Outline, Rough Daft, Research

Running head: Childhood Obesity 1

Childhood Obesity and the Socio-Ecological Model

National University

Childhood Obesity 2

Childhood Obesity and the Socio-Ecological Model

Throughout the United States, there continues to be a major issue with the increasing

number of individuals that suffer from obesity. Unfortunately, this major health issue is not

limited to the adult population, children are also being plagued with this serious medical issue.

According to the Center for Disease Control and Prevention (2019), obesity affects 1 in 5

children and adolescents in the United States. That is a staggering 13.7 million children and

adolescents in the United States alone. Obesity affects all age groups of children and adolescents,

but there is a higher prevalence among 12 to 19-year olds. Similar to its cause in adults, obesity

in children is caused by both behavioral and genetic factors (CDC, 2019). One way to combat

such a major health issue is to address the problem from all levels of influence using the socio-

ecological model. The socio-ecological model is an approach that demonstrates that there are

separate as well as interconnected factors that can influence an individual’s health behaviors,

meaning that an individual can be influences by their own action, the actions of their family,

community, organization and even society (Cottrell et al., 2018). The socio-ecological model can

help to understand how each level of influence “intersects to shape” the choices that a person

makes about their food and physical activity. (U.S. Department of Health and Human Services

and U.S. Department of Agriculture, 2015). This essay will demonstrate how the application of

various levels of the socio-ecological model affects childhood obesity and will show how

changes at each level can address the prevention of childhood obesity.

Intrapersonal Level

The first socio-ecological level is the intrapersonal level. This level focuses on and

identifies an individual’s “knowledge, attitudes, and behaviors” in regards to actions that they

may or may not engage in to prevent or address childhood obesity (Callahan, 2014). Some of the

Childhood Obesity 3

influences in the intrapersonal level can include knowledge or skills, motivations or personal

traits. However, it is arguable whether or not a child or adolescent’s personal skills or knowledge

is enough to prevent childhood obesity because children are dependent on adults to provide them

with recommended healthy choices. According to authors Penney et al. (2014), the choices that

children make about the types of food that they may consume depends on the options given to

them while at home, school, or at daycare (para. 1). Some important interventions at the

intrapersonal level would have to focus on teaching children about what they should do to be

healthy. This can include teaching children in school what a healthy meal consists of and the

importance of physical activity. The website Nutrition.gov provides activity sheets, videos,

songs, games, and activities to teach youth about nutrition in a variety of settings, such as

choosing a new food at the grocery, tasting and rating it like a food critic (U.S. Department of

Agriculture, n.d.).

Interpersonal Level

The next level of the socio-ecological approach is the interpersonal level. This level

focuses on a group of people that have some form of relationship with an individual. For

children this would be their friends and relatives (Cottrell et al., 2018). Physicians can also play

a role at this level. Individuals around the child hold the greatest amount of influence (Callahan,

2014). The influence that parents or guardians have on a child’s eating habit and the amount of

physical activity the child or adolescent receives is the most vital in the prevention of obesity.

According to the 2015-2020 Dietary Guidelines, parents need to be actively involved in the

providing healthy options for their children and this can decrease the overall prevalence of

childhood obesity (U.S. Department of Health and Human Services and U.S. Department of

Agriculture, 2015). There is a need for programs that teach parents how to properly feed their

Childhood Obesity 4

children, how to organize their time to be able to make healthy meals, how to find healthy foods

that fit within their budget and how to reinforce good behavior with things other than food.

Schools can host discussions and provide suggestions to parents on how to cook dinner, shop for

healthy foods, read labels and pack lunches with their children, as well as do fun family outings

like pick fruit or go on hikes (CDC, 2012). Physicians should also play an active role in helping

parents with children that are suffering from obesity by having a non-judgmental attitude and

using terms that do not stigmatize weight (Gordon, 2019). They can also suggest limiting TV and

video time to 2 hours a day and to promote unstructured play at home (Committee on Nutrition,

2003). After-school programs can also influence diet and physical activity by using tools such as

the Healthier Out-Of-School Time Assessment to guide these programs in how to include

healthy foods and physical activity (Alliance for a Healthier Generation, 2010).

