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Nutrition News Dee Sandquist, MS, RD Southwest Washington Medical Center Vancouver Director, Center

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Title: Nutrition News Dee Sandquist, MS, RD Southwest Washington Medical Center Vancouver Director, Center


1
Nutrition NewsDee Sandquist, MS, RDSouthwest
Washington Medical Center VancouverDirector,
Center for Weight ManagementAmerican Dietetic
Association Spokesperson
  • May 23, 2006

2
Objectives
  • Simplify strategies for patients to help them
    decrease 100 calories per day and increase
    physical activity by 2000 steps
  • Answer your questions
  • Provide how to strategies for you to use with
    patients

3
Questions for Patients
  • 1. Why are you here today
  • 2. What are your barriers
  • (What is keeping you from _____)

4
  • Using the most accurate data available, it is
    estimated that 36 of all children born in the
    year 2000 will be diabetic sometime in their
    lives
  • among Hispanics, 50 will become diabetic.
  • Source Aldana, Steven G., The Culprit and the
    Cure How Lifestyle is the Culprit Behind
    Americas Poor Health and How Transforming that
    Lifestyle Can be the Cure. 2005, Maple Mountain
    Press.

5
Priorities
  • We do not hesitate to pay 3.19 for a
  • bag of chips, but we wont spend that much
    on a bag of oranges.
  • Physical activity in small quantities is ok.

6
Movies - POPCORN
20 Years Ago
Today
270 calories 5 cups
630 calories11 cups
Calorie Difference 360 calories
7
Quiz Bagel Breakfast
350 calories
8
Calories In Calories Out
If you walk 1 hour and 20 minutes, you will burn
approximately 305 calories.
Based on 130-pound person
9
Calories In Calories Out
If you walk 1 hour and 20 minutes, you will burn
approximately 305 calories.
Based on 130-pound person
10
Calories, Calories
  • Increase in average food energy intake between
    1971 and 2000
  • Among men, the average energy intake has
    increased from 2450 to 2618 calories per day.
  • Among women, the increase was from 1542 to 1877
    calories per day.
  • (NHANES - MMWR 2004)

11
Yo-yo Math
  • Lose weight (fat and water) rapidly
  • Regain as fat
  • It takes fewer calories to feed fat than muscle
  • A person who previously lost weight on 1500
    calories may not because the yo-yo lost and gain
    replaced muscle with fat.

12
How did this happen?
Weight gain
Energy Out
13
What has changed?
  • We are eating more calories
  • Portion sizes have increased
  • Consumption of sugar and soft drinks has
    increased
  • Increased availability and affordability of high
    calorie foods

Source dietz
14
How did this happen?
  • The gap
  • Environment
  • Genetics

Source Dietz 04
15
Where to start
  • Prevent weight gain
  • Small steps
  • Decrease calories 100/day
  • Increase steps 2000/day

16
Choose a diet rich in plant-based foods.
  • Whole grains,
  • Fruits, and
  • Vegetables
  • Using the plate method think of ¾ of your
    dinner plate contents as being of plant origin
    and ¼ animal or other protein source.

17
The Goal
  • Maintain a Healthy Weight and be Physically
    Active
  • A body mass index (BMI) of 18.5 25 is
    recommended
  • Healthy weight results from a balance of calories
    (energy) in and energy expended.

l
18
Select Foods Low in Fat and Salt
  • The US Dietary Guidelines recommend 2.4 gms (2400
    mg) sodium or less per day
  • Reduce animal fats and hydrogenated fat
    sources, limiting total fat to 30 of calories.

19
Prepare and Store Foods Safely
  • Use safe storage methods and promptly chill or
    freeze leftovers.
  • Do not eat charred food.
  • Avoid burning of meat juices.
  • Consume only occasionally meat and fish grilled
    in direct flame cured and smoked meats.

