1. 1
A Review on the Relationship between Obesity, Dietary Habits, and the Many Other Factors
Contributing to this Deadly Epidemic
Jenna Dennis, Caitie Thomas, Ryan Bright, Vivian Arula
Spring 2016
Georgia Southern University

2. 2
Table of Contents
Planning Team Biographies 3
Planning Committee Members 5
Abstract 6
Introduction/Literature Review 7
Needs Assessment 13
Mission, Goals, and Objectives 17
Framework 18
Timeline 20
Logic Model 21
Intervention 22
Budget 25
Methods 29
Results 32
Discussion 35
References 39
Appendix 46

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Planning Team Biographies
Jenna Dennis
My name is Jenna Dennis and I am from Vidalia, Georgia. I am a senior at Georgia
Southern University about to graduate with my Bachelor’s Degree in Public Health Education
and Promotion. After graduation in May, I have obtained an internship through the International
Rescue Committee with their Resource Development Program.
Vivian Aralu
My name is Vivian Aralu and I am from Nigeria but have lived in Atlanta Georgia for six
years. I am a senior at Georgia Southern University and will be graduating in the fall will my
Bachelor’s Degree in Health Education and Promotion from the college of Public Health.

4. 4
Caitie Thomas
My name is Caitie Thomas and I am from Macon, Georgia. I am currently a senior at
Georgia Southern University and I will be graduating in the fall with my Bachelor’s Degree in
Public Health.
Ryan Bright
My name is Ryan Bright and I am from Riverdale, Georgia. I am a senior at Georgia
Southern University and will be graduating in the fall of 2016 with my Bachelor’s Degree in
Public Health and a minor in Nutrition.

5. 5
Planning Committee Members
This planning committee will consist of students of Georgia Southern University’s
College of Public Health. Members from this group hold a specific role towards the
implementation of the program at the Hearts and Hands Clinic of Bulloch County. Each member
will help contribute equally to assure the success of the program, each providing different insight
on health dietary habits and ideas of how to avoid obesity, specifically within the realm of the
Statesboro community. The members include:
Urkovia Andrew, Hearts and Hands Clinic, Executive Director
Caitie Thomas, Program Planner, student at Georgia Southern University, (Health Education and
Promotion)
Jenna Dennis, Program Planner, student at Georgia Southern University, (Health Education and
Promotion)
Vivian Aralu, Program Planner, student at Georgia Southern University, (Health Education and
Promotion)
Ryan Bright, Program Planner, student at Georgia Southern University, (Health Education and
Promotion)
Ms. Urkovia Andrew is the Executive Director of The Hearts and Hands clinic of Bulloch
County. Being the Executive Director for over a year at this facility, she understands our target
population and will help guide the program to meet our overall mission, goals, and objectives.
She will also assist in executing our marketing plan to help reach a majority of the patients that
attend the Hearts and Hands Clinic. Ms. Andrews will also help monitor the program to ensure
that the program is being carried out effectively. Caitie Thomas, Jenna Dennis, Vivian Aralu, and
Ryan Bright will act as Program Planners and will actively implement the program to the
program participants which will include, patients at the Hearts and Hands Clinic, and to members
of the Statesboro/Bulloch County community who may also attend the program. The Program
Planners will utilize Health Education Strategies such as print materials including flyers, to
ensure that there is an equal opportunity for individuals to attend the program, as well as utilize
PowerPoint lectures along with the two activities outlined in the Centers for Disease Control and
Prevention Road to Health Toolkit, including “Community Kitchen” and “Portion Distortion”, to
ensure program participants receive the information they need to incorporate healthy dietary
practices into their daily life. Each member is significant and it is vital that they carry out their
roles effectively to ensure the success of the program.

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A Dietary Habits Intervention Program for Middle Aged Adults: Eat Healthy, Be Healthy
Jenna Dennis, Ryan Bright, Caitie Thomas, Vivian Arula
Georgia Southern University
Abstract
Background: Adult obesity is becoming an increasing concern in the United States.
Obesity can be linked to other health conditions like heart disease, type 2 diabetes, stroke and
many more. The two main risk factors for adult obesity include dietary habits and lack of
physical activity. Objective: The purpose of this study was to evaluate the effectiveness and
feasibility of an intervention held at a low poverty dental organization aimed to educate middle-
aged adults on healthy dietary habits with emphasis on understanding how to read food labels
correctly and learning correct portion sizes. Methods: Through voluntary-based participation,
the participants attended the intervention at the Hearts and Hands Clinic (n=4). This intervention
was a one group pretest/posttest design. Program intervention consisted of two 20 minutes
portions: reading food labels and understanding portion sizes. Through a researcher developed
pretest and posttest, participants were tested to measure knowledge. Results: The intervention
displayed no statistical significance. The overall outcome of the study displayed an increase in
the mean score of the pretest and posttest from (5.250) to (10.500) with an overall increase of
5.25. Conclusion: This study overall confirmed early insinuations for increasing knowledge in
middle aged adults of healthy dietary habits through education.

