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Community 0utieach Pioject

N0TN S1u, Fall 2u1S
Linusey Patteison & Chelsea Small

!"#$%& vegetaiian, vegan anu Alteinative Biets: a Class foi WIC Paients anu theii Chiluien
'()$& To piomote goou health thiough nutiition euucation foi WIC paiticipants following vegetaiian,
vegan oi othei iestiictive uiet patteins.
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1. veibally paiticipate in uiscussion at least once
2. Be able to list at least S nutiients that may be insufficient if following a vegetaiian oi vegan uiet,
anu uietaiy oi supplemental souices of each nutiient
S. Intenu to auu oi inciease at least one foou oi supplement to they anuoi theii chiluien's uiet to
ieuuce the likelihoou of inauequate intake of that nutiient of focus foi vegans anu vegetaiians
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This stuuy focuseu on the effectiveness of euucation given to S,uuu WIC paiticipants to eat moie anu
gieatei vaiiety of fiuits anu vegetables, whole giains anu switch to low-fat milk. Paiticipants weie
ianuomly sampleu anu cioss-sectional suiveys given befoie anu aftei nutiition euucation. The stuuy founu
that aftei nutiition euucation, women anu caiegiveis iepoiteu incieaseu iecognition of nutiition messages,
positive movement in stage of change foi taiget foou items, anu significantly incieaseu family consumption
of fiuits anu whole giains anu ieplacement of whole milk with low-fat milk. Stuuy concluueu that
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cooiuinateu nutiition euucation in WIC can significantly influence consumption of moie healthful foou
choices.
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This stuuy useu a leainei-centeieu class (focus gioup) to impiove fiuit anu vegetable consumption in 6u
Califoinian WIC motheis with young chiluien. The most significant uiffeience between the inteivention
anu compaiison gioups' iepoits was that inteivention paiticipants iuentifieu moie value, impoitance, anu
ielevance of the fiuit anu vegetable infoimation anu auopting new fiuit anu vegetable piactices aftei
attenuing the class. Califoinia WIC uemonstiateu that messages ueliveieu thiough this piocess can be
ietaineu anu integiateu into family life piactices.
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This stuuy summaiizeu the potential pioblems with atypical uiets, which aie moie likely to cause pioblems
of malnutiition in chiluien than in auults uue to theii gieatei nutiient iequiiements ielative to bouy
weight. The giowth of a chilu is a sensitive inuicatoi of the potential negative effects of iestiictive uiets.
Pioblems founu incluueu; vegan anu vegetaiian chiluien youngei than two yeais of age exhibiting
significantly lowei mean weight anu length velocities anu oveiall lightei in weight anu smallei in statuie
than iefeience populations, vitamin B12 ueficiency in chiluien on vegan anu maciobiotic uiets without
supplementation, majoi skin anu muscle wasting in Su% of maciobiotic infants anu seven infants
exclusively bieastfeu by vegan motheis ueveloping vitamin B12 ueficiency. The stuuy also ievieweu past
cases of vegan paients accuseu of chilu abuse aftei theii chiluien weie founu to be seveiely malnouiisheu,
which in one case iesulteu in the ueath of an infant.
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vegetaiian oi vegan uiets can be healthful anu nutiitionally auequate foi all stages of the lifecycle if well-
