barrow, gordon, jackson, floyd and bartow county health...

irstFW

Preventive Health Education Program

Sponsored byThe University of Georgia

Department of Foods and Nutrition& Department of Human Resources

with in-kind contributions provided by:Barrow, Gordon, Jackson, Floyd and Bartow County Health Departments

Program Purpose: Wellness First (WF) is a nutrition education program for adults but is also suitable for teens. It is important to emphasize that this is not a weight loss program but a program developed to improve one’s health and decrease the risk of chronic diseases (i.e. diabetes, high blood pressure, heart disease, stroke and some cancer). Program Description: The program provides a practical and gradual approach to improving eating habits and increasing physical activity. The translation of the recommendation from The Dietary Guidelines for Americans and The President’s Council for Physical Activity will serve as the foundation of the program. WF has adopted the Take Charge of Your Health Campaign logos and some program materials from the Office of Nutrition, Division of Public Health, Georgia Department of Human Resources. The program has also added two original class topics for enhanced nutrition knowledge (“Take a Look at Food Labels” and “Take Control of Dining Out”). WF is sponsored by the The University of Georgia Department of Foods and Nutrition and the Department of Human Resources. The Barrow, Jackson, Gordon, Floyd, and Bartow County Health Departments also help provide matching, in-kind funding that makes the program possible. The project also has several community partnerships, including the following: Barrow and Jackson County Department of Family and Children Services, Winder and Calhoun Housing Authorities, Barrow County Pre-K Program, Community Action, Publix SuperMarket in Winder, Wal-Mart SuperCenter in Calhoun, and Gordon County Family Connection.

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Wellness First Peer Nutrition Educators’ Guide

● Introduction……………………………………..● Instructor Responsibilities………………………Page 3● Program Outline………………………………...Page 4● Recipe Demonstration Information………….….Page 5● Chair Stretching Information……………………Page 6● Session One “Take Charge of Your Health”…....Pages 7-17● Session Two “Take Down Fat”…………………Pages 18-36● Session Three “Take 5-a-Day”…………….……Pages 37-47● Session Four “Take Action”…………………….Pages 48-57● Session Five “Take a Look at Food Labels”...….Pages 58-73● Session Six “Take Control of Dining Out”….….Pages 74-97● Food Safety Guidelines………………………. Appendix A● Advertising……………………..………………..Appendix B

Before each session, you will find a page called the “Instructor’s Sheet” that lists all handouts, props, etc. that are recommended for that particular session. At the end of each session, you will find the reproducible handouts for the session. These materials can be printed in full color off of the program web site (http://www.fcs.uga.edu/wellnessfirst) or from the disk included in this binder.

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WF Instructor Responsibilities

WF Instructor Responsibilities: It is crucial to give participants accurate information. Therefore, we do not recommend that you give specific dietary guidelines or diet prescription to clients, unless you are a licensed dietitian or health care professional. As a WF instructor 1) you are not to prescribe, diagnose or make hearsay comments that may mislead a participant, 2) you should practice what you preach to help set an example for the class participants, 3) you should refer all participants with specials needs to their physician, the local Health Department, or a program coordinator and 4) you should document questions from the participants in the WF Question log and follow-up with one of the program coordinators or the county’s approved health authority. WF Contact Information: If you have any questions please contact The University of Georgia Department of Foods and Nutrition at (706)542-4869, the WF coordinators at 1-888-700-0185 or (706)583-0663, or your local county Health Department. If you need any additional WF materials or program updates please check the WF web site at http://www.fcs.uga.edu/wellnessfirst. Please contact coordinators prior to beginning a class series at a new location, so that the information can be posted to the web site and advertised throughout the community. *If you need color copies of any materials or information regarding recipe material reimbursement, contact project coordinators. Important Instructor Note: If possible, one or both project coordinators should be present whenever the instructor is beginning a class series with a new group. During this session, a great deal of information about the participants will be gathered in order to provide program coordinators with information about the group.

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Wellness First Program

Take Charge of Your Health

Take 5-A-Day Take Down Fat Take Action

Program Outline: The WF Program includes six 1 hour sessions. The WF sessions can be taught in any order or as individual, one-time lectures, depending on the needs of the class and time constraints. The following instructor notes were developed to be used as a guide and not to be read word for word. Remember, the best instructors are those who are enthusiastic and well prepared. Each instructor should review and become familiar with the instructor notes at least 1 week prior to the scheduled session. This will allow time to contact program coordinators if you have any questions. Session 1- Take Charge of Your Health: This session is based on the personal and environmental assessment of the individual. Participants will learn what factors influence them on a daily basis and how to gradually set goals and action plans to improve their behaviors. The main component of this session is to give a general description of practical nutrition and physical activity guidelines. It also serves as an introduction to the classes that follow. The “Take Charge of Your Health” testimonial video can be shown at this class. Session 2 - Take Down Fat: This session focuses on how to change the type and amount of fat in the typical American diet. It helps participants understand how to decrease the amount of fat in their diets without counting fat grams. The class also identifies fat replacers that can be used in favorite recipes.

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Session 3 - Take 5-A-Day: This session focuses on helping participants to increase their daily intake of fruits and vegetable to a combination of 5-a-day. Participants will learn the importance of dietary fiber and how 5-a-day will help reduce their risk of many chronic diseases (cancer, diabetes, elevated cholesterol, heart disease and high blood pressure). Session 4 - Take Action: This session will help participants identify factors that influence their interest in physical activity and they will learn how to continue to increase or maintain their current level of physical activity. This session will also focus on the importance of goal-setting. Session 5 - Take a Look at Food Labels: This session helps participants understand how to read a food label. Participants will learn to identify the most important information on the label and how to estimate 30% of calories from fat. Session 6 - Take Control of Dining Out: This session focuses on making the best choices when eating out, including ethnic restaurants and fast food establishments. Tips for cutting down fat when dining out will also be included, as well as key words to look for on a menu.

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Recipe Demonstrations

There should be a recipe demonstration at the beginning of each class session. Each lesson plan in the guide will provide recipe suggestions and handouts. All recipes have been tested for accuracy. You can also check out the program website periodically for new recipes. Please review the food safety guidelines (Appendix A) carefully before performing any cooking demonstration. Another option is to use a favorite family recipe that has been modified to fit the following criteria:

Less than 30% of calories from fat 6 or fewer ingredients Low cost ($10 or less) Delicious

Take time before each class to carefully plan your cooking demonstration. Make sure that you have tested the recipe beforehand if it does not appear in the appendix. You must know exactly what you will need to prepare it in front of your class. For example, do not forget to pack pots, pans, can openers, knives, cutting boards, dish cloths, spatulas, etc. Also, check with the location where the class will be held to ensure that a proper cooking facility will be available for your use. Ask about the equipment in the kitchen (stove, microwave, refrigerator, sink, etc.). Then, choose an appropriate recipe for the available equipment. Also, take into consideration that you will need to purchase paper goods (plates, napkins, forks, cups, etc.) to provide your class with a sample of the food you prepare. Contact program coordinators prior to purchasing food to discuss sponsor agencies that donate food. For reimbursement of food demonstration materials, peer nutrition educators must save a copy of the receipt. A cooking demonstration allows program participants to sample low-fat foods that are flavorful. This will, in turn, encourage them to prepare similar dishes at home. Because this program is designed for a low-income audience, we recognize that these individuals do not have the money to spend on food for experimenting.

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Chair Stretches

Chair stretching should be done at the beginning of each class. You can choose to do the exercise before or after the cooking demonstration. Remind participants to only do the activities they feel comfortable doing. Chair stretching to music - (2-3 minutes) For the 1st class you may want to supply the music. However, to involve the participants ask them to bring music that motivates them and use their music for the following sessions.

1. Ask the participants to place items on the floor to clear their hands of any distractions

2. Remind participants to breathe throughout the stretching and to sit up in their chair.

3. Talk them through each stretch and remind them that they should not feel any discomfort.

Stretch #1: Take deep breaths in and out. As you breathe in, stretch your arms over your head and lower your arms as you exhale. Repeat 3 times. Stretch #2: Lift your knees one at a time. Pretend like you are marching in your chair, with your arms comfortably resting by your side. Repeat for a count of 16. Stretch #3: Now, leave one leg lifted and twist your foot around at the ankle for a count of 8. Then, twist the foot in circles the other way for another count of 8. Repeat with the opposite foot. Stretch #4: Reach arms towards the ceiling one at a time for a count of 16. Leave both arms in the air and reach a little higher with one arm (feeling the stretch through your side) for a count of 4. Repeat with the other arm. Feel free to add any stretches of your own and end with repeating deep breaths from Stretch #1.

