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How We Eat Matters - Addressing Challenges and Opportunities

Download forum presentations here.

Have you ever been confused by inconsistent child feeding guidance from different health care providers? It is hard to know what the best practice is when you receive several different recommendations.

The BC Dairy Association’s 2016 Nutrition Forum gathered together key influencers and stakeholders with a vested interest in ensuring consistent messaging around best practice child feeding guidance in BC. This was a key step towards BC speaking with one voice.

Since 1983, when Ellyn Satter first published Child of Mine: Feeding With Love and Good Sense, BC dietitians have been aware of Ellyn Satter’s message about the importance of the division of responsibility (sDOR). The sDOR model encourages parents to decide what, when and where their child eats. The child then decides whether to eat and how much. Ensuring that this advice is provided consistently across BC is important to support parents in raising competent eaters.

Satter addressed a packed room when she visited BC over 20 years ago, a demonstration of how solid her following was among dietitians. She once again filled the forum venue in 2015. Nevertheless, she is perhaps not as widely known by other health professionals and educators.

This year’s BCDA Nutrition Forum aimed to build on the main messages from last year’s forum with Ellyn Satter and address challenges in implementing consistent messaging centered on Satter’s Division of Responsibility (sDOR) across BC.

Carol Danaher, board president and faculty member at the Ellyn Satter Institute, provided the keynote address. She spoke of her experience with the childhood feeding collaborative in Santa Clara County, California. Through this collaborative, she spearheaded the idea of providing consistent sDOR messaging. The strategy emphasizes consistent messaging around best practice child feeding guidance and coordinated communication among health care service providers (such as public health nursing and maternal, child, and adolescent health) and organizations (such as childcare and preschool programs).

The collaborative’s vision is, “All families in Santa Clara County receive Division of Responsibility based feeding guidance from each of their relevant service providers.” The childhood feeding collaborative has developed many resources to support their messaging, such as the “5 Keys to Raising a Healthy, Happy Eater” parenting class, along with many bi-lingual materials.  

A two-month follow-up survey was conducted among health care providers after implementing the childhood feeding collaborative in 2008. The results indicated that there is a significant increase in confidence in discussing sDOR principles, as well as fewer perceived barriers to addressing feeding and weight issues. Health care providers also feel that their interventions are more effective. Another follow-up was conducted in 2010. A pediatrician was quoted saying, “The Division of Responsibility gives providers an easy-to-understand way to discuss feeding and improve the consistency and effectiveness of their message.”

When working with health care providers to implement consistent messaging, ensure that it is done in a way that considers their time constraints and competing priorities, says Danaher. Make it easy for them to understand and implement and ensure the benefits to them and their patients are clearly defined.

The feedback from parents on the childhood feeding collaborative was also exceptionally positive and many think that its programs provided invaluable lessons and insights about the sDOR.

Carol Danaher ended her presentation at the 2016 Nutrition Forum with a powerful quote from Dr. Daniel Delgado, the founder of the Pediatric Healthy Lifestyle Center in Santa Clara County: “To this day, most providers do not get that it is not about the weight. [We] cannot teach what to eat if folks don't know HOW to eat.” 2016 nutrition forum yogurt picture

After Carol’s presentation, the forum continued with informative panel presentations from key influencers in BC, including Marg Yandel, Jane Wark, and Kristen Yarker. Marg Yandel, manager of public health nutrition at the British Columbia Ministry of Health, explained that sDOR messaging is an important part of educational resources on HealthLink BC and the Dietitians of Canada website, and that this messaging will continue to be a key component of new resources being developed.

Consistent messaging is the goal, but where can we work to further integrate this message? Public health dietitian Jane Wark discussed how progress on implementing sDOR messaging throughout Fraser Health has unfolded:

  • Providing workshops and eLearning courses to public health nurses has improved their knowledge and confidence around sDOR messaging.
  • Engaging community partners, using social media, and placing digital signage in waiting rooms can increase messaging opportunities.
  • Some challenges that still exist include:
    • reaching physicians
    • overcoming language barriers
    • acknowledging different cultural values

The panel presentations were followed by an engaging discussion among the panel and audience. It became clear that there is much support for moving this initiative for consistent messaging forward. We need to work together to ensure families in British Columbia receive Division of Responsibility based feeding guidance from each of their health care providers. Let’s speak with one voice!

You can find the presentations for the 2016 Nutrition Forum here.  

The forum is presented by BC Dairy Association, a not-for-profit organization funded entirely by the dairy producers of British Columbia. BC Dairy Association has been providing innovative nutrition education programs to schools for over 30 years and resources for the community distributed by health professionals.

Thank you to the Dairy Farmers of Canada for their continued support of this event.