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Dishing Up a Helping Hand: Common Threads Expands Into Texas
By Hadley Turner

Any RD who's worked with lower-income populations has witnessed the cycle of poverty that can deprive generation after generation not just of financial security but also of good nutrition and health. That said, many also have seen the difference that basic nutrition and cooking education can make on health outcomes and quality of life, regardless of income level.

Founded in Chicago in 2003, Common Threads boosts health and wellness among children, families, and communities of poorer socioeconomic status by providing cooking and nutrition education for disease prevention. Its school-based Small Bites program, which has been implemented in schools in low-income areas throughout the country, teaches pre-K to eighth-grade students healthful, knife-free cooking and nutrition while incorporating math, language arts, and science per state Common Core standards.

This past September, Common Threads received a $1 million grant through the USDA Food and Nutrition Service's Supplemental Nutrition Assistance Program Education (SNAP-Ed) to expand Small Bites to Texas' six largest counties: Bexar (San Antonio), Dallas, El Paso, Harris (Houston), Tarrant (Fort Worth), and Travis (Austin).

Texas: State of the State
As in the rest of the United States, obesity rates in Texas are at a historic high. Based on 2016 numbers, the state ranks eighth in the nation for adult obesity at 33.7% of the population.1 The figures for childhood overweight and obesity aren't better; one-third of Texan adolescents have overweight or obesity,1 compared with the national rate of 20.6%.2

As RDs know, poverty and food insecurity compound overweight and obesity, and Texans are no stranger to these factors. The state has the sixth-highest childhood food insecurity rate at 23.8% (compared with 17.9% nationwide), and four of the 14 counties in the United States with more than 100,000 food-insecure children are located in Texas.3

Help Where It's Needed Most
The counties in which Common Threads has expanded its education program include school districts with exceptionally high rates of students qualifying for free or reduced-cost lunches—77%, on average, throughout the counties.

Del Valle Independent School District (ISD), one of the schools implementing the Small Bites program, is located in unincorporated Travis County, Texas, which includes parts of the city of Austin. Approximately 87% of Del Valle students qualify for free or reduced-cost lunch, the highest proportion of all the Texas districts in Common Threads' Small Bites rollout, and 82% of the students are considered economically disadvantaged.

The district helps students' food security through free breakfast in the classroom, after-school snack and dinner programs through the Child and Adult Food Care Program, and the Seamless Summer Feeding Program for summer meals. However, these benefits don't address cyclical problems in families and communities such as lack of nutrition education, cooking skills, and understanding of how healthful meals can fit when time and money are limited.

Kelly Crook, PhD, superintendent of Del Valle ISD, says that, in spite of Del Valle including a portion of southeast Austin, Del Valle students can't reap the benefits of city nutrition education and cooking programs or funds, as it's mostly in an unincorporated part of Travis County. Part of Crook's job is to coordinate with programs that can help improve health and wellness throughout the district. Traditionally, though, this has been a challenge due to Del Valle's size and scope. The 174-square mile district stretches from urban east Austin to suburban and highly rural areas southeast of the city. "It's difficult for some of our smaller, more regional programs to be able to meet the needs of such a varied district," Crook says.

But Common Threads is changing the game. According to Crook, it's "the first organization Del Valle's worked with that's really been able to do a broad-scale program that's longer term at multiple campuses. … It really is campus specific." 

Serving Up Knowledge
The Small Bites program comprises hour-long sessions that incorporate Common Core education standards into nutrition and cooking lessons. Linda Novick O'Keefe, CEO of Common Threads, says that the organizations' program coordinators work onsite with school administrators to ensure teachers are trained to lead the lessons and schools are successfully implementing the program. "Curriculum fidelity … is really important to us," she says.

In one example lesson, children learn how to read nutrition labels and what a healthful eating pattern looks like; armed with those elements, they can more easily make healthful food choices. How the information is presented varies based on the children's age. For instance, a third-grade lesson plan introduces the nutrition label and ingredient list and tells children in a broad sense what to look for. A pre-K lesson includes coloring and drawing foods as well as songs about healthful foods and making healthful choices based on the "Whoa, Slow, Go" method.

