Download Dietary education

Dietary education
Slides current until 2008
Dietary education
Why educate?
Curriculum Module III-5
Slide 2 of 47
• People with diabetes need to
develop the appropriate skills,
decision-making and self-care
strategies to maintain good health
• Ongoing practical learning,
behaviour-change strategies and
motivation are the keys
• Theoretical information alone is not
enough
Slides current until 2008
Dietary education
Approach to meal planning
Curriculum Module III-5
Slide 3 of 47
• A uniform approach to meal
planning does not work for
everyone
• A flexible plan or a variety of
approaches is required to deal
with differing needs
Slides current until 2008
Dietary education
Approach to meal planning
Curriculum Module III-5
Slide 4 of 47
Before deciding on an approach to
meal planning it is necessary to:
• Understand the person with
diabetes, their background and
preferences
• Be aware of their willingness to
learn and readiness to change
Slides current until 2008
Dietary education
Meal planning
Curriculum Module III-5
Slide 5 of 47
Before deciding on the content of meal
plans, consider:
• Previous experience, knowledge and
skills
• Current clinical, psychological and
dietary status
• Appropriate clinical and nutritional
goals
• Lifestyle factors
Slides current until 2008
Dietary education
Dietary education: tools
Curriculum Module III-5
Slide 6 of 47
Stage 1
• Awareness of the basics of healthy
eating/balance of good health
• The food pyramid
• The signal system (healthy food
choices)
• The Zimbabwe hand jive
• The plate model
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Dietary education
Dietary education: strategies
Curriculum Module III-5
Slide 7 of 47
Stage 2
• Food exchange system
• Carbohydrate counting
• Glycaemic Index
Slides current until 2008
ACTIVITY
Dietary education
Curriculum Module III-5
Slide 8 of 47
Give examples of education
methods in your culture and
practice.
Slides current until 2008
Dietary education
Healthy eating
Curriculum Module III-5
Slide 9 of 47
Australian food guide
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Dietary education
Curriculum Module III-5
Slide 10 of 47
Healthy eating
Canadian
Food Guide
Grain
products
Vegetables
and fruits
Milk
products
Meat and
alternatives
Health Canada, 1997 Reproduced with permission of the Minister of
Public Works and Government Services Canada 2004
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 11 of 47
Balance of good health
Fruits and vegetables
Bread, cereals and potatoes
UK food guide
Meat, fish and
protein alternatives
Milk and dairy products
Foods rich in sugars and fat
Reproduced with kind permission of the Food Standards Agency
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 12 of 47
Food pyramid
Fats,
oils,
sweets,
confectionery
Milk,
yoghurt,
dairy
products
Vegetables
Meat,
fish,
egg,
cheese
Fruit
Bread, rice, wheat, potato, pasta,
couscous, polenta, corn, sorghum
Slides current until 2008
Dietary education
ACTIVITY
Curriculum Module III-5
Slide 13 of 47
Food pyramid
Develop a food pyramid
including appropriate food
from your country
Slides current until 2008
Dietary education
Food pyramid
Curriculum Module III-5
Slide 14 of 47
Use moderately
(Servings 35)
(Servings 35)
Servings 12
Reprinted with permission of M.V, Hospital for Diabetes and Diabetes
Research Centre, Chennai, India
Slides current until 2008
Dietary education
Diabetes food pyramid
Curriculum Module III-5
Slide 15 of 47
American
Diabetes
Association®
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Dietary education
Diabetes food pyramid
Curriculum Module III-5
Slide 16 of 47
Fats, oils, sugars, refined foods,
fatty foods: eat sparingly
Low fat milk and milk
products: 2-3 servings
Vegetables:
3-4 servings
Lean meat, fish,
poultry, pulses:
1-2 servings
Fruits: 12 servings
Cereals, whole
grains and starch:
6-11 servings
Exercise for at least 30 minutes every day
Slides current until 2008
Dietary education
Signal system
Curriculum Module III-5
Slide 17 of 47
The signal system is based on a traffic lights
concept:
Red foods (to be taken in small amounts)
– those rich in fat
– sugars (refined carbohydrate)
– high glycaemic index foods
– low fibre content
Yellow foods (to be taken in moderation)
– high glycaemic index foods
– low fibre content
Green foods (healthy choice)
– low glycaemic index
– high fibre content
– low in fat
Kapur K et al 2004
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Dietary education
Healthy versus unhealthy food
choices?
