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Section 9.4 WLM LG Session Outline
G13
Group Session 13
SESSION AT A GLANCE
Key Behavioral Strategies:
Planning ahead
Self-assessment
Identifying barriers
Problem-solving
Participant behavioral objectives:
Before the next group session, the participant will:
1. Keep food records of what they eat and how much they exercise.
2. Make plans to stay on track while dining out.
3. Contact a community resource to help with weight management efforts.
4. Choose lower-sodium foods
Process objectives and session content:
At this session, participants will:
1. Learn how to modify or adjust meals when dining out
2. Discuss strategies for dining out
3. Identify local community resources for weight management support
4. Identify strategies for lowering sodium in foods they regularly eat
Topics/Agenda (2 hours)
Taste-It! ~20 Minutes
Check-in ~30 Minutes
Try It Discussion/Activities ~40 Minutes
Dining out
Where’s the sodium?
Finding community resources for support
Next Steps ~30 Minutes
WELCOME AND AGENDA
1.
2.
3.
Welcome
Collect attendance and weight data
Agree on the agenda for the session
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CHECK IN ~30 MINUTES
Note: Use the “Check-In” purpose document from the leader’s guide to help guide the checkin discussion process.
Topics for this week’s Check-In:
 Handling vacations
 Practicing positive self talk
 Food and mood – observations from keeping records this week
 Successes and challenges
TASTE IT! ~20 MINUTES
Note: Use the Taste It! Guidelines from the Leader’s Guide to plan your Taste It! and guide
the process.
Topic for this week’s Taste It!: TBD by site
TRY IT! DISCUSSION/ACTIVITIES ~40 MINUTES
Note: The following Try It! activities are suggestions only. Choose only appropriate Try It!
activities based on time available and the needs and preferences of your group. Do not feel
compelled to cover all the material.
1. Dining Out
a. Facilitate a brief discussion about eating out. Ask:
o What is your experience dining out?
o What makes eating out challenging when you are trying to eat fewer calories?
o What strategies have you used to make healthier choices when dining out?
b. Summarize the discussion and highlight the key points below.
 Fast foods tend to be very high in calories and sodium.
 Choosing restaurants that provide a wide variety of foods can make ordering
easier, especially when trying to include foods that meet the study guidelines and
your goals.
c. Food record activity:
1. Have participants find any restaurant meals in their completed food record and
total the calories and sodium for the meals.
2. Have a few participants share their findings. What surprised you?
d. Menu activity:
1. Divide participants in 4 groups. Pass out menus from local restaurants and the
“May I Take Your Order?” worksheet.
2. Each group identifies all possible fruit and vegetables available to order (if any).
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3. Each group selects a meal they are likely to order.
4. Groups complete the “May I Take Your Order?” worksheet by discussing ways to
modify or alter the selected item to meet the fruit, vegetable, and dairy servings
goal and reduce the calories, fat and sodium.
5. If time permits: Groups use the Food and Fitness Guide to look up the calories,
fat, and sodium in the original and modified selection.
6. Have participants practice how to make requests when ordering.
7. Debrief: Have each group share the original meal and the changes they made
with the large group. Ideas for changes include:
 Add a tossed salad
 Fruit juice or fat-free milk
 Fruit salad for dessert
 Baked potato, limit the toppings
 Omit or reducing added table salt
 Request a specific preparation method
 Eat half of portion, ask for a take-home box
 Share a meal with a friend or spouse
 Eat a salad with fat-free dressing
 Request added fats and sauces be served on the side
 Ask that breads and chips not be brought to the table
8. (If time permits) Record ideas generated by participants on a flip chart or
overhead.
9. Use the “Guide for Dining Out” and “Sodium Watch When Dining Out” handouts
at any time to further facilitate a group discussion.
2. Sodium discussion
a. Introduce activity by asking participants about their current sodium knowledge:
 What do you know about the sodium content of food?
 Where do we get most of our sodium?
 Do we need sodium? Why?
 How much sodium do we need? What is the WLM guideline?
b. Where’s the Sodium? activity
1. Materials Needed
- Four to six packaged/processed high sodium and four to six low sodium
food items. (see Leader’s Guide Resource “High- and Low-Sodium
Food Items”).
- Salt packets that represent the amount of sodium contained in a typical
serving of each food item selected for 2-a, above [salt (g)=sodium (mg)
x 0.00254].
- One salt packet that illustrates the WLM lifestyle guideline [2400 mg
