Katie Brown

The State of America’s Wasted Food and Opportunities to Make a Difference

From the farm through the production and distribution process to the grocery store to the home e wherever there is food, there is unfortunately food waste. In a world of finite resources and growing populations, wasting food is a luxury no one can afford. As nutrition and dietetics practitioners, we are uniquely qualified to assist farmers, food companies, governments, communities, institutions, stores, restaurants, families, and individuals to reduce the amount of food that is wasted each year. As Academy members, we have no higher duty than to help everyone create and maintain their nutritional health. This includes wise production strategies and a commitment to conservation that minimizes wasted food. I hope you’ll find this report informative and an inspiration to engage deeply in this cause, in which so many Academy members are leaders. —Dr Evelyn F. Crayton, RDN, LDN, FAND Academy President, 2015-2016 O VER ONE-THIRD OF ALL food produced in America goes uneaten each year, with most of it ending up in our landfills. To put this in perspective, this is the equivalent of throwing 320,000 jumbo jets’ worth of food directly into the landfill each year. Reducing, reusing, and recycling wasted food and creating an infrastructure that supports these actions across the food supply chain can assist with feeding the estimated 49 million Americans who are food insecure, reduce agricultural pressures on the environment, and increase business efficiencies for those producing and selling food. This report highlights where wasted food can potentially occur throughout the food supply chain, the environmental and economic impact of wasted food, and opportunity areas for registered dietitian nutritionists (RDNs) to help reduce wasted food within a total infrastructure that has both a business and consumer-facing perspective. The Academy of Nutrition and Dietetics (the Academy) is committed to advancing the practice of nutrition and dietetics and has funded this report to highlight opportunities around improving our current levels of wasted food.

Energy Balance at a Crossroads: Translating the Science into Action

O NE OF THE MAJOR CHALlenges facing the United States is the high number of overweight and obese adults, along with the growing number of overweight and unfit children and youths. To improve the nation’s health, young people must move into adulthood without the burden of obesity and its associated chronic diseases. To address these issues, the American College of Sports Medicine, the Academy of Nutrition and Dietetics (the Academy), and the US Department of Agriculture’s (USDA) Agriculture Research Service convened an Expert Panel meeting in October 2012, entitled “Energy Balance at a Crossroads: Translating the Science into Action.” Experts in the fields of nutrition and exercise science came together in Washington, DC, to identify the biological, lifestyle, and environmental changes that will most successfully help children and families understand the dynamic nature of energy balance and tip the scale toward healthier weights. The desired outcome of this expert panel meeting was to translate the science of energy balance into practical and appropriate recommendations for training current and future professionals in nutrition, exercise/physical activity (PA), health education, and prekindergarten through grade 12 teacher education. This included discussing the associated components necessary to achieve and maintain a healthy body weight. The specific goals are as follows:

Development and Validation of the Guide for Effective Nutrition Interventions and Education (GENIE): A Tool for Assessing the Quality of Proposed Nutrition Education Programs.

OBJECTIVE To develop and validate the Guide for Effective Nutrition Interventions and Education (GENIE), a checklist of research-based quality indicators for nutrition education programs. DESIGN A prospective test of criterion validity and inter-rater reliability of a new tool comparing expert assessments and trained reviewer GENIE scores of the same nutrition education proposals. PARTICIPANTS Ten nutrition education experts; 13 volunteer reviewers. VARIABLES MEASURED GENIEs face, content, and criterion validity and inter-rater reliability compared using expert assessments and reviewer objective and subjective scores. ANALYSIS Reviewer scores compared using Spearman correlation. Inter-rater reliability tested using intra-class correlation (ICC), Cronbach alpha, and ANOVA. Criterion validity tested using independent t test and point bi-serial correlation to compare reviewer with expert scores. RESULTS Correlation found between total objective and total subjective scores. Agreement found between reviewers across proposals and categories considering subjective scores (F = 7.21, P < .001; ICC = 0.76 [confidence interval, 0.53-0.92]) and objective scores (F = 7.88, P < .001; ICC = 0.82 [confidence interval, 0.63-0.94]). Relationship was not significant (r = .564, P = .06) between expert and reviewer proposal scoring groups (high, medium, and low). CONCLUSIONS AND IMPLICATIONS Results support the validity and reliability of GENIE as a tool for nutrition education practitioners, researchers, and program funding agencies to accurately assess the quality of a variety of nutrition program plans.

