Download tips for utilizing myPlate with Patients with wounds

nutrition 411
Tips for Utilizing MyPlate with Patients
with Wounds
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USDA Food Guides Past and Present
The USDA food guides were introduced between 1916
and the 1930s, with the publication of Food for Young Children and How to Select Food, which provided direction
on the food groups and household measures, with a focus
on “protective foods”. As the years passed, these guides
were revised to account for new nutrition knowledge and
changing times. Depending on your age, you may recall
some of the various campaigns including: A Guide to Good
Eating (Basic Seven) in the 1940s, Food for Fitness (Basic
Four) from 1956 through the 1970s, the Hassle-Free Daily Food Guide in 1979, the Food Wheel in 1984, the Food
Guide Pyramid in 1992, the MyPyramid Food Guidance
System in 2005, and finally, in 2010, MyPlate.
The Food Guide Pyramid and the MyPyramid system
were criticized for being too complicated and difficult for
people to apply at the grocery store and at the dinner table.
In response, MyPlate was created, and although some experts now criticize it as oversimplified, it is much better than
the pyramids.
watch portion sizes; 2) Increase consumption of fruits and
vegetables, whole grains, and skim or 1% milk; and 3) Decrease consumption of sodium and sugary drinks.
HCPs can print several useful handouts for patient education, including the Let’s Eat for the Health of It brochure,
which highlights the messages above. Another great resource is the 10 Tips Series in which each of 15 topics is
broken into 10 simple tips in an easy-to-read format. The
handouts parallel advice typically given to patients with
wounds by highlighting lean protein sources and foods
rich in vitamin C and vitamin A and by emphasizing limited
consumption of empty calories.
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lthough patients with wounds often benefit from nutrition education, they often do not have the opportunity to meet with a registered dietitian (RD) or nutrition
professional. Other healthcare practitioners (HCPs) must
fill the educational gaps. Fortunately, many credible resources are available online to obtain patient handouts,
sample meal plans, and other tools. One of these sources
is the MyPlate program from the US Department of Agriculture (USDA). Many HCPs are not aware of the MyPlate
program and the variety of resources available for free.
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Nancy Collins, PhD, RD, LD/N, FAPWCA; and Elaine Koontz, RD, LD
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Individualized Dietary Advice for Patients
General advice and broad nutrition principles may be
the basis of nutrition education, but patients often want
specific menus and recipes to help translate the information into meals. To meet that need, a sample 7-day,
2,000-calorie menu with recipes based on the food
groups is available. Patients can log on to www.ChooseMyPlate.gov to receive individualized eating plans
based on their lifestyle and food preferences. At the end
of 2011, the USDA released a tool called the SuperTracker that facilitates personalized recommendations for
what and how much to eat based on physical activity.
Each user can track his or her food intake and physical
activity utilizing a large database of foods and activities.
Additional features such as goal setting, virtual coaching, weight tracking, and journaling are also available.
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MyPlate.gov — a Wealth of Information and Resources
MyPlate was introduced along with the updated 2010
Dietary Guidelines for Americans and was designed as a
symbol to provide a reminder to eat healthfully. The illustration or icon depicts the five food groups (protein,
vegetables, fruit, grains, and dairy) using a place setting
as the background. A website, www.ChooseMyPlate.
gov, was launched at the same time to provide simple,
practical tips and information to help the average American make wise food choices. The selected messages for
consumers are: 1) Balance calories by enjoying food but
Specific Examples Utilizing MyPlate
Case 1: Patrick is a 78-year-old who lives independently
but has had a number of health scares requiring medical
intervention. He developed a Stage II pressure ulcer on his
sacrum during his recent hospitalizations. He experienced
a loss of appetite and has lost 25 lb in the past 2 months.
He is now 5 feet, 8 inches tall and 130 lb with a BMI of
19.8. Finances are a concern for him.
Handouts that would be helpful to Patrick include:
• Eating better on a budget: 10 tips to help you stretch
your food dollars
• Smart shopping for veggies and fruits: 10 tips for affordable vegetables and fruits
Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of RD411.com and Wounds411.com. For the past 20 years, she has served as a
consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Elaine Koontz RD, LD, resides in Ohio and works
as an acute care clinical dietitian and an outpatient wellness dietitian. She also is a staff writer and member of the management team for RD411.com. This
article was not subject to the Ostomy Wound Management peer-review process.
