Urbani School Health Kit TEACHER'S RESOURCE BOOK
A Strong and Healthy Me A Campaign on Healthy Food Choice for Health Promoting Schools
Urbani School Health Kit
World Health Organization Western Pacific Region
Urbani School Health Kit TEACHER'S RESOURCE BOOK
A Strong and Healthy Me A Campaign on Healthy Food Choice for Health Promoting Schools
Urbani School Health Kit
World Health Organization Western Pacific Region
Objectives After the lessons, schoolchildren ages 5 to 9 will be able to: ! Explain why food is important ! Describe the three major food groups ! Identify healthy food choices (such as avoiding foods with too much fat, sugar, and salt) In addition, schoolchildren ages 10 to 12 will be able to: ! Discuss what good nutrition means ! Determine one's ideal body weight ! Discuss the importance of maintaining a healthy weight ! Explain the importance of balancing food intake and physical activity ! Explain how healthy food choices can prevent diseases in the future
In addition, for ages 10 to 12 ! Good nutrition means eating a variety of food at the right amount. ! Maintaining a normal weight is indicative of good nutrition. ! It is important to balance food intake and physical activity. ! Diet and physical activity today affect future health.
Activities For ages 5 to 9 ! Height and weight monitoring ! Lunch monitor ! Food plate puzzle ! School fair For ages 10 to 12 ! Weight monitoring and computation of BMI ! Lunch monitor ! Food pyramid puzzle ! 24-hour diet recall ! Picture tells a story ! Meal planning ! Investigative report on school canteen ! School fair
Key Messages For ages 5 to 9 ! Food is important for growth, energy and proper functioning of the body. ! The three major food groups are the sources of essential nutrients needed by the body: carbohydrates, proteins, vitamins and minerals. ! Fruits and vegetables, rice and whole grain products, and fish/meat products are good for the body if taken in appropriate amounts. ! Eating too much sweets, fats and salty foods is bad for the body.
Materials/Resources For ages 5 to 9 ! Tape measure ! Weighing scale ! Growth chart (weight-for-age) ! Picture cards
For ages 10 to 12 ! Tape measure ! Weighing scale ! Growth chart (weight-for-age)
! ! !
Forms for 24-hour diet recall Forms for meal planning Physical activity/ exercise audio or video tape (optional)
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Teaching children about healthy food choice contributes to establishing lifelong healthy dietary patterns and healthy lifestyles. Dietary habits are formed early in life, thus it is very important that children are taught early on what constitutes a healthy diet. Good nutrition also maximizes the learning potential of children. Schoolchildren who are properly nourished are brighter, more alert and energetic, and more able to participate well in class. By helping schoolchildren make the healthy choice when it comes to food, you teach them one of the most essential life skills that will impact on their health and social well-being.
Why is healthy food choice important?
Food is important because: ! ! ! Food contributes to the body's growth and repair. Food is the source of energy for the body. Food is essential to the regulation of the functions of the body.
What should children know about healthy food choice?
Food can be categorized into three basic food groups: ! Body-building foods
Body-building foods are important for promoting growth and repairing body tissues. These foods are rich in proteins, the substances called the “building blocks” of the body. Without proteins, the body cannot grow or repair itself. Examples of foods rich in proteins include milk, fish, meat, eggs, and cheese. ! Energy foods
Children need energy for body processes such as breathing, blood circulation and maintaining normal body temperature. Children also need energy for growth and play. Foods that are rich sources of energy include rice, bread, cereals, grains, potatoes, cassava and other starchy foods.
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Urbani School Health Kit TEACHER'S RESOURCE BOOK
Activity: Ask your Mother about Breastfeeding Breastmilk is best for babies. It is nutritionally complete and it even builds up the baby’s immune system. Breastmilk is clean, safe and has no cost. Breastfeeding also creates a stronger bond between mother and baby. Infants should be exclusively breastfed from birth up to six months. Ask your mother: ! Was I breastfed? ! For how long? ! Why is breastmilk best for babies?
!
Protective foods
The body needs vitamins and minerals to regulate its processes and ensure proper functioning. Vitamins and minerals help fight germs and build strong muscles and bones. They also help develop clear vision, and healthy hair, skin, gums and teeth. Protective foods include a wide variety of fruits and vegetables.
