Linda Omichinski, "Teens and Diets: No Weigh", Healthy Weight Journal, Volume 10, No 3, May/June 1996

How and Why to Deliver the Nondieting Message
Registered dietitian and nondiet leader Linda Omichinski provides readers with a look inside the development stages of her new program Teens and Diets: No Weigh. After ten years of assisting adults seeking a stop to the dieting cycle through her nondiet programs, Omichinski is uniquely qualified to bring nondiet empowerment to the adolescent age group.

Teens & Diets: No Weigh

By Linda Omichinski, RD

What legacy are we passing on to the next generation? Are we a society of dieters unhappy with the way we look because media messages tell us we should be slim? Food preoccupation and dieting has become an obsession for too many. The right to enjoy food and accept the inherent satisfaction and sustainment that comes from nourishing your body seems to have been stolen away.

The good news is that healthy, nondieting is a valid lifestyle choice that comes with a freeing set of parameters and characteristics far surpassing the restrictions of a diet lifestyle.

For teens, the question is not so much how do I eat healthy but more as a response to their own personal symptoms "I'm tired, jumpy, grumpy, bored" and so on. The heart of the Teens & Diets: No weigh program rests in transferring confidence to teens around making their own decisions based on personal health, energy and emotional needs - our classic nondieting definition. Guidance from the program leader enables this information acquisition and experimentation to occur with safety. A new system of teen powered decisions emerges from the process. To demonstrate how healthy living can occur, we put the teen squarely in the drivers seat by using a road and road signs as one of the primary graphic demonstrations of nondiet concepts.

Teen Needs

We decided to get involved with nondiet programming for teens because of several compelling factors. From our facilitator network we were hearing comments like… "There's nothing out their for teens that isn't weight loss," "I'm counseling too many kids with eating disorders," "Parents in my group said they'd like this for their teen."

Diet myths and diet mentality are entrenched in our culture. Curriculum and programs in schools are locked with diet and weight bias. Educators are inadvertently passing on myths, fallacies and mixed messages simply because alternate material hasn't existed.

We identified six areas and concern in schools:

1. "Correct weight" references and material. Measures and figures such as BMI (body mass index) and height/weight charts, weigh ins and use of skin calipers carry the potential to seriously affect self-esteem.
2. Focus on weight instead of health. Students need to feel an appreciation of different body shapes and sizes. Weight is determined by one's genetic predisposition, history of chronic dieting and lifestyle.
3. Showing students how to lose weight instead of emphasizing the living concepts (eat and exercise for energy and fun), and accept the weight that grows out of that. Otherwise perfectionist tendencies and preoccupation with weight can arise.
4. The food pyramid contains useful information about the roles of foods. But good/bad food connotations often arise during discussions that stick with people's permanent perception of the food.
5. A widespread "fat is bad" bandwagon. Fats are essentially for a healthy body as they supply energy (fat soluble vitamins and fatty acids) and/or other important nutrients to help teens grow.
6. Often one or two competitive sports dominate the focus of acceptable physical activity. The public school system can and should provide opportunities to experiment with different types of activities. Teems should be able to experience a range of activities to discover ones that are personally enjoyable.

There is no better time to establish a new way of living than the teen years.

We recommend four prongs to reach the public with nondieting health message for teens: through schools, teen grapevines, parental concern, and the medical/health professional community.

Moving Ahead

Initially we thought a teen program could be developed by inserting teen examples into our existing lesson plans. However, a detailed look at the key issues soon proved that hope wrong.

We had in place a network of facilitators in several countries, a pool of experienced health professionals delivering our non-diet program to groups of adults using a facilitative, empowerment health promotion model , a fully developed nondieting program of concepts and techniques, supported by books, self-esteem tapes, fitness video and support group newsletter, and published documentation of our success rates of breaking the diet cycle (J Canadian Dietetic Assoc, Summer 1995;56:2:00).