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A REVIEW ON THE RELATIONSHIP BETWEEN OBESITY, DIETARY HABITS, AND
THE MANY OTHER FACTORS CONTRIBUTING TO THIS DEADLY EPIDEMIC
Obesity is a major public health problem in the United States affecting a very large
portion of the population. Obesity is the result of an imbalance between how much energy one
intakes and how much energy one puts out which leads to the buildup of excess fat (Skolnik &
Ryan, 2014). In order to determine if individuals are overweight or obese a tool recognized as
(BMI) or Body Mass Index, is used to estimate and determine the amount of fat in the bodies of
adults and children (Overweight and Obesity Statistics). Obesity is based on the BMI greater
than 30.0 kg/m2 of an adult’s total body fat (Skolnik & Ryan, 2014). More than one third of the
population in the United States is obese. Obesity itself is brought on by many different factors
and from that can cause other types of diseases such as diabetes, heart disease, some cancers, and
high blood pressure. Not only can obesity cause minor problems to a person’s well-being, but it
can cause severe and deadly complications. Many people are not properly educated in the
different factors that affect your chances of getting to the state of obesity. The epidemic of
obesity draws major concern due to the risk factors associated with this condition as well as other
health issues and chronic illnesses including heart disease, stroke, diabetes, and some types of
cancers, which are all diseases associated with individuals that are overweight and obese, and are
recognized for being some of the leading causes of death in the United States
(permanent.access.gpo.gov).
A report from the Harvard School of Public Health indicated that as at 1990, about 15%
of the United States population were obese. As of 2010, the number has risen to 25% (The
Nutrition Source, 2015). According to the Journal of Intellectual Disability Research over the
past several years the obesity rate has increased from 15% to 35% over the past 20 years (Hsieh,
Rimmer, & Heller, 2014). The Centers for Disease Control and Prevention Vital Signs monthly

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report recognizes obesity as common, serious, and costly (VitalSigns). In the United Stated
States more than 12 million adults are obese and persons who are obese have medical costs that
are $1,429 higher than those of normal weight, and no state in America is recognized for having
an obesity rate less than 15%, which is the national goal (VitalSigns). The United States has
spent about $147 billion just in 2008 as medical cost of obesity (CDC, 2015).
Obesity is not exclusively eating excessive amounts of food, there are many other factors
that play a part in an adult resulting in obesity. Food insecurity is defined as limited access to the
correct, healthy amount of food. (Nguyen, Shuval, Bertmann & Yaroch, 2015) With food
insecurity, comes an increased amount of stress levels and decreased amount of one's overall
wellbeing (Nguyen, Shuval, Bertmann & Yaroch, 2015). Food insecurity is a major stressor on
adults which can cause them to have many other health problems.
The greatest age population that obesity affects is middle aged adults. Middle aged adults
suffer from tremendous amounts of stress which can lead to a lack of physical activity and a
decreased amount in the adequate amount of food they are supposed to intake. Many adults do
not have enough time during the day to plan out their meals. As middle aged adults move into
the next stages of their life, it is a critical time period for the progression of the risk of obesity
(Xiang & An, 2014). Midlife is the most common period in which obesity peaks in an
individual's lifetime. Middle adulthood is also a time in which one's immunity begins to decline
which leads to excess weight gain, poor exercise, and poor dietary habits (Xiang & An, 2014).
Individuals in their middle ages need to be more aware of the risks that obesity can lead to.
Middle age adults need to be knowledgeable about outcomes because of their vulnerability.
There are many variables that factor into a person’s dietary habit causing their unhealthy
lifestyle. A person’s option of food is generally based on their location. Some Americans have

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less access to stores and markets that provide healthy and affordable foods such as fruits and
vegetables, especially in rural, minority and lower income neighborhoods where the foods being
easiest to access are foods high in sugar, fat, and salt; also restaurants, snack shops and vending
machines provide food that is often higher in calories and fat than food made at home
(VitalSigns). Those who live in rural areas are more likely to be obese because of how accessible
fast food restaurants are in the area. Rural areas face two distinct, but nevertheless related
phenomenon: high obesity rates coupled with obesity disparities between racial and ethnic
groups. As stated in research by Richard Dunn, understanding how to reduce obesity, and thus
the cost of obesity-related morbidity, is a topic of great interest for policy makers. The quick
increase of the obesity rate in the United States corresponds with the outburst in the number of
fast-food establishments. Also, Dunn made it known that “the cost and availability of fast-food
are both actionable policy levers; lawmakers can restrict access through zoning decisions,
impose taxes on the sale of fast-food items, require nutritional information be made available to
consumers, and prohibit the use of particular ingredients” (Dunn, 2012). This would increase
awareness in areas that are restricted to fast-food institutions and help create a healthier lifestyle.
Many changes can be attributed to a healthier lifestyle to avoid excessive weight gain and
possible health concerns. Alteration in dietary habits can be adjusted with knowledge of what to
eat, how much too considerably eat and what not to. Possible price taxes on high-calorie foods,
placements of more local grocery stores and farmers markets, and education on dietary habits
can lead to healthy weight reduction plummeting the risks of major health issues.
As a result of with obesity, many adults experience negative mental health effects that
can lead to certain mental disorders. It has been linked in a study that fat mass and obesity is
associated with a certain gene that relates obesity to impaired cognitions (Xiang & An, 2014).