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Session 1

Take Charge of Your Health“Beginning to Make Changes”

Instructor Notes: Introductions: Welcome participants and remind all participants to sign in and add their names to the door prize basket. Introduce yourself and explain your relationship to the Wellness Program. Inform participants that we will be gathering some background information on each of them. We will not identify individuals by name, so urge participants to answer all questions truthfully and ask any questions as necessary. The following materials should be completed: Health Risk Appraisal, Food Frequency Questionnaire, Pre-Test and Consent Forms (These forms can be found in the back of Lesson one) Participants should also be weighed and this weight should be recorded on the weight sheet located in the back of lesson one. Explain that they will be weighed again after the last class session.

4. Ask the participants to introduce themselves and answer the“Ice Breaker” question. Ice Breaker- “What is your favorite food?”

B. Purpose: This class introduces future classes and allows us to collect baseline data from participants. In this session, we will be assessing the individuals on personal and environmental levels. We will try to identify factors that are influencing the participant to make behavioral changes. This class focuses on emphasizing the daily motivational reminder, basic nutrition information, and physical activity guidelines.

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Session 1

Take Charge of Your Health“Beginning to Make changes:

Materials needed for class session number 1: Handouts: Consent Forms (1), Health Risk Appraisal (2), Food Frequency Questionnaire (3), Recipe (4), Daily Reminder (5), Reasons to Take Charge of Your Health (6), Health Guide (7), and Goal Sheet (8) Props: “Take Charge of Your Health” testimonial video, TV and VCR, Handouts (listed above), Extra pens and pencils, Weight Scale, Sign-In Sheet, Music (tape), Tape Player, and Water Bottle Recipe Demo: Because of the length of time it will take to fill out the paper work for this session, the recipe for this class should be prepared ahead of time. Then, explain to participants how the food was made and provide samples and recipes. Recipe suggestions for this session include: Orange Fluff, Low-Fat Brownies, or Spinach Dip.

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Instructor Notes: (3-4 minutes) There are many reasons to Take Charge of Your Health. We might decide to make changes because our doctor told us we were at risk for a disease, like diabetes, or maybe for our family, our friends, or because we want more energy. Ask participants, “What are your reasons to Take Charge of your Health?” Listen to all responses. Remind participants that these are all great reasons, but the most important reason is you (“ME”). It is one time that it is okay to be selfish. Let’s look at 3 basic steps to help you Take Charge of Your Health. We will be discussing all of these steps in more detail in the weeks to come.

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Instructor Notes: (1-2 minutes) (The Health Guide is to help participants stay focused on making small, not drastic, changes that will help them Take Charge of their Health. Encourage them to use the Health Guide as a daily reminder of their goals to become a healthier person. Hand out the Health Guide and ask participants to follow along.) Here are 3 basic but essential steps for you to follow to help you Take Charge of Your Health. 1. Take Down Fat 2. Take 5-A-Day 3. Take Action If you follow these 3 basic steps everyday, or at least most days, you are Taking Charge of Your Health and most importantly lowering your chances of many chronic diseases such as cancer, high blood pressure, high cholesterol, and obesity. (Now review the Health Guide with the participants one step at a time. Start with Take Down Fat.)

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Take Charge by Taking Down Fat

5 Ways to Lower Your Fat Intake Without Counting Fat Grams or Calories

Instructor Notes: ( 5-10 minutes) (As you discuss each of the Take Down Fat steps, involve the participants by asking what challenges they may have in each step.) Let’s look at the 1st basic step: Taking Down Fat (This will be discussed in further detail in Lesson 2) When we talk about removing fat from our diets many of us may feel like we are removing all of the flavor or what makes our food taste so good. So let’s look at ways we can cut back on fat without removing all of the fat or counting fat grams or calories. Eat most of your food during the day- Most of us are more physically active during the day than at night. This means that we are more likely to burn the calories that we eat during the day, instead of storing them as fat. So try to eat three meals a day (do not skip breakfast) and make dinner your smallest meal. Eat smaller amounts of food- Cut your portions in half. Instead of eating a large portion of something try seeing if less will do. Try sharing food items, like a piece of cake or an order of french fries. You will be amazed at how many fat grams and calories you will reduce by sharing. Drink water every day-This is very important. Most people do not drink enough water. Instructor should hold up a water bottle and tell class how many times they would need to fill it up to reach their water goal. We should all try to drink at least 8 cups (64 ounces) a day. That may be too much for most of you, so start by drinking one cup with each meal or before a meal. Drinking water before a meal will help reduce your hunger and then you will be able to eat smaller amounts of food.

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Eat when you are hungry- This seems very basic, but think of the times you have eaten because you were bored or because someone else was eating (ex. during the holidays, watching TV). If you eat only when you are hungry, you are most likely to eat when your body needs additional calories for energy. Stop eating when you are full- Try to get the participants talking about how hard it is to stop eating when they are full, especially when it’s one of their favorite foods. This is probably the most difficult thing to do, especially if you are eating your favorite food. Your body only needs a certain amount of food or calories at a time. If you eat more than you need, then you are more likely to store the extra calories as fat. Remember cleaning your plate is not going to save the starving children and leftovers are wonderful for the next day.

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Take Charge by Taking 5-A-Day

Instructor Notes: (8-10 minutes) Refer participants to the Health Guide. Remember fruits and vegetables to most people are boring foods, or foods that are not favorite foods, so focus on the health benefits of 5-A-Day and how it is a great way for the participants to get their disease fighting vitamins. Now let’s look at the 2nd basic step: Taking 5-A-Day (This will be further discussed in Lesson 3) Fruits and Vegetables are so important to your health. They are full of vitamins, especially Vitamins A, C, and E, and they are a great source of fiber. The vitamins and fiber that come from eating fruits and vegetables are what help us stay healthy. The vitamins and fiber help fight cancer, diabetes, and heart disease (high cholesterol and high blood pressure), and they help keep our intestine clean. You might be thinking, “Well, they are just too expensive to buy,” or “Each time I spend my money on fruits and vegetables, they are wasted,” or “My family just does not like fruits and vegetables.” Well, let’s see if I can help: Fresh fruit and vegetables are great, but frozen and canned fruits and vegetables are great too! Lets see if we can get you started. Your goal is to eat 2 fruits and 3 vegetables or 3 fruits and 2 vegetables everyday. Start by eating one of each. Plan what you are going to buy and when you are going to eat it. Then each week add an extra fruit or vegetable. Remember to plan ahead. Think of it this way, each time you eat a fruit or vegetable you are Taking Charge of Your Health and you are living a healthier life.

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Take Charge by Taking Action

Goal: 30 minutes of Physical Activity a Day

Instructor Notes: Now let’s look at the 3rd basic step: Taking Action (This will be discussed in greater detail in Lesson 4 ) I think the hardest thing about physical activity is getting started. So sometimes it is best to find a fitness buddy (suggest that the participants meet 15 or 20 minutes before class to walk, if weather permits) or plan a time that is best for you. Some people find it best to do their activity in the morning; that way it is part of the routine like brushing their teeth. If you are currently doing some type of physical activity, that is great. Your goal may be to try to increase the amount of time or the intensity or maybe even try something new so you do not get burned out. If you are not doing any type of physical activity, today is the perfect day to start. Chair aerobics is an excellent activity, because you can do it in your home, watching your favorite show or listening to music. Walking is another great activity. Think of a place you can walk. Start small. Maybe to the mail box, around the block, to the post office, to the store. Once you start, you will love how it makes you feel. However the first few times you might feel real tired and that is just because you are doing something new. I find that music always makes me feel better. Recommend that all participants consult with their physicians before starting an exercise program. By week 4, each participant should accumulate 30 minutes of physical activity on most days, preferably every day.

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Testimonial Video

At this point, you can show the “Take Charge of Your Health” testimonial video, if a TV and VCR are available. The video lasts about 10 minutes. Inform participants that the women in the video have made some or all of the changes we have discussed in class today. Explain that this video was made using real program participants from Wellness First’s pilot county, Barrow. After viewing the video, talk to the class about how “Taking Charge of Your Health” can make you feel better just like it has for these women. Ask the class to think of some changes they believe they can make in the next week. This will lead them into setting goals.

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Personal Goal Sheet

Instructor Notes: (5 minutes) (You do not have to include this as part of the first session. Setting goals and action plans are covered in each of the first 4 sessions. Each class has specific goals for that particular session. However, you can get them started and thinking about weekly goals by using the Personal Goal Sheet. For the first week, have the participants select their goals from the health guide.) Ask the class what an example of a goal may be. Remember that goals should be specific and measurable. They should also be realistic. Participants should keep in mind that they can be very small goals to begin with, and that even small changes will make a big difference. Then, ask them for an action plan to help meet that goal.