Good nutrition means: ! Eating a variety of food
The body needs different nutrients. Foods vary according to the kind and amount of nutrients. Eating a variety of food is the best way to ensure that you get all the needed nutrients. This means eating a balanced diet that consists of different types of foods with different nutrients. The nutrients in food are: ! Carbohydrates ! Proteins ! Fats ! Vitamins ! Minerals ! Fibre Carbohydrates are the main fuel of the body. They provide most of the energy needed to perform bodily functions like moving, breathing or keeping warm. Grains and starchy foods are very good sources of carbohydrates. Fruits also provide carbohydrates in the form of sugar. Candy and cola contain sugar but almost no other nutrients. Protein is the building material for all body parts, such as muscle, bones, internal organs, skin, hair, nails and body fluids. It is important
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for growth, repair of worn-out tissues, replacement of used-up body fluids and resistance against infections. Protein is largely derived from cereals, meat, fish, milk, eggs and legumes. Fat is a concentrated source of energy. It helps provide the energy needed by the body. Fat provides the building material for the brain, nerves and hormones. It also facilitates the absorption of some vitamins. Meat, some fish, seeds and nuts all contain fat. Fat from fish and plant sources is considered a better kind of fat compared to fat from meat. Diets high in fat are more likely to cause overweight and obesity. Vitamins help regulate body functions and maintain health. They help the body build cells and make use of carbohydrates, proteins and fats. They also help the body fight infections. There are many kinds of vitamins and each one has a specific use. For example, Vitamin C is needed for fast wound healing. Iron prevents iron-deficiency anemia and boosts the immune system. Vitamin A is needed to prevent night blindness. Minerals are important for building strong bones, teeth and nails. They also help build blood, nerves, and muscles. Minerals are vital to physical and mental development. They help protect the body against infections. Meat, fish, milk, cheese, tofu, green leafy vegetables and legumes provide most of the minerals needed by the body. Dietary fibre is not usually absorbed by the body, but it helps intestinal and bowel function. Dietary fibre makes food bulky, making food stay longer in the stomach. It also makes stools soft, thus preventing constipation. To some extent, dietary fibre traps harmful substances. Vegetables, unrefined cereals, tubers, legumes and fruits are good sources of fibre. Lack of some nutrients will lead to specific nutritional problems such as: ! Protein energy malnutrition - the child is thin and short for age ! Iron-deficiency anemia - the child is pale, weak and performs poorly in school ! Vitamin A deficiency - the child has difficulty seeing at night or A Campaign on Healthy Food Choice for Health Promoting Schools
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!
may be totally blind Iodine deficiency - the child is short for age with poor mental development
!
Eating the right amount of food
Everyone needs the right amount of food to stay healthy. Having a healthy diet means having enough energy for daily activities, and being able to grow and develop normally. If not enough food is eaten, you will lose weight, feel weak, and get sick more easily. If too much food is eaten, you can become overweight or obese, and develop hypertension, diabetes and heart disease as you grow older. Half of the food you eat each day should come from the energy food group, about one third from the protective food group and the remainder from the body-building food group. Another guide to eating right is the food pyramid. You should eat more of the food from the base of the pyramid and less of those from the top of the pyramid. ! Least: oils, sugary foods and sweet drinks like cola, alcohol and salt ! Some: body-building foods ! More: protective foods ! Most: energy foods Drinking 6 to 8 glasses of water a day is also important. ! Choosing healthier options within food groups
It is important to identify which foods within food groups have too much fat, sugar or salt. Eating too much fat (including oil) can increase the risk of heart disease and certain cancers later in life. A Strong and Healthy Me
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Eating too many sugary or sweet foods/drinks can lead to tooth decay; especially if you do not brush your teeth (see campaign on oral health: “A Smiling and Healthy Me”). Eating too many sweets can also cause overweight. Eating too much salt and salty food can cause an increase in blood pressure later in life, especially if this becomes the habit.
! Maintaining an ideal weight. Monitoring children's weight is the simplest way to know whether a balance is being achieved between energy intake and utilization. Children should understand the need for both a healthy diet and physical activity. A healthy diet means eating a variety of foods in adequate amounts to supply the body with necessary nutrients. For children, physical activity is important for growth, development, and obesity prevention starting from a young age. Children should have a minimum of one hour of physical activity daily. Children should be able to demonstrate the following skills: ! Monitoring height and weight (with teacher supervision for younger children) ! Planning for variety and right amounts of food in daily meals ! Choosing healthier options within food groups ! Exercising or doing adequate physical activity
What skills should children learn in order to make healthy food choices?
1. Monitoring height and weight Monitoring the height and weight of children helps us see how they are growing in comparison to other children their age. Children who are undernourished may either fail to gain weight or even lose weight. The “Growth Chart” Learning Activity will help you in monitoring the growth of children in your class.