Organizational Level

The next level of the socio-ecological approach is the organizational level. This level

includes the “rules, regulations, policies … informal structures” that increase or decrease healthy

behaviors (Cottrell et al., 2018). At this level, the focus can be on schools or daycare settings for

children. These types of institutions have a continuous amount of contact with children for a

majority of their young lives. In the United States alone, 56.6 million children are enrolled in

school (National Center for Education Statistics, 2019a). As the place where children are

learning and socializing with their peers, schools have been identified as ideal for teaching

children how to maintain healthy active lifestyles (CDC, 2018). For example, schools “can adopt

policies and practices” to promote eating more fruits and vegetables, to consume less sugary

drinks and to increase physical activity (CDC, 2019a). These policies can be cost effective and

have a great impact on the reduction of childhood obesity. Schools can make sure to provide

Childhood Obesity 5

plentiful drinking water, use non-food rewards for celebrations and events, limit or eliminate

vending machines, and have staff model healthy behaviors (CDC 2019b). Schools can also

involve parents in planning school health activities and invite them to participate in physical

activities such as walkathons (CDC, 2012). Medical practices can also provide programs with

teams of professionals such as dieticians, psychologists and health educators. One example is

the IDEAL Clinic at Children’s National Hospital (Improving Diet, Energy and Activity for Life

(Gordon, 2019). Doctors can measure BMI yearly in their young patients to identify excessive

weight gain and encourage breastfeeding by parents (Committee on Nutrition, 2003).

Community Level

The next level is the community level. The community level is defined as the network of

social norms that exist within a community (Cottrell et al., 2018). Implementation and creation

of local policies or ordinances can support beneficial health behaviors. Childhood obesity can be

a significant issue when the environment is not conducive to having healthy food options

available and locations for children to be physically active. How the community is designed can

determine the health behaviors of its children and parents (Callahan 2014). If a community lacks

adequate recreation space for walking or physical activity and has several fast food restaurants

within the community then it is more likely to have an increased obesity rate. The environment

that a child lives in can have a direct impact on physical activity. Some interventions that can be

put into place are making parks more accessible for children by locating them close to a child’s

home, increasing the walkability and safety of the neighborhood and organizing neighborhood

walking groups. Community members can push for making healthy foods more available by

getting local stores to stock fresh produce. Community health workers can reach out to families

Childhood Obesity 6

to teach them about healthy nutrition and hospitals or non-profits can conduct community health

screenings and fairs.

Public Policy Level

The final level to discuss is the public policy level. At the public policy level there are

local, state, or federal policies or laws that “regulate or support healthy actions” to address the

childhood obesity epidemic (Cottrell et al., 2018). There are currently policies in place that that

focus on dietary requirements for schools. National food campaigns, mandated school wellness

policies as well as wellness regulations are all some of the ways to promote healthy eating

behavior to combat childhood obesity. Other policy and legislative solutions can include

agricultural subsidies, regulating exposure to obesogenic chemicals in foods and food packaging,

and banning super-sized sodas. There is a need for more policies to support healthier lifestyles

choices for children to have proper nutrition and enough opportunity for regular physical activity

(Committee on Nutrition, 2003).

In conclusion, childhood obesity is a preventable public health issue. The best way to

overcome this issue is through the utilization of the socio-ecological approach. Changes need to

be implemented at each of the levels, focusing heavily on the upper levels like the

organizational, community and public policy level. Unfortunately, at the individual level children

are not in control of making necessary changes to the lifestyle without the help of their

caregivers at the interpersonal level. In the end, changes need to be made at every level for there

to be a reduction of childhood obesity.

Childhood Obesity 7

References

Alliance for a Healthier Generation. (2020). Out of school time. Retrieved from

https://www.healthiergeneration.org/take-action/out-of-school-time

Callahan, K. (2014). Assessing the Social and Ecological Factors that Influence Childhood

Overweight and Obesity. Retrieved from

https://dc.etsu.edu/cgi/viewcontent.cgi?article=3812&context=etd

Centers for Disease Control and Prevention. (2012). Parent Engagement: Strategies for Involving

Parents in School Health. Retrieved from

https://www.cdc.gov/healthyschools/parentengagement/pdf/parent_engagement_strategie

s.pdf

Center for Disease Control and Prevention (2018). CDC healthy schools: School health

guidelines. Retrieved from https://www.cdc.gov/healthyschools/npao/strategies.htm