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Instructor Notes: (2-3 minutes) Daily Reminder: This motivational tool can be used at different times through out the class lecture. You can even use it as part of the ice breaker. If you watched the video, remind the class that the women in the video were repeating this phrase during the introduction. Say the Daily Reminder out loud then ask the class participants to say with you. What you want the participants to do is think about making behavioral changes so that they can truly “Take Charge of their Health.” Tell them before they can start Taking Charge they must think about it and to remember that each day is a new day. Refer them to the Health Guide for daily and weekly goals. Personal Notes for Session 1:

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Session 2: Take Down Fat

Instructor’s Notes: A. Introductions: Welcome participants back and new participants for joining the program. Remind all participants to sign-in and add their name to the door prize basket. Introduce yourself and go around the room for first names and ask each participant to include a challenge or success of the prior week. Answer any questions or concerns about the program. Make sure to document any questions that should be referred to a licensed health professional. Review the daily reminder: “Today is a new day, and I am in charge of my health. I am Taking Down Fat, Taking 5-a-Day, and Taking Action. I know I have the power and ability to take charge of my health. I am in charge!” B. Purpose: This session focuses on teaching the participants how to change the amount and type of fat in their diet.

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Materials needed for class session number 2:

Handouts: Food Guide Pyramid, Portion Sizes, Sizing Up Portions, Portions for You, Types of Fat, 5 Ways to Lower Fat, Recipe Replacers, Goal Sheet, and Recipe Recipe Suggestions: Mexican Ole Casserole, Vegetable Lasagna or Chicken Pot Pie Props: Recipe Ingredients, Music (tape), Tape Player, Food Models (if available), Handouts, and Sign In Sheet. Chair stretching: For the 1st class you may want to supply the music. However, to involve the participants ask them to bring music that motivates them and use their music for the following sessions. Ask the participants to place items on the floor to clear their hands of any distractions. Remind participants to breathe throughout the stretching and to sit-up in their chair. Talk them through each stretch and remind them that they should not feel any discomfort.

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Take Charge of Your HealthHealth Guide

Step 3

Step 2

Step 1

Instructor Notes: (1 minute) Here are 3 basic steps for you to follow to help you Take Charge of Your Health. 1. Take Down Fat 2. Take 5-a-Day 3. Take Action If you follow these 3 basic steps every day, or at least most days, you are Taking Charge of Your Health and most importantly lowering your chances of many chronic diseases. Today, we will discuss taking down fat in more detail. First, however, we will review some basic concepts in nutrition. This will begin with an explanation of the Food Guide Pyramid.

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Instructor Notes: (4-5 minutes) The Food Guide Pyramid (FGP) shows a range of servings for each major food group. The number of calories that are right for you depends on your age, sex, size and activity level. Almost everyone should have at least the lowest number of servings in the ranges. If you are trying to lose weight you should concentrate more on increasing your activity level than on cutting back on calories. A. 1600 calories is the low-range of each food group recommendation. 2200 calories is the mid-range of each food group recommendation. 2800 calories is the high-range of each food group recommendation. The FGP’s base is the bread, cereal, rice, and pasta group. This means we should be eating the most from this group, and as we move up the pyramid, we should eat less of the foods toward the top. Therefore, you can see why the high-protein, low-carb diets, like Dr. Atkins and the Zone, are not good eating plans. They concentrate too much on the foods around the top of the pyramid and do not promote eating according to the pyramid. C. As you move higher on the pyramid, these foods have more and more fat. Therefore, it is especially important to choose low-fat products from the milk, yogurt, and cheese group and the meat, poultry, fish, dry beans, eggs, and nuts group. By choosing low-fat options in these groups, you will be cutting a lot of fat and calories in your diet.

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(Use food models if available. Contact project coordinator about these.) D. One Serving for each group equals: Bread Group-1 slice of bread, 1oz of ready- to- eat cereal, 1/2 cup cooked cereal, rice or pasta. Vegetable Group- 1 cup of raw, 1/2 cup cooked or chopped and ¾ cup of juice. Fruit Group- 1 medium fruit, 1/2 cup cooked, chopped or canned and ¾ cup of juice. Milk Group- 1 cup milk or yogurt, 1 1/2 oz natural cheese, 2 oz of processed cheese. Meat Group- 2-3 oz of cooked lean meat, poultry or fish, 1/2 cup cooked dry beans, 1 egg, 2 tablespoons of peanut butter. Fat Group- 1 teaspoon of margarine, butter or mayonnaise.

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When you are not cooking for yourself (like when you eat at a friend’s house or a restaurant) it is difficult to measure out the servings. In order to get an idea of what a portion is of different types of foods, there are ways you can “eyeball” serving sizes. A 3-ounce serving of meat is about the size of a deck of cards or the palm of a woman’s hand. Think about this serving size the next time you eat a hamburger or a steak. Usually, you are served a much larger portion. When looking at fruits, vegetables, pasta, or rice, the best way to determine what equals a 1/2 cup is to determine if the serving is about the size of a small fist. A teaspoon of fat, such as margarine, is about the size of your thumb. A bagel should be about the size of a hockey puck to be considered a serving. Most bagels are much bigger than this and would probably be considered 2-4 bread servings. A one ounce serving of cheese is equivalent to 4 dice. That is not very much cheese to total up one serving. Think about how many little blocks of cheese you could eat.

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(Continued from page 23) A slice of bread should be about the size of a compact disc case. Sometimes, restaurants will serve the “big and hearty” slices of bread, and although it is okay to eat them, you must consider that they would be equal to 2 or 3 bread servings. Refer to handout above: How many portions of each food should be eaten per day? The amount of food you should eat daily depends on your age, frame size, activity level, and many other factors, but this handout can provide you with an estimate of how many portions you need to add up to your calorie level.

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You may wonder how many servings of fat you should be eating and what type of fat that should be. If you look at a food label, many times you will see a number for total fat, as well as several other numbers, and here is what they mean. Fats can be divided into three groups, but most foods contain a combination of the different fats. Saturated fats are found in animal or animal-based products. Saturated fats are usually solid at room temperature. Saturated fat increases blood cholesterol levels in most people and increases their risk of heart disease. To limit the amount of saturated fat in your diet try using lean meats and skim or low-fat dairy products, use unsaturated vegetable oils and margarines that list vegetable oils as the first ingredient. Read labels to see the amount and type of fat. Limit intakes of non-dairy creamers, and rich baked products such as pie crust, pastries, cookies and cakes.

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Polyunsaturated fats “SMART FATS” (when eaten in limited amounts) are found in large proportions in many foods from plants, including sunflower, corn, soybean, cottonseed, and safflower oils. Some types of fish are sources of polyunsaturated fats. Polyunsaturated fats are usually liquid at room temperature. This type of smart fat has been linked to decreasing total blood cholesterol by lowering LDLs*, which are the bad blood cholesterols. Monounsaturated fats “SMART FATS” (when eaten in limited amounts) come from plants and are found mainly in olive, canola and peanut oils. This type of smart fat has been linked to increasing HDLs*, which are the good blood cholesterols. HDLs help fight against heart disease.

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Butter v. Margarine? There is a lot of talk about whether you should you use butter or margarine, and the answer is this: choose what you are most comfortable using, but always use it in moderation. The reason some people think that margarine is bad for you is because it goes through a process called hydrogenation, which makes it hard. This process creates “trans-fatty acids”, which act much the same way that saturated fats do in your body. This is the reason why there is so much controversy about margarine. You must keep in mind, though, that a fat is a fat, and the best thing you can do is use all fats in moderation! Participants may be better able to remember the difference between “good” and “bad” cholesterol by saying HDL is a “healthy” cholesterol and LDL is a “lousy” cholesterol.

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Facts on FAT.........

● Essential part of the diet● Provides major source of energy● Transports and stores fat-soluble

vitamins● Cushions and protects vital organs● Provides flavor, texture and color● Provides a feeling of fullness

Instructor Notes: ( 3-4 minutes) Do you think because less fat is good, then no fat is even better? Well, that is NOT TRUE! With everyone trying to lose weight and becoming healthy, fat has been given a bad name. However, some fat intake is essential to our diet on a daily basis for many reasons. For example:

A. Fat provides a lot of energy. 1 gram of fat = 9 calories 1 gram of carbohydrate or protein = 4 calories

B. Fat helps your body use certain vitamins. Those vitamins are known as fat soluble vitamins which are A, D, E, and K.

C. Fat is needed to help protect our vital organs, such as our heart, liver and kidneys.

D. Fat in food serves a number of purposes. It provides flavor, texture, color, and gives us the feeling of fullness.

The challenge with fat is learning how much is enough? Where is the balance?

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. How Much Fat is Enough?

Calories a day160018002000220024002800

Fat grams a day: 20-30% of calories36 to 53 grams of fat per day40 to 6044 to 6549 to 7353 to 8062 to 93

Note:

1600 calories-most sedentary women & some older persons

2200 calories-most children, teen girls, active women, and sedentary men. Breastfeeding women &pregnant women need a little more.