sodium (a little more than 1 tsp. salt)] and one that represents typical
consumption [4000-6000 mg sodium (2-3 tsp. salt)].
2. Instructions:
a. Show all packaged foods; participants “vote” on the highest sodium food
or “rank” foods in order of sodium content.
b. Participant “match” the packets of salt with each food item.
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c. In pairs, small groups or as a large group have participants review
previous Food and Fitness Diaries and identify approximately four to six
foods that may be high in sodium (At this point, participants have not been
asked to track sodium)
d. If they have not already done so, have participants use the Food and
Fitness Guide or food labels to look up the sodium content of one to two
of the foods they identified as possibly being high in sodium.
e. Facilitate a discussion about the sodium content of foods and strategies for
lowering sodium intake (see Leader’s Guide Resource “Sodium
Discussion”). Ask open-ended questions to draw the information from the
participants rather than simply lecturing.
f. Plan for the Week: Based on the discussion about strategies for lowering
sodium intake have participants identify ways to reduce the sodium
content of one to two foods identified as high in sodium and write this
plan in their Food and Fitness Diary.
g. If time, participants share chosen strategies
3. Finding community resources for support
Behavioral Strategies: This activity helps participants identify community resources for
additional weight management support during Phase 2.
a. Prior to the session, develop a list of local community resources that participants might
use to help their weight management efforts.
b. Introduce topic.
“Your local community can provide important sources of support for your weight
management efforts. Neighborhood community centers, health organizations and fitness
centers are a few examples of resources that are available to you.”
c. Create a list of local community resources with the group.
1. Brainstorm with the group. Ask: What are some community resources you’ve used
to help you make healthy lifestyle changes?
a. YMCA
b. Gyms/fitness centers
c. Community centers
d. Weight Watchers, TOPS, Overeaters Anonymous, etc
e. Church groups
f. Health food stores
g. Etc.
2. Write their responses on a flipchart.
3. Debrief
d. Distribute a Community Resource List (site-specific).
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NEXT STEPS ~30 Minutes
1. Plan for the Week
Participants write a weekly action plan on the inside cover of the diary in at least the
following areas:
-- Strategies for dining out (increasing fruit/vegetable intake, reducing portions, etc)
-- Reducing sodium intake
-- Finding a local place for physical activity
-- Participant choice
2. Tracking (Self-Monitoring) – STANDARD + SODIUM
The recommended tracking for the week is:
a. Write down all the food you eat and drink every day.
b. Calculate the calories from the foods you eat and drink, total, and summarize for at
least three days.
c. Keep track of servings of fruits and vegetables each day.
d. Keep track of the servings of low-fat dairy each day.
e. Keep track of your sodium intake at least three days this week.
f. Write down the minutes of exercise above your normal routine.
3. What to expect next week
- Bring your food records for discussion at next session.
- Bring shoes and comfortable clothes for exercise next week.
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May I Take Your Order?
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Using the menu, select
new foods or modify the
existing items to decrease
calories, fat, and sodium
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Sodium
Ideas for how
to increase
fruits and
vegetables
Fat
Sodium
Fat
Calories
Original Menu
Items
Calories
List all Fruit and Vegetable options available to order:
Section 9.4 WLM LG Session Outline
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Sodium Watch While Dining Out
These cooking words and phrases can indicate that a food is high in sodium.
Seasoned – Usually means salted. While most restaurants use salt, some can leave the salt
off upon request. Seasoned may also mean cooked with a high-sodium meat such as ham or
bacon.
Spicy, Blackened, Cajun – These seasonings are largely made up of salt.
Barbecued – May be grilled and basted with salt-rich sauce or cooked in BBQ sauce.
Breaded, Battered, Southern Style, and Parmesan –Foods that are coated with breading
and batters often contain salt for seasoning. When fried, they add extra calories and fat.
Creole, Cocktail, Tomato (Marinara), Mustard, Alfredo – Most sauces are made ahead
with salt for seasoning, order these “on the side.”
Pickled – Preserved in brine that contains salt and vinegar.
Marinated –Usually soaked in a sodium-rich liquid to tenderize or add flavor. Often the
foods are then grilled.