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Urbani School Health Kit TEACHER'S RESOURCE BOOK
Learning Activity: Growth
Chart
Preparing for the activity: ! Have at least one copy of growth charts for boys and girls. ! Prepare a weighing scale and tape measure. You can either bring these to class, or arrange a trip to the school clinic or a community health center where instruments for height and weight measurement are available. During the activity: ! Post a tape measure on a wall and measure the children’s height in meters. Children should take their shoes and socks off. Put a ruler or piece of cardboard on the child's head and, making sure the ruler/cardboard is parallel to the floor, read the corresponding measurement. ! Measure the children’s weight in kilograms using an accurate weighing scale. ! Plot each child’s height and weight on the Growth Chart. ! Check the equivalent percentiles of their height and weight measurements. On the Growth Chart, these are represented by the curved lines marked 5 to 95. If a child is on the 60th percentile for height, this means that in a group of 100 children, she is taller than 60 of them, and shorter than 39. If a child is under the 3rd percentile for height-for-age, be sure that she is referred to a health service. ! Calculate their Body Mass Index (BMI) using this formula: 4 Weight (kg) ÷ Stature (meters) ÷ Stature (meters) ! Check whether the children's BMI are appropriate for their age by comparing these to Tables 1 and 2. There is a problem if: 4 BMI-for-age >= 85th percentile 4 BMI-for-age is < 5th percentile ! If these conditions are seen, make sure the children at risk are referred to a health service. A very high BMI-for-age means that the child is at risk of overweight, and may have high blood pressure later in life. A very low BMI-for-age signals under nutrition, or other significant health problem. After the activity: ! Discuss height, weight and BMI as indicators of good nutrition ! Explore children's ideas on weight and nutrition Note: If you are a mathematics teacher, this activity is a good way for you to integrate health messages in your curriculum. Reference: WHO. (1995). Physical Status: The use and interpretation of anthropometry. WHO Technical Report Series 854. Geneva: WHO. A Strong and Healthy Me
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Table 1: Percentiles of BMI-for-age: male adolescents, 9-24 yearsa Age (years) 9 10 11 12 13 14 15 16 17 5th 14.03 14.42 14.83 15.24 15.73 16.18 16.59 17.01 17.31 15th 14.71 15.15 15.59 16.06 16.62 17.20 17.76 18.32 18.68 Percentiles 50th 16.17 16.72 17.28 17.87 18.53 19.22 19.92 20.63 21.12 85th 18.85 19.60 20.35 21.12 21.93 22.77 23.63 24.45 25.28 95th 21.47 22.60 23.73 24.89 25.93 26.93 27.76 28.53 29.32
Table 2: Percentiles of BMI-for-age: female adolescents, 9-24 yearsa Age (years) 9 10 11 12 13 14 15 16 17 a
5th 13.87 14.23 14.60 14.98 15.36 15.67 16.01 16.37 16.59
15th 14.66 15.09 15.53 15.98 16.43 16.79 17.16 17.54 17.81
Percentiles 50th 16.33 17.00 17.67 18.35 18.95 19.32 19.69 20.09 20.36
85th 19.19 20.19 21.18 22.17 23.08 23.88 24.29 24.74 25.23
95th 21.78 23.20 24.59 25.95 27.07 27.97 28.51 29.10 29.72
Reference data are based on the first National Health and Nutrition Examination Survey (NHANES 1) in the United States of America. Reference: WHO. (1995). Physical Status: The use and interpretation of anthropometry. WHO Technical Report Series 854. Geneva: WHO. For adults (ages 18 years and above) the cut-offs for overweight and obesity are, respectively, BMI = 25 and 30.
B
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Urbani School Health Kit TEACHER'S RESOURCE BOOK
Food Pyramid Puzzle (for older children) Game: Divide the children into teams. Give each team a triangular piece of paper and several picture cards of different types of food. Each team will assemble the Food Pyramid by pasting the type of food appropriate for each level of the pyramid. The team that gets the most number of correct food items in the pyramid (in the shortest time) will be declared the winner. After the game, you can have a classroom discussion on the following key questions: ! What are the types of food that should be consumed in the most amounts? ! What are the types of food that should be consumed in moderate amounts? ! What are the types of food that should be consumed in little amounts?
Eat a little Eat some Eat more Eat most Drink a lot
Fats, oils, sugar, salt Fish, poultry, dry beans, nuts, egg, lean meat, low-fat dairy Vegetables, green salads, fruits or juices Rice, root crops, corn, noodles, bread, cereals Fluids (6 to 8 glasses a day): water, fruit juice, soup
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2. Planning for variety and right amount of food in daily meals Eating a variety of food in the right amounts ensures that a person gets all the essential nutrients needed for growth, development and body functioning.