2800 calories-most teenage boys, active men, and very active women

Instructor Notes: (1-2 minutes) Try using the 5 tips to take down fat in your diet, but if you are the type of person who likes to keep track of the number of fat grams you should eat per day, you can refer to these numbers. This will help you keep your fat intake to the recommended 30% or less of total calories from fat. The calorie guide listed above can be used for most people, but you must keep in mind that individual variations, such as activity level, muscle mass, and age, make a difference in calculating your calorie needs. These calorie recommendations are only estimates. Refer the participants back to the handout, “How Many Servings for You?” (page 24) This will give them a better idea of how to distribute their calories among the food groups each day.

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Why Should We “Take Down Fat”?

● Reduce the Risk of Heart Disease and Diabetes

● Lower Odds for Developing Cancer● Decrease Your Body Weight● Feel Better!

Instructor Notes:( 2-3 minutes) Eating meals that are high in fat and especially saturated fat, tend to raise blood cholesterol levels and increase the risk of heart disease and stroke. If you smoke, have extra weight around your belly, have high blood pressure or have a family history of heart disease, your risk is even greater. Diets that are high in fat are associated with certain types of cancer, such as colon and breast cancer. Fat is a concentrated source of calories. Making small changes can add up to be a big savings over time. For example, if you reduce your fat intake by 10 fat grams per day, in one year you could lose about 10 pounds.

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Instructor Notes: ( 10-15 minutes) Review the 5 ways to “Take Down Fat” using the motivational tool sheet above. Remind participants that these are 5 ways of lowering fat in their diets without removing the fat, counting fat grams or calories. Go over each step and ask for audience input/ testimonials. Eat most of your food during the day- Most of us are more physically active during the day than at night. This means that we are more likely to burn the calories that we eat instead of storing them as fat. So try to eat three meals a day (do not skip breakfast) and make dinner your smallest meal. Some people think that there is a set time of day after which you should not eat anymore or you will surely gain weight. This is not true! What tends to happen if we have not eaten all day is that we tend to reach for the wrong choices as it gets later. For example, we may just grab some ice cream out of the freezer because it is convenient instead of eating a healthy, well-balanced meal. If you eat on a regular schedule throughout the day, you will be able to have the patience to prepare a real meal, and you may not give in to easy-to-grab snacks.

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Eat smaller amounts of food- Cut your portions in half. Instead of eating a large portion of something try seeing if less will do. Try sharing food items, like a piece of cake or an order of French fries. You will be amazed at how many fat grams and calories you are reducing by sharing. Don’t “supersize” your fast food orders and take home half of your food when you eat out at a restaurant. Drink water everyday- Water is very important for many reasons, and most of us do not drink enough water. We should all try to drink at least 8 cups (64 ounces) a day. That may be too much for most of you, so start by drinking one cup with each meal or before a meal. Drinking water before a meal will help reduce your hunger and then you will be able to eat smaller amounts of food. Begin by just increasing the amount you are currently drinking. You can even try drinking “Crystal Light” or another sugar free/caffeine free powder drink mix to have a little variety.

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Eat when you are hungry- This seems very basic, but think of the times you have eaten because you were bored or because someone else was eating (ex. during the holidays, watching TV). If you eat only when you are hungry, you are most likely to eat when your body needs additional calories for energy. We must train our brains to recognize hunger. So if you are not sure if you are hungry try drinking a glass of water, wait 5 minutes and if you are still hungry eat a healthy snack or a meal. Stop eating when you are full-This is probably the most difficult thing to do, especially if you are eating your favorite food. A study of 3- year- old and 5- year- old children indicated that the younger children instinctively quit eating when they had consumed enough energy. The older children, however, responded to eating cues, such as mothers telling them to clean their plates, or receiving a large portion from a restaurant.

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Instructor Notes: You may wonder how you can take down fat in your favorite family recipes. By using recipe replacers, you can easily cut back on fat without cutting back on flavor. For example, when a recipe calls for 1 egg, replace it with 2 egg whites. Most of the fat and cholesterol in eggs is found in the yolks, so by using the whites, you are cutting a lot of fat! In many Italian recipes, like lasagna, ricotta cheese is used. This cheese is very high fat, so to avoid the fat and calories in this type of cheese, try using low-fat cottage cheese, which has the same consistency. Also, fat-free versions of ricotta cheese are available in some stores. When a baked good calls for butter, you can use half of the amount of butter and replace the other half with a fruit puree, such as unsweetened applesauce. In place of sour cream in recipes, use plain low-fat yogurt or fat-free sour cream. Because it all gets mixed into other things, you can’t even tell it is fat-free!

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In place of oil in recipes, such as boxed brownies, use an equal amount of unsweetened applesauce or prune baby food. To decrease the fat that is added to meats and vegetables when you add a gravy or sauce, use broth, juices, and herbs to boost the flavor. You can also make low-fat gravy by skimming the fat off of the broth. The bottom of the handout lists some “Smart Fats.” These are foods that are high in the monounsaturated fats that we talked about earlier in class. Remember that all fat intake should be in moderation!

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Instructor Notes: Ask the class what are some examples of goals. Remember that goals should be specific. Then ask them for an action plan to help meet their goal. Personal Notes for Session 2:

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Session 3: Take 5-a-Day

Instructor Notes: Introduction: Welcome participants back and new participants for joining the program. Remind all participants to sign-in and add their name to the door prize basket. Explain the purpose of the session. Introduce yourself and go around the room for first names. Ask each participant to include a challenge or success of the prior week. Answer any questions or concerns about the program. Make sure to document any questions that should be referred to a licensed health professional. Review the daily reminder: “Today is a new day, and I am in charge of my health. I am Taking down Fat, Taking 5-a-Day, and Taking Action. I know I have the power and ability to take charge of my health. I am in charge!” B. Purpose: This session focuses on encouraging participants to incorporate more fruits and vegetables into their daily life. This session will discuss the importance of fiber to help reduce the risk of chronic diseases.

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Materials needed for class sessionNumber 3

Handouts: Take 5-A-Day, Choosing Fruits and Vegetables, Fiber Facts, Saving the vitamins and Minerals in your Fruits and Vegetables, Goal Sheet Props: Fruit and Vegetable Bingo (if available), Music (tape), Tape Player, Sign In Sheet, and Recipe Ingredients Recipe Suggestions: Vegetable Casserole, Vegetable Chili, or Oven-fried Okra Chair stretching: For the 1st class you may want to supply the music. However, to involve the participants, ask them to bring music that motivates them and use their music for the following sessions. Ask the participants to place items on the floor to clear their hands of any distractions. Remind participants to breathe throughout the stretching and to sit up in their chair. Talk them through each stretch and remind them that they should not feel any discomfort.

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Step 3

Step 2

Step 1

Instructor Notes: (1 minute) Here are 3 basic steps for you to follow to help you Take Charge of Your Health. 1. Take 5-A-Day 2. Take Down Fat 3. Take Action If you follow these 3 basic steps everyday, or at least most days, you are Taking Charge of Your Health and most importantly lowering your chances of many chronic diseases.

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Instructor Notes: (5 minutes) Refer participants to the 5-A-Day motivational class tool Remind the participants that they should try to increase the type and amount of fruits and vegetable on a weekly basis. Review with the participants why it is important for them to reach the 5-A-Day goal . Fruits and Vegetables are so important to your health. They are full of vitamins especially Vitamin A, C, and E and they are a great source of fiber. The vitamins and fiber that come from eating fruits and vegetables are what help us stay healthy. The vitamins and fiber help fight cancer and heart disease and they help keep our intestines clean. You might be thinking, “well they are just too expensive to buy,” or “Each time I spend my money on fruits and vegetables they are wasted,” or “My family just does not like fruits and vegetables.” Well, let’s see if I can help: Fresh fruit and vegetables are great, but frozen and canned fruits and vegetables are great too! Let’s see if we can get you started. Your goal is to eat 2 fruits and 3 vegetables or 3 fruits and 2 vegetables everyday. Start by eating one of each. Plan what you are going to buy and when you are going to eat it. Then each week add an extra fruit or vegetable. Remember to plan ahead. Think of it this way, each time you eat a fruit or vegetable you are Taking Charge of Your Health and you are living a healthier life.

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Many people wonder if using frozen and/or canned fruits and vegetables is okay, or if fresh produce is the only way to go. Well, they all have some good points and bad points that we will discuss now. You can tell by the smiley face how each one rates in each category. Let’s begin with Vitamins and Minerals. There are many vitamins and minerals in fruits and vegetables. However, the canning process sometimes destroys these vitamins and minerals. Freezing, however, does not affect the vitamin and mineral content of the produce. You can find the most fiber in fresh fruits and vegetables, and you get the most fiber if you eat the skin on your produce. Frozen fruits and vegetables also have fiber, but not as much as fresh. Canned has the least amount because when fruits and vegetables are canned, they are usually peeled first, which takes off a great deal of fiber. The canning process also destroys some of the fiber.