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With all the different effects that obesity has on the body such as stress, and the factors brought
on by it, also not to mention the different chronic diseases, it clearly begins to affect the way
adults think about themselves. Obesity and depression have been proven to be linked to one
another and differ by sex, race and ethnicity (Xiang & An, 2014) Functional impairment can put
a strain on an individual's daily regular activities and reduce one’s overall quality of life. As a
result of these impairments, obesity can increase the morbidity and mortality rate (An & Shi,
2015).
The relationship between the occurrence of obesity and an individual being diabetic has
been studied extensively with an emphasis on the effects of physical activity. The interaction
between physical activity and obesity and how they influence the onset of type 2 diabetes was
studied by Qin et al in 2010. From this study, they observed that obesity was a stronger
independent risk factor than physical activity for type 2 diabetes (Qin et al., 2010). Environment
plays a role in obesity for middle aged adult; snacking or unhealthy eating, physical activity,
access to gyms, time and many more. Adults who spend an excessive amount of time in the
workplace are more likely to indulge in snacking as a result of stress induced overeating habit,
skipping meals, occupational sitting time and less time for physical activity (Park et al., 2014).
It is unarguable to state that the occurrence of diabetes related to obesity can be reduced
in the United States if the sufferers of these health conditions participate or increase their
participation in physical activities. For substantial health benefits, adults should do at least 150
minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic
physical activity, or an equivalent combination of moderate and vigorous intensity aerobic
activity.

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Another major factor about the obesity epidemic is its prevalence in minority
populations. A review conducted by the Department of Biostatistics and Epidemiology at the
University of Pennsylvania Perelman School of Medicine, stated, the growing interest in obesity
in minority populations reflects an awareness of the high prevalence of obesity among black,
Hispanic, Asian and Pacific Islander and Native Americans as well as a generally increased
interest in minority health (Kumanyika, 2012). What is also identified is the fact that some
aspects of obesity among minorities differ from those in white populations, which suggests that
new insights may be gained from studying obesity in diverse populations. In the United States
minority populations are identified into four major subgroups including: African Americans,
Hispanic Americans, Asian-Pacific Islander Americans, and American Indians and Alaskan
Natives (US Department of Health and Human Services). In the United States, minority or “non-
white” status predicts certain negative health outcomes with a conspicuous degree of certainty
(Kumanyika, 2012). Describing health disparities according to minority group categories has
been very useful in epidemiological research. However, scholarly considerations of racial and
ethnic differences must acknowledge the uncertainties inherent in minority group classifications
and guard against the numerous pitfalls associated with their use (Kumanyika, 2012). The
dependency on these racial and ethnic classifications has become increasingly problematic for
health researchers, particularly as the diversity among minority populations increases
(Kumanyika, 2012).
There are many variables that factor into a person’s dietary habit causing their unhealthy
lifestyle. A person’s options of food is generally based on their location. Other factors that
contribute to an adults dietary habits have been identified by six key determinants: biological,

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economic, physical, social, psychological, attitude, beliefs, and knowledge about food (Yasmeen,
Jamshaid, Khan, Salmon, & Ullah, 2015).
With the prevalence of obesity rising in the United States, there is a more generated
extensive investigation into the many different consequences of obesity and the many diseases
associated with it (Skolnik & Ryan, 2014). Over the past several years, the prevalence of adult
obesity has more than doubled with the morbid obesity rate quadrupling (An & Shi, 2015).
Currently, the most readily available treatments for weight loss are are reducing food intake
while controlling appetite to produce better results for a reduced weight (Skolnik & Ryan, 2014).
Population-based strategies that improve an adult's social and physical environmental situations
for healthful eating and physical activity are available in forms such as clinical preventative
strategies and treatment programs for those who are already obese. (Flegal, Carroll, Ogden, &
Curtin, 2010). More preventative interventions about the link between the built environment and
the food environment may lead to health benefits for the adult population. (Flegal, Carroll,
Ogden, & Curtin, 2010). Intensifying efforts need to be made to provide health education on
obesity in order to lead to improved health and a decrease in the prevalence of obesity among
adults (Flegal, Carroll, Ogden, & Curtin, 2010). More programs need to be done to find better
and effective ways of curbing the incidence of obesity among middle aged adult in the United
States.