The RD Parent Empowerment Program Creates Measurable Change in the Behaviors of Low-Income Families and Children: An Intervention Description and Evaluation

Dietary and physical activity habits are developed early in life and are influenced by family environments. We describe and evaluate an intervention for low-income families to encourage healthy habits. The RD Parent Empowerment Program (http://www.eatright.org/programs/kidseatright/activities/content.aspx?id=6442477891) consists of four workshops centered on the 8 Habits of Healthy Children and Families (Academy of Nutrition and Dietetics Foundation). Registered dietitian nutritionists conduct the workshops in school and community settings using a structured leader guide and tailor the communication and interactive activities to the audience. Participants are parents of young children. Our goals were to use a phenomenologic approach to elicit participant feedback, determine whether participants in the RD Parent Empowerment Program made healthier choices for their families after attending the workshops, and identify which elements of the program participants believed contributed most to its success. The evaluation design used a pragmatic, mixed-methods approach utilizing postintervention focus groups and pre-post intervention scores on the Family Nutrition and Physical Activity (FNPA) survey. All workshop attendees aged 18 years or older were eligible to participate in the evaluation. One hundred twenty-three parents participated in the intervention across seven sites. Focus group results were analyzed using thematic analysis methods to match themes to the main intervention goals. t Tests were used to compare pre- and postintervention FNPA scores and demographic characteristics pooled across sites. FNPA scores significantly improved from pre- to postintervention by a mean of 4.3 FNPA points (6.5%; P<0.01). Focus group participants reported behavior changes as a result of the program and identified the site leaders as integral to the programs success, triangulating the results. The RD Parent Empowerment Program generates meaningful self-reported behavior change in parents. Long-term sustainability of the changes must be investigated.

The RD Parent Empowerment and Supplemental Food Pilot Program for Improved Food Security, Nutrition, and Family Behaviors

T HE RD PARENT EMPOWERment Program was developed by the Academy of Nutrition and Dietetics Foundation (Academy Foundation) in collaboration with Healthy Children, Healthy Futures, and was designed to motivate and support parents in making targeted changes in their family health environments and behaviors. The RD Parent Empowerment Program was initially implemented in 12 urban schools in three cities in 2012. The intervention aimed to improve family health behaviors through a series of workshops targeting low-income parents. Workshops promoted the 8 Habits of Healthy Children and Families. The RD Parent Empowerment Program demonstrated statistically significant improvements in self-reported family behaviors and modified home environments supportive of healthy body mass index for children. This article describes the implementation and evaluation of an enhanced RD Parent Empowerment Program that was piloted at a community center with low-income, predominantly Hispanic families with school-aged children living in Indianapolis, IN, in 2015. This project was a partnership with Eskenazi Health. As one of the leading health care systems in central Indiana, Eskenazi Health services a mobile health clinic to Shepherd Community Center. The Shepherd Community Center’s mission is to “break the cycle of poverty on the near Eastside of Indianapolis.” The near Eastside of Indianapolis comprises a younger than average demographic with a greater number of children than other areas of Indianapolis’ Marion County. Almost one-quarter of residents (24%) are living in poverty, 34% do not have a high school diploma, and 9.79% are unemployed. The overall objective of the enhanced RD Parent Empowerment Program was to empower parents to serve as healthy role models for family meal behaviors and to improve family food security. This evaluation sought to determine how the RD Parent Empowerment Program, enhanced with supplemental foods and additional workshop sessions, influenced family health behaviors, family food security, and nutrition quality of foods and meals served at home.

What Is Your Nutrition Program Missing? Finding Answers with the Guide for Effective Nutrition Interventions and Education (GENIE)

to guide the development of nutrition education programs, or to evaluate program plans or proposals. GENIE has been validated across a wide range of nutrition education program proposals, 12 giving this tool the unique ability to compare disparate programs. This article describes a literature review in which GENIE was used to assess and compare published program descriptions and to: 1) identify qualities of nutrition education programs commonly present or absent in both high-scoring and lower-scoring interventions when assessed with GENIE; 2) provide examples of high-scoring programs in each category; and 3) determine the relationship between GENIE score and program outcomes.

