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					                     know more about schoolchildren’s
Before leaving for   nutritional needs
the day, you’ll…
                     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
Stormy and perilous          ‘You’-oriented
Completely exposed to        Cross-sector synergistic
drawbacks from all sides     cooperation
Countless difficulties and   Continual support
barricades                   Appreciation and reward
Strength-exhausting and      Assessment and review
brain-racking
                             Leaving a lasting
                             reputation
Health and Nutrition
Nutritional Guidelines on School Lunch for
Primary Students and compliance monitor
Nutritional Guidelines on Snacks for Primary
Students and compliance monitor
Organising projects promoting healthy eating at
school
Support, record and reward
Q&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 habits
     increase the risk of chronic illnesses
     cause overweight and obesity
*Data of 2005 *
   • The percentage of primary schoolchildren
     with obesity*
                                  25.0%


                                  20.0%
    • rose from 16.4%
                                  15.0%
      in 1997/98                                                                                  男生
                                                                                                  女生

    • to 19.4% in                 10.0%                                                           總計


      2005/06                     5.0%


                                  0.0%
                                          97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06



                                                  Boys            Girls           Total
* Data Source: DH Student Health Service
Obesity refers to the excessive storage of fat
in the body, which may cause health
impairment
                                          Energy
                                          Output

Energy
 Input
Children

  – Growth Charts
    e.g. : Weight-for-Height Chart
Healthy eating habits built up in childhood are
more likely to be carried on into adulthood
Schoolchildren generally fail to follow healthy
eating principles
Studies abroad pointed out that school-based
intervention programmes are found with proven
effectiveness in promoting healthy dietary habits
among schoolchildren
             Yoghurt Wheat bread    Chicken leg in   Pure orange
                                     Chinese ‘Lo        juice
                      with raisin    Shui’ sauce




Healthier
              95.6%      95.9%         95.0%          97.7%

More
unhealthy
              4.4%        4.1%         5.0%           2.3%
            Ice cream   Hot dog     Deep-fried       Soft drink
                                    chicken leg
             Yoghurt Wheat bread    Chicken leg in   Pure orange
                                     Chinese ‘Lo        juice
                      with raisin    Shui’ sauce




Healthier    48.1%       49.1%
                                       65.2%           64.9%


More         51.9%       50.9%
                                       34.8%           35.1%
unhealthy
            Ice cream   Hot dog     Deep-fried       Soft drink
                                    chicken leg
  Recipes
without ‘less
   healthy
ingredients’
                Recipes with
    36.8%
                ‘less healthy
                 ingredients’
                    63.2%
                                         Items
               Items sold   Items sold
                                         brought
                 at tuck    in vending   to school
                  shops      machines    from home
‘Snacks to
choose more’      14.6%       10.0%      13.1%

‘Snacks to                    28.8%
                  29.7%
 choose in                               51.3%
moderation’
‘Snacks to                    61.3%
                  55.7%
choose less’                             35.6%
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
 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
    one third of the nutrients
       they need every day
Tips on healthy lunch
box




Grains & cereals, vegetables and meat
should be in the ratio of 3 : 2 : 1 by
                volume
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,    1-2 servings    1½ - 2½ servings
 Eggs, Legumes
       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 &             Vegetables Meat, Legumes,
     cereals                              Eggs
 ~1/5 bowl                1 bowl of raw  4 slides of cooked
                            1/2 bowl of
 ~1/4 bowl of              cooked
 noodles                                   1/2 bowl of cooked

 ~1/3 bowl                                1/3 bowl
 ~1/2 slice of bread
                                          1
~ 1          as big as
 an egg
One serving =
               Fruit                     Fats and Oils
 1 medium-sized (as big as a fist)     1 tsp of plant oil


 1/2                                   1 tbsp of salad
                                          dressing
 1 handful (about 10 grapes)


 1 glass (150ml)


 1/2 box of unsweetened dried fruit
(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
Encouraged Food Items

 Natural and fresh

 ‘3 lows, 1 high’ food
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 oil
        e.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 skin
   e.g. chicken wings, spare ribs,
   chicken legs, ox belly, fatty
   minced meat cake


  Whole-fat dairy products
   e.g. full-cream milk, regular
   cheese, full-cream yoghurt
Limited Food Items
 Processed or preserved meat, eggs
  and vegetables
  e.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


                    Say
                    NO!
Strongly Discouraged
Food Items


 Deep-fried                  Deep-fried
               French fries    fish fillet
  food



               Deep-fried     Deep-fried
                  Tofu        chicken leg
Strongly Discouraged
Food Items
  Food with added animal fat,
   plant-based saturated fat and
   hydrogenated fat
   e.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
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 Diet
  Is 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:




 (1) Grouping list of    (2) Nutritional Quality
food items for lunch    Evaluation Form of School
                                  Lunch

                                 (3) Lunches of the
                                        week
1




2   3   4




5
How to observe changes in
food quality?
                        Provision of vegetables in lunch



   100



    80



    60
     %




    40



    20



     0
         Sept    Oct    Nov    Dec    Jan    Feb    Mar    Apr    May   June   July
         2006   2006   2006   2006   2007   2007   2007   2007   2007   2007   2007
E.g. Low-fat Curry Chicken
with Vegetable Red Rice