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The quality of fresh produce is usually best because in frozen fruits and vegetables, you may end up with a soft product after thawing. The color may be off when you use canned fruits and vegetables, and the texture is also usually soft. Of course, fresh produce is the best, but that comes with a price! Fresh is the most expensive, with frozen being medium priced and canned is the lowest cost. In order to pay less for fresh produce, buy fruits and vegetables that are in season. When you buy frozen fruits and vegetables, stay away from the vegetables that are packed in high fat sauces (cheese, butter, etc.) and salt, and look for fruits that are not packed in syrup. When buying canned, also look for “no salt added” vegetables or you can rinse vegetables to cut back on salt. Fruit packed in its own juice is best, and packed in light syrup is second best. Try to avoid fruit packed in heavy syrup, because that means that a lot of sugar has been added.

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5-a-Day Every Day

How to incorporate more fruits and vegetables into our everyday hectic life.

● Plan ahead● Purchase items you and your family like● Buy convenience items

Instructor Notes: (3-5 minutes) Plan ahead-

1. Encourage participants to make a grocery list 2. Spend one day a week, such as a Sunday evening, getting prepared for

the week 3. Bring fruits/vegetables to work with you and keep some in the car.

A. Purchase items you like- the goal is simply to eat a combination of 5 fruits and vegetables per day, preferably every day. C. Buy convenience items (Refer to “Tips for Success: 5-a-Day”) 1. Fresh 2. Frozen 3. Canned Optional Activities: Can you name 15 Fruits and Vegetables? Divide participants into groups of 3-4 and ask them to work on this activity together. Play “Fruit and Vegetable Bingo.” To borrow the game, talk to the project coordinators.

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Instructor Notes: (5-10 minutes) The average American eats 10 grams of fiber per day. National guidelines recommend 25-35 grams per day. The handout above will give participants ideas to incorporate more fiber into their diet. Fiber is found only in plant foods and is not digested by the human body. Fiber used to be called roughage. There are two types of fiber: Soluble Fiber: May help to reduce cholesterol by binding to it and causing it to be eliminated. Examples of foods that contain soluble fiber include: apples, grapes, citrus fruits and carrots. Other foods include, some cereal grains, such as oats and barley, and beans. Insoluble Fiber: Aids with digestion and adds bulk to stool, which may help prevent constipation. Because soluble fiber speeds the process of digestion through the lower intestines, it may help reduce the chance of colon cancer. Examples of foods that are good sources of insoluble fiber include: wheat bran, whole grains, such as whole wheat and brown rice, and many fruits and vegetables.

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Instructor Notes: (5-10 minutes) Props:(Optional) Have fresh fruits and vegetables available (your choice) to show participants how to purchase correctly and then do a taste test. You can also conduct a taste comparison between canned and fresh fruits and vegetables. It is important for participants to understand that the storage and preparation of fruits and vegetables has an effect on nutrient value. Encourage participants to buy fresh, high-quality produce if they can financially afford it. Also, encourage participants to examine fresh fruits and vegetables thoroughly for appropriate color, size, and shape. Refer to the handout above for tips to help maintain nutrition and taste. Enzymes that cause fruits and vegetables to ripen are more active at room temperature. To help produce last longer, encourage participants to store fresh fruits and vegetables in the refrigerator, which stops the aging process. The exception to this is green bananas, avocados, potatoes, and onions.

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Foods should not be stored for too long, as lengthy storage causes nutrient loss. Try to use fresh fruits and vegetables within a week from purchase. Wash fruits and vegetables with water but avoid soaking them. Soaking causes nutrients to leach from fresh produce. Also, encourage participants to avoid commercial cleansers for fruits and vegetables due to questions about efficacy and high cost. Vitamins and minerals are found directly under the skin of many fruits and vegetables instead of in the center. Eating the skin helps retain those nutrients and is also a good source of fiber. Avoid cutting vegetables too small. Cut vegetables no more than necessary to conserve vitamins A, C, E, and some B-vitamins. Frying vegetables can destroy some vitamins and should also be avoided due to high fat content. Steaming, micro waving, and stir-frying use little or no water when cooking and are good choices to retain nutrients when cooking. These methods are also quick and easy.

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Instructor Notes: (5 minutes) Ask the class what an examples of a goal. Remember that goals should be specific. Then ask them for an action plan to help meet their goal. Personal Notes for Session 3:

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Session 4: Take Action

Instructor’s Notes: Introduction: Welcome participants back and new participants for joining the program. Remind all participants to sign-in and add their name to the door prize basket. Introduce yourself and go around the room for first names and ask each participant to include a challenge or success of the prior week. Answer any questions or concerns about the program. Make sure to document any questions that should be referred to a licensed health professional. Review the daily reminder: “Today is a new day, and I am in charge of my health. I am Taking down Fat, Taking 5-a-Day, and Taking Action. I know I have the power and ability to take charge of my health. I am in charge!” B. Purpose: This session will help participants identify factors that influence their interest in physical activity and they will learn how to continue to increase or maintain their current level of physical activity. This session will also focus on the importance of goal setting and will include a sharing of testimonials to help motivate the participants.

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Materials needed for class session number 4:

Handouts: Daily Physical Activity Guide, Average Calories burned in 30 Minutes, and Recipe Props: Sign In Sheet, Music (tape), Tape Player, Beginner’s Exercise Video, TV, and VCR (optional), and Recipe Materials Recipe Suggestions: Perfectly Healthy Pizza, Shells with Black Bean Sauce, or Pasta & Salmon Salad Chair stretching: For the 1st class you may want to supply the music. However, to involve the participants ask them to bring music that motivates them and use their music for the following sessions.

1. Ask the participants to place items on the floor to clear their hands of any distractions.

2. Remind participants to breathe throughout the stretching and to sit-up in their chairs.

3. Talk them through each stretch and remind them that they should not feel any discomfort.

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Step 3

Step 2

Step 1

Instructor Notes: (1 minute) Here are 3 basic steps for you to follow to help you Take Charge of Your Health. 1. Take 5-A-Day 2. Take Down Fat 3. Take Action If you follow these 3 basic steps every day, or at least most days, you are Taking Charge of Your Health and most importantly lowering your chances of many chronic diseases.

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Top Reasons to Get Active

● This is not a hand out, but please explain the information to class participants.

● It is very important to understand all of the reasons why exercise is so important in your life!

Everyday energy - Exercise gives you the energy to do all of the things in life that you want to do. Mood monitor - Exercise helps reduce feelings of stress, anxiety, and depression. Sound sleep - When you get active during the day, you will get better sleep at night. Peak performance - Physical activity can help you clear your head, so that you can get back to work with a fresh mind and more ability to concentrate. Feel better about yourself - Exercise can increase your strength, flexibility, and appearance, which can leave you feeling good about yourself. Weight watch - If you get moving, you may be able to shed some extra pounds, since you will be burning excess calories. Exercise may help you reach and maintain a healthy weight! Heart health - Decrease your risk of heart disease by exercising regularly. Cholesterol count - Exercise may increase your “good” (HDL) cholesterol. Blood sugar balance - Regular activity controls blood sugar (glucose) levels, which is very important if you have, or are at risk for, diabetes. Bone benefits - You can improve your bone density by exercising. Better bone density means less risk of osteoporosis and fractures as you age!

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Obstacles of Physical Activity

TimeAbility

Fear

Instructor Notes: (3-5 minutes) Ask the participants to think of their own daily challenges to physical activity as you talk about the ones below. Ask participants to discuss some of these obstacles with the class. Time- this is an issue for everyone, but proper planning will help. Make an appointment with yourself to do physical activity. Think of it like brushing your teeth. Leave an extra pair of shoes at work with a change of clothes. Keep extra items in your car (trunk). Ability- there is something all of us can do. It does not have to be aerobics. Walking is the most natural of all physical activities. Refer the participants to the Daily Activity Guide. Ask participants, “What activities do you enjoy?” Fear- of failure, looking stupid, or the unknown. It will go away once you begin and get comfortable with the program. All individuals go through some type of fear as they begin any new program, not just physical activity. Ask the participants to share some of their personal obstacles.

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Physical Activity Made Easy

1. What do you like to do or not do?

2. What are you currently doing or thinking of doing?

3. Use the Wellness First Physical Activity Guide.

Instructor Notes: (3-4 minutes) Ask the participants to answer questions 1 and 2 and then discuss them as a group. Wellness First Physical Activity Guide- review how the guide can be used with the participants.