Centers for Disease Control and Prevention (2019a). Childhood obesity facts. Retrieved from

https://www.cdc.gov/healthyschools/obesity/facts.htm

Centers for Disease Control and Prevention (2019b). Comprehensive framework for addressing

school nutrition environment and services. Retrieved from

https://www.cdc.gov/healthyschools/nutrition/pdf/School_Nutrition_Framework_508tagg

ed.pdf

Committee on Nutrition. (2003). Prevention of pediatric overweight and obesity. American

Academy of Pediatrics. 112, 424-430. Retrieved from

https://pediatrics.aappublications.org/content/pediatrics/112/2/424.full.pdf

Childhood Obesity 8

Cottrell, R. R., Girvan, J. T., Seabert, D. M., Spear, C., & McKenzie, J. F. (2018). Principles and

foundations of health promotion and education. Retrieved from

https://nu.vitalsource.com/#/books/9780134552002/cfi/6/18!/4/2/2/2/4@0:0

Gordon, M. (2019). How doctors can stop stigmatizing kids and start helping kids with obesity.

Retrieved from https://www.npr.org/sections/health-shots/2019/06/05/728812078/how-

doctors-can-stop-stigmatizing-and-start-helping-kids-with-obesity

National Center for Education Statistics. (2019). Fast facts: Back to school statistics. Retrieved

from https://nces.ed.gov/fastfacts/display.asp?id=372g

Penney, T., Almiron-Roig, E., Shearer, C., McIsaac, J., & Kirk, S. (2014). Modifying the food

environment for childhood obesity prevention: challenges and opportunities. 73(2), 226–

236. https://doi.org/10.1017/S0029665113003819

U.S. Department of Agriculture. (n.d.). Nutrition.gov. topics. Retrieved from

https://www.nutrition.gov/topics/nutrition-age/children/kids-corner

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015).

2015 – 2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from

https://health.gov/dietaryguidelines/2015/guidelines/.

Rough Draft Ecological Research Paper Instructions

Students will apply the social ecological model to a given health topic in a specific community. Students will address each level of the ecological model and identify how health promotion will be/has been used at each level to address the health topic in their specific community.

INTRODUCTION: The introduction must clearly identify the health topic and community (e.g., cultural

group or population) and provide valid statistical information.

LEVELS OF THE MODEL: In the next section you need to clearly and comprehensively identify and show

that you understand each of the levels in the Ecological Model of Health. In addition, you need to

provide several examples within each of the levels of the model as follows:

Important: Your examples should be based on actual agencies, organizations, policies, laws, programs,

recommendations, guidelines or other activities you found in your sources.

INDIVIDUAL - several specific examples of ways to increase knowledge, attitudes and behaviors regarding the health behavior. INTERPERSONAL - several specific examples on how social networks and support can influence the issue or health behavior change (e.g. family, friends, health workers, support groups, etc). ORGANIZATIONAL - several specific examples of how organizational systems and policies can influence the issue or health behavior change (e.g. worksite wellness programs, state/local health departments, health insurance plans, medi-care/medi-caid, etc). COMMUNITY - several specific examples of how community efforts can influence the issue or health behavior change (e.g. faith based institutions, local media, community based organizations, research institutions, community health collaborative/coalitions). POLICY/SOCIETAL - several specific examples of how policy efforts can influence the issue or health behavior change (e.g. Healthy People 2020, ACA, laws, federal wide programs, NIH, CDC) SUMMARY: Summarize how the various levels of the model can affect change.

FORMAT: Students must cite at least 3 peer reviewed journal articles and include a total of 7-10 references from scholarly sources.

DO NOT INCLUDE AJNY QUOTATIONS LONGER THAN 5 WORDS.

Students must follow APA 6th edition guidelines for in-text citations and references from scholarly sources. All References on the References list must be cited in the text and all in-text citations must be listed on the References list.

Papers should be 5-8 pages in length (not including reference page and title page), 12-font, double spaced, and Times New Roman.

Strive to make each sentence are well -constructed with varied structure and to sound natural and are easy -on-the-ear when read aloud. Check for errors in grammar or spelling or capitalization that distract the reader from the content.

See the sample paper for guidance.

Developing Outline and Annotated Bibliography

The purpose of this assignment is to develop the outline of empirical studies you plan to include in your

final paper. Do not use this information for your own paper. This is a sample on how to structure an

outline.