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Needs Assessment
Health Status
Obesity in the United States is a public health concern and a social problem because the rise in
the obesity prevalence rate has been stunning over the past three decade (Morales, 2013). The
health risks associated with obesity make reducing the high prevalence of obesity a public health
priority. Previous publications have shown both racial and ethnic disparities in obesity
prevalence and no change in the prevalence of obesity among adults since 2003–2004. Compared
to 2008, more than one-third (age-adjusted 34.9%, crude 35.1%) of U.S. adults were obese in
2011–2012. Overall, the prevalence of obesity among middle-aged adults aged 40–59 was higher
than among younger adults aged 20–39 or older adults aged 60 and over. Middle age adult men
had 39.4% prevalence of obesity while middle age adult women had 39.5% prevalence of
obesity. More than 78 million adults were obese in 2011–2012. The majority of these obese
adults (more than 50 million) were non-Hispanic white. (CDC, 2013).
According to Georgia Department of Community Health, Obesity is also one of the
health issues in the state of Georgia. The prevalence of obesity has increased rapidly in Georgia.
The rise in obesity has had a severe health and economic impact on Georgia with a huge cost of
$2.4 billion every year. Reports states that 28% (1.9 million) of civilian adult, non-
institutionalized Georgians are obese. The percentage of the obese adults in Georgia does not
meet the Healthy People 2010 national goal (15%) regardless of age, sex, race, ethnicity, income
or education. Only 1 in 2 (48%) adults in Georgia are regularly active. Only 1 in 4 (25%) adults
in Georgia consume 5 or more servings of fruits and vegetables daily. Across all racial groups,
men (51%) are more regularly active than women (45%). All these factors are some of the things
that have an impact in the increased rate of obesity in Georgia.

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According to Georgia Department of Community Health, in overall, 29% of adult Georgians
were obese in 2007. However, the prevalence of obesity varies across the counties, ranging from
23.3% to 35.6%. Bulloch county rating for obesity is 29.2% and 24.2 to 34.9 confidence interval.
Community Description
Bulloch County of Southeast Georgia is up-coming and prospering to become a larger
community. The estimated population is roughly 72,087 according to the census of 2010 and is
made up of four cities; Statesboro, Register, Portal, and Brooklet. The different races that make
up Bulloch county are as given: White 67.0%, African American 29.1%, Hispanic 3.7%, Asians
1.7%, and other 0.5% as of July 1, 2014 (Quick Facts 2015). People who are 18 years of age and
under make up 20.4% of Bulloch County and those who that are 65 years old and accommodate
for 10.4% of the area. The median household income as of 2013 is $35,840 and 30.6% are living
under the poverty level. The local university of Bulloch County is Georgia Southern University,
with 20,517 students a of the 2014-2015 academic year, adding on to the total population and is
continuing to grow (Georgia Southern, 2015).
Preliminary Qualitative Data
On September 25, 2015, a formal meeting, and interview, with the Executive Director of
The Hearts & Hands Clinic, Ms. Urkovia Andrews, was conducted. When discussing and
assessing the needs of the population to formulate an effective program that will tailor the needs
of the Clinic, it was important to have an accurate depiction of the population of patients that
receive services from the Hearts & Hands clinic. Ms. Andrews stated, that we would be “dealing
with obese and diabetic patients that could benefit from programs incorporating healthy eating
habits and physical activity” (Andrews, U. 2015, September 25). What was also important was to
understand the dynamic and background of these individuals to have a degree of cultural

15. 15
competence and sensitivity when dealing with this population and Ms. Andrews stated that, “all
of our patients are 200% below the poverty line and this clinic is their only access to receiving
health services” (Andrews, U. 2015, September 25). The proposed program to Ms. Andrews was
adopted from the Centers for Disease Control and Prevention Road to Health Toolkit and
Activities Guide, known as Activity 4: Community Kitchen. This program activity was
formulated to teach the healthier side of cooking, how to read labels, and how to make dishes
lighter without giving up flavor as well as teach participants how to recognize healthier food
choices (ndep.nih.gov). This program is complementary to the services already provided by the
Clinic as it promotes health education and assist in accomplishing the purpose of the Clinic
which is to “serve the community by providing support for individuals as they seek ways to
better themselves”(The Hearts & Hands Clinic).
Community Link
According to Georgia Demographics, Bulloch County is recognized as the 32nd most
populated county in the state of Georgia out of 159 registered counties (Bulloch County
Demographics). What has to be recognized, since Bulloch County is one of the largest counties
in the state, is the fact that health disparities do exist. This is why programs that help and give
assistance to these individuals living in poverty is vital for this community. The Georgia
Volunteer Health Program, or (GVHCP), of the Department of Public Health, is recognized for
providing protection to licensed health care professionals who volunteer to treat uninsured
individuals at or below 200 percent of the federal poverty level (GVHCP). The Georgia
Volunteer Health Care Program is also recognized for partnering with free clinics and service
providers across the state of Georgia in order to ensure that health care services are made
available and are more accessible to low-income Georgia resident (Hearts and Hands Clinic).

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One of these free clinics can be found in Bulloch County, and is known as The Hearts & Hands
Clinic, which is Statesboro’s only free health care clinic for the medically uninsured (The Hearts
& Hands Clinic). The Hearts & Hands Clinic offers services for its patients at no cost, these
services include medical, dental, and vision care (Agency Information). The increase in
volunteer medical staff has resulted in about 80 healthcare providers volunteering their time in
support of the clinic, and the increase in array of services is due to a now full time executive
director administering this facility (Agency Information). The clinic also continuously offers
and conducts free educational programs to the public, as well as the patients at the Hearts &
Hands Clinic, topics covering issues related to diabetes, heart healthy living, and managing
chronic illness (Agency Information).