20
Educating the Patient
  • Survival skills
  • Social and emotional issues
  • Plan strategies
  • Face the challenge with a positive outlook
  • Fine tune

21
Associations between excess weight and disease
  • Depression
  • Poor self-esteem
  • Eating disorders

X
  • Stroke

X
X
  • Heart failure
  • Heart disease
  • High cholesterol
  • Sleep apnea
  • Exercise intolerance
  • Asthma

X
X
X
X
  • Digestive problems
  • Several cancers
  • High blood pressure
  • Kidney problems

X
  • Osteoarthritis
  • Joint problems
  • Flat feet
  • Insulin resistance
  • Diabetes Type 2
  • Polycystic ovary syndrome

X
X
X
X
Source Adapted from Lancet 02, CDC
22
Food Allergen Labeling and Consumer Protection Act
  • Effective January 1, 2006, food labels must
    clearly state if the product contains any of 8
    major food allergens
  • Milk Fish
  • Eggs Shellfish
  • Peanuts Wheat
  • Tree Nuts Soy

23
Counseling Philosophy
  • What are your barriers?
  • Food Log
  • Do you cook?
  • Keep it basic
  • Keep it positive
  • Plan strategies

24
Educating the Patient
  • What do you want to learn?
  • Do you use the internet?
  • Eating out/label reading
  • Resources

25
Limit Alcohol Intake
  • Limit alcohol
  • lt2 drinks for men, 1 for women
  • 1 drink is 12 oz beer, 5 oz wine, 1.5 oz liquor
  • When is a moderate intake too much?

26
Limit Salt
  • Ability to taste salt changes over time
  • 8 weeks.
  • High salt foods dont taste salty

27
Limit Salt
  • Salt does still matter, although some people are
    more sensitive to it than others
  • Avoid adding salt at the table
  • Rule of thumb the more processed the food, the
    higher the sodium content

28
DASH diet resources for patients
  • www.nhlbi.nih.gov/health/public/heart/hbp/dash
  • Complete DASH diet info
  • www.nhlbi.nih.gov/hbp/index.html
  • General hypertension treatment/prevention info
    (includes DASH)

29
Tips to Help With Changes
  • Start with half the meat at a meal.
  • Add extra vegetables, rice, pasta and dry beans
    in meals.
  • Go meatless once a week.

30
Ideas for DASHing Your Diet
  • Eat 2 fruits or vegetables at each of 3 meals
    then add 2 more as snacks
  • Use fresh, frozen, canned or dried fruits
  • Use fresh, frozen, or no salt added canned
    vegetables

31
DASH pyramid
  • Sweets 5/week
  • Beans, Nuts, Seeds-1/day
  • Low Fat Dairy-2-3/day
  • Grains-
  • 7-8/day

Oils, salad dressing,mayo-2-3/day Seafood,
poultry, lean meat- 0-2/day Vegetables/fruit8-10
/day
32
DASH Diet
  • A diet rich in fruits, vegetables, whole grains,
    nuts/seeds/legumes, and nonfat dairy, and low in
    saturated fat/red meat. 2,000 cal example
  • Grains 7-8/day (1 slice bread)
  • Vegetables 4-5/day (½ cup cooked vegetable)
  • Fruits 4-5/day (1 medium fruit, 6 oz juice)
  • Nonfat dairy 2-3/day (1 cup yogurt, 8 oz milk)
  • Fish, poultry, lean meat 2 or less/day (3 oz
    cooked)
  • Nuts,seeds,dry beans 4-5/week (1/3 cup)
  • Fats Oils 2-3 day (1 tsp vegetable oil)
  • Sweets 5 per week (1/2 oz jelly beans)

33
The Influence of a Parent
  • Children model their parents behavior and eating
    patterns.
  • Treating the parents of obese children is more
    effective than directly treating the obese child.
  • Parents with poor nutrition and exercise habits
    cannot expect their children to eat healthy foods
    and exercise daily.

34
Childrens Nutrition Rights
  • Children have the right not to go hungry or
    endure deprivation.
  • Children have the right to choose among the foods
    available.
  • Children have the right to eat as much or as
    little as they need.
  • Children have the right to enjoy their favorite
    foods.