Smoked –Nitrates and salt may be added during the smoking process.
Oriental Style, Teriyaki – Often contains soy sauce or mono sodium glutamate (MSG).
Soups, Broths, Gravies – Usually made with high-salt soup stock or bouillon.
TIPS FOR ORDERING
Appetizers – Try a vegetable plate or salad, with dip or dressing on the side so that you can
control the amount (and sodium) eaten. Add flavor by dressing salads with flavored vinegar.
Select a fruit cup or shrimp cocktail with a wedge of lemon and the sauce on the side. Avoid
soups and vegetable juices. They can add 500 to 1000 mg of sodium to your meal.
Entrees – Enjoy entrées that are prepared simply such as grilled, baked, broiled, or poached
with sauces or gravies served separately. Avoid marinated entrees and those cooked in a
sauce or gravy.
Side Dishes – Savor the flavor of plain roasted, steamed, or baked vegetables. Southernstyle vegetables are often cooked with salty meat. Avoid salads that are mayonnaise- based.
Some examples are potato salad, cole slaw, macaroni salad and some pasta salads.
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Condiments – Go easy on the condiments. Extras such as ketchup, tartar sauce, mustard,
and relish steak sauce all add extra sodium to your meal.
Breads – Some quick breads contain baking soda and/or baking powder. This makes them
higher in sodium than yeast breads and rolls. Enjoy yeast breads plain or with just a little
spread. Munch on unsalted crackers when selection is limited.
Desserts – Top off a great meal with simple desserts such as fresh fruit, sherbet, sorbet, light
ice cream, or pudding. Enjoy “just a taste” of special desserts such as cakes, pies, and
cobblers by sharing them with several friends or the whole family.
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Guide for Dining Out
Dining out challenges a low-calorie and low-sodium pattern of eating. Super-sized portions,
fried and salted foods, rich sauces, added condiments, and all too few fresh fruits and
vegetables create a nearly impossible environment for success. Good news! With a little
trial and error, planning ahead, and sorting through your favorite menus, you can enjoy
restaurant dining while still meeting your dietary goals.
Tips for Specific Types of Restaurants
Italian restaurants often feature low-fat dishes but be alert to portion size. Pasta dishes are a
good choice provided that the pasta is not stuffed with a heavy cheese or cream sauce (e.g.,
fettuccine alfredo). Look for sauces made with tomatoes and other vegetable. Many Italian
eateries serve a variety of salads with reduced or low-fat salad dressing.
Asian restaurants (including Chinese, Japanese, Thai, and Vietnamese) offer dishes with
steamed vegetables and small portions of meat. Steamed rice, steamed noodle dishes, and
vegetarian dishes make good choices. Substitute steamed rice for fried rice to save calories
and fat. However, many Chinese dishes also are very high in fat and sodium. Limit added
soy sauce to keep sodium levels reasonable. Look for Asian restaurants that advertise lowfat meals. Ask to have your dish prepared with little or no oil, soy sauce or monosodium
glutamate (MSG). Try fresh spring rolls instead of deep-fried egg rolls.
Mexican restaurants may offer lean cuts of meat, vegetarian dishes, and limited use of lard
when requested. Fill up on low calorie options like extra tomato, onion, or lettuce. Season
with fat-free salsa while avoiding the extra cheese, guacamole, and excess chips. Take half
your dinner home or share a meal with a friend to keep portion sizes closer to your goals.
Fast food is can be high in fat, sodium, cholesterol, and calories. Most fast food restaurants
offer salads with low-fat and reduced-fat salad dressings. Many fast-food restaurants now
offer low-fat milk, baked potatoes, lean meat, grilled chicken sandwiches, and whole grain
bread products. Make wise selections and you can eat fast and healthy.
Pizza restaurants can make a low-fat option. Order a low-fat pizza by specifying no oil, a
tomato-based sauce, lots of vegetables and half or no cheese. Most pizza restaurants serve
salads or provide a salad bar. Keep total intake under control by eating plenty of salad (use
dressing lightly or stick to vinegar or lemon juice alone) and then limit yourself to a moderate
serving of pizza (one to two slices).
Deli sandwiches can be very low in fat if made without mayonnaise or cheese. Using fat-free
mayonnaise and low-fat cheese on your sandwich helps reduce the total grams of fat. Extra
vegetables added to the sandwich add flavor and crunch and help eliminate the need for high
fat extras. Choose lean and low-sodium meats (turkey or chicken breast, roast beef). Avoid
ordering tuna or egg-salad; they may contain as much as 20-30 grams of fat per sandwich.
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Tips for Healthy Eating when Dining Out