Food groups
Green zone
Yellow zone
Curriculum Module III-5
Slide 18 of 47
Red zone
Rice
Steamed rice
Pulao
Fried rice/biryani
Bread
Whole wheat
bread
White bread
Croissants and
cakes
Noodles
Steamed
noodles
Indian
breads
Chappati
Potatoes
Baked potato
Vegetables
Steamed
vegetable
Salad
Green salad
Salad with
mayonnaise
Sauce
Tomato based
Cream based
Fish
Steamed fish
Fish curry
Fried fish
Chicken
Grilled chicken
Pan fried
Butter chicken
Deep fried noodles
Naan
Butter naan/puri
French fries
Sauteed
vegetable
Deep fried
vegetable
Slides current until 2008
Dietary education
ACTIVITY
Curriculum Module III-5
Slide 19 of 47
Green
Yellow
Red
Cereals
Bread
Chicken
Fish
Vegetables
Dessert
Slides current until 2008
Dietary education
Signal system – advantages
Curriculum Module III-5
Slide 20 of 47
• A simple tool – easy to understand
• A useful tool for less motivated
people
• Useful for mass communication
• Encourages healthy eating by
focusing on high-fibre, low-fat foods
with a low glycaemic index
• Processing and cooking form an
integral part of its recommendations
Slides current until 2008
Dietary education
Zimbabwe hand jive
Curriculum Module III-5
Slide 21 of 47
Carbohydrates (starch and
fruit): choose an amount
equivalent to the size of two
fists. For fruit use one fist.
Protein: choose an amount
equivalent to the size of
the palm of your hand and
the thickness of your little
finger
Reprinted with permission from Can J Diabetes 2003; 27(suppl 2): S130
Slides current until 2008
Dietary education
Zimbabwe hand jive
Curriculum Module III-5
Slide 22 of 47
Vegetables: choose as much
as you can hold in both
hands. These should be low
carbohydrate vegetables –
green or yellow beans,
cabbage or lettuce.
Fat: limit fat to an amount
the size of the tip of your
thumb. Drink no more than
250 ml of low-fat milk with a
meal
Reprinted with permission from Can J Diabetes. 2003;27(suppl 2):S130
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 23 of 47
Plate model
Fruit
Protein
Milk/yoghurt
Vegetable
Vegetable
Starch/cereal
Slides current until 2008
ACTIVITY
Dietary education
Curriculum Module III-5
Slide 24 of 47
Draw on a paper plate either:
• The recommended proportions of
foods from your region
• The proportions of what you ate
last night
Slides current until 2008
Dietary education
Plate model
Curriculum Module III-5
Slide 25 of 47
Useful as a first-stage teaching tool for
people who:
• Have recently been diagnosed
• Want a simple plan or find it difficult to
implement other advanced plans
• Have difficulty reading or dealing with
numbers
• Learn better by visualizing
• Eat out frequently
• Want to reduce the amount of proteins
or carbohydrates they ingest
Slides current until 2008
Dietary education
Educational tools – summary
Curriculum Module III-5
Slide 26 of 47
The plate model, the Zimbabwe
hand jive and the signal system
are simple ways to offer dietary
advice.
Slides current until 2008
Dietary education
What to teach and when?
Curriculum Module III-5
Slide 27 of 47
Level 1
• Basic information about
nutrition
• Nutrient requirements
• Healthy eating guidelines
• Making healthy food choices
• Self-management training and
use of educational tools
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 28 of 47
What to teach and when?
Level 2
• How to prepare a structured
meal plan
– counting carbs, food
exchanges, glycaemic index
• How to deal with special
situations
• Complications
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Dietary education
Evaluation
Curriculum Module III-5
Slide 29 of 47
• Individual or personal outcomes
• Process outcomes
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Dietary education
Curriculum Module III-5
Slide 30 of 47
Fad diets
• Promise easy, painless weight loss
• Exploit people’s vulnerable
psychological state
• Place severe restrictions on some
foods
• Claim that counting calories is not
important
• Work in the short term – low in
calories
Roberts DC, Med J Aust. 2001
Slides current until 2008
Dietary education
Fad diets
Curriculum Module III-5
Slide 31 of 47
Some popular fad diets
• Mono-food diets (grapefruit, rice,
banana diets)
• Scarsdale, cabbage soup diet
• High-carbohydrate, very low-fat
diets (Pritikin diet)
• Low-carbohydrate, high-fat diets
(Atkins diet)
• Low-carbohydrate, high-protein
diets (zone diet)
• South Beach diet
Slides current until 2008
Dietary education
Fad diets
Curriculum Module III-5
Slide 32 of 47
Low-carbohydrate diets tend to
produce:
• Greater initial weight loss
• Improvements in lipid markers
• Improved insulin sensitivity
But:
• No evidence of sustained results
in the long term
• No long-term data on safety
Slides current until 2008
Dietary education
Dietary myths: good and bad
foods for people with diabetes
• The bad foods
– fruits, especially
bananas
– sugar
Curriculum Module III-5
Slide 33 of 47
• The good foods
– vegetarian food
– molasses, honey
– artificial
sweeteners
– three meals and
snacks
– rice
– bread, wheat
– carrots, plantain,
potatoes, sweet
potatoes
– fasting
Slides current until 2008
Dietary education
ACTIVITY
Curriculum Module III-5
Slide 34 of 47
Dietary myths
• What are the dietary myths in
your region?