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Physical Activity Guide

Instructor Notes: You don’t have to wear tight fitting clothes and go to a gym to get exercise. There are many different and easy ways to squeeze more activity into your life every day! You can take the stairs, instead of the elevator whenever possible. Also, taking a walk at lunch time is a good way to get more active. If you find a “fitness buddy,” someone that will exercise with you, you will have more fun. Also, you will have someone that counts on you, so that would make it more difficult for you to get out of your daily activity. Can you believe that even cleaning the house is a form of exercise? Another way you can exercise at home is by using TV fitness programs or exercise videos.

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Take Charge by Taking Action

Goal: 30 minutes of Physical Activity a Day

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Instructor Notes: Hand out the“Take Action” motivational tool sheet. Remember: this a review and you are trying to motivate the participants to include physical activity in their everyday life. Remind them of the example above: Start walking 15 minutes per day. Increase your time by 5 minutes each week. Continue increasing your time until you reach 30 minutes per day. They should use this example with any type of activity they choose. If you choose an alternate activity, such as climbing stairs, dancing, or bicycling, follow the same guidelines as the walking program. I think the hardest thing about physical activity is getting started. So sometimes it is best to find a fitness buddy or plan a time that is best for you. Some people find it best to do their activity in the morning; that way it is part of the routine, like brushing their teeth. If you are currently doing some type of physical activity, that is great. Your goal may be to try to increase the amount of time or the intensity or maybe even try something new so you do not get burned out. If you are not doing any type of physical activity, today is the perfect day to start. Chair aerobics is an excellent activity, because you can do it in your home, watching your favorite show or listening to music. Walking is another great activity. Think of a place you can walk. Start small. Maybe to the mail box, around the block, to the post office, to the store. Once you start, you will love how it makes you feel. However the first few times you might feel real tired and that is just because you are doing something new. Music might help motivate you.

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The first step is the hardest when you are working towards being more active. After a few weeks, your new physically active lifestyle will become a habit. At times, though, you may need a little extra encouragement to stay motivated. Try these tips: Only choose activities that you actually enjoy, so you won’t dread exercise. Try to change your exercise routine. Maybe you could do different exercises on different days of the week. For example, walk one day, garden another, and do some flexibility and strength exercises on another day. Work out with your “fitness buddy.” Set realistic long and short term goals for yourself, and then, reward yourself for meeting them. Some examples of good rewards might be an article of clothing or a book. Change the place where you exercise, so you get a change of scenery. Don’t give up on yourself if you miss your exercise routine; just get back to it as soon as possible!

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Instructor Notes (5-8 minutes): The rationale of the Physical Activity Goal:

A. The Dietary Guidelines for Americans states:Balance the foods you eat with physical activity to help maintain or improve your weight.

B. The President’s Council on Physical Activity states: “Physical activity

with a decrease in caloric intake is the best way to decrease body fat and to maintain a lean body weight.” and “Incorporate a walking or alternative program to accumulate 30 minutes of physical activity on most days, preferably every day” By week 4, each participant should accumulate 30 minutes of physical activity on most days, preferably every day.

Weekly Goal Sheet: Ask the class for examples of a goal. Remember that goals should be specific. Then ask them for an action plan to help meet their goal. Personal Notes for Session 4 (write on back):

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Session 5: Take a Look at FoodLabels

Instructor Notes: Introductions: Welcome Participants Review the daily reminder: “Today is a new day and I am in charge of my health. I am Taking down Fat, Taking Five-a-Day, and Taking Action. I know I have the power and ability to take charge of my health. I am in charge!” Purpose: This class focuses on the basics of how to read a food label. Please provide actual sample labels for a variety of products.

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Materials Needed for ClassSession Number 5

Handout: Reading Food Labels Props: Examples of fat-free, low fat, reduced fat, cholesterol free, sodium free, reduced sodium, sugar-free and high fiber product labels. Sign in Sheet, Music (tape), Tape Player and Recipe Ingredients Recipe Suggestion: Meat Lover’s Turkey Loaf, Low-Fat Cornful Cornbread, Low-Fat Chicken Salad Chair stretching: For the 1st class you may want to supply the music. However, to involve the participants, ask them to bring music that motivates them and use their music for the following sessions. Ask the participants to place items on the floor to clear their hands of any distractions. Remind participants to breathe throughout the stretching and to sit up in their chair. Talk them through each stretch and remind them that they should not feel any discomfort.

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Instructor Notes: Begin by asking participants “How many of you read food labels? What do you look at to decide if you should buy a product? Are you confused by all the numbers on the label?” Refer to above, Reading Food Labels. This is a copy of the actual handout that should be passed out to participants. Begin at the top of the handout by explaining this label is for a Chicken Enchilada Dinner. Refer now to the Nutrition Facts. Explain that the Serving Size is 12 ounces for this particular label. The calories, fat, cholesterol, sodium, carbohydrate, protein are based on this 12 ounce serving size.

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Instructor Notes: Continue to look at the right hand side of handout number 1: Reading Food Labels. Now look at the Servings per Container. The servings for this example are one. Explain that in many instances this is not the case. Serving size and servings per container is often a difficult idea for many participants to grasp. Show another example, such as a bag of potato chips. Ask participants “Is one serving the whole bag of chips”? The answer of course is- No! Discuss the serving size which is usually one ounce (about 1 handful of chips) as compared to the servings per container which is usually 8-12. Now look at the next item, the Amount Per Serving. Reinforce that all the values from the calories through the protein listed on the label is based only on ONE serving.

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Next is the Calories. Explain that this 12-ounce serving has 340 calories. Calories from Fat: Out of the 340 total calories, 45 of those calories are coming from fat. State that there are 9 calories per 1 fat gram. % Daily Value: These percentages are based on a 2,000 calorie diet. Use total fat at 8% as your first example. If you ate the chicken enchilada dinner you have consumed 8% of your daily value of total fat based on a 2,000 calorie intake. Many people eat much less or more than 2,000 calories per day and this is not an accurate way to decide if you should buy a product. Encourage participants not to use percent daily values to avoid confusion and concentrate on the left side of the label instead.

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Total Fat: This example contains 5 grams of fat for the 12-ounce serving. Remind them the American Heart Association recommends 30% or less of total calories should come from fat. One way to decide if a product contains 30% fat or less is to do this simple equation: Allow yourself 3 grams of fat or less per 100 calories. Again use the handout example: This product contains 5 grams of fat and there are 340 calories. Does this fit within the guidelines? Yes, you could have up to 9 fat grams but this only has 5 so it fits well within the guidelines. Use several more examples: 1) A product contains 200 calories and has 10 grams of fat. Does that fit within the guidelines? No, three grams per 100 calories means the product should have 6 grams of total fat or less per serving. 2) A product contains 175 calories and 3 grams of fat. Does this fit within the guidelines? Yes! Ask if there are any questions regarding the equation.

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Saturated Fat: Explain that by Federal guidelines this type of fat must be listed on every label. Saturated fat is the worst type of fat because it raises cholesterol in the body and contributes to heart disease. Saturated fat on a label is part of the total fat gram amount. The other two types of fat, that by law, do not have to be listed are polyunsaturated and monounsaturated fat. Examples of polyunsaturated fat are corn or safflower oil. Monounsaturated fat is the best type of fat and a good example is Olive oil. The American Heart Association recommends 10% or less of total calories should come from saturated fat. Saturated fat grams should be half or less of the total fat grams amount on a label. Refer to the sample label: The saturated fat is 2 grams and the total fat is 5 grams. Is this a good product--Yes! The saturated fat is less than half of the total fat gram amount. Cholesterol: Ask participants what type of products contain cholesterol? Remind them that cholesterol only comes from animal products. Examples include beef, chicken, fish, milk, eggs and cheese.

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Cholesterol (Continued): Refer to sample label handout: Ask participants “Why does this product contain cholesterol?” Explain that it contains chicken, and probably cheese, which are both animal products. Emphasize that many products do not contain cholesterol. Reducing saturated fat in the diet to reduce the risk of heart disease is more important than reducing cholesterol. The best way to reduce cholesterol intake is to reduce your intake of animal products and/or choose low-fat animal products such as skim milk. Sodium: “Salt” is the combination of sodium and chloride. Sodium may raise blood pressure in salt-sensitive individuals. The American Heart Association recommends 2400 mg or less per day. One teaspoon of salt contains 2300 mg of sodium. Sodium is highest in processed and canned foods. It is used for taste but it is also used as a preservative.

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Total Carbohydrate: There is no set amount of carbohydrate grams to look for on a label to decide if it is a good product. If you have diabetics in your class, explain that 15 grams of carbohydrate is equivalent to 1 serving. Under the heading of Total Carbohydrate there are 2 categories: Dietary Fiber and Sugar Dietary Fiber: A good source of dietary fiber is 5 grams per serving.