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MissionStatement
The mission statement for this program is to provide information on healthy dietary
habits to the adults of the Hearts and Hands Clinic to promote healthy eating habits.
Goals
1. To increase education on healthy dietary habits for adults at the Hearts and Hands Clinic
2. Provide strategies to increase knowledge on healthy portion sizes for a healthy diet
among adults at the Hearts and Hands Clinic
Objectives
1. By the end of our program, more than 80% of the participants at the Hearts and Hands
Clinic will be able to read food labels with an 80% accuracy.
2. By the end of our program, more than 50% of the participants at the Hearts and Hands
Clinic will be able identify accurate portion sizes within food groups with an 80%
accuracy.

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Framework
Other important concepts incorporated in the Social Cognitive Theory include behavioral
capability and self-efficacy. Behavioral capability is defined as the knowledge and skill to
perform a given behavior; or promoted mastery learning through skills training (Social Cognitive
Theory). Through the implementation of our program we intend to increase the behavioral
capability of our participants by using two of the activities outlined in the Centers for Disease
Control and Prevention Road to Health Toolkit, including “Community Kitchen” and “Portion
Distortion”. The participants will be able to display their level of understanding through these
activities which will promote self-efficacy and an overall change in behavior. Self-efficacy is
defined as an individual’s confidence in performing a particular behavior; or to approach
behavior change in small steps to ensure success (Social Cognitive Theory). Having the
participants gain a sense of self-efficacy will be vital to their overall change in their behavior.
Using the constructs collectively that are outlined in the Social Cognitive Theory will positively
affect behavioral change in our participants at the Hearts and Hands Clinic.

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(“Bandura’s Triadic Reciprocal Determinism model”, 1989)

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Timeline
February 3, 2016
Meeting with Community Partner
Discussion of Program
March 7, 2016
Program Implementation
Pretest Given
March 7, 2016
Program End date
Posttest Given

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Logic Model
Inputs
Money for
incentives
Time
Road to Health
Toolkit
Activities
Community
Kitchen
Food Detective
1
Outputs
Program
Implmentation
with
Participants
Powerpoint
Presentation
with Activities
Outcomes
1. Increasein
being ableto
read food labels
2. Increasein
understanding
accurate
portion sizes
Impact
Increased
education on
Dietary Habits

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Intervention Strategies
The intervention that will be implemented for this program will involve both Health
Communication and Health Education strategies. The outlined steps will be used to promote
healthy dietary habits for the adults at the Hearts and Hands Clinic. The primary audience will
include the adults at the Hearts and Hands Clinic and the secondary audience will be the adults
of the community of Bulloch County. Presenters will develop a program to provide middle age
adults with knowledge and specific tools that will promote healthy dietary habits.
Health Communication Strategies
- the health communication strategy will be successful to inform our
participants how to improve their dietary habits
- the health communication tools that our implementators will use include:
- Food Detective I: to compare portion sizes and how they’ve
changed and the negative impact of them
- Community Kitchen: to teach participants how to read food labels
and how to recognize healthier food choices
- Printouts and Pens: for participants to interact and answer
questions from the activities and to complete pre and post tests
- This seminar will be successful in promoting healthy dietary eating habits.
It will also help our participants properly read food labels and make
healthier eating choices and improve their eating habits and portion sizes.
It will communicate to participant’s information about how portion sizes
have changed over the years by using the Portion Distortion activity. By
using the Community Kitchen Activity, we will be able to communicate to
participants the proper way to read food labels and how to recognize the
differences between healthy and unhealthy food choices.
- These elements will focus on an intrapersonal approach because it is in the
individual's best interest to understand how to properly read food labels
and correctly make portion sizes that are healthiest for them. Individuals
will have to want to change themselves for the better.
In order to grab the attention of our target audience of middle age adults, we will be using flyers
and posters that will be posted around the downtown area of Bulloch County. They will also be
left in the lobby of the Hearts and Hands Clinic. We will list in these promotional tools facts on
how dietary habits can have a direct correlation with obesity. We will offer snacks, drinks, and
hand out prizes such as lotions, travel size toiletries, and other simple things for everyday use, as
an incentive to increase our program participation.

23. 23
Health Education Strategies
- the health education tools that we will be using are:
- Flyers: to get people to attend our seminar in our to gain
knowledge on how to improve everyday eating habits
- PowerPoint Lecture: to grab the attention of participants while
presenting our Portion Distortion activity, which will compare
foods and help explain the adequate portions needed.
The different materials used for this program will be used to draw attention from the
audience to get them involved in the activities and eager to learn about healthier dietary
habits. The main goal is to educate and inform individuals on the importance and the
positive impacts of a healthy diet.

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Lesson Plan for Hearts and Hands Clinic
Hearts and Hands Clinic
Statesboro, Georgia
Spring 2016
Materials:
Printed handouts, PowerPoint, pens, arranged chairs, music, snacks
Time: Type Action
8 mins
3mins
15 mins
15 mins
15 mins
3 mins
10 mins
Introductions and
Description
Pretest
Lecture
Activity #1
Activity #2
Post-Test
Discussion
Introduce ourselves to the audience and allow them to introduce
themselves to the group, go over what our program is about, how it
will affect them and the importance of it. Go over the objectives.
Will measure pre-existing knowledge on the topic.
Provide information on healthy dietary habits as discussed in our
literature review and discuss the consequences and benefits
Portion Distortion: go through different types of food and share the
difference in calories, fat, and sugar of each pair.Share
how food portions have changed over time.
Community Kitchen: To teach the healthier side of cooking, how
to read labels, and how to make dishes lighter without giving up
flavor.
Will measure the knowledge after information is provided.
Review what the audience has learned from the both the lecture
and activities regarding the importance of understanding healthy
dietary habit. Participants will be asked if they have any questions
or if they need clarity over what was presented.
Assignment/Extra time activity:
To go home and read at least 1-3 different food labels of anything they have in their food cabinets.
Notes:
*Discussion- Audience members will be able to name one thing that they learned from the Intervention
Program.

