Margaret Raber

An evidence-based conceptual framework of healthy cooking

Eating out of the home has been positively associated with body weight, obesity, and poor diet quality. While cooking at home has declined steadily over the last several decades, the benefits of home cooking have gained attention in recent years and many healthy cooking projects have emerged around the United States. The purpose of this study was to develop an evidence-based conceptual framework of healthy cooking behavior in relation to chronic disease prevention. A systematic review of the literature was undertaken using broad search terms. Studies analyzing the impact of cooking behaviors across a range of disciplines were included. Experts in the field reviewed the resulting constructs in a small focus group. The model was developed from the extant literature on the subject with 59 studies informing 5 individual constructs (frequency, techniques and methods, minimal usage, flavoring, and ingredient additions/replacements), further defined by a series of individual behaviors. Face validity of these constructs was supported by the focus group. A validated conceptual model is a significant step toward better understanding the relationship between cooking, disease and disease prevention and may serve as a base for future assessment tools and curricula.

Evaluating a school-based fruit and vegetable co-op in low-income children: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013-2015). Six schools received BB (n=407 parent-child dyads); six comparison schools implemented a coordinated school health program (n=310 parent-child dyads) in Houston, Texas, 2013-2015. Brighter Bites (BB) is a 16-week school-based food co-op comprising weekly distribution of fresh produce (50 servings); nutrition education in schools and for parents; and weekly recipe tastings. Measurements included parent-reported home nutrition environment surveys, and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71% Hispanic, 24% African American; 43% of 1st graders were overweight/obese. Children receiving BB had significant increases in intake of fruit servings (P=0.046), vegetable servings (P=0.049), and decreased intake of added sugars (P=0.014). Among parents, there were significant increases in fruit consumed (P=0.032); vegetable intake increased baseline to midpoint but not post-intervention. Among BB families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases (P<0.05), frequency of cooking (P=0.007), rules and practices regarding eating family meals (P=0.022), serving fruits (P=0.005) and vegetables (P=0.028) at meals, and limiting portion sizes (P=0.016). In conclusion, a school-based food co-op model shows promising results in improving dietary habits and home nutrition environment among low-income families.

Developing a Healthy Web-Based Cookbook for Pediatric Cancer Patients and Survivors: Rationale and Methods

Background Obesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues, and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. Objective The objective of this study was to document the development of a Web-based cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. Methods The Web-based cookbook, named “@TheTable”, was created by a committee of researchers, a registered dietitian, patients and family members, a hospital chef, and community advisors and donors. Recipes were collected from several sources including recipe contests and social media. We incorporated advice from current patients, parents, and CCS. Results Over 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the website. In addition to healthy recipes, social media functionality and cooking videos are integrated into the website. The website also features nutrition information resources including nutrition and cooking tip sheets available on several subjects. Conclusions The “@TheTable” website is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment, and survivorship. Through evaluations of the website’s current and future use, as well as incorporation into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors, and the general public.

Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review

Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.

Lessons Learned From the Implementation of Brighter Bites: A Food Co-op to Increase Access to Fruits and Vegetables and Nutrition Education Among Low-Income Children and Their Families

BACKGROUND Food co-op models have gained popularity as a mechanism for offering affordable, quality produce. We describe the challenges, successes, and lessons learned from implementation of a school-based program using a food co-op model combined with nutrition education to improve access to and intake of fresh fruits and vegetables among low-income children and their families. METHODS Brighter Bites is a 16-week intervention comprising of fresh produce deliveries, recipe demonstrations, and nutrition education. A mixed-methods approach was used comprising survey and focus group data collected from Brighter Bites staff, parents, and teachers. Descriptive statistics and frequencies were computed for the survey data collected. RESULTS Brighter Bites was implemented across 9 schools, serving a total of 1530 predominantly low-income families in the 2013-2014 school year. Brighter Bites distributed an average 60.2 servings of fresh fruits and vegetables per family per week. Lessons learned included the importance of leveraging existing infrastructure of food banks and schools to implement the program, early school and parent engagement, and incorporating strategies to track and optimize engagement. CONCLUSIONS Clear expectations and reliable partnerships are keys to the delivery of the Brighter Bites program.