Learning Activity:
Lunch Monitor
Ask the children to open their packed lunch (or go visit the school canteen). Then tell them to draw their food (or the food they would normally buy from the school canteen). Provide them with paper and crayons or paint. After the drawing session, you can have a classroom discussion on the following key questions and activities: 1. What are the types of food and drinks that the children take to class (or buy from the school canteen)? 2. Classify the drawings into the three major food groups (body-building, energy-giving, and protective foods). For older children, classify the drawings into six groups (carbohydrates, proteins, fats, vitamins, minerals and dietary fibre). 3. Identify which of the specific food items are good for the body and what are the not-so-good ones (or those that should be taken in moderation). 4. Add more food items to each major food group using the picture cards in the Urbani School Health Kit.
Game:
Food Plate Puzzle (for younger children)
Ask the children to form pairs. Give each pair a paper plate (or a piece of paper cut into a circle the size of a plate). Using a pencil or marking pen, ask each pair to divide the plate into three portions (like cutting a cake or pie into three pieces) These three portions represent the energy food group, the body-building food group, and the protective food group. Ask them to assemble on the plate picture cards of different types of food that they eat in one day (including snacks). Alternatively, they can draw representations of the different food groups. The pair that gets the right amount (or proportion) of food in the plate will be declared the winner. Recall: Half of the food you eat each day should come from the energy food group, about one third from the protective food group and the remainder from the body-building food group. The children’s diet may be very different from the ideal. Discuss how they can improve their diet so that they can follow the recommended proportion of the three types of food. After the game, discuss the following:
! What are the three major food groups? ! What should be the proportion of the three major food groups in each plate? A Campaign on Healthy Food Choice for Health Promoting Schools
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3. Choosing healthier options within food groups It is essential that children learn to make healthy food choices. Aside from demonstrating knowledge of different types of food, it is also important to identify which foods have too much fat, sugar or salt content. Older children should be able to identify what future health problems may develop due to unhealthy diet. Learning Activity: 24-hour 1.
diet recall (for older children)
Ask the children to recall all the food they ate the previous day. Ask them to quantify the amount they ate of each type of food using practical measures (for example, half a plate of rice, one handful of chips). Use the table below as a guide. Food taken Breakfast Morning snacks (if any) Lunch Afternoon snacks (if any) Dinner Evening snacks (if any) Amount Food Group
2.
After they have filled out the form, ask them to analyze their diet. Did they follow these five guides to good nutrition? ! Eating a variety of food (food from different food groups) ! Eating the right amount of food (use the Plate model or Food Pyramid as guides) ! Avoiding foods that have too much fat ! Avoiding foods that have too much sugar ! Avoiding foods that have too much salt Help the children rate themselves. If they followed all the guidelines, then they receive five stars. Show the children samples of a day’s ideal diet. Use foods that they recognize and are available in the community.
3.
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4. Exercising Maintaining a balance between food intake and physical activity enables children to achieve their ideal body weight. Help children understand this concept by doing the next activity: Learning Activity: Picture
Activity: Get Physical! Children should have at least one hour of physical activity everyday. You can achieve this goal by:
tells a story
! Doing morning exercises ! Encouraging sports and outdoor activities
In the following activity, match the pictures with the correct message.
! Spicing up classroom
discussions with physical tasks
A When you eat more food (calories) than is needed to perform a day's activities, your body stores the extra calories and you gain weight.
B When you eat less food (fewer calories) than you need, your body uses calories in body stores and you lose weight.
C When you eat the same amount of food (calories) as your body uses, your weight stays the same.
Stress that at this point in their lives, children are still growing and therefore MUST gain weight over time. What is important is that they stay within the ideal weight range for their age. A Campaign on Healthy Food Choice for Health Promoting Schools
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Putting It All Together
The following activities can help children integrate the knowledge and skills they learned in the previous discussions and activities.