planneu. Supplements oi foitifieu foous can pioviue useful amounts of neeueu nutiients. vegetaiians tenu
to have lowei LBL, iates of hypeitension anu cancei, iisk of heait uisease, inciuence of type 2 uiabetes, anu
lowei BNI scoies. Bowevei, such uiets may have lowei intakes of B12, Ca, vitamin B, zinc anu omega S
fatty acius. Piotein neeus may be highei in vegetaiian anu specifically vegan uiets uue to ieliance on pooily
uigesteu piotein souices. The iecommenueu iion intake foi vegetaiians is 1.8x highei than foi non-
vegetaiians anu zinc iequiiements of vegetaiians may exceeu the RBA. vegetaiians have not met uietaiy
stanuaius foi B12, zinc, folate anu iion in at least one countiy. It is essential that vegans iegulaily utilize
vitamin B12 supplements oi foitifieu foous to meet neeus. Rates of bone fiactuie among vegans is Su%
highei than non-vegans uue to low Ca consumption. Low vitamin B status has also been iepoiteu in vegan
gioups who uo not consume vitamin B foitifieu foous oi supplements. Neeus aie easiei to meet by
consuming calcium anu vitamin B foitifieu foous oi supplements. Stuuies suggest vegan chiluien aie
slightly smallei but within noimal ianges, howevei, chiluien on veiy iestiictive uiets have pooi giowth.
Extiemely iestiictive uiets such as fiuitaiian oi iaw foou uiets aie not iecommenueu foi chiluien. The
Acauemy suggests that health piofessionals pioviue infoimation about meeting iequiiements foi vitamin
B12, calcium, vitamin B, zinc, iion, anu n-S fatty acius because pooily planneu vegetaiian uiets may
sometimes fall shoit of these nutiients.
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The goal of this ieview was to assess B12 ueficiency in people auheiing to vaiious types of vegetaiian uiets.
Among the most significant finuings in this ieview is that vegetaiians uevelop vitamin B12 ueficiency
iegaiuless of uemogiaphic chaiacteiistics, age, oi type of vegetaiian uiet consumeu. Baseu on this stuuy it
is cleai that it is not only vegans who aie at iisk foi B12 ueficiency. This ieview also founu that the
ueficiency iate among infants anu chiluien is at least equal to that of auults. Auuitionally, highei iates of
ueficiency weie founu in chiluien who followeu a vegan uiet fiom biith compaieu to those who auopteu
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the uiet latei in life. While in theoiy it is possible foi vegetaiians to get enough B12 thiough uaiiy, eggs, anu
foitifieu foous, this ieview suggests that vegetaiians anu especially vegans woulu benefit fiom taking
supplemental vitamin B12 in oiuei to pievent oi ieveise ueficiency.
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Cieating a class specifically uesigneu foi WIC paiticipants following a vegetaiian oi vegan uiet is an
extiemely impoitant way of insuiing optimal nutiition in a vulneiable anu at iisk population. While
vegetaiian anu vegan uiets can pioviue piopei nutiition when implementeu coiiectly, these uiets involve
iestiictions that can make it uifficult to meet the neeus of ceitain nutiients incluuing Calcium, Zinc, Iion,
B12, 0mega S fatty acius anu vitamin B when pooily planneu. Because WIC paiticipants aie eithei giowing
chiluien oi piegnant oi bieastfeeuing women, they aie a population even moie susceptible to insufficient
nutiient intake. Piegnant women have incieaseu nutiient neeus anu because chiluien aie still giowing, it is
ciucial that they meet all of theii nutiient neeus.

