We Can! Louisiana: Adapting the Dietary Guidelines for All Americans

3 women in kitchen


children and tomato plants

Bernestine B. McGee and Glenda S. Johnson

The Dietary Guidelines for Americans are science-based recommendations to promote health, reduce the risk of chronic diseases, and reduce the prevalence of overweight and obesity through diet and physical activity. The Dietary Guidelines for Americans 2010, published by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, emphasize three major goals for Americans: balance calories with physical activity to manage weight; consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products and seafood; and consume fewer foods with sodium, saturated fats, transfats, cholesterol, added sugars and refined grains.

Studies have shown that most Americans are not meeting the dietary guidelines, especially low-income groups, some racial and ethnic groups, and children. There is convincing evidence that regular physical activity and appropriate dietary patterns protect against chronic diseases and unhealthful weight gain. The nutrition information in the dietary guidelines is of little value if consumers do not follow the recommendations and make the necessary dietary changes to lead more healthful lives. Effective strategies must be identified to enhance adherence to the healthful food and physical activity patterns set forth in the Dietary Guidelines for Americans, particularly for diverse population groups in the United States.

Obesity in Louisiana
Obesity prevalence in Louisiana was 34.7 percent while Colorado had the lowest rate at 20.5 percent, according to the latest report from the Centers for Disease Control and Prevention. As income decreases, obesity rates tend to increase. Low-income families generally live in neighborhoods lacking safe outdoor areas for exercise and play and have limited access to supermarkets selling fresh produce and healthful foods. Recent findings have reported that childhood obesity is declining in several states; however, obesity rates in rural Louisiana children do not reflect this decline. The most recent state-by-state data on obesity rates for youth 10-17 years old indicated Louisiana ranked fourth in the country with 21.1 percent. 

Childhood Obesity Prevention Research at Southern University
Research shows that parents and caregivers are the primary influence on 8- to 13-year-old children. The family is a major influence on eating behavior of children and adolescents. The family mediates children’s dietary patterns in two ways: the family is a provider of food, and the family influences food attitudes, preferences and values that affect lifetime eating habits. The amount that children exercise and eat, and whether they are overweight, often has a lot to do with the examples set by parents.

There is a consensus among health researchers and professionals that health promotion programs and associated materials should be culturally sensitive. The concept of cultural sensitivity can be considered as the extent to which ethnic or cultural characteristics, experiences, norms, values, behavioral patterns and beliefs, as well as relevant historical, environmental and social forces, are incorporated in the design, delivery and evaluation of targeted health promotion materials and programs. Another term related to culturally sensitivity is cultural tailoring, which is the process of creating culturally sensitive interventions, often involving adapting existing materials and programs for racial or ethnic subpopulations.

Cultural tailoring is recommended when implementing national health campaigns, such as the U.S. Dietary Guidelines or Choose MyPlate with rural, low-income populations. Low levels of economic and social resources in disadvantaged communities may make it difficult for the participants to assimilate and use print information accompanying the campaigns. In addition, most print materials used with national campaigns have been developed for middleincome, nonminority populations and usually require high literacy levels. For this reason, Southern University researchers chose to tailor the National Institutes of Health program titled We Can! (Ways to Enhance Children’s Activity & Nutrition) to implement research related to preventing childhood overweight and obesity in Louisiana families.

The NIH We Can! program is designed for parents and caregivers to encourage healthful eating, increase physical activity and reduce “screen time” (television, computer, video games) in children 8-13 years old. We Can! Louisiana is an educational program aimed at promoting adherence to the healthful food and physical activity recommendations set forth in the U.S. Dietary Guidelines for Americans and the resulting effect on reducing weight gain and the risk factors for obesity-related chronic disease in parents and children in rural Louisiana communities. Findings from focus group sessions held with rural Louisiana parents and children and community advisory committee sessions guided the plan ning of the education program and materials that reflected the ethnic and cultural characteristics, beliefs, values and traditions that influence dietary and physical activity behaviors and perceptions of health and obesity prevention in the target population.

The education program was designed with input from representatives of the target population, including time and location of classes. It included topics gathered from the focus groups that were historical, social, cultural and environmental that influence health behavior of the target population. Culturally tailoring the national We Can! program included adding pictures to the front cover of the parents’ handbook and adding foods and physical activities that were not included on the Dietary Guidelines to reflect the ethnicity of the target population. To ensure that the materials were at the appropriate grade level for the audience’s ability to comprehend the information, the researchers employed several measures for developing print materials for low-literacy readers.

The weekly We Can! Louisiana parent sessions included food preparation instructions, physical activity and discussion sessions on progress and challenges in following recommended child-feeding principles, as well as selfefficacy and social support for meeting the U.S. Dietary Guidelines for Americans recommendations. It also has a gardening component. The biweekly sessions were held with the children to reinforce the parental instructions. Parents and children demonstrated sustained interest in weekly nutrition and physical activities and offered suggestions for making the program interesting. We Can! Louisiana began in May 2012 in St. Landry Parish and concluded in November 2013.

Empowering parents and caregivers to make behavioral choices that support a healthy lifestyle can help children and families attain and maintain a healthy weight, reduce their risk of chronic disease and promote overall health. Some strategies for parent and caregivers and children emphasized in We Can! Louisiana include:

  • Choose a sufficient amount of a variety of fruits and vegetables every day.
  • Decrease consumption of high-fat foods and energydense foods low in nutrient value.
  • Enjoy small portions at home and at restaurants.
  • Substitute water, fat-free milk or low-fat milk for sweetened beverages.
  • Engage in at least 60 minutes of moderate physical activity on most – preferably all – days of the week.
  • Reduce sedentary activity by limiting screen time (watching TV, using a home computer for fun or playing video games) to no more than two hours per day.
  • Support and enable family physical activity.

Bernestine B. McGee is a professor and Glenda S. Johnson is a nutrition research scientist in the Human Nutrition and Food Program, Southern University and A&M College, Baton Rouge, La.

(This article was published in the fall 2013 issue of Louisiana Agriculture magazine.)

12/3/2013 9:27:03 PM
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