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Budget
Place
Hearts and Hands Clinic of Statesboro, Georgia $0
Equipment
Cups 5 @ $2.50/pack $12.50
Juice 5 @2.00 $10.00
Fruit Tray 2 @ $15.00 $30.00
Vegetable Baked snacks 10 @ $1.50 $15.00
Poster/Flyers 50 @0.50 $25.00
Pens 3 pack of 8 @3.99 $11.97
Chairs 15 $0
Projector 1 $0
Computer 1 $0
Printouts of Activities 30 $0
People
Community Partner (Urkovia Andrews) In Kind $0
TOTAL $104.47
Deductions $0
No Deductions $0
GRAND TOTAL $104.47

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Budget Justification
Place
Hearts and Hands Clinic of Statesboro, Georgia
The Hearts and Hands Clinic is a free health care clinic for the medically uninsured and
individuals living 200% at or below the federal poverty line. The program will be held at this
facility and will be open to all citizens of Bulloch County, there will be no cost associated for
attending.
Equipment
Cups
We will be providing refreshments for all of the participants who choose to come to our
program. We will utilize the cups for the juice provided during our program.
Juice
We are offering juice as a beverage option for participants that enter the program. This
offering will act as an incentive for participants to enjoy while listening to the the information
being provided to them.
Fruit Tray
The fruit trays we are providing for our participants will be an incentive for them. It also
enforces the purpose of our program, which is to provide them with healthier and more nutrient
dense food options, part of the purpose of our program.

27. 27
Vegetable Baked Snacks
These will be utilized during the Road to Health Toolkit Activity Community Kitchen.
Individuals will utilize this snack in order to properly read a food label and recognize healthier
options in regards to food intake.
Poster/Flyers
Posters and flyers are needed to promote and advertise the program. Posters and flyers
will be placed in the lobby of the Hearts and Hands Clinic as well as distributed throughout
downtown Statesboro, Georgia. These advertisements will be produced by the Georgia Southern
University Eagle Print Shop.
Pens
Pens are needed for completing the pre and post-tests. The activities may also require the
participants to use this utensil. They can also simply write their names on their cups if they so
choose.
Chairs
The chairs are provided by the Hearts and Hands Clinic and placed in the lobby where the
program will be implemented for the participants to sit in.
Projector
The projector is needed in order to educate the participants using the slideshow that we
have created. Also, enlarged copies of the printouts we have for provided them will also be
displayed to participants in order for them to actively learn from our program.

28. 28
Computer
A single computer is needed in conjunction with the projector in order to show our
presentation of our slideshow and materials that we will use throughout the program. We need a
computer in order to have our information on hand in case anything goes wrong with the
projector.
Printouts of Activities, Pretests and Posttests
In order to engage with our participants we need to have the activities from the Road to
Health Toolkit. We will also need the pretests and posttest in order for us to measure the quality
of our program and to measure how accurate our program was and to discover if it was
successful.
People
Community Partner Mrs. Urkovia Andrews
Mrs. Andrews is our community partner and the Executive Director of the Hearts and
Hands Clinic. She is our main contact in regards to scheduling the days and times of our
program, and when implementing our program at the Hearts and Hands Clinic. She will assist in
helping us setup appropriate times that work well with her schedule and will help facilitate us
contacting patients that use the services at the Hearts and Hands Clinic.

29. 29
Methods
Participants:
Following the Institutional Review Board approval, an estimated sample group of 10-20
local citizens of Statesboro, Georgia will be obtained for this intervention. The research design
for the “Eat Healthy, Be Healthy” study is an experimental study consisting of groups being
tested with a pretest and posttest. Participants of the study are obtained via flyers placed in the
lobby of the Hearts and Hands Clinic of Statesboro, as well as around the downtown area. The
demographics of the participants range from a variety of backgrounds and ages approximately
from 30-50 years of age.
Intervention:
The Eat Healthy, Be Healthy program about proper dietary habits consists of two
PowerPoint lectures and two activities from the Road to Health Toolkit. The first part of the
lecture include information on how to properly interpret food labels such as what amount of each
ingredient is considered to be excessive or lacking. The PowerPoint for this section will involve
actual food labels from people's everyday diet. After this section of the PowerPoint will be
demonstrating the Road to Health Toolkit Activity labeled “Community Kitchen” where as a
group we will do a hands on activity with the actual food labels and help the people one on one
on how to read them.
After the first part of the PowerPoint and the activity that goes along with it, we will
being the second point of the PowerPoint lecture. This part of the lecture will involve
information on how to correctly measure out food portions and how much a male and female
need of each food group. The lecture will include easy tips on how to hands on measure food
without proper measuring materials and how to help them remember the correct portions.