Ask how dishes are prepared. Choose foods that are steamed, broiled, baked, roasted,
poached, garden fresh, or cooked in their own juices. These phrases indicate low-fat
preparation.

When choosing beverages try tonic water with a twist of lime. It’s sodium free and low
in calories. Fruit juices, low-fat milk, and seltzers are also excellent beverage choices.

Avoid foods prepared with heavy sauces and gravies. Instead, order plain, broiled, or
baked foods.

Feel free to substitutes foods. Order a green salad, or baked potato, in place of French
fries. Order fruit or sherbet instead of ice cream.

Have the butter that comes with bread removed from the table.

For a smaller appetite, order low-fat appetizers instead of a meal, split an entree with a
friend, or get a bag to take half your meal home.

Ask to have your table cleared as soon as you have finished your meal, that way you can
avoid post-meal nibbling.

Have sauces, gravies, margarine, butter, and salad dressings served on the side. Use them
sparingly.

Have salad dressing come on the side, then dip your fork in the dressing before each bite.

At salad bars, limit the amounts of dressing, ham, croutons, pasta salads, potato salads,
and cheese that you select. Opt for lettuce, tomatoes, mushrooms, carrots, green peppers,
onions, and cucumbers. Choose low-calorie or low-fat salad dressing.

To reduce fat calories on sandwiches, omit mayonnaise; add mustard, tomatoes,
mushrooms, lettuce, and/or onions.

Avoid fried chicken or fried fish, hot dogs, sausages, and untrimmed steaks or chops.