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nutrition 411
cup dairy, and 4 oz protein): 2 small (6 inch) corn
tortillas, 4 oz lean ground beef, 1½ ounces reducedfat cheddar cheese, ½ cup chopped tomato on the
tacos, ½ cup green beans as a side dish, 1 cup of
diced melon
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Tips for Presenting MyPlate to Patients
MyPlate can appear deceptively simple. It is important
that HCPs delve into the details of the recommendations
behind the colorful graphic when presenting it. The handouts and other tips available on www.ChooseMyPlate.gov
are intended to go along with the graphic, which was never intended to be used alone or to provide specific dietary
advice. Things to make sure to review with each patient
include:
1.Your plate does not need to look like the picture at
every meal. MyPlate can be used as a guide for what
to eat in a day and the proportion that a specific
food group should make up of your total intake.
2. Protein is a nutrient, not a food group. It is found
in a variety of foods, such as beef, poultry, fish,
beans, tofu, meat replacement products, and
eggs/egg replacements.
3.Many foods actually bridge two food groups —
eg, milk or yogurt count as a serving of dairy and
also contain protein. Beans count as both protein and vegetables.
4. Fat should be monounsaturated and polyunsaturated; people should strictly limit their intake of saturated fats and trans fats.
5. Half of the grains a person consumes should be
whole grains.
6.Recommended portion sizes need to be described
— the size of the plate matters.
7.It’s important to choose from a wide variety of foods
to ensure that nutrient needs are being met.
8. People 51 years of age and older, African Americans,
and people with hypertension, diabetes, or chronic
kidney disease should consume no more than 1,500
mg of sodium/day. Everyone else should consume
no more than 2,300 mg of sodium each day. One
teaspoon of salt contains 2,300 mg of sodium.
8.Desserts and snack foods have no place on this
plate, which is not realistic for most people. It’s important to talk about making the best choices when
someone wants to indulge.
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• Eating on a Budget – the 3 Ps (Plan, Purchase, Prepare)
• With protein foods, variety is key: 10 tips for choosing
protein
• Add more vegetables to your day: 10 tips to help you
eat more vegetables
• Focus on fruits: 10 tips to help you eat more fruits
• Sample menus at 2,000-calorie level with recipes
Case 2: Veronica is a 42-year-old who lives with her husband and three children. She has diabetes and a history
of poor adherence to her medical regimen. She has developed a diabetic foot ulcer that has not healed in the past
5 months. She is 5 feet, 3 inches tall and 215 lb with a BMI
of 38.1. She is concerned about the health of her children
as well, because two of them are overweight and one has
recently been diagnosed with insulin resistance. At this
time, she is sedentary secondary to the wound, although
she would like to be more active in the future.
Handouts that would be helpful to Veronica include:
• Choose MyPlate: 10 tips to a great plate
• Make half your grains whole: 10 tips to help you eat
whole grains
• Kid-friendly veggies and fruits: 10 tips for making
healthy foods more fun for children
• Be a healthy role model for children: 10 tips for setting good examples
• Cut back on your kid’s sweet treats: 10 tips to decrease added sugars
• Enjoy your food, but eat less: 10 tips to enjoying
your meal
• The 1,800 calorie meal plan created on SuperTracker
using her age, height, weight, and activity level
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A Sample Menu
Veronica should consume approximately 1,800 calories per day. The SuperTracker breaks this down into 6
oz grain, 2½ cups vegetables, 1½ cups fruit, 3 cups dairy,
8 oz protein, and 5 tsp of oil each day. Although these
amounts are general recommendations, the HCP should
determine if her medical conditions necessitate any adjustments, such as additional protein for wound healing
or carbohydrate adjustments for blood glucose fluctuations. The plan also recommends that Veronica limit her
empty calories to <161 a day. A day’s menu:
Breakfast (1 oz grain, 1 cup dairy, 1 oz protein): 1 slice
whole wheat bread, 1 Tbsp peanut butter, 1 cup yogurt
Mid-morning snack (½ cup fruit, ½ cup dairy): 16
seedless grapes, ½ cup skim milk
Lunch (2 oz grain, 1 cup vegetables, ½ cup dairy, 3
oz protein): 1 cup brown rice, 1 cup cooked stir-fry
vegetables, 3 oz grilled chicken strips, ½ cup pudding made with milk
Mid-afternoon Snack (2 oz grain, ½ cup vegetables):
½ cup baby carrots (about six), 3 cups low-fat popcorn
Dinner (2 oz grain, 1 cup vegetables, 1 cup fruit, 1
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Practice Points
Just as there are many different types of wounds, there
are many different types of patients. Some patients eat
almost everything, while others have extensive food likes
and dislikes. For others, financial constraints, depression,
isolation, polypharmacy, cultural habits, and additional
confounding factors interfere with proper nutritional intake. It is up to the provider to determine the level of information and education needed to aid wound healing
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