Utility of eButton images for identifying food preparation behaviors and meal-related tasks in adolescents

BackgroundFood preparation skills may encourage healthy eating. Traditional assessment of child food preparation employs self- or parent proxy-reporting methods, which are prone to error. The eButton is a wearable all-day camera that has promise as an objective, passive method for measuring child food preparation practices.PurposeThis paper explores the feasibility of the eButton to reliably capture home food preparation behaviors and practices in a sample of pre- and early adolescents (ages 9 to 13).MethodsThis is a secondary analysis of two eButton pilot projects evaluating the dietary intake of pre- and early adolescents in or around Houston, Texas. Food preparation behaviors were coded into seven major categories including: browsing, altering food/adding seasoning, food media, meal related tasks, prep work, cooking and observing. Inter-coder reliability was measured using Cohen’s kappa and percent agreement.ResultsAnalysis was completed on data for 31 participants. The most common activity was browsing in the pantry or fridge. Few participants demonstrated any food preparation work beyond unwrapping of food packages and combining two or more ingredients; actual cutting or measuring of foods were rare.ConclusionsAlthough previous research suggests children who “help” prepare meals may obtain some dietary benefit, accurate assessment tools of food preparation behavior are lacking. The eButton offers a feasible approach to food preparation behavior measurement among pre- and early adolescents. Follow up research exploring the validity of this method in a larger sample, and comparisons between cooking behavior and dietary intake are needed.

Healthy cooking classes at a children's cancer hospital and patient/survivor summer camps: Initial reactions and feasibility

OBJECTIVE Childhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour. DESIGN A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. SETTING One paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes. SUBJECTS One hundred and eighty-nine CCS of varying ages and thirteen parents of CCS. RESULTS Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. CONCLUSIONS Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.

A randomized nutrition counseling intervention in pediatric leukemia patients receiving steroids results in reduced caloric intake

Quality of life in survivors of pediatric acute lymphocytic leukemia (ALL) can be compromised by chronic diseases including increased risk of second cancers, cardiovascular disease, and diabetes. Overweight or obesity further increases these risks. Steroids are a component of chemotherapy for ALL, and weight gain is a common side effect. To impact behaviors associated with weight gain, we conducted a randomized nutrition counseling intervention in ALL patients on treatment.

Examining the impact of a school-based fruit and vegetable co-op in the Hispanic community through documentary photography

Hispanic families are at elevated risk for certain diet related illnesses including obesity and diabetes. Brighter Bites is a 16-week school-based program that delivers produce and nutrition education to high-need areas. The purpose of this study was to explore the adoption of Brighter Bites healthy eating strategies in low-income Spanish-speaking families as well as barriers to the sustainability of improved dietary behaviors using Photovoice. Two researchers worked with a predominately Hispanic, low-income public school to conduct the project. Spanish speaking parents participating in Brighter Bites were recruited and five mothers completed the study. Participants developed research questions, took documentary photos, attended group analysis sessions, and organized a community event. Photos from participants were gathered at two time points: i) during the Brighter Bites produce distributions, and ii) when the distributions were no longer in session. Participants organized resulting photos into themes during discussion groups that proceeded each photo-taking period. Themes that emerged during the produce distribution period included: cost savings, increased variety and accessibility of fresh produce, and ability to practice healthy eating. Themes that emerged when the weekly produce distributions were no longer in session included: increased costs, lack of variety, the continued effect of Brighter Bites, and innovative ways to cook with produce. Overall, participants were enthusiastic about the benefits they experienced with the program, but noted hardships in accessing nutritious food without the produce distributions in session. Innovative approaches are needed to create sustainable pathways to healthful food access after community nutrition interventions are complete.

Development and Feasibility of a Culturally Sensitive Cooking and Physical Activity Program Designed for Obese Hispanic Families

Objective: To determine whether a 10-week cooking and physical activity pilot intervention could be delivered in a health care setting. Development and feasibility of the program with a small sample size are explored. Methods: The MUNDO (Moviendonos hacia Una Nutricion Divertida y Optima) program was delivered weekly at a local primary care clinic. The curriculum included culturally sensitive cooking demonstrations, tastings, and organized physical activity sessions for children and their parents. Questionnaires and measurements were completed at baseline and completion of the study. Outcomes were feasibility, anthropometrics, and behavior change. Results: Four families were recruited, and 3 families attended 74% of the sessions. No significant changes in outcomes were reported. Families provided positive feedback about most aspects of the program. Conclusions: Future research is needed to understand how delivery of MUNDO could be optimized, within and beyond a clinic setting. Low-cost meal planning and c...