30. 30
Following this part of the lecture we will being our second activity titled “Food Detective 1.” For
this activity we will have actual food from each food group and help the participants of our
program accurately measure out the correct portions needed daily for their gender and for each
food group. This part will help them have hands on experience and practice so they can take
home what they learned.
At the beginning of our lecture after the introductions we will provide them with a pretest
to test their knowledge, and we will provide a posttest at the very end of our program to be able
to measure how much they learned. The Food Detective activity also has a take home handout
for the participants for them to refer back to for adequate portion sizes.
Measurement:
The program is designed to measure knowledge on portion sizes and food label reading.
Measurement will be determined through a researcher designed multiple choice pretest and
posttest. Half of the questions will be used to measure knowledge on portion sizes while the
other half will be used to measure knowledge on reading food labels correctly. The section on
the tests pertaining to portion sizes contains questions on the amount of food needed daily for
men and women. The other section on the test pertaining to food labels will contain questions on
how to calculate and read a food label correctly. Participants who will be given the tests will be
told that it is completely voluntary and will include names in order to be able to measure the
change in knowledge in SPSS from the beginning of the program to the end.
Data Analysis:
Data analysis for the program Eat Healthy, Be Healthy, will be conducted using computer
processing. The IBM SPSS Statistics 23.0 software will be utilized. Using a Quasi-experimental
research design data will be collected from the pre and post-tests. It will be analyzed using

31. 31
detailed coding instructions in the IBM SPSS Statistics 23.0 software. Once the given data has
been processed it will give a description of the result of the program and a measurement of the
knowledge of the participants before and after the program.

32. 32
Results
“Eat Healthy, Be Healthy” had a total of 4 participants (n=4). Table 1 shows the increase
in mean score from the pretest (5.250) to the posttest (10.500) with an increase of 5.25 overall.
However, there was no significant difference between the two tests because the value reads
above the designated p value.
Table 1. Report of overall means of knowledge of portion sizes and comprehension
of reading food labels accurately as determined by T-test.
Variable n x̄ SD df F Significance
Group
Pretest 4 5.250 3.30 6.000 .833 .397
Posttest 4 10.500 4.43 5.546
_________________________________________________________________________________
*p≤0.05

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The significance level is set at a p value that is less than or equal to 0.05. The table shows that
there is a no significance for any of the demographics in this study.
Table 2. Statistical significance of Portion Sizes and comprehension of reading food
labels accurately as determined by ANOVA’s.
Demographics Degrees of
Freedom
Mean Sq. F Significance
Age 3 1.375 0.039 0.988
Gender 1 6.125 0.261 0.628*
Race 1 6.125 0.261 0.628
Group 1 55.125 3.605 0.106
*p ≤ 0.05

34. 34
A descriptive analysis of participant’s responses was reported by frequencies and percentiles.
There are some questions that are highlighted meaning that the majority of the participants
answered the question incorrectly. Refer to Table 3.
Table 3. Descriptive analysis of participant’s responses as reported by frequencies
and percentiles.
Correct Incorrect
n(%) n(%)
1. How many ounces of protein should women have in their daily 2(50%) 2(50%)
2. intake?
3. How many ounces of protein should men have in their daily 1(25%)
1(75%)
4. intake?
5. How many cups of fruit should men consume daily? 3(75%)
1(25%)
6. How many cups of fruit are recommended for women daily? 0(0%) 4(100%)
7. How much dairy is recommended for men and women daily? 3(75%)
1(25%)
8. ___ cups of vegetables are needed daily for women? 1(25%) 3(75%)
9. ___ cups of vegetables are needed daily for men? 1(25%)
3(75%)
10. How many ounces of grains (rice, oatmeal, bread) are 0(0%) 4(100%)
11. needed daily for men?
12. How many ounces of grains (rice, oatmeal, bread) are 1(25%)
3(75%)
13. needed daily for women?
14. How many calories are in this container? 0(0%)
4(100%)
15. How much protein is in this container? 0(0%)
4(100%)
16. How much cholesterol is in this container? 0(0%)
4(100%)
17. How much sodium is in 1 serving 4(100%) 0(0%)
18. How many servings are in this container? 3(75%) 1(25%)
19. How many calories per fat are in 1 serving? 2(50%)
2(25%)