35
Ask the right questions about
  • Ethnic background
  • Education level
  • Economic status
  • Religious beliefs
  • Take care to individualize suggestions to a
    family rather than giving a template

36
How parents can encourage exercise
  • Limit TV, video games and computer time.
  • Use physical activity as a reward.
  • Include children in activities that parents
    enjoy.
  • Let your child win sometimes.
  • Plan exercise as a way of life.
  • Include physical activity in a vacation.

37
How parents discourage exercise
  • Allow endless TV, video games and computer time.
  • Reward a child with TV.
  • Use TV as a babysitter.
  • Spending sunny, cool afternoons indoors.
  • Make fun of exercise.
  • Plan vacations that involve mostly driving,
    eating and sitting.

38
The Family that eats togetherfrom
ChristianityToday.com
  • National Merit Scholars without exception came
    from families who ate together three or more
    nights a week.
  • Family meals can make your kids smarter, and
    stronger spiritually and emotionally.
  • Kids who feel close to their families are more
    likely to take the familys value system to heart.

39
The Family that eats togetherovercoming the top
5 excuses
  • Dad or Mom doesnt get home in time for dinner.
  • We have too many after-school activities.
  • Dinnertime is our only time to talk without kids
    around.
  • The kids wont eat what we eat.
  • Our kids arent old enough to sit still.

40
Did You Know?
  • Anyone can claim they are a nutritionist
  • Anyone can write and sell a book
  • Anyone can start selling supplements
  • Anyone can create a website and post nutrition
    statements

41
Weight Loss Industry
  • 30 -50 Billion Industry
  • Poorly Regulated
  • Rarely Prosecuted
  • Exploits ideal and overweight individuals
  • Includes diet programs, Diet books, and
    Over-the-counter Pills

42
Weight Loss Claims
  • Unrealistic!
  • Lose 30 in 30 days!
  • Use words like Magical, Cure,
  • Offers permanent weight loss
  • Are unproven
  • No need to exercise
  • Melts the fat away
  • Lose weight forever
  • Guaranteed

43
Professional Resources
  • American Dietetic Association
  • www.eatright.org
  • American Obesity Association
  • www.obesity.org
  • Federal Trade Commission
  • www.consumer.gove/weightloss
  • North American Association for the study of
    Obesity www.naaso.org
  • Shape Up America www.shapeup.org
  • WIN Weight-Control Information Network
    http//win.niddk.nih.gov

44
America on the Move
  • www.americaonthemove.org
  • Key messages move more, eat less
  • 2000 steps,
  • 100 calories

45
National Weight Control Registry
  • People who have lost 30 pounds and have kept it
    off 3 years
  • 1400 calories/day
  • Eat breakfast
  • Daily physical activity 60-90 minutes
  • Portion control

46
Nutrition News
  • Americans are overweight and undernourished in
    several nutrients
  • Children live in a sensory world that prefers
    sweets. This declines in adolescence.
  • The diet of mothers in pregnancy and lactation
    influences the childs acceptance of foods.

47
Nutrition News
  • The parent is responsible for what, when and
    where for feeding
  • The child is responsible for how much and whether
    to eat.
  • Breakfast is the most important meal of the time
    of day.
  • Inflammation plays a role in many human diseases

48
Nutrition News
  • Obesity increases the bodys inflammatory
    response.
  • Phytonutrients from plant-based foods help
    prevent disease risk.
  • By the time fruits and vegetables are consumed,
    fresh, frozen, and canned are likely to be
    nutritionally similar. Canning increases the
    bioavailability of beta-carotene and lycopene,
    however reduces water-soluble vitamin content for
    B and C vitamins.

49
Nutrition News
  • Emerging reasons to chew gum
  • Help focus
  • Help feel relaxed
  • Chew gum instead of high calorie snack
  • Benefits of chewing gum
  • Stress relief
  • Cognitive performance
  • Weight Management

50
The Role of Protein in Weight Management
  • Protein as a percent of weight not calories
  • Need the right amount for the right person,
    people are different
  • Protein has more effect on women with weight loss

51
Distilled Alcohol Council
  • Resources to facilitate patient discussions about
    drinking
  • www.alcoholtoolkit.org
  • www.standarddrinks.com

52
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