Euucating WIC paiticipants on how they can meet theii nutiient neeus given theii uiet iestiictions will
positively impact theii health anu giowth. This class will focus on using paiticipant centeieu euucation as a
way to hone focus, neeu anu inciease unueistanuing as well as positively impact behavioi change. By using
this appioach, WIC paiticipants will be moie likely to paiticipate anu will feel that theii input anu
paiticipation in the uiscussion is valueu. The goal of this class is to cieate a non-juugmental, open,
collaboiative enviionment in which paiticipants feel empoweieu to make euucateu uiet changes that will
inciease the health anu wellbeing of theii families.

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0ntil iecently WIC uiu not offei vegetaiian anu vegan foou alteinatives, such as tofu anu soy milk. Tiaining
foi WIC ceitifieis on pioviuing appiopiiate nutiition euucation foi vegetaiian anu vegan uiets is lacking, if
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not often altogethei absent. Banuouts anu classes on vegan anu vegetaiian nutiition aie also not available.
Accoiuing to WIC counselois anu Canuy Butlei, the Registeieu Bietetian who attenus WIC clinics in
Ashlanu, 0iegon, almost all WIC clients in Ashlanu follow vegan, vegetaiian oi othei iestiictive uiet
patteins. This pioject hopes to help fill this gap foi WIC paiticipants anu theii chiluien.
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The taiget auuience is women who aie cuiiently piegnant, postpaitum women up to 6 weeks if not
bieastfeeuing anu up to one yeai if bieastfeeuing anu infants anu chiluien up to the chilu's S
th
biithuay who
meet WIC income eligibility anu iesiuency iequiiements anu who have been founu to have a "nutiition
iisk." The auuience will be these WIC paiticipants that follow oi aie inteiesteu in vegetaiian, vegan oi
othei iestiictive uiet patteins. The income of the taiget auuience will be between 1uu peicent of the
Feueial poveity guiuelines but not moie than 18S peicent of the Feueial poveity income guiuelines issueu
yeaily by the Bepaitment of Bealth anu Buman Seivices. A poition of the auuience is likely to paiticipate in
SNAP benefits, Neuicaiu oi Tempoiaiy Assistance foi Neeuy Families. "Nutiition iisk," of the taiget
auuience is establisheu by a health piofessional such as a physician oi a WIC employee thiough height,
weight, hemoglobin levels anu uiet analysis. A "nutiition iisk," can be any meuical oi uietaiy baseu
conuition on 0iegon's list of WIC nutiition iisk ciiteiia. The auuience may have "nutiition iisks," such as
anemia, unueiweight, pooi uiet, histoiy oi pooi piegnancy outcomes anu many otheis. Bue to a laigei
piopoition of the population of Ashlanu, 0iegon, following vegetaiian anu othei iestiictive uiet patteins
anu the lack of a WIC clinic in the immeuiate aiea, this pioject is taigeteu to the above uesciibeu auuience
living in Ashlanu, 0iegon. Attenuance anu paiticipation in this 4S minute activity is optional thiough WIC.




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24#9(7:-#"(4 Thank paiticipants foi attenuing & intiouuce ouiselves. Besciibe what we will
be uiscussing anu welcome paiticipation. Example: "We'll be focusing on
impoitant nutiients to incluue in vegetaiian anu vegan uiets; Calcium, Zinc,
Iion, B12, 0mega S fatty acius anu vitamin B."

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Questions to ask to stait class, guiue topics anu encouiage paiticipation:
! Woulu any of you be willing to shaie if you follow a vegan oi vegetaiian
uiet anu why.
! Any othei uiet plans.
! Bo you have any conceins about youi own oi youi chilu's uiet.
! What have you heaiu about vegetaiian anu vegan uiets.
! What aie the most common ueficiencies in vegetaiianvegan uiets.