Integrative Nutrition and Health Models Targeting Low-Income Populations: A Pilot Intervention in Three Food Banks

I N 2012, THE ACADEMY OF Nutrition and Dietetics (Academy) introduced their Future of Food Initiative. This initiative aims to address domestic and global food and nutrition security, as well as consumers’ interest in a safe and healthy food supply, through education, communication, and research. This initiative has provided the Academy with opportunities for collaboration with other organizations concerned about food security, including Feeding America (FA), a leading domestic hunger relief organization supporting a network of over 200 food banks, annually serving 46.5 million people facing food insecurity. Individuals and families facing food insecurity lack access to sufficient amounts of nutrient-rich foods. Food banks serve as valuable resources to lessen hunger in communities facing food insecurity. Food bank clients also often lack access to health-promoting resources such as health screenings and other medical services. According to a comprehensive hunger report published by FA, nearly half (47%) of food bank clients report that they are in fair or poor health, and 31% report having to choose between paying for food and medical expenses each month. As part of its Future of Food Initiative, the Academy of Nutrition and Dietetics Foundation (Academy Foundation) had the opportunity to collaborate with FA in a unique project to address the intersecting health needs of food bank clients. Funded by Morgan Stanley, the Healthy Cities intervention uses a “supersetting” approach; this approach recognizes that health interventions are most effective when they take place in people’s everyday environment. This integrative nutrition and health model takes an ecological approach to health promotion, recognizing that 1) multiple levels of influence exist for health behavior change, 2) environmental contexts are significant determinants of health, and 3) influences of behavior interact across levels. Primary prevention interventions are those that aim to prevent onset of disease through education and behavioral strategies, such as those related to physical activity and nutrition. Health promotion efforts aimed at children and adolescents may lay the foundation for a lifetime of primary prevention health behaviors; approximately 39% of households served by FA have at least one child younger than 18 years, and 94% of these families are eligible for free or reduced-price meals through the Federal School Breakfast and Lunch Programs. Figure 1 displays the conceptual model of the Healthy Cities intervention: because schools are a part of children’s everyday lives, health behaviors of children and adolescents are targeted bymaking schools the primary community hub or “supersetting,” where food banks can serve as facilitators of the partnerships necessary to carry out integrative nutrition and health intervention. As shown in Figure 2, the Healthy Cities intervention intersects three levels of the ecological model: intrapersonal (child/adolescent), interpersonal (parents and caregivers), and community (school). The overall objective of this proof-ofconcept pilot intervention was to determine the feasibility of using community food banks as the primary facilitators of the partnerships necessary for an integrated nutrition and health services program aimed

Plentiful, Nutrient-Dense Food for the World: A Guide for Registered Dietitian Nutritionists

A FEBRUARY 2014 SURVEY OF A representative sample of Academy of Nutrition and Dietetics (Academy) members showed high interest in learning more about domestic and global farming and food production practices, strategies for increasing global food security, care of animals raised for human consumption, and environmental considerations along the food supply chain. In response, the Academy produced a series of four educational webinars exploring the increasingly more complex relationship between agriculture and food and nutrition. As a follow-up to the webinar series, the Academy Foundation hosted a symposium before the 2014 Food & Nutrition Conference & Expo in Atlanta, GA, titled “The RDN’s Guide to Plentiful, Nutrient-Dense Food for the World.” The symposium was designed to:

Changes in Student-Athletes' Self-Efficacy for Making Healthful Food Choices and Food Preparation Following a Cooking Education Intervention

Social Cognitive Theory-based cooking workshops were offered to student-athletes enrolled in a Life Skills college course. The workshops were hands-on and emphasized the Performance Plate and basic cooking skills. Student-athletes reported increased self-efficacy for healthy food choices and cooking skills (P<0.05).

How Community Food Banks Support School Breakfast: Strategies Used and Lessons Learned.

X X B REAKFAST EATING AMONG children has been linked to a variety of positive outcomes such as reduced body mass index, improved cognitive function and academic performance, and improved psychological well-being and behavior in school. Despite the known benefits, it has been reported that up to one-third of school-aged children do not eat breakfast. To improve access to breakfast, the federal School Breakfast Program was authorized to provide free or low-cost breakfast to children living in households at or below 185% of the federal poverty level. Unfortunately, a variety of barriers continue to prevent the School Breakfast Program from reaching all eligible students. Feeding America (FA) is the largest hunger relief organization in the United States, supporting a network of more than 200 member food banks. In addition to food procurement and distribution to families facing food insecurity, FA member food banks are involved in innovative programming, advocacy, and outreach activities to assist families eligible for federal food assistance programs. Approximately 39% of households served by FA have at least one child younger than age 18 years, and more than two-thirds of client households fall at or below 100% of the federal poverty level. To better understand the role of FA network food banks in school breakfast promotion, the Academy of Nutrition and Dietetics Foundation (Academy Foundation) led a project with FA to assess current efforts and practices. The primary aims of this project were to determine strategies used by food banks for school breakfast promotion, identify challenges faced by food banks to promote school breakfast, and to determine best practices for food banks related to school breakfast promotion. A secondary aim was to identify national nonprofit partner organizations with school breakfast initiatives.