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Refer to sample label: “Is this a good source of fiber”? Yes, because it contains 5 grams of fiber per serving. Sugar: Sugar intake should not exceed 10% of your total calories per day. For example, if you eat 1800 calories per day, only 180 should come from sugar. Protein: Protein intake should be about 10-15% of total calories consumed per day. Most Americans get plenty of protein in the foods they eat on a daily basis. They do not have to look at the gram amount when reading a label to decide if they should buy a product. Emphasize that the most important things to look for on a label are: Serving size, servings per container, calories, fat, and saturated fat when deciding to buy a product. Sodium should also be considered for those with high blood pressure.

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Refer now briefly to the next section on vitamins and minerals: These percentages are based on the Recommended Dietary Allowances (RDA’s) for these vitamins and minerals. For example, when you eat the chicken enchilada meal you consume 10% of your Vitamin A need for the day based on the RDA’s. Now refer to the bottom half of the sample label handout. Explain that this is the same on every label and participants do not need to spend their time reviewing when buying products. Briefly review the guidelines for total fat, saturated fat, cholesterol, sodium, total carbohydrate, and dietary fiber. Emphasize that these are only general guidelines and are not meant for everyone. Participants personal needs depend on many factors such as height, weight, activity level, sex, etc.

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Briefly discuss the calories per gram for fat, carbohydrate, and protein on the last section of the sample handout. 1 gram fat = 9 calories 1 gram carbohydrate = 4 calories 1 gram protein= 4 calories

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Reading Food LabelsFat-Free – Less than ½ gram of fat per serving

Low-Fat- 3 grams of fat or less per serving

Reduced-Fat- 25% less fat than the original product

Light- 50% less fat than the original product

Low Cholesterol- 20 milligrams or less of cholesterol and 2 grams fat per serving

Sodium Free- Less than 5mg of sodium

Sugar Free- Less than ½ gram of sugar

High Fiber- 5 grams or more of fiber

Continue to use handout number one: Reading Food Labels. Refer now to the definitions listed above. Please provide examples of these type of products. Fat-Free: The product still contains some fat at 1/2 gram per serving. Show a sample label of a fat-free product. Encourage the use of fat-free salad dressing, cream cheese, and sour cream. Remind participants that these products still contain calories so you can’t eat them in unlimited amounts. Low- Fat: Does not mean fat-free. By law, low- fat means the product must have 3 grams of fat or less per serving. Show an example of a low-fat product. Encourage the use of low-fat mayonnaise, margarine, cheese, cookies and ice cream.

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Reduced Fat: A product that has 25% less fat than the original product can still contain a high amount of fat. For example, cookies contain 10 grams of fat for one serving, but now as a reduced fat product it contains 8.5 grams. Is this a good option? No, because it still contains too much fat. Show an example of a reduced fat product. Light: Light products have 50% less fat than the original product but remember, they can still have too much fat. Encourage participants to refer to the label on the back of the product before making a decision to buy. Show an example of a light product.

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Low Cholesterol: 20 mg or less of cholesterol and 2 grams or less of saturated fat. Show an example. Ask participants again “Where does cholesterol come from?” Reinforce that cholesterol only comes from animal products. Sodium-Free: Less than 5 mg of sodium. Show an example of this type of product. Also, show an example of a low-sodium canned product. A low-sodium product contains 140 mg or less per serving. Sugar-Free: Less than 1/2 gram of sugar. Show an example of this type of product, such as sugar-free soft drinks or gelatin. Remind participants that water is always a better choice than any type of soft drink.

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High Fiber: 5 grams or more per serving. Show an example of a high fiber cereal such as Fiber One, All-Bran, or Shredded Wheat-N-Bran. Ask participants if they have any questions regarding food labels. Personal Notes for Session 5:

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Session 6: Take Control of Eating Out

Instructor Notes: Introductions: Welcome Participants. Review the daily reminder: “Today is a new day and I am in charge of my health. I am Taking down Fat, Taking Five-a-Day, and Taking Action. I know I have the power and ability to take charge of my health. I am in charge!” Purpose: This session focuses on making healthier food choices when dining out at restaurants and fast food establishments. The class explains diet pitfalls in ethnic cuisine and encourages participants to pack a healthy sack lunch to reduce calories and save money.

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Material needed for class sessionNumber 6

Handouts: Simple Tips for Dining Out, Eating Out in Ethnic Restaurants, Good Choices at Common Fast Food Restaurants, and Sack Lunch Ideas Props:. Fast Food Nutrition Guide (provided by the Wellness First program), Sign in Sheet, Music (tape), Tape Player and Recipe Ingredients Recipe Suggestions: Egg less Salad, Chocolate Crunch Cake, or Pumpkin Pie (seasonal) Chair stretching: For the 1st class you may want to supply the music. However, to involve the participants, ask them to bring music that motivates them and use their music for the following sessions.

Ask the participants to place items on the floor to clear their hands of any distractions. Remind participants to breathe throughout the stretching and to sit up in their chair. Talk them through each stretch and remind them that they should not feel any discomfort.

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Material needed for class sessionNumber 6

Instructor’s Please Note: Because this is the last class of the six week program, participants must fill out post data information. This includes the Food Frequency Questionnaire and Health Risk Appraisal (found at the end of Lesson 1). A post-test (located at the end of this lesson) must also be administered to participants. A post-weight should be completed and the weight sheet for comparison purposes can be found at the end of Lesson 1. Please also have them fill out the evaluation sheet, found at the end of this lesson.

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Instructor Notes: Begin by asking participants “How many of you eat out at least one time per week?” (Remind them this includes fast food). How many eat out 3 times per week or more? What types of restaurants do you like? What is your favorite restaurant in town? ( This will help you gauge dining out activities with your audience.) Refer to handout listed above: Simple Tips for Dining Out.

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Instructor Notes: Explain that eating out is fine, but it is important to make healthier choices, especially if eating out 3 times or more per week. Encourage participants to be assertive and ask for food to be prepared the way they want it. Remind them they are paying the bill--they are the customer. Almost all restaurants are willing to accommodate substitutions or minor changes. Refer to handout above. Begin at the top with healthy key words. Foods prepared the healthy way include steamed, in its own juice, broiled, dry broiled, roasted or poached. Using the term “dry broiled” is important because many times foods are broiled and then butter or oil is added on top. Ask for foods to be prepared without butter or oil. For fish or chicken, use lemon. High fat key words include: buttery, fried, crispy, creamed, au gratin or in cheese sauce. These types of entrees should be avoided or eaten only occasionally.

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Instructor Notes: Portion sizes in restaurants are often too large for one person to eat. Try sharing with a friend or ask for a doggie bag. You can eat the leftovers the next day and then you have stretched your money, calories and fat. Don’t be a member of the “Clean Your Plate” Club--just because you paid for it does not mean you have to eat it all at one sitting. Buffet-style restaurants present a particular problem because you want to get your money’s worth and “your eyes are bigger than your belly.” Try choosing what you know you will eat instead of choosing something just because it is available. Also, try loading up on healthier choices such as fruits and vegetables and eat smaller portions of high-fat items.

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Instructor Notes: Appetizers: Examples of high-fat appetizers include chicken wings, potato skins, fried mozzarella, and cream soups. Better choices are crab meat with lemon, shrimp cocktail or a broth based soup. You can also just skip the appetizer all together to save fat and money. Salads: Can be high in fat if items such as meat, cheese, eggs, or nuts are added. Remember salad dressing is also high in fat. The average Caesar salad contains 50 grams of fat. Ask for low-fat dressings which are available at most restaurants. Ask for regular dressing on the side and use the “fork method”. Spear your lettuce with your fork and then dip in the dressing on the side, or dip your fork first in your dressing and then spear your lettuce. Either way is a great way to get the taste of salad dressing without all the fat.

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Instructor Notes: Entrees: Baked, broiled or grilled is best. Ask for “dry” broiling or grilling so that fats like oil or butter will be omitted during cooking. Remove the skin of chicken and trim the fat around beef cuts. With seafood, like lobster or shrimp, ask for butter on the side instead of being cooked in your meal. The fork method (described on previous page) with butter can also be used. Vegetables: Choose those prepared without butter, oil, cheese, or cream sauce. Avoid fried vegetables.

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Instructor Notes: Bread/Starch: Bread is fine to eat before or with your meal, but remember: butter, margarine, or oil is high in fat. One teaspoon or pat of margarine or butter contains 5 grams of fat. If you eat 2 pieces of bread with a teaspoon of fat on each slice from the bread basket that is served before dinner, you have already consumed 10 grams of fat. Biscuits and croissants are higher in fat than other breads. Ask for steamed rice or pasta with marinara sauce. Try salsa or ketchup on a baked potato. Order sour cream or butter on the side for your potato and again use the fork method. Desserts: Try fresh fruit, frozen yogurt, or sorbet. To cut the calories and fat in half, share with a friend. Try skipping dessert completely!