But teens have entirely different lifestyle issues and influences from adult concerns. Nondiet techniques and an empowerment model were transferable, but without indefinable scenarios, relevant demonstrations and accommodation for varied learning styles, teens would tune out the message. If we were to build a lifestyle program we needed to revisit the lifestyle needs of people from 12 to 17 years.

Here's what we found. Teens juggle the twin factors of school and parental authority in their daily lives. Above all, the influence of their friends and peers is paramount. Surrounded with this bombardment of influence, teens need a personally developed system for making healthy decisions.

We developed this profile of contemporary teens:

• love new ideas
• love to be in groups
• love to do things differently from their parents; (i.e. you diet, dieting doesn't work; I'm not going to diet; I've found a better way to live)
• love choice and freedom to be experimental
• love to question the status quo
• love to be busy with things they like to do
• like action

Eating disorders have been highly popularized and teens do worry about this. The benefits of eating for energy have to be experienced, not explained. Understanding the connections between food and feelings has to happen in that instant of decision of reaching for that bag of chips or a fresh bun and cheese when hunger strikes.

New Materials

We worked through these issues to enable us to design relevant and innovative approaches, and scripts. An early pilot project at the grade 8 level provided valuable first hand experience that started our redesign. During development, material was consistently drawn from an informal pool of teens. We tried to accommodate the strengths in their fresh approach instead of filtering out the criticisms. Also, we wanted feedback and field tests to verify our initial materials. The completed program was offered to our network of facilitators who felt comfortable working with teen groups.

We designed the facilitator manual to include dialogue guidance scripts, games, interactive, brainstorming questions, and role plays. For example we tried to anticipate the kinds of questions , we developed the appropriate probing questions and illustrations; even coining new definitions such as protein - the carbo-charger - a rocket ship graphic to describe the role of protein as a booster to carbohydrates in extending the holding power of a food choice in that category. Contrast this example to the idea that you should have cheese for a snack because it's good for you - and it better be low fat!

Another highly interactive activity is "Throwing out the Dieting Myths". We wanted teens to really throw out the dieting myths that underlie so many diet decisions.

We developed new support materials: a Parent Guide and Teen Journal/Workbook. With the journal, our aims were to provide a long term reference for the teen, a permanent source of information as well as mechanism to encourage the self reflection that leads to growth and discovery around life issues. Passing through life in the fast lane does not enable an adequate internalization of experience.

The reality in our initial testing was slightly different. Teens today have tons of homework. Journal assignments were not always done. However, most of the teens had answers in their heads if they had not completed their journal questions. Many of them could talk well beyond 15 to 20 minutes. The Journaling was important to tie the lesson plans into their own lives. Journaling was seen by teens to be like homework. Even though Journaling is often not done at home, good discussions regarding the past week occurred and students would write down in their journals for future reference.

We decided to use our cookbook, Tailoring Your Tastes, because research indicates that teens cook about twice a week and are often responsible for getting their own food even if it's not cooking per se (What! About Teens Spring 1995;1:2:00). Comments from completed classes indicate that teens and their parents enjoy cooking together.

Through this program teens learn to:

• take responsibility for their own appetite for taste within the family setting
• understand personal body signals for hunger
• use consistent physical activity as a source of energy
• eat for energy and health
• appreciate genetic and growth factors in personal appearance changes
• have a healthier body image
• express themselves assertively
• critically look at media messages around health/body image
• measure health as a state of energetic and confident well-being as opposed to a number on the scale

Parents learn how and why to:

• respect individual food preferences
• offer a variety of foods
• understand physical differences in needs for food
• convey non-judgmental attitude
• demonstrate unreserved acceptance of their teen at any size and shape

Working with teens

Would it take a special skill level to work with teens?

Part of working with teens involves letting go of the control and enabling them to make the decisions. Comments like, "that's a very interesting point of view. Could you tell me more about that?" lets the teen express their own perspective.