Paper Outline. The outline should be at least 1 page, single spaced, using standard outline

numbering/lettering, and should break down the major issues (i.e., Health issue, community, 5 levels of

ecological model) you plan to cover in your final signature assignment. For example, an outline for

developing an educational program on breast cancer screening (see section IV. b of the outline) might

look like this:

I. Introduction.

A. High incidence of breast cancer among Vietnamese women (Deepen & Cockburn, 2010; ACS,

2013).

B. Importance of breast cancer screening for early detection (ACS, 2013; ASCO, 2009).

C. Lower rates of mammography among Vietnamese (Tanjasiri, 2007; Kagawa-Somger & Pourat,

2009).

II. Individual psychological factors associated with Asian breast cancer screening.

A. Fear and other cultural beliefs about breast cancer (McPhee, 2008; Kagawa-Singer, 2003).

B. Cultural modesty and lack of breast cancer screening (Kagawa-Singer, 2003; Tanjasiri, 2007).

C. Summary: Asian women tend not to discuss screening with anyone.

III. Interpersonal factors-Importance of social support for Asian women.

A. Role of social support in coping with cancer (Ashing-Giwa, 2012; Pasick, 2008).

B. Importance of medical providers promoting screening to women (McPhee & Nguyen, 2009;

Tran, 2009).

C. Role of community health educators to promote screening among women and providers

(Nguyen, 2009; Kagawa-Singer, 2008).

D. Summary: Social support from family and friends is promising to promote screening among

Asian women.

IV. Organizational

A. Health insurance coverage on mammograms (Yi, 2010; McPhee, 2006).

B. State/local health departments to support breast cancer screening (CDC, 2007).

V. Community

A. Community based organizations to support breast cancer screenings (CDC, 2008).

B. Comprehensive cancer control coaliation on breast cancer screening (NIH, 2013).

VI. Policy/Societal

A. Healthy People 2020 goals on national breast cancer screenings

B. Affordable Care Act policies

VII. Summary

A. Paragraph summarizing gaps regarding lack of efforts to increase women’s social support

around screening.

B. The purpose of this project is to develop and pilot test an educational program to increase

social support among friends to promote screening among Vietnamese women in Orange County.

Annotated Bibliography (OPTIONAL). Write a brief summary of each empirical study you plan to

include in your final paper. Each entry should start with a full reference to the study in APA style

followed by a 100-150 word description and evaluation of the articles. Do not merely copy the abstract –

you should highlight only the things relevant to your topic.

Specific Instructions

1. Typed, single spaced, one inch margins on all sides, 12 point font (preferably Times New Roman).

2. Use APA style for citations and reference page.

Running head: Childhood Obesity 1

Childhood Obesity and the Socio-Ecological Model

National University

Childhood Obesity 2

Childhood Obesity and the Socio-Ecological Model

Throughout the United States, there continues to be a major issue with the increasing

number of individuals that suffer from obesity. Unfortunately, this major health issue is not

limited to the adult population, children are also being plagued with this serious medical issue.

According to the Center for Disease Control and Prevention (2019), obesity affects 1 in 5

children and adolescents in the United States. That is a staggering 13.7 million children and

adolescents in the United States alone. Obesity affects all age groups of children and adolescents,

but there is a higher prevalence among 12 to 19-year olds. Similar to its cause in adults, obesity

in children is caused by both behavioral and genetic factors (CDC, 2019). One way to combat

such a major health issue is to address the problem from all levels of influence using the socio-

ecological model. The socio-ecological model is an approach that demonstrates that there are

separate as well as interconnected factors that can influence an individual’s health behaviors,

meaning that an individual can be influences by their own action, the actions of their family,

community, organization and even society (Cottrell et al., 2018). The socio-ecological model can

help to understand how each level of influence “intersects to shape” the choices that a person

makes about their food and physical activity. (U.S. Department of Health and Human Services

and U.S. Department of Agriculture, 2015). This essay will demonstrate how the application of

various levels of the socio-ecological model affects childhood obesity and will show how

changes at each level can address the prevention of childhood obesity.