24@(9<)#"(4 Q#)8% Reaffiim theii choice in following theii chosen uiet anu benefits of vegetaiian
uiets anu go into pioviuing infoimation. Piesent PoweiPoint on calcium,
vitamin B, Zinc, B12, iion anu omega S fatty acius thioughout the lifecycle in
vegetaiian anu vegan uiets anu theii iespective foou
souicessupplementsfoitifieu foous, one at a time.
! Pass aiounu "coloieu nutiient-foou hanuouts" anu encouiage questions
as they come up
! Banu-outs will incluue many foou souices of nutiients as well as
specific WIC foou souices of all 6 chosen nutiients
Q:<<)9I Q#)8% Summaiize key points anu take-away message.
! Questions to ask:
" Boes anyone have any questions about foitifieu foous oi
supplements.
" What aie some piactical ways you coulu incluue these nutiients in
youi uiet (offei iueas)
" Ask final evaluations questions of paiticipants (use "going aiounu
the ciicle" to take tuins to shaie anu ieview infoimation) foi final S-
1u minutes
3$(/% Thank paiticipants, answei any questions they may have anu offei iespective
hanuouts to take home
Bietetic Inteins will only facilitate this class once on Naich 11
th
2u14; howevei, }ackson County WIC will have access
to the euucation mateiials anu will leau the class foi 2 futuie sessions in 2u14 anu peihaps cycle the class in theii
iegulai scheuule foi upcoming yeais.
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The mouel which this pioject is uesigneu aiounu is the "Paiticipant Centeieu Euucation," (PCE) mouel
wiuely useu by WIC. This mouel was chosen uue to its success in inuiviuual anu gioup euucation activities
at WIC.
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PCE places the client at the centei of the euucation piocess. Insteau of focusing on pioblems anu
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negatives, the focus is on the paiticipant's stiengths anu abilities. A paiticipant is able to ueciue theii own
goals, inteiests anu motivation to change.
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The euucatoi's iole is to listen, offei useful infoimation anu
encouiage change that leaus to a healthy lifestyle. The ielevant piinciples of PCE incluue; collaboiation,
engagement, iespect, ambivalence, autonomy, voice, anu piioiitizing neeus. Some of the ielevant
techniques useu in PCE incluue; change talk, paii shaie, piesentation anu facilitation, motivation,
exploieoffeiexploie, affiimation anu ieflect anu summaiize.
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The objectives of this pioject will be measuieu thiough open uialogue with paiticipants thioughout anu at
the enu of the class. We will take note of active paiticipation anu answeis to evaluation questions uuiing
class, anu will also iepeat these questions at the enu of the class foi final evaluation using a gioup shaiing
methou wheie we go aiounu the ioom anu have paiticipants shaie answeis:
" Which nutiients uo you think aie especially impoitant foi vegetaiians anu vegans to incluue in
theii uiets.
" Which nutiients stanu out to you as most impoitant. Can you name a fooufoitifieu foou oi
supplement souices of these nutiients.
" Bo you plan to use the infoimation you have leaineu at home. If so, can you shaie what you plan to
uo at home.
" Bo you have any comments oi anything you founu paiticulaily suipiising.
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Rogue valley 0nitaiian 0niveisalist Fellowship: This oiganization allows Neufoiu WIC to
host a clinic uay once a month foi WIC clients in anu aiounu Ashlanu to ieceive voucheis anu
nutiition anu health euucation. This 4S minute class will use this facility, its utilities anu
chaiis to host the class uuiing the once monthly clinic houis.
Rental
space foi
half uay:
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0ne oi two 0BS0 uietetic inteins oi 1 WIC employee tiaineu in nutiition euucation anu
motivational inteiviewing foi 2 houis laboi
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Piojectoi, 1 uay iental !&&$
Banuouts:
6 full-page nutiient, leaining aius in coloi, in 6 plastic sleeves
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2u copies of 1S page hanuouts foi each of the 6 nutiients uiscusseu
2u copies of 1S page hanuout on specific foou-safety anu iestiictive uiet infoimation
2u pencils oi maikeis
6- V page example iecipes, 2u copies each
0BS0 Bietetic Inteins 2u1S uesign laboi (poweipoint anu hanuout uesign) !#
Poitable computei, 1 uay iental !(#$
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*These items aie pioviueu by WIC, 0BS0 uietetic inteins, oi aie on a volunteei-basis anu not contiibuting
to the actual cost





































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1. Ritchie LB, Whaley SE, Spectoi P, et al. Favoiable Impact of Nutiition Euucation on Califoinia WIC
Families. ) *+,- ./+0 12345. 2u1u;42(S):2-1u
2. ueistein BE, Naitin AC, Ciockei N, et al. 0sing Leainei-centeieu Euucation to Impiove Fiuit anu
vegetable Intake in Califoinia WIC Paiticipants. ) *+,- ./+0 12345. 2u1u;42(4):216-224.
S. Bi uenova T, uuyua B. Infants anu chiluien consuming atypical uiets: vegetaiianism anu maciobiotics.
642/74,- 8379/ :249. 2uu7;12(S):18S-188.
4. Position of the Ameiican Bietetic Association: vegetaiian Biets. ) ;< =72, ;>>?0. 2uu9;1u9(7):1266-
1282.
S. Pawlak R, Paiiott S}, Raj S, Cullum-Bugan B, et al. Bow pievalent is vitamin B12 ueficiency among
vegetaiians. *+,- @25. 2u1S;71(2):11u-117.
6. Califoinia WIC+s Paiticipant Centeieu Euucation (PCE): 0veiview. 2u1S. Available at:
http:www.cuph.ca.govpiogiamswicwoiksPagesPaiticipantCenteieuEuucation.aspx.