The best breakfast choices include hot or cold cereal with low-fat milk, English muffin or
bagel with nonfat cream cheese, toast with preserves, and fresh fruit or juice. Avoid
pancakes or waffles, French toast, fried potatoes, bacon or sausage, and biscuits,
croissants or sweet rolls.
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LEADER’S GUIDE RESOURCE
High- and Low-Sodium Food Items
High Sodium Foods
Serving Size
Amount of Sodium
(mgs)
Frosted Flakes (or other sweetened cereal)
Ritz Crackers (or other butter cracker)
Saltine Crackers, regular
BBQ sauce
Catsup
Mustard, yellow
Bread, white
Seasoned noodle mix
Cottage cheese, 2%
“Reduced sodium” cream of mushroom soup
1 Cup
8 crackers
10 crackers
1 Tbsp.
1 Tbsp.
1 tsp.
1 slice
1 cup, prepared
½ cup
1 cup, prepared
265
240
325
155
180
65
135
935
460
480
Low Sodium Foods
Serving Size
Quick-cooking oatmeal
Frosted Mini-Wheats
or
Raisin Squares
Sunshine Krispy Crackers
Quaker Apple Cinnamon Rice Cakes
Honey Cup Mustard
Hunt’s No Salt Added Catsup
Pepperidge Farm 100% whole wheat bread
Uncle Ben’s Boil-in Bag rice
Alpine Lace Swiss Cheese
Healthy Choice Chicken with Rice Soup
½ cup
1 cup
Amount of Sodium
(mgs)
0
0
5 crackers
1 cake
1 tsp.
1 Tbs.
1 slice
2/3 cup
1 oz.
1 cup
120
0
0
5
120
15
35
320
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LEADER’S GUIDE RESOURCE
Sodium Discussion
Facts about Sodium
Sodium is a naturally occurring mineral with important physiological functions including:
 Regulating extra-cellular fluid
 Maintaining water balance
 Allowing muscle contraction
 Conducting nerve impulses.
 Forming body fluids (e.g., saliva, digestive juices and perspiration)
Sodium needs vary, but usually the body requires only 500 mg of sodium per day for normal
health. The Food and Nutrition Board, National Academy of Sciences, National Research
Council, recommends that daily intakes of sodium be limited to 2400 mg or less. Most
Americans typically consume 4000 to 6000 mg of sodium per day.
The WLM Guideline
Eat a low sodium diet (2400 mg or less of sodium daily)
Why Limit Sodium?
 Dietary sodium increases blood pressure.
 Dietary sodium promotes fluid retention.
 Reducing dietary sodium reduces blood pressure.
Dietary Sources of Sodium
 Processed foods: For most people, the largest contributor of sodium (75%) is processed
and packaged foods such as frozen dinners, canned foods, cereals, baked products, and
condiments.
 Added salt from the salt shaker: Sodium added at the table as well as in cooking
contributes only 15% eaten by most Americans.
 Sodium occurring naturally in foods such as eggs, meats, poultry, and vegetables
provides another 10%.
Salt vs. Sodium
 Sodium chloride, or table salt, is just one of the many sodium compounds found in foods.
 Table salt is 40% sodium.
 Sodium is usually measured in milligrams; 1,000 milligrams equals one gram.
Common sodium-containing compounds found in foods:
 Sodium chloride, sodium benzoate – used as preservatives.
 Sodium nitrite, sodium nitrate – prevent growth of pathogens in cured products.
 Sodium chloride, monosodium glutamate – added as seasoning or flavoring and as a less
expensive alternative to herbs and spices.
 Baking soda (sodium bicarbonate) and baking powder – used as leavening agents in
certain baked products.
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Food Labels and Sodium
 The information on the label pertains to one serving, not the entire package.
 Adjust the amount of sodium listed in the “Nutrition Facts” with the amount actually
consumed.
 Compare the amount of sodium consumed to the WLM goal of 2400mg per day.
 How much of the WLM daily goal is provided by this food item?
 The ingredient list shows all sodium compounds in the food. Ingredients are listed in
descending order by weight.
 Percent Daily Value (%DV) is useful when comparing foods of equal serving size.
Label Claims
Manufactures can print certain health claims on food labels. Label claims, however, are
regulated by strict government definitions. Here are some that can help you find foods that
meet your sodium goals.
Very low sodium – 35 milligrams or less sodium per serving.
Low sodium – 140 milligrams or less sodium per serving.
Sodium free/salt free – less than five milligrams sodium per serving.
No salt added, unsalted – no salt added during processing, the food it resembles and for
which it substitutes is normally processed with salt; if not sodium free, the words "Not
sodium free” must also appear on the information panel.
Reduced or less sodium – at least 25 % less sodium than reference food and the reference
food is not low sodium.
Light in sodium – This food has 50% less sodium that the regular food item.
Lightly salted – at least 50 % less sodium than normally added to reference food; if not low
sodium; the information panel must state “not low sodium.”
Strategies for Lowering Sodium Intake
 Find a lower sodium alternative
 Eat a smaller portion of that food.
 Eat that food less often.
 Substitute a low-sodium food for a high-sodium food.
 Avoid using the salt shaker and sodium-containing seasonings.
 Season with fresh herbs, ginger, lemon zest, and/or hot peppers.
 Use flavored and seasoned vinegar.
 Season large amounts of food with small amounts of highly flavored items like sausage.
 Cut the amount of salt a recipe calls for by one-half, one-quarter, or eliminate it.
 Avoid canned vegetables by using frozen or fresh, or rinse canned vegetable (not those in
brine) for one minute under cold running water to remove 70% of the sodium.
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