Intrapersonal Level

The first socio-ecological level is the intrapersonal level. This level focuses on and

identifies an individual’s “knowledge, attitudes, and behaviors” in regards to actions that they

may or may not engage in to prevent or address childhood obesity (Callahan, 2014). Some of the

Childhood Obesity 3

influences in the intrapersonal level can include knowledge or skills, motivations or personal

traits. However, it is arguable whether or not a child or adolescent’s personal skills or knowledge

is enough to prevent childhood obesity because children are dependent on adults to provide them

with recommended healthy choices. According to authors Penney et al. (2014), the choices that

children make about the types of food that they may consume depends on the options given to

them while at home, school, or at daycare (para. 1). Some important interventions at the

intrapersonal level would have to focus on teaching children about what they should do to be

healthy. This can include teaching children in school what a healthy meal consists of and the

importance of physical activity. The website Nutrition.gov provides activity sheets, videos,

songs, games, and activities to teach youth about nutrition in a variety of settings, such as

choosing a new food at the grocery, tasting and rating it like a food critic (U.S. Department of

Agriculture, n.d.).

Interpersonal Level

The next level of the socio-ecological approach is the interpersonal level. This level

focuses on a group of people that have some form of relationship with an individual. For

children this would be their friends and relatives (Cottrell et al., 2018). Physicians can also play

a role at this level. Individuals around the child hold the greatest amount of influence (Callahan,

2014). The influence that parents or guardians have on a child’s eating habit and the amount of

physical activity the child or adolescent receives is the most vital in the prevention of obesity.

According to the 2015-2020 Dietary Guidelines, parents need to be actively involved in the

providing healthy options for their children and this can decrease the overall prevalence of

childhood obesity (U.S. Department of Health and Human Services and U.S. Department of

Agriculture, 2015). There is a need for programs that teach parents how to properly feed their

Childhood Obesity 4

children, how to organize their time to be able to make healthy meals, how to find healthy foods

that fit within their budget and how to reinforce good behavior with things other than food.

Schools can host discussions and provide suggestions to parents on how to cook dinner, shop for

healthy foods, read labels and pack lunches with their children, as well as do fun family outings

like pick fruit or go on hikes (CDC, 2012). Physicians should also play an active role in helping

parents with children that are suffering from obesity by having a non-judgmental attitude and

using terms that do not stigmatize weight (Gordon, 2019). They can also suggest limiting TV and

video time to 2 hours a day and to promote unstructured play at home (Committee on Nutrition,

2003). After-school programs can also influence diet and physical activity by using tools such as

the Healthier Out-Of-School Time Assessment to guide these programs in how to include

healthy foods and physical activity (Alliance for a Healthier Generation, 2010).

Organizational Level

The next level of the socio-ecological approach is the organizational level. This level

includes the “rules, regulations, policies … informal structures” that increase or decrease healthy

behaviors (Cottrell et al., 2018). At this level, the focus can be on schools or daycare settings for

children. These types of institutions have a continuous amount of contact with children for a

majority of their young lives. In the United States alone, 56.6 million children are enrolled in

school (National Center for Education Statistics, 2019a). As the place where children are

learning and socializing with their peers, schools have been identified as ideal for teaching

children how to maintain healthy active lifestyles (CDC, 2018). For example, schools “can adopt

policies and practices” to promote eating more fruits and vegetables, to consume less sugary

drinks and to increase physical activity (CDC, 2019a). These policies can be cost effective and

have a great impact on the reduction of childhood obesity. Schools can make sure to provide

Childhood Obesity 5

plentiful drinking water, use non-food rewards for celebrations and events, limit or eliminate

vending machines, and have staff model healthy behaviors (CDC 2019b). Schools can also

involve parents in planning school health activities and invite them to participate in physical

activities such as walkathons (CDC, 2012). Medical practices can also provide programs with

teams of professionals such as dieticians, psychologists and health educators. One example is

the IDEAL Clinic at Children’s National Hospital (Improving Diet, Energy and Activity for Life

(Gordon, 2019). Doctors can measure BMI yearly in their young patients to identify excessive

weight gain and encourage breastfeeding by parents (Committee on Nutrition, 2003).

Community Level

The next level is the community level. The community level is defined as the network of

social norms that exist within a community (Cottrell et al., 2018). Implementation and creation

of local policies or ordinances can support beneficial health behaviors. Childhood obesity can be

a significant issue when the environment is not conducive to having healthy food options

available and locations for children to be physically active. How the community is designed can

determine the health behaviors of its children and parents (Callahan 2014). If a community lacks

adequate recreation space for walking or physical activity and has several fast food restaurants

within the community then it is more likely to have an increased obesity rate. The environment

that a child lives in can have a direct impact on physical activity. Some interventions that can be

put into place are making parks more accessible for children by locating them close to a child’s

home, increasing the walkability and safety of the neighborhood and organizing neighborhood

walking groups. Community members can push for making healthy foods more available by

getting local stores to stock fresh produce. Community health workers can reach out to families

Childhood Obesity 6

to teach them about healthy nutrition and hospitals or non-profits can conduct community health

screenings and fairs.

