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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 Slides current until 2008 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 Slides current until 2008 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® Slides current until 2008 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 Slides current until 2008 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 Slides current until 2008 Dietary education Evaluation Curriculum Module III-5 Slide 29 of 47 • Individual or personal outcomes • Process outcomes Slides current until 2008 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