For a sixth-grader, on the other hand, the lesson goes into more detail, advising children on how to measure their portions accurately and synthesize what they know about a healthful diet to independently make healthful choices. This lesson also has students track their food intake and strategize to meet food group goals.

"We're teaching these kids the skills and knowledge to make healthful choices," Novick O'Keefe says. "We're empowering them and really trying to help them see the importance of getting back to the table and making the family meal a real priority."

Cooking skills are the other major component of Small Bites classes. Common Threads offers a myriad of recipes not just for its classes but also for the public, with full nutrient profiles. Novick O'Keefe says professional chefs and RDs have been involved in recipe development since Common Threads was founded. A team of RDs reviews every recipe and ensures it adheres to USDA nutrition standards for SNAP and WIC, such as including abundant whole grains, making one-half of their plates fruits and vegetables, and choosing lean proteins and low-fat or fat-free dairy products. Instructors choose the recipes, which include dishes such as a Baked Kale Frittata, Banana "Ice Cream," and a Chickpea Mushroom Pita. "All of our recipes are under $10, feed a family of four, and take 20 to 30 minutes to make," Novick O'Keefe says.

According to Crook, one popular aspect of the program in the Del Valle ISD has been substitution recipes, which have achieved the quickest and biggest buy-in of all program elements. "A really popular one for us is an ice cream sundae that becomes a watermelon sundae made with fresh coconut, lime, watermelon, and then some caramel sauce or chocolate chips," she says. Crook also has seen success with "things like chip substitutes—pretzels, nuts, celery with homemade guacamole. These get kids away from just eating bags of chips."

Health-Promoting Outcomes
As a whole, Common Threads has seen success with the Small Bites program. Impressive, statistically significant postprogram metrics include the following:

• 52% of students consume fruits and vegetables at least once per day (16.3% increase from preprogram);
• 90% of students are confident in their cooking skills (not measured preprogram);
• 79% could answer at least five out of seven nutrition knowledge questions correctly (26.8% increase);
• 54% showed their families how to cook at home (11.3% increase);
• 67% told their families about healthful eating (10.1% increase);
• 51% like vegetables (13.2% increase); and
• 97% had tried three or more vegetables (10.5% increase).

Novick O'Keefe posits that these outcomes are achieved because Common Threads is able to "meet families where they are" in terms of skills, budget, and other resources.

"We try to make it easy for our families by, for example, teaching them to paint their plate with color," she says. Common Threads also offers a free handbook on their website with eight weeks' worth of recipes and information on meal planning for families. The handbook "allows our families to see that cooking healthful, affordable meals is accessible, doable, and fun," she says.

Though the program has only just begun, Crook has seen positive outcomes in the Del Valle ISD as well. As of this writing, 110 students and 508 parents are involved in the Small Bites pilot program in the district. For a pilot program, Crook points out, "These are strong numbers. That shows us that this is something our parents really value."

Ultimately, Small Bites helps kids and families understand that "health isn't necessarily the absence of sickness; it's a lifestyle," Novick O'Keefe says. "It takes constant practice and inspiration.When nutrition education is presented in a hands-on, affirmative and joyful way vs 'don't eat this, don't eat that,' it's fun and it sticks. And that applies to all of us, regardless of socioeconomic status."

— Hadley Turner is an editorial assistant for Today's Dietitian.

References
1. The state of obesity in Texas. The State of Obesity website. https://stateofobesity.org/states/tx/. Accessed April 16, 2018.

2. Centers for Disease Control and Prevention, National Center for Health Statistics. Prevalence of obesity among adults and youth: United States, 2015–2016. https://www.cdc.gov/nchs/data/databriefs/db288.pdf. Published October 2017. Accessed April 16, 2018.

3. Feeding America. Map the Meal Gap 2017: highlights of findings for overall and child food insecurity. http://www.feedingamerica.org/research/map-the-meal-gap/2015/2015-mapthemealgap-exec-summary.pdf. Published 2017. Accessed April 16, 2018.