Public Policy Level

The final level to discuss is the public policy level. At the public policy level there are

local, state, or federal policies or laws that “regulate or support healthy actions” to address the

childhood obesity epidemic (Cottrell et al., 2018). There are currently policies in place that that

focus on dietary requirements for schools. National food campaigns, mandated school wellness

policies as well as wellness regulations are all some of the ways to promote healthy eating

behavior to combat childhood obesity. Other policy and legislative solutions can include

agricultural subsidies, regulating exposure to obesogenic chemicals in foods and food packaging,

and banning super-sized sodas. There is a need for more policies to support healthier lifestyles

choices for children to have proper nutrition and enough opportunity for regular physical activity

(Committee on Nutrition, 2003).

In conclusion, childhood obesity is a preventable public health issue. The best way to

overcome this issue is through the utilization of the socio-ecological approach. Changes need to

be implemented at each of the levels, focusing heavily on the upper levels like the

organizational, community and public policy level. Unfortunately, at the individual level children

are not in control of making necessary changes to the lifestyle without the help of their

caregivers at the interpersonal level. In the end, changes need to be made at every level for there

to be a reduction of childhood obesity.

Childhood Obesity 7

References

Alliance for a Healthier Generation. (2020). Out of school time. Retrieved from

https://www.healthiergeneration.org/take-action/out-of-school-time

Callahan, K. (2014). Assessing the Social and Ecological Factors that Influence Childhood

Overweight and Obesity. Retrieved from

https://dc.etsu.edu/cgi/viewcontent.cgi?article=3812&context=etd

Centers for Disease Control and Prevention. (2012). Parent Engagement: Strategies for Involving

Parents in School Health. Retrieved from

https://www.cdc.gov/healthyschools/parentengagement/pdf/parent_engagement_strategie

s.pdf

Center for Disease Control and Prevention (2018). CDC healthy schools: School health

guidelines. Retrieved from https://www.cdc.gov/healthyschools/npao/strategies.htm

Centers for Disease Control and Prevention (2019a). Childhood obesity facts. Retrieved from

https://www.cdc.gov/healthyschools/obesity/facts.htm

Centers for Disease Control and Prevention (2019b). Comprehensive framework for addressing

school nutrition environment and services. Retrieved from

https://www.cdc.gov/healthyschools/nutrition/pdf/School_Nutrition_Framework_508tagg

ed.pdf

Committee on Nutrition. (2003). Prevention of pediatric overweight and obesity. American

Academy of Pediatrics. 112, 424-430. Retrieved from

https://pediatrics.aappublications.org/content/pediatrics/112/2/424.full.pdf

Childhood Obesity 8

Cottrell, R. R., Girvan, J. T., Seabert, D. M., Spear, C., & McKenzie, J. F. (2018). Principles and

foundations of health promotion and education. Retrieved from

https://nu.vitalsource.com/#/books/9780134552002/cfi/6/18!/4/2/2/2/4@0:0

Gordon, M. (2019). How doctors can stop stigmatizing kids and start helping kids with obesity.

Retrieved from https://www.npr.org/sections/health-shots/2019/06/05/728812078/how-

doctors-can-stop-stigmatizing-and-start-helping-kids-with-obesity

National Center for Education Statistics. (2019). Fast facts: Back to school statistics. Retrieved

from https://nces.ed.gov/fastfacts/display.asp?id=372g

Penney, T., Almiron-Roig, E., Shearer, C., McIsaac, J., & Kirk, S. (2014). Modifying the food

environment for childhood obesity prevention: challenges and opportunities. 73(2), 226–

236. https://doi.org/10.1017/S0029665113003819

U.S. Department of Agriculture. (n.d.). Nutrition.gov. topics. Retrieved from

https://www.nutrition.gov/topics/nutrition-age/children/kids-corner

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015).

2015 – 2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from

https://health.gov/dietaryguidelines/2015/guidelines/.