluation study

• By post, fax or e-mail to DHBy post, fax or e-mail to DH

• For events lasting longer than 8 weeks, an For events lasting longer than 8 weeks, an interim report is to be submitted, followed by interim report is to be submitted, followed by the final report upon the completion of event.the final report upon the completion of event.

• Judging criteriaJudging criteria– Nature of eventNature of event

(Policy / Environment, continual surveillance, knowledge / (Policy / Environment, continual surveillance, knowledge / concern)concern)

– Scale of eventScale of event

(Number of participating parents / students / members of (Number of participating parents / students / members of the community)the community)

– DurationDuration

– Participation of volunteersParticipation of volunteers

– Evaluation of effectivenessEvaluation of effectiveness

• Record of the event’s scoring Record of the event’s scoring

– NutriSchool RecordNutriSchool Record

– NutriAgent RecordNutriAgent Record

• InfinityInfinity

• Childhood obesityChildhood obesity

• Chronic illnessesChronic illnesses

• EnjoyEnjoy

of satisfactionof satisfaction

no moreno more

morbidity declinesmorbidity declines

lifelife