Demonstration: Meal
planning (for older children)
Ask the children to plan for their ideal meals the next day, starting with breakfast, then lunch, dinner and snacks in between. Use the table below as a guide. Food Breakfast Morning snacks Lunch Afternoon snacks Dinner Bedtime snacks Amount Food Group
Remember these five guidelines: ! Eating a variety of food (food from different food groups) ! Eating the right amount of food (use the Plate Model or Food Pyramid guides) ! Avoiding foods that have too much fat ! Avoiding foods that have too much sugar ! Avoiding foods that have too much salt
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Learning Activity:
Investigative Report on School Canteen
Tell the older children that they are field reporters for the school newspaper and their task is to investigate the types of food available in the school canteen. Use the quick survey below as a guide. Fill in this quick survey: Yes ___ ___ ___ ___ ___ ___ ___ ___ ___ No ___ ___ ___ ___ ___ ___ ___ ___ ___
Children are allowed to bring their own food to school. Our school canteen provides a variety of body-building foods. Our school canteen provides a variety of energy foods. Our school canteen provides a variety of protective foods. Our school canteen sells too much sweet foods and drinks, such as candies and sodas. Our school canteen sells mainly fatty foods such as fried chicken, potato fries, etc. Our school canteen sells a lot of salty foods such as “junk food” or empty-calorie snacks. Our school encourages planting vegetables in the garden. Our school gives us information on healthy diet and good nutrition.
They should make detailed notes on available foods at the school canteen. If resources permit, ask them to take photos of the different varieties of foods. On the next class meeting, ask the students to make a report on their findings. After the report, discuss the following: ! What are the good practices on diet and nutrition in the school? ! What are the not-so-good practices on diet and nutrition in the school? ! How can the school environment to be improved so that it encourages children to adopt healthy eating habits? You may want to invite a school administrator to observe the class report. Be sure to document the students' findings and present these to school officials, along with your recommendations.
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School Canteen Improvements Exhibit: Launch a school-wide campaign to improve availability of healthy foods in the school canteen. Children can take photos or cut out pictures of different food groups that should be available in the canteen. Clean drinking water should also be emphasized as one of the necessary provisions in the canteen.
If you find that the school canteen is lacking in providing different types of healthy food, talk to school administrators about making improvements. You can then document actions taken in an exhibit (see the Learning Activity on “School Canteen Improvements”). Remember that change in health behaviour can be better maintained if the environment is supportive of that change. Therefore a review of the environment, in terms of how well it supports healthy food choice, is needed. A health promoting school can support good nutrition for children by: ! Having a policy on what foods to serve at the canteen and ensuring cooperation of food vendors in school premises ! Discussing healthy diet and good nutrition during parent-teacher meetings ! Constantly reminding children about making healthy food choices ! Linking sports and exercise programs to nutrition campaigns
School Fair “A Strong and Healthy Me” can be the theme of a school fair. Set up six booths/stations/classrooms that showcase the following: ! Why food is important ! The three major food groups ! The six basic nutrients ! The Food Pyramid ! Meal planning ! Diet and physical activity Groups of students can be asked to prepare a poster on each topic, with a prize awarded for best work.
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“I want to grow up healthy and strong.” Being able to make the right food choices is an important life skill that children must learn early. At this stage of their lives, good nutrition will help them go, grow and glow! In the future, good nutrition means lifelong health and well-being.
What attitude should children develop in making healthy food choices?
“I choose the foods that are best for me.” Help the children foster responsibility for their nutrition and health. Help them talk to their parents about healthy diet. Older children can be encouraged to prepare healthy meals for themselves and for other members of the family. If children buy their own food, show them that they now have the responsibility to choose which foods are best for them. Eating right is a measure of maturity.
“I do my best to stay within the ideal weight range for my age.” Children in the lower percentiles for BMI-for-age should be counseled regarding healthy eating. They should remember that they are still growing and developing at this stage, and they need to build up their bodies. Remember that in adolescence, physical appearance (including weight) is a factor in the development of self-image. Children may have a distorted concept of what is “fat” and “thin” based on what they see in mass media. Tell them that going on a “diet” is unnecessary if they are in the ideal weight range. Children with high BMI-for-age should be counseled on making healthy food choices and exercising. Overweight and obesity are risk factors for cardiovascular disease, stroke, and diabetes.
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“I exercise so that I will be healthy and strong.” A healthy diet should co-exist with adequate exercise and physical activity. Explain to children that exercising is not just doing calisthenics. It also means participating in sports and active games; or doing chores at home like polishing the floor, cleaning windows or helping to wash the car. Remind children that sedentary activities like watching television or playing computer games are okay as long as these are balanced with moderate intensity physical activities. They should also see the value of adequate rest after exercising.
A Strong and Healthy Me
! ! ! ! ! ! !
Food is important for growth, energy and proper functioning of the body. The three major food groups are the sources of essential nutrients needed by the body: carbohydrates, proteins, vitamins and minerals. Good nutrition means eating a variety of food at the right amount. Eating too much sweets, fats and salty foods is bad for the body. Maintaining a normal weight is indicative of good nutrition. It is important to balance food intake and physical activity. Diet and physical activity today affect future health.
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