 23/9   Low-fat Curry Chicken with                  362
        Vegetable Red Rice
Action Time!
 Activity 1
 Dissemination of
Surveillance Results
            School Executives,
            Headmasters / Teachers




                   Students



 Lunch                               Parents
Suppliers
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
               1.5 – 2 hours
        between snacks and main meals
  to avoid spoiling children’s appetite for the
                     next meal.
Appropriate serving size
for snacks…
It is usually smaller than that for a main
   meal, and it does not mean to replace
                the main one.
 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
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:
                                    Low in fat
Containing at least one type of
 nutrients (e.g. dietary fibre,    Low in sugar

 protein, calcium), and             Low in salt

                                   High in fibre


‘3 Lows, 1 High’ Principle
Snacks to Choose More
 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
          Low-fat dairy products

Low-fat                            Low-fat
yoghurt                              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 Less
Food 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   Sweetened fruit juice
Moderation  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                       Claims


                      Nutrition claims Function claims
                         Nutrient       Health claims
                       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
How many servings are there in 1 pack of   4 servings
Udon?

How many grams are there in 1 serving of
Udon?                                      200 grams




 Udon
How to use nutrition
labels?
 Step 2: Check out the calorie content
  How many calories are there in 1
  serving of Udon?
                                         320kcal

 How many calories are there in 1 pack   1280kcal
 of Udon?
How to use nutrition
labels?
 Step 3: Look for the nutritional value
What is the unit of nutritional Per Serving
content?
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
             Calcium
             Protein
           Dietary fibre
FAQs on children’s
      diet
FAQs on children’s diet
    There 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:




(1) Snack categorising list      (2) School Snacks
                                Monitoring Checklist

(3) A list of snacks and beverages supplied at school
tuck shop and/or vending machines
1   2




        4
    3
How to observe changes
in snack quality
 60
                                           Snack Supply Trendlines

          Snacks to Choose More
 50


 40
      %




           Snacks to Choose in Moderation
 30


 20


 10
          Snacks to Choose Less
 0
          Oct-06   Nov-06    Dec-06      Jan-07   Feb-07      Mar-07     Apr-07   May-07   Jun-07      Jul-07


             Snacks to Choose More (%)       Snacks to Choose in Moderation (%)    Snacks to Choose Less (%)
Let’s group them up
     French fries    Choose Less

      Raisin puff    Choose in Moderation

        Cookies      Choose less

     Boiled corn     Choose more
                     Choose in moderation
Bean curd dessert
                     / Choose more
   Chocolate milk    Choose in moderation
 Orange-flavoured    Choose less
             drink
Action Time!
  Activity 2
 Dissemination of
Surveillance Results
            School Executives,
            Headmasters / Teachers




                   Students



Tuck shop                            Parents
operators
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

   Potato chips       Cornflakes or fruit
                      chips
    Luncheon meat    Wholewheat bread with
 and ham sandwich    fresh tomato & boiled egg
    Full-fat dairy   Low-fat dairy
         products    products

     French fries    Baked mashed potato /
                     Baked potato wedges
Deep-fried chicken   Baked chicken leg or
      leg and wing   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
   activities
4. Proposals on projects / programmes promoting
   healthy eating
5. Support, record and reward
We have developed 26 proposals of promotional
activity in TWO categories:
1. Policy, surveillance, environment and behaviour
2. Knowledge, attitude and awareness
Policy, surveillance, environment and behaviour
(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
Knowledge, 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
School ‘NutriAgent’ Project Requirements
 ** No less than two activities are to be conducted for the
     academic year 2006-2007

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

  • Optional activities
    Activities suggested in the Handbook and other school-
    based activities designed for healthy eating promotion
Professional advice
 – Through our enquiry hotline, our
   professional team provide
   consultancy on:                       Resources available
    • the process of organising events
                                          – Health education
    • problem solving                       resources
    • resources available
                                          – Community
    • recommendation of community           resources
      resources
                                         Volunteers’ support
    • the progress follow-up of the
      programme organisation for the
      year
         Appreciation
      Record and Reward
  Appreciation and commendation to the
‘NutriAgents’ who are cordially devoted to
  proactive running of events promoting
         healthy eating in school
• Proposals
• Evaluation Reports
           Evaluation Reports
• Photographs, promotion posters,
  questionnaires and results of evaluation study
• By post, fax or e-mail to DH
• For events lasting longer than 8 weeks, an
  interim report is to be submitted, followed by
  the final report upon the completion of event.
• Judging criteria
   – Nature of event
     (Policy / Environment, continual surveillance, knowledge /
     concern)
   – Scale of event
     (Number of participating parents / students / members of
     the community)
   – Duration
   – Participation of volunteers
   – Evaluation of effectiveness
• Record of the event’s scoring
   – NutriSchool Record
   – NutriAgent Record
•   Infinity            of satisfaction
•   Childhood obesity   no more
•   Chronic illnesses   morbidity declines
•   Enjoy               life

				
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