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Transcript of Dietary Education
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Dietary education
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Dietary educationCurriculum Module III-5
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Why educate?
• People with diabetes need todevelop the appropriate skills,decision-making and self-carestrategies to maintain good health
• Ongoing practical learning,behaviour-change strategies and
motivation are the keys
• Theoretical information alone is notenough
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Approach to meal planning
• A uniform approach to mealplanning does not work for
everyone
• A flexible plan or a variety ofapproaches is required to deal
with differing needs
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Before deciding on an approach tomeal planning it is necessary to:
• Understand the person withdiabetes, their background andpreferences
• Be aware of their willingness tolearn and readiness to change
Approach to meal planning
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Meal planning
Before deciding on the content of mealplans, consider:
• Previous experience, knowledge andskills
• Current clinical, psychological anddietary status
• Appropriate clinical and nutritionalgoals
• Lifestyle factors
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Dietary education: tools
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: strategies
Stage 2
• Food exchange system
• Carbohydrate counting
• Glycaemic Index
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Dietary educationCurriculum Module III-5
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Give examples of educationmethods in your culture and
practice.
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Healthy eating
Australian food guide
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Healthy eating
Grain
products
Vegetables
and fruits
Milk
products
Meat and
alternatives
CanadianFood Guide
Health Canada, 1997 Reproduced with permission of the Minister ofPublic Works and Government Services Canada 2004
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Balance of good health
Bread, cereals and potatoes
Milk and dairy products
Foods rich in sugars and fat
Meat, fish andprotein alternatives
Fruits and vegetables
Reproduced with kind permission of the Food Standards Agency
UK food guide
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Dietary educationCurriculum Module III-5
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Food pyramid
Develop a food pyramid
including appropriate food
from your country
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Servings 1-
2
(Servings 3-
5)
Use moderately
(Servings 3-
5)
Reprinted with permission of M.V, Hospital for Diabetes and DiabetesResearch Centre, Chennai, India
Food pyramid
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Diabetes food pyramid
American
Diabetes
Association®
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Diabetes food pyramid
Cereals, wholegrains and starch:
6-11 servings
Fruits: 1-2 servings
Vegetables:3-4 servings
Low fat milk and milkproducts: 2-3 servings
Lean meat, fish,poultry, pulses:
1-2 servings
Fats, oils, sugars, refined foods,fatty foods: eat sparingly
Exercise for at least 30 minutes every day
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Signal system
The signal system is based on a traffic lightsconcept:
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 contentGreen foods (healthy choice)– low glycaemic index– high fibre content– low in fat
Kapur K et al 2004
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Healthy versus unhealthy foodchoices?
Food groups Green zone Yellow zone Red zone
Rice Steamed rice Pulao Fried rice/biryani
Bread Whole wheatbread
White bread Croissants andcakes
Noodles Steamed
noodles
Deep fried noodles
Indianbreads
Chappati Naan Butter naan/puri
Potatoes Baked potato French fries
Vegetables Steamedvegetable
Sauteedvegetable
Deep friedvegetable
Salad Green salad Salad withmayonnaise
Sauce Tomato based Cream based
Fish Steamed fish Fish curry Fried fish
Chicken Grilled chicken Pan fried Butter chicken
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Green Yellow RedCereals
Bread
Chicken
Fish
Vegetables
Dessert
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Signal system – advantages
• 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
d
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Zimbabwe hand jive
Carbohydrates (starch andfruit): choose an amountequivalent to the size of two
fists. For fruit use one fist.
Protein: choose an amountequivalent to the size of
the palm of your hand andthe thickness of your littlefinger
Reprinted with permission from Can J Diabetes 2003; 27(suppl 2): S130
Di d i
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Zimbabwe hand jive
Vegetables: choose as muchas you can hold in bothhands. These should be lowcarbohydrate vegetables –
green or yellow beans,cabbage or lettuce.
Fat: limit fat to an amountthe size of the tip of yourthumb. Drink no more than250 ml of low-fat milk with ameal
Reprinted with permission from Can J Diabetes. 2003;27(suppl 2):S130
Di t d ti
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Plate model
Vegetable
Milk/yoghurt
Fruit
Vegetable
Protein
Starch/cereal
Di t d ti
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Draw on a paper plate either:
• The recommended proportions of
foods from your region
• The proportions of what you ate
last night
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Plate model
Useful as a first-stage teaching tool forpeople who:
• Have recently been diagnosed
• Want a simple plan or find it difficult to
implement other advanced plans
• Have difficulty reading or dealing withnumbers
• Learn better by visualizing
• Eat out frequently
• Want to reduce the amount of proteinsor carbohydrates they ingest
Di t d ti
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The plate model, the Zimbabwe
hand jive and the signal systemare simple ways to offer dietaryadvice.
