Happy New Year! As we enter 2015, many of us make New Year’s Resolutions, and the number one resolution centers around health: lose weight, exercise more, and eat healthier. We’re all feeling a little blah, considering holiday overindulgence. This issue will focus on how to help moms make healthy lifestyle choices – Warm Regards Jan 2015.

As health professionals, you know that fats and sugars make us feel tired, sluggish, and unmotivated. They create a cycle of cravings and often increase depression. When we’re able to break that vicious cycle by adding fruits, vegetables, whole grains, nuts, lean meats, and exercise into our lives, it does wonders for our health. We feel better, have more energy, and think clearer.

A secondary, but equally important, benefit is the impact healthy choices have on our children. Children are going to copy us. If we load up on chips and sodas, so will they. But when we encourage our families to eat healthy and stay active while under our roof, the odds are greatly increased they will continue these lifestyles into adulthood.

The goal of WIC is to improve the health of infants and children. WIC is a tremendous educational resource teaching moms how to properly take care of themselves while pregnant/nursing, and how to manage the health of their children. But as you know, these healthy choices need to become healthy lifestyles to truly affect change. If WIC can effectively create behavioral changes in moms, it will filter down to the children as they grow and continue with their own families.

First, let’s look at trends and habits of the Y Generation (aka Millennials), which comprise the majority of today’s WIC caseload and 1/3 of our nation’s adults.

In the past, the majority of homes planned meals before shopping, shopped for ingredients, and stocked pantries with familiar foods. We were more cooks than eaters. We ate together, and typically had three defined meals with snacks reserved for the afternoon. What we ate and how we ate was very predictable.Shopping trends have evolved where we are becoming a society of eaters versus cooks. Millennials, especially, are eaters. As eaters, we shop more spontaneously, do more fill-in shopping, and shop for new and unique foods. Fewer than half of all trips to the grocery store are pantry-stocking trips. We look at food more as an occasion driven by cravings, cost, and convenience. Millennials are anxious to try new foods and flavors, and are not particularly loyal to any brand. See full story.

Millennials are serial snackers and are said to spend a higher percentage of their total foodservice dollars on snacks than other generations. According to the trend watchers, The Kruse Co, 35% of meals eaten by Millennials aren’t really meals at all; they’re snacks. “Desserts are now eaten at any time, sometimes even before breakfast. Lunch and dinner are increasingly combined into ‘linner,’ and many consumers insist on breakfast for dinner, forcing restaurants to keep the breakfast grills fired all day to serve ‘brinner.’

A study published in the European Journal of Preventive Cardiology found that adults age 30 are so unhealthy, they are like their parents or grandparents were at age 45. They are more likely to suffer from high blood pressure and diabetes. They are 20% more likely to be obese, and women in their 20s are twice as likely to be obese. One-third of those ages 16 to 27 years old are overweight or obese.A highly computer-literate generation, Millennials are spending more time than ever on their laptops, smartphones, and video games. The shopping malls are deserted on the weekends; instead of walking around the shops, Millennials are at home or at Starbucks, glued to the internet.

What can be done to encourage WIC moms to shop smart, eat healthy, and get active? Spontaneous shopping and snacking isn’t likely to change, so the goal would be to encourage moms to think of new fun and flavorful healthy foods. Millennials want good taste and they want something to differentiate their experience from their friends.WIC can also help by providing nutrition education to moms where knowledge gaps exist, such as appropriate serving size and balancing daily caloric intake with physical activity. Show moms ways to incorporate physical activity with their family into their busy schedule. Ideas are to walk the dog with the children and exercise while watching TV. They can develop a set of activities that are always available regardless of the weather, such as stair climbing, rope skipping, dancing, and active games that you can play indoors. WIC can also help teach moms how to understand the “nutrition facts” panel, watch for unhealthy/unnatural ingredients, and deceptive labeling. Since over three quarters of all eating occasions by Millennials involve processed food, the ability to accurately look at a label to ascertain if it’s healthy for her family is vital.

The book Slim by Design by Brian Wansink PhD, Executive Director of the USDA Center for Nutrition Policy and Promotion 2007-2009, promotes the idea that small changes in the food environment will encourage healthier eating.What would Batman eat? When 22 students were given a choice of apples vs fries, all but 2 ordered the fries. However, when asked “What would Batman eat: apples or fries?” 10 children ordered apples. Studies showed it didn’t matter who you said: Batman, Joker, or the kid’s teacher, simply having to answer for anyone makes them think twice and nearly half of the children made the healthier choice.