Empowerment techniques are ideally suited for teen development. We've charted a sampling of eight techniques to provide the illustration of how empowerment offers the most effective answer to teen issues.

It's critical to have an open attitude about the seeming negatives in this age group so that true learning can take place. Personal qualities of openness, caring and a good sense of humor aid educators of any age group and particularly for teens.

Build a relationship based on trust; share personal stories and some background so they can identify with you. Treat teens as adults, with the acceptance that will enable feeling good, relaxing and opening up to occur. Emphasize that no question is stupid. Use lots of humor.

Be watchful for fear in the group and offer reassurance and support for the courage to try something new. Build flexibility within the structure of your time together and introduce new concepts very gradually. Take the time to appreciate where they are in their maturity and background as a group and individually. Understand the range of behaviors and accept that everyone learns a different way. It often takes time for teens to buy into the dynamic of a group. Not everyone is ready for the same message at the same time or able to implement the ideas in their own situation - we all grow at a different pace.

When you are in a leadership role, the words you use, particularly in a one-on-one situation, can have permanent impact. The message received may not always be the one you intended to deliver. Draw on your own personal experience to see the truth of this premise. And, it's not just the words, but the tone that delivers the message. Your aim is to nurture, assist and guide; not destroy and break down.

Encourage feedback from others to see if your verbal reflection matches your intent. Find out what words will encourage and empower teens to become stronger, healthier people. Words can be verbal shoves, especially to those with underdeveloped or low self esteem. With teens the unexpected should be expected so that your non-judgmental tones have to always be ready. An attitude of casual but respectful curiosity encourages frankness.

Evaluations

What did the teens really like?

1. The recipes and trying something new that was healthy
2. The discussion time (they loved to talk once they got comfortable with the class)
3. Learning how their bodies work and how food and activity affects their bodies
4. The games
5. The physical activities scheduled outside class (aquasize, cross, country skiing)
6. Acting out the hunger scale
7. PAST scenarios
8. Handsome/beautiful/the Barbie fantasy
9. Body shapes
10. Why diets don't work
11. Regular eating - starting out with breakfast
12. How to get the most energy out of foods
13. Media influences
14. Feelings of fullness and not overly stuffed

One parent summarized thoughtfully… "The idea of not having to diet made them relax and not be so anxious about eating (as that made them eat more), also the knowledge of their different food choices and the help with making the right choices was good. This program was helpful, as they got tired of their mother telling them, they can just refer back to the info they received from this program."

Another mother felt her daughter really benefited from the program as she now eats breakfast.

One program facilitator delivered classes through a community health service because the content meant the criteria of the regions business plan to empower people to be the best they can be. A strength is that the material on teen smoking fits the goal of decreasing the incidence of smoking. The program was delivered at the junior high school and will later be brought into the senior high school level.

Her evaluations were very positive. "The format of the facilitator binder was excellent. It was extremely easy to follow and provided enough information to be prepared to student questions. It was nice to have things written out word for word to get a good grasp of the class content and to be well prepared. The teens really enjoyed the games and group activities. The role plays and scripts were effective (the teens could relate to the examples). The key points were very useful."

Another said, "The concept of the program is terrific. It is just the thing that most teens need. So many teens go on diets - more so than adults - creating a great need for this program. Hopefully, we will be able to reach a lot of teens and show them that diets don't work. Overall, the program was a success. Most of the teens really enjoyed the program."

As the program developer, it is gratifying to read these positive evaluations, but there is a long road ahead. Our program is still being evaluated in various settings and we expect to continually fine tune our approach just as we did with the adult program.

Originally envisioned as eight modules delivered in 1.5 hour sessions, we now see that the program content is much richer and could support up to 16 sessions. Customization opportunities are very evident.

We believe that our original aims in the program creation are now validated through field testing and expect increasing reporting of these positive outcomes.

The importance of breaking the diet cycle at an early age can't be overemphasized. As health professionals we can take some new directions and responsibility to change the cultural message.