Educational tools – summary
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What to teach and when?
Level 1
• Basic information aboutnutrition
• Nutrient requirements
• Healthy eating guidelines
• Making healthy food choices• Self-management training and
use of educational tools
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Level 2
• How to prepare a structuredmeal plan
– counting carbs, foodexchanges, glycaemic index
• How to deal with specialsituations
• Complications
What to teach and when?
Dietary education
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Evaluation
• Individual or personal outcomes
• Process outcomes
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Fad diets
• Promise easy, painless weight loss
• Exploit people’s vulnerablepsychological state
• Place severe restrictions on somefoods
• Claim that counting calories is not
important
• Work in the short term – low incalories
Roberts DC, Med J Aust. 2001
Dietary education
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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-proteindiets (zone diet)
• South Beach diet
Fad diets
Dietary education
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Fad diets
Low-carbohydrate diets tend toproduce:
• Greater initial weight loss
• Improvements in lipid markers
• Improved insulin sensitivity
But:
• No evidence of sustained resultsin the long term
• No long-term data on safety
Dietary education
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Dietary myths: good and badfoods for people with diabetes
• The bad foods
– fruits, especiallybananas
– sugar
– artificialsweeteners
– rice
– carrots, plantain,potatoes, sweetpotatoes
• The good foods
– vegetarian food
– molasses, honey
– three meals andsnacks
– bread, wheat– fasting
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Dietary myths
• What are the dietary myths inyour region?
• How would you approach theperson who has incorrect beliefsabout certain foods?
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Eating out
Problems eating out:
• Large amounts of fat used incooking
• Unhealthy cooking methods (frying)
• Large portion sizes
• Rich dressings on salad• Rich in salt
• Lack of healthy choices
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Some healthy strategies:
• Be selective
• Avoid buffets
• Understand portion sizes
• If possible make special request
• Ask for fruit desserts or eat halfthe quantity
Eating out
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Choose foods which are:
• Steamed
• Broiled
• Baked
• Roasted
• Poached
• Lightly sauteed or stir-fried
Eating out
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More clinical trials are necessary
to evaluate the dietary education
tools described in this module.
Dietary education
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“Helping others is good, teaching
them to help themselves is
better.”
George Orwell
Dietary education
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Review question
1. Which food is at the base of thefood pyramid?
a. Apple
b. Cheese
c. Spinach
d. Bread
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Dietary education
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3. In a plate model, half the plate shouldbe filled with which food?
a. Fruit
b. Vegetables
c. Milk
d. Grains/cereals
Review question
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4. Which of the following is thehealthiest option?
a. Steamed fish
b. Fried fish
c. Butter chicken
d. Chocolate cake
Review question
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yCurriculum Module III-5
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5. Are the following statements true orfalse?
a. Non-vegetarian food is not good forpeople with diabetes
b. Banana is not good for people withdiabetes
c. The amount we eat is important tocontrol diabetes
d. Sweets are good for your health
Review question
Dietary education
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yCurriculum Module III-5
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Answers
1. d
2. a
3. b
4. a
5. A=T; b=F; c=T; d=F
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yCurriculum Module III-5
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References
1. The Australian Guide to Healthy eating. Australian Government Department ofHealth 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/onpp-bppn/food_guide_rainbow_e.html
3. The UK Food Guide, Balance of Good Health.www.healtheschool.org.uk/nutrition/pdfs.balanceofgoodhealth.balanceofgoodhealth.pdf
4. ADA Food Pyramid (cited 2004 Nov 14) (1 page). Available fromwww.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp
5. Kapur K, et al. Making Healthy Food Choices, Novo Nordisk EducationFoundation, 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 fromwww.diabetes.ca/Files/Glycaemic%20Index%20Presentation.pdf
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yCurriculum Module III-5
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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). Availablefrom www.novonordisk.co.in/otherint/Nina1/pyramid.asp?pageval=3
11. Franz M, Montz A, Bergenstal R, et al. Outcomes and Cost effectiveness of MedicalNutrition Therapy for non-insulin dependent diabetes mellitus. Diabetes Spectrum1996; (2): 122-7.
12. Powers MA. Medical Nutrition Therapy for Diabetes, Handbook of Diabetes MedicalNutrition Therapy, Aspen Publication 1996.
References