Download Measuring Usual Food Intake

Weight Management Course
Dr A Blazos, 15/1/2001
Measuring Usual Food Intake
The food diary method requires that patients write down everything they consume over a period of 4 days
or more. Ideally, a weekend day should be included since food intake can change significantly from
weekdays to weekends. This method is very good for making patients aware of their food intake, however,
patients may start to choose healthier foods or they may eat less (to make recording easier!)
As a result, the clinician may not end up getting a good picture of the patients usual food intake when this
method is used. If food intake changes simply because it is being recorded then the clinician will not
understand what aspects of the patient’s past food intake may have contributed to the patient’s current
health problems.
1
Weight Management Course
Dr A Blazos, 15/1/2001
Assessing Nutritional Adequacy of
Usual Food Intake
Nutrient approach (12345+ food pyramid)
+
Food approach (food variety score, cultural models of eating)
The basic model provides 1500 kcal per day. For greater energy intakes, the extra energy should come from
cereals, vegetables or fruits. A novel feature of this guide is that it addresses indulgences - one is allowed 2
indulgences (or a total of 300kcal) a day on 1500kcal. Indulgences are not included on energy intakes
below 1500kcal e.g weight loss diets. Even though it is not evident in this pyramid, 6g of margarine/oil is
allowed for each serving of cereal. In other words, for 5 serves of cereal, 30g added fat is allowed in the
diet to achieve recommended fat intake. The brown bars represent the average number of serves of each
food group consumed by Australians in 1995.
2
Weight Management Course
Dr A Blazos, 15/1/2001
Obesity
Treatment - Practical Food Intake Tips
Imagine your plate. How much is covered by meat? If it is more than one-fifth of the plate, it may be too
much. A rough guide is two-fifths vegetables, two-fifths potato/rice/pasta/bread (select types with a low
glycaemic index) and one-fifth meat/fish/chicken. These principals apply to heart disease, cancer, obesity
and diabetes.
Recommended changes for people needing to lose weight, diabetes, high blood lipids are the same as those
encouraged for all Australians for optimum health. Rather than thinking of it as a short term 'diet' it is better
to re-educate patients to make long term healthy food choices. To lose weight, it seems that very small
changes to energy intake are needed over a long period of time, rather than a drastic reduction that cannot
be sustained.
For many patients with chronic conditions such as heart disease or diabetes, or even patients who are at risk
of developing them, a small amount of weight loss (e.g 5-10kg) is enough to reverse adverse effects of
being overweight, such as high blood pressure, high cholesterol and glucose intolerance and even artery
elasticity is reversible with weight loss.
Weight loss will be achieved on 1300-1500 kcal/day for most patients if combined with 1/2 to 1 hour of
walking daily (does not have to be in one session - can accumulate over the day in several sessions - see
module on Obesity). This is a modest energy restriction, but sustainable in the long term. Lower energy
intakes may result in faster weight loss, but are harder to keep in the long term and can result in nutrient
3
Weight Management Course
Dr A Blazos, 15/1/2001
deficiencies. The 12345 pyramid (see Module on Assessment of Usual Food Intake) provides about 13001500 kcal as long as indulgences are reduced to one or less/ day.
Another approach to weight loss is to establish how many calories your patient usually consumes and
deduct 500 kcal - this should result in 0.5 kg weight loss per week. 1 kg of fat is equivalent to about 7500
calories.
Evidence suggests that small frequent meals (e.g 5-6/day) as opposed to 3 larger meals appears to be
associated with greater food variety, lower body fat, blood glucose and lipid levels and may be more
effective in assisting weight loss. Alternatively, there is evidence that avoiding large meals in the evening
and having the main meal at lunch time can also assist weight loss (Wahlqvist, Kouris-Blazos, Appetite
1999; 32: 23-32).
People with diabetes are used to thinking about the glycaemic index, they use it to help control their blood
sugar levels. But until now, we have not really been aware of its significance for people without diabetes.
Even though sugar per se has not been linked with any diseases of affluence, diets with a high glycaemic
load have been associated with an increased risk of diabetes, obesity (especially abdominal/visceral
obesity) and heart disease. All patients can be advised to consume at least ONE low glycaemic index food
at each meal.
Read this on-line summary about the Glyceamic index:
http://www.healthyeating.org/general/glycaemic_index.htm
And an on-line table of GI of foods http://www.healthyeating.org/general/GI-Table.htm
To read this article and view table off-line click here
4