35. 35
Findings and Discussion
In this study, we considered the correlation between middle aged adults below the
poverty level and dietary habits in regards to the escalating epidemic of obesity in the Statesboro,
Georgia. We explored the knowledge middle aged adults in Statesboro, Georgia currently had on
proper dietary habits with emphasis on reading food labels correctly and measuring portion sizes
correctly for their age group and gender. The two objectives for this study are as follows, (1) At
the end of our program, more than 50% of the participants at the Hearts and Hands Clinic were
able to understand accurate portion sizes within food groups with 80% accuracy, (2) At the end
of our program, more than 80% of the participants at the Hearts and Hands Clinic were able to
read food labels with 80% accuracy. There are very few studies on low poverty level adults
examining their knowledge and how it affects their everyday dietary habits and overall how it
reflects the society as a whole. There are articles out there regarding research on low poverty
level adults and their availability to resources in regards to their location, however there are few
in the field of public health that are looking at their knowledge and how it affects their everyday
life and overall understanding of proper dietary habits. This study fills a crucial gap that needs to
be met regarding the availability of educational programs that need to be made to middle aged
adults in low poverty areas. Key findings of the study were that (1) middle aged adults had a low
understanding of how to correctly read a food label, (2) middle aged adults showed a
substantially low understanding of which portion sizes were necessary for men and women for
each food group. These findings are further discussed below.
Increased Accuracy in Understanding Portion Sizes
At the end of our program, more than 50% of the participants at the Hearts and Hands
Clinic were able to understand accurate portion sizes within food groups with 80% accuracy. All

36. 36
of our participants showed improvement between their pre and post-test when compared. This
was not surprising because we used different types of learning styles (written, visuals, and hands
on) during our program. We provided different food from each food group and calculated the
portion sizes for each food group on their own. This result was similar to Parikh, Hamadeh, &
Kuk (2015), study on estimating serving sizes for healthier and unhealthier versions of what their
study suggested that serving sizes may be poorly understood, by overestimating serving sizes for
certain vegetables, fruits, and grains (Parikh, Hamadeh, & Kuk, 2015). Interestingly, during our
program for the pretest we observed some of our participants overestimating portion sizes for
fruit, vegetables, and grains. It is uncertain whether the larger estimated portion sizes of healthier
food are due to conscious action which is associated with the assumed healthful benefits (Parikh,
Hamadeh, & Kuk, 2015). Our result was also similar to that of Zlatevska, Dubelaar, & Holden
(2014), study on Sizing up the effect of portion size on consumption which showed that the
portion-size effect is substantial, although it was smaller than they expected if consumption were
guided by the portion size (Zlatevska, Dubelaar, & Holden, 2014). We had a substantial increase
between our pre and post-test, and according to the participants they felt more comfortable about
their portion sizes and food control. We provided information on healthy dietary habits as
discussed in our literature review and discussed the consequences and benefits of healthy dietary
habits. We provided visual example of different food group which according to the participants
made it easier to them to understand. More program on educating people about portion sizes and
the way it has changed overtime should be put out there and made available to the public.
Accurately calculating portion sizes is important in having a healthy dietary habit, which
in turn can reduce the rate of diseases such as, diabetes, obesity, cardiovascular disease. A lot of
people are unaware of the right way to calculate portion sizes or the right portion needed on a

37. 37
daily base for the different food. There are too little programs on educating the population on the
daily right portion sizes.
Increased Accuracy in Understanding Food Labels
At the end of our program, more than 80% of the participants at the Hearts and Hands
Clinic were able to understand food labels with an 80% accuracy. As with the portion sizes, the
participants were able to show their understanding from the pre-test to the post-test given. These
results were no surprise as well, as to the assumption that providing visual education and lecture
aided their understanding.
These results are a prime example from a study done about the effects of fast food
consumption for those who live in rural areas due to its cost-availability by Richard
Dunn. Because fast food is more readily available and cost effective for families, that is the
majority choice that is chosen for meals instead of going to a grocery store or food market to
purchase healthier items that may not be as “cheap”. If health promotion specialists, or even the
government, could educate a rural population and implement a program providing health facts
and food labels, it could possibly change their perspective. A quote from Dunn’s research, “The
cost and availability of fast-food are both actionable policy levers; lawmakers can restrict access
through zoning decisions, impose taxes on the sale of fast-food items, require nutritional
information be made available to consumers, and prohibit the use of particular ingredients”
(Dunn, 2012). By providing nutritional information (food labels), people may be more cautious
about the ingredients they are essentially putting into their body and will think twice about food
only based on a low cost.
Educating people on how to accurately read a food label could help lower obesity
because from research gathered and from personal observations, many people (mostly middle

38. 38
age adults) consume more than required. Education on what is measurably healthy could reduce
obesity that leads to other illnesses and diseases.
With the food labels, a hands-on lecture was given and a small bag of a healthy snack to
show and educate them on correctly reading and understanding a food label was provided to the
participants. The good nutrients to look for and the ones to avoid were discussed as well as
looking at how many calories are in a serving size and how many servings come in a container.
Limitations and Weaknesses/Hypothesis
The results of the program helped to illustrate that the program was effective in educating
individuals on how to read food labels and recognize healthy portion sizes. The limitations
included the fact that there was a small sample size and that the program was conducted at only
one intervention site, The Hearts and Hands Clinic. There was also the limitation of having only
one opportunity to administer both the pretest and posttest. Despite the fact that the program was
only conducted at this specific site, it has to note that the objectives that were set were met and it
is also conclusive from the results that this program is suitable to be tested further at other
locations to confirm its validity and reliability.
Based upon the results of the program, it can be concluded that this program can be
implemented in further research. After implementing this intervention, a newfound
understanding was grasped in regards to helping program participants increase their knowledge
and understanding of portion sizes and food labels. It is understood that hands on instructions is
necessary in order to ensure comprehension.

39. 39
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Appendix