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Instructor Notes: Refer to handout above: Eating Out in Ethnic Restaurants. Ask participants, “What is your favorite type of ethnic food?” Explain that Mexican, Italian, and Chinese are the 3 most popular ethnic restaurants. Begin with Mexican food. Ask participants to guess how much fat is in the average Mexican meal. Refer to example below. 2 ounces tortilla chips 272 calories 14 grams/fat Combo Meal:

1 Beef Burrito 387 14 1 Cheese Enchilada 320 19 1 taco 370 21 Spanish Rice 21 4 Refried Beans 248 2

Total……………………...…………1810 74

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Instructor Notes: (Mexican Eating Continued) Encourage participants to choose bean dishes instead of beef. Portion sizes are often huge so there is no need to order “grande” sizes. Remind participants that sharing is always a good idea. Frijoles “a la charra” or “borracho” beans are prepared without fat and are a better choice than refried beans. You can also ask your server if the refried beans are made with or without lard or fat. If they are made without fat, refried beans are also a good choice. Salsa is fat-free! It makes a great alternative for sour cream, cheese and guacamole. Remind participants that the chips before the meal are high in fat. Two ounces (which is about 2 handfuls) is equal to 272 calories and 14 grams of fat. Don’t avoid chips, just be aware of how many you are eating. For a lower fat alternative to chips, try corn or flour tortillas dipped in salsa. Encourage participants to order chicken fajitas or taco salad without the shell rather than fried items or quesadillas.

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Instructor Notes: Now discuss Italian food. Ask participants to guess the fat in an average Italian meal. Refer to breakdown of sample meal below: Italian Bread, 1 slice 85 calories 0 grams of fat Side Caesar Salad 150 10 Fettuccini Alfredo, 16 ounces 702 60 Total……………………………937 70

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Instructor Notes: ( Italian Eating Continued) Encourage participants to try spaghetti with marinara sauce instead of meat sauce. Try pizza with vegetables instead of high fat meats such as pepperoni and sausage. Thin crust also has less fat and calories than thick crust. Ask for pizza with less cheese to cut the calories and fat. Order a salad with low fat dressing or dressing on the side to go with your meal. Italian dressing is oil-based and is not considered a low fat dressing. Tomato sauces are a great alternative to cream sauces. Explain that “Alfredo” sauce and cream sauces are made with cream and butter so they are high fat choices. They also contain saturated fat which is the bad type of fat. Limit cheese and meat filled pastas such as manicotti, cannelloni, and lasagna.

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Instructor Notes: Continue to use handout above and now discuss Chinese food. Again, ask participants to guess the fat in a typical Chinese meal. Refer to breakdown of sample meal below: Won-ton Soup, 1 cup 80 calories 2 grams of fat Egg Roll, 1 180 10 Sweet-n-Sour Shrimp 953 84 Fried Rice, 1 cup 376 10 Fortune Cookie, 1 30 0 Total…………………………..1619 106

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Instructor Notes: (Chinese Eating Continued) Chinese food is not low in fat because when prepared, large amounts of oil are used in sauces and many of the meats are fried. Authentic Chinese cooking uses small amounts of both meat and oil, but the American version of Chinese is different. Wonton and hot-and-sour soup are the best soup choices. Broiled, boiled, steamed and stir-fried entrees are better choices. Avoid sweet and sour items, which are deep-fried. Choose dishes with vegetables instead of meat. Try a tofu dish. Save yourself 10 grams of fat for one cup of fried rice by ordering steamed rice instead. Sweet and sour sauce, plum, or duck sauce are fine to use. Soy sauce contains no fat but is high in sodium.

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Class Activity: (optional) Pass out Fast Food Nutrition Guide Booklet to all participants. If you do not have booklets, please disregard this exercise and skip to the above handout: Good Choices at Common Fast Food Restaurants. Ask participants to find their favorite fast food restaurant and look up the fat and calories in the meal they would regularly buy. Allow 2-3 minutes for this exercise and assist as needed. Do a round robin, asking each participant to share the calories and fat in their favorite fast food meal. This is a great exercise to help participants become aware of the fat and calories they consume when eating fast food. Encourage participants to keep fast food booklet in their purse or car glove compartment as a quick reference guide.

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Instructor Notes: Refer to handout listed above to discuss better choices when eating out. If possible, copy this handout onto cardstock to allow participants to cut out cards and keep in their wallet as a reference. Burger King: Better choices include the broiled chicken sandwich or plain hamburger. Remind participants that adding cheese or mayonnaise increases the fat content. Add lettuce or tomatoes to a sandwich to make it more nutritious. Just because Burger King broils their hamburgers does not mean they are low in fat. Ground beef is naturally high in fat. Try a side salad with low-fat dressing instead of French fries. Frozen yogurt is a low-fat dessert. KFC: Skinless Tender Roasted chicken is a great alternative to fried chicken. Remind participants that the skin of the chicken is high in total fat and saturated fat. Encourage participants to remove the skin. Acceptable side choices include, baked beans, and corn-on-the-cob. The mashed potatoes with gravy contains only 6 grams of fat.

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Instructor Notes: (Good choices continued) McDonald’s: Again, try a grilled chicken sandwich or plain hamburger. If you must have fries, purchase a small order or share. Low-fat vanilla frozen yogurt and fat-free muffins are also available. Try a salad with low-fat dressing. For breakfast, try an Egg McMuffin instead of an egg, cheese, and sausage biscuit. Taco Bell: Ask for sour cream on the side. A bean or chicken burrito is acceptable. A soft chicken taco or regular taco contains about the same amount of fat. The taco salad at 850 calories and 52 grams of fat is not a low-fat item. Wendy’s: Try a baked potato with chili on top for a delicious, low-fat meal. A grilled chicken salad or plain junior hamburger is also acceptable. Try a garden salad with low-fat dressing. Your Favorite Fast Food Meal: Ask participants if they have a favorite place that was not covered in class and respond accordingly.

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Instructor Notes: Briefly discuss pizza. Domino’s Pizza: Two pieces of the large, deep dish pepperoni pizza contains 510 calories and 25 grams of fat. The thin crust version contains 308 calories and 16 grams of fat. Encourage the thin crust over the thick crust to save calories and fat. Encourage healthier toppings, such as mushrooms, onion, green peppers, spinach and other types of vegetables. Ask for 1/2 the regular amount of cheese. Limit the number of slices eaten also. Have two slices of pizza and a salad with low fat dressing.

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Instructor Notes: Refer to handout above: Sack Lunch Ideas. Encourage participants to bring their lunch to work. Emphasize that they will save calories, fat, and money. Ask participants “Would you get up 5 minutes earlier in the morning to save a $100 per month?” Refer to this equation: the average lunch per day is $5 and that translates to $25 per week and $100 per month. Five minutes is all it takes to prepare a healthy, low fat lunch. Try packing a lunch 4 times per week and eat out on Fridays, as a treat. Optional: Have a sample brown bag lunch such as a turkey sandwich, apple, pretzels and yogurt or use any of the ideas listed above to show participants.

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Instructor Notes: Refer to handout above for healthy ideas. Try a bagel with turkey, fat-free cream cheese, and vegetables. Use bagels instead of regular bread for something new. Try onion, garlic, or everything bagels for added flavor. Pasta salad with low-fat Italian dressing is easy and economical. Add fresh vegetables to the salad such as tomatoes, broccoli, carrots or anything you like. You could also add tuna fish or chicken. You can make a batch on Sunday and eat it over several days during the week. Tuna fish or chicken salad sandwich with low-fat mayonnaise is a great choice. Try it on whole wheat bread or crackers. Bean Burritos are quick and delicious. Use canned non-fat refried beans that you can buy at the grocery store. Lay a tortilla flat and spread beans on tortilla. Add onions, salsa, and low-fat cheese. Roll it up, heat for 1-2 minutes in the microwave, and you have an easy alternative to a sandwich.

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Instructor Notes: Pita bread is also an excellent alternative to regular bread. You can use pita bread for tuna and chicken salad sandwiches or for a vegetarian-style. Try sliced chicken with tomatoes, lettuce and salsa in a tortilla. Low-fat leftovers can also be used for lunch. This is another way to save money by not wasting what you have cooked the night before. Review snacks and sides to fill a sack lunch: (on handout) *Veggie sticks with low fat dressing make a great snack. *Try fruit with your lunch or as a mid-morning snack. *Yogurt is a wonderful snack that is high in calcium.

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Instructor Notes: Continue to discuss snacks and side items. *Baked or WOW chips are a good alternative to fried snacks. *Try pretzels instead of chips for a low-fat choice. *Popcorn is an excellent low-fat, high fiber snack. Be sure to buy the low-fat varieties of microwave popcorn. *Dry cereal, such as Cheerios, also makes a great snack in the morning or any time during the day. Personal Notes for Session 6:

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Personal Notes:

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Questions Did you have questions that you were unsure how to address? Please write them below and contact us anytime at 1-888-700-0185 or e-mail us at [email protected].

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