Dividing the cart. When shoppers had or placed a dividing line in the middle of their cart and asked to put all fruits and vegetables in the front half and everything else in the back, they found shoppers bought 23% more fruits and vegetables than shoppers whose carts were not split in half.

The slim person’s kitchen. After studying slim people’s vs overweight people’s kitchens in Syracuse, NY, it was discovered that the average woman who kept a bag of chips on the counter weighed 8 pounds more, and those who kept one box of breakfast cereal visible weighed 21 pounds more than their neighbors who didn’t. When it’s “in sight, it’s in the stomach.” We eat what we see, not what we don’t. Dr. Wansink’s book suggests rearranging the pantry and refrigerator so that the first visible foods are the best for us.

Experts who study behavior change agree that long-lasting change is most likely achieved when it’s self-motivated and rooted in positive thinking. Studies have also shown that goals are easier to reach if they’re specific (“I’ll walk 20 minutes a day,” rather than “I’ll get more exercise”) and not too numerous (having too many goals limits the amount of attention and willpower you can devote to reaching any single goal).

Here are a few factors perceived as motivational for Millennials:

Effectively addressing the health challenges facing the Millennials will require an integrated approach across multiple sectors. In a generation where 8 out of 10 of its members sleep with their cell phones on or next to their bed, mobilizing social media tools to advance the health of young people (M-Health) will be critical. Increased study of this generation’s health trends and needs, as well as developing effective delivery mechanisms for health information, will be important for this age group.Studies have found that periodic prompts and reminders are an effective method to encourage and reinforce healthy behaviors. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082846/. Therefore, increased communication, accountability, and reinforcement created by text messaging may increase the likelihood of remembering the changes that one should be making. Other features used to tailor messages to individuals included using a participant’s nickname.

Eight of the nine sufficiently powered studies found evidence to support the effectiveness of text messaging as a tool for behavior change in disease prevention and management.

Significant clinical outcomes observed included greater weight loss in obese adults at 4 and 12 months, and greater decrease in hemoglobin A1C levels in adolescents and obese and non-obese adult diabetics.

This evidence is consistent with existing literature suggesting that mobile phones are a useful tool for interventions seeking improvement in health outcomes. Specifically, it supports recent evidence that text messaging is a useful tool for behavior change interventions.

Dr. Thomas Brennan, who researches mobile health applications at the University of Oxford, believes text messaging is especially useful for chronic diseases. “Conditions like hypertension, diabetes, asthma, obesity, smoking – they all have to do with changing individual behavior over time. SMSes are probably the most useful way of engaging with [patients with these conditions].”From an operational standpoint, there is a very real risk of health text messages eventually being considered spam. Brennan believes this risk is greatest if the messages are not personalized. “If they’re just coming out of the cloud,” Brennan said, “I think they’ll have a limited impact.”

An interesting study was conducted by Seattle’s King County in 2010 at two mass vaccination clinic settings with 1,225 ethnically diverse attendees. This study is posted in the American Journal of Public Health: Text Messaging to Communicate with Public Health Audiences. http://www.medscape.com/viewarticle/781061_5

Researchers looked at PHI, electronic information, the Security/Privacy Rule, and the effectiveness of text messages sent to its participants. This study concluded, “Despite inherent risks, public health departments have a responsibility to use communication channels that will reach their communities effectively, particularly in instances in which there is a benefit to the public’s health. Texting is a powerful communication channel, in part because it can be customized. If all personally identifying information is removed, this may eliminate the greatest strength of text messaging.”

“In summary, we recommend that the federal government take steps now to clarify how health departments can reasonably use text messaging to send protected health information. Text messaging is a technology that reaches the vast majority of US adults and has the potential to be a powerful tool to improve health and wellbeing.”

A study on Marketing to Millennials states, “As consumers, we’re now expecting a more personalized experience. This is a result of our current experience on the web, where we spend the large majority of our time and where we’re seeing more prevalent contextual experiences of content and messages tailored to our behaviors and needs.

In summary, it will be easier for moms to make healthy lifestyle changes if they: 1) are educated in understanding labels and encouraged to think up creative healthy food options for their families; 2) have attainable goals to incorporate physical activity into their daily life; 3) make small changes in their food environment; and 4) receive positive, upbeat, and personalized mobile health text messages made to encourage self-motivation.