• How would you approach the
person who has incorrect beliefs
about certain foods?
Slides current until 2008
Dietary education
Eating out
Curriculum Module III-5
Slide 35 of 47
Problems eating out:
• Large amounts of fat used in
cooking
• Unhealthy cooking methods (frying)
• Large portion sizes
• Rich dressings on salad
• Rich in salt
• Lack of healthy choices
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 36 of 47
Eating out
Some healthy strategies:
•
•
•
•
•
Be selective
Avoid buffets
Understand portion sizes
If possible make special request
Ask for fruit desserts or eat half
the quantity
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 37 of 47
Eating out
Choose foods which are:
• Steamed
• Broiled
• Baked
• Roasted
• Poached
• Lightly sauteed or stir-fried
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 38 of 47
More clinical trials are necessary
to evaluate the dietary education
tools described in this module.
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 39 of 47
“Helping others is good, teaching
them to help themselves is
better.”
George Orwell
Slides current until 2008
Dietary education
Review question
Curriculum Module III-5
Slide 40 of 47
1. Which food is at the base of the
food pyramid?
a. Apple
b. Cheese
c. Spinach
d. Bread
Slides current until 2008
Dietary education
Review question
Curriculum Module III-5
Slide 41 of 47
2. Which food, at the top of the food
pyramid, should be taken in restricted
amounts?
a. Chocolates
b. Carrots
c. Grilled fish
d. Yoghurt
Slides current until 2008
Dietary education
Review question
Curriculum Module III-5
Slide 42 of 47
3. In a plate model, half the plate should
be filled with which food?
a. Fruit
b. Vegetables
c. Milk
d. Grains/cereals
Slides current until 2008
Dietary education
Review question
Curriculum Module III-5
Slide 43 of 47
4. Which of the following is the
healthiest option?
a. Steamed fish
b. Fried fish
c. Butter chicken
d. Chocolate cake
Slides current until 2008
Dietary education
Review question
Curriculum Module III-5
Slide 44 of 47
5. Are the following statements true or
false?
a. Non-vegetarian food is not good for
people with diabetes
b. Banana is not good for people with
diabetes
c. The amount we eat is important to
control diabetes
d. Sweets are good for your health
Slides current until 2008
Dietary education
Curriculum Module III-5
Slide 45 of 47
Answers
1. d
2. a
3. b
4. a
5. A=T; b=F; c=T; d=F
Slides current until 2008
Dietary education
References
Curriculum Module III-5
Slide 46 of 47
1.
The Australian Guide to Healthy eating. Australian Government Department of
Health and Ageing, Population Health Division, Commonwealth Copyright 1998.
www.health.gov.au.pubhlth/strateg/food/guide/guide2.htm
2.
Health Canada. Healthy Eating Canadian Food Guide. 1997 (cited 2004 Nov 14)
(1 page) Available from www.hc-sc.gc.ca/hpfb-dgpsa/onppbppn/food_guide_rainbow_e.html
3.
The UK Food Guide, Balance of Good Health.
www.healtheschool.org.uk/nutrition/pdfs.balanceofgoodhealth.balanceofgoodheal
th.pdf
4.
ADA Food Pyramid (cited 2004 Nov 14) (1 page). Available from
www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp
5.
Kapur K, et al. Making Healthy Food Choices, Novo Nordisk Education
Foundation, 2004. http://www.diabeteseducation.org/signal1.htm
6.
Jimbabwe Hand Jive. Can J Diab 2003; 27(suppl 2): S130.
7.
To help you plan for healthy eating. Can J Diab 2003; 27(suppl 2): S132.
8.
Glycaemic Index Explained (cited 2004 Nov 14) (23 pages). Available from
www.diabetes.ca/Files/Glycaemic%20Index%20Presentation.pdf
Slides current until 2008
Dietary education
References
Curriculum Module III-5
Slide 47 of 47
9.
Brand Miller J, Foster-Powell K, Colagiuri S, Leeds A. The GI factor. Hodder 1998.
10.
Novo Nordisk India. Indian food pyramid (cited 2004 Nov 14) (1 page). Available
from www.novonordisk.co.in/otherint/Nina1/pyramid.asp?pageval=3
11.
Franz M, Montz A, Bergenstal R, et al. Outcomes and Cost effectiveness of Medical
Nutrition Therapy for non-insulin dependent diabetes mellitus. Diabetes Spectrum
1996; (2): 122-7.
12.
Powers MA. Medical Nutrition Therapy for Diabetes, Handbook of Diabetes Medical
Nutrition Therapy, Aspen Publication 1996.
Slides current until 2008