Vegetarian, Vegan, and Alternative Diets:

A Class for WIC Parents and Their Children

Lindsey Patterson & Chelsea Small OHSU Dietetic Interns

Project Goal
The goal of this project is to promote good health through nutrition education for WIC participants following vegetarian, vegan or other restrictive diet patterns

Objectives
WIC Clients who attend the group appointment will
1.! 2.! Verbally participate in discussion at least once Be able to list at least 3 nutrients that may be insufficient if following a vegetarian or vegan diet, and dietary or supplemental sources of each nutrient Intend to add or increase at least one food or supplement to their and/or their childrens diet to reduce the likelihood of inadequate intake of that target nutrient

3.!

Summary of the Literature

! Nutrition education for WIC participants increases recognition of nutrition messages and significantly increases consumption of more healthful foods ! Learner-centered education for WIC participants increases the value and relevance participants place on adopting healthy food choices ! Breastfed infants, young children and pregnant women following vegetarian and vegan diets are more likely to have poor growth and develop B12 deficiency

Summary of the Literature

ADA Position Paper
! Vegetarian or vegan diets can be healthful and nutritionally adequate for all stages of the lifecycle if well-planned ! Recommended iron and zinc intake for vegetarians is higher than for non-vegetarians ! These diets may have lower intakes of B12, Ca, Vitamin D, zinc, iron and n-3 fatty acids ! Nutrient needs are easier to meet by consuming fortified foods or supplements

Significance
! Vegetarian/vegan diets involve restrictions that can make it difficult to meet the needs of Ca, Zinc, Iron, B12, n-3 fatty acids and Vitamin D when poorly planned ! Restrictive diets are more likely to cause malnutrition in children and pregnant women than in average adults due to their greater nutrient requirements ! It is extremely important for both pregnant and breastfeeding women and children to meet their nutrient needs to ensure proper growth and development

Significance Continued
! Vegetarian/vegan food alternatives only recently offered at WIC ! WIC education on vegetarian/vegan diets is lacking ! Almost all WIC clients in Ashland, OR follow vegan, vegetarian or other restrictive diet patterns ! Project aims to fill this gap for WIC participants The AND suggests that health professionals provide information about meeting requirements for the following nutrients because poorly planned vegetarian/vegan diets may sometimes fall short of: !! Vitamin B12 !! Calcium !! Vitamin D !! Zinc !! Iron !! N-3 fatty acids

Target Population
! Pregnant, breastfeeding and postpartum women up to 6 weeks if not breastfeeding and up to 1 year if breastfeeding ! Infants and children up to 5 y/o who meet WIC income eligibility and residency requirements and who have been found to have a nutrition risk ! The audience will be these WIC participants that follow or are interested in vegetarian, vegan or other restrictive diet patterns ! This class will be held in Ashland, OR during a distance clinic

Implementation Details for 45 minute Group Education Activity, March 11th 2014 at 10:45am
Introduction

Thank participants for attending & introductions. Describe what we will be discussing and welcome participation. Ask participants questions to start class, guide topics and encourage participation Reaffirm their choice in following their chosen diet and benefits of vegetarian diets and go into providing information using PowerPoint presentation and handouts Summarize key points and take-away message. -Ask open-ended questions -Offer practical solutions and advice -Group share for evaluation (final 5-10 minutes) Thank participants and offer respective handouts to take home

Question Stage Information Stage

Summary Stage

Close

Theory/Model
! Designed around Participant Centered Education, (PCE) model widely used by WIC ! PCE was chosen due to its success in individual and group education activities at WIC ! Places the client at the center of the education process ! Focus is on participants strengths and abilities instead of problems and negatives ! The educators role is to listen, offer useful information and encourage change that leads to a healthy lifestyle ! Relevant techniques

Evaluation
Objectives measured through open dialogue throughout and at the end of class during group share. Evaluation questions: "! Which nutrients do you think are especially important for vegetarians and vegans to include in their diets? "! Which nutrients stand out to you as most important? Can you name a food/fortified food or supplement source of these nutrients? "! Do you plan to use the information you have learned at home? If so, can you share what you plan to do at home?

Facilities, Personnel Required & Budget!

Rogue Valley Unitarian Universalist Fellowship space, utilities and chairs to host class during once monthly clinic hours; estimated rental space for half day:! OHSU dietetic interns or 1 WIC employee trained in nutrition education and motivational interviewing for 2 hours labor! Projector, 1 day rental ! Handouts: Visuals, Learning aids, recipes, food safety info OHSU dietetic Interns design labor (powerpoint and handout design) ! Portable computer, 1 day rental ! Total Estimated Cost:! Actual Cost to WIC: !

Estimated Cost! $100*!

$100*!

$99*! $30! $0! $50*! $394! $30!

Questions?

References
Ritchie LD, Whaley SE, Spector P, et al. Favorable Impact of Nutrition Education on California WIC Families. J Nutr Educ Behav. 2010;42(3):2-10 Gerstein DE, Martin AC, Crocker N, et al. Using Learner-centered Education to Improve Fruit and Vegetable Intake in California WIC Participants. J Nutr Educ Behav. 2010;42(4):216224. Di Genova T, Guyda H. Infants and children consuming atypical diets: Vegetarianism and macrobiotics. Paediatr Child Heal. 2007;12(3):185 188. Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009;109(7):12661282. Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, et al. How prevalent is vitamin B12 deficiency among vegetarians? Nutr Rev. 2013;71(2):110 117. California WICs Participant Centered Education (PCE): Overview. 2013. Available at: http://www.cdph.ca.gov/programs/wicworks/Pages/ ParticipantCenteredEducation.aspx.