dietary education

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Dietary education



Dietary educationCurriculum Module III-5

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Why educate?

• People with diabetes need todevelop the appropriate skills,decision-making and self-carestrategies to maintain good health

• Ongoing practical learning,behaviour-change strategies and

motivation are the keys

• Theoretical information alone is notenough




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Approach to meal planning

• A uniform approach to mealplanning does not work for

everyone

• A flexible plan or a variety ofapproaches is required to deal

with differing needs




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Before deciding on an approach tomeal planning it is necessary to:

• Understand the person withdiabetes, their background andpreferences

• Be aware of their willingness tolearn and readiness to change

Approach to meal planning




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Meal planning

Before deciding on the content of mealplans, consider:

• Previous experience, knowledge andskills

• Current clinical, psychological anddietary status

• Appropriate clinical and nutritionalgoals

• Lifestyle factors




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Dietary education: tools

Stage 1

• Awareness of the basics of healthy

eating/balance of good health

• The food pyramid

• The signal system (healthy food

choices)

• The Zimbabwe hand jive

• The plate model




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Dietary education: strategies

Stage 2

• Food exchange system

• Carbohydrate counting

• Glycaemic Index




Slide 8 of 47ACTIVITY


Give examples of educationmethods in your culture and

practice.




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Healthy eating

Australian food guide




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Healthy eating

Grain

products

Vegetables

and fruits

Milk

products

Meat and

alternatives

CanadianFood Guide

Health Canada, 1997 Reproduced with permission of the Minister ofPublic Works and Government Services Canada 2004




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Balance of good health

Bread, cereals and potatoes

Milk and dairy products

Foods rich in sugars and fat

Meat, fish andprotein alternatives

Fruits and vegetables

Reproduced with kind permission of the Food Standards Agency

UK food guide






Food pyramid

Develop a food pyramid

including appropriate food

from your country




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Servings 1-

2

(Servings 3-

5)

Use moderately

(Servings 3-

5)

Reprinted with permission of M.V, Hospital for Diabetes and DiabetesResearch Centre, Chennai, India

Food pyramid




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Diabetes food pyramid

American

Diabetes

Association®




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Diabetes food pyramid

Cereals, wholegrains and starch:

6-11 servings

Fruits: 1-2 servings

Vegetables:3-4 servings

Low fat milk and milkproducts: 2-3 servings

Lean meat, fish,poultry, pulses:

1-2 servings

Fats, oils, sugars, refined foods,fatty foods: eat sparingly

Exercise for at least 30 minutes every day




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Signal system

The signal system is based on a traffic lightsconcept:

Red foods (to be taken in small amounts)– those rich in fat

– sugars (refined carbohydrate)– high glycaemic index foods– low fibre content

Yellow foods (to be taken in moderation)– high glycaemic index foods

– low fibre contentGreen foods (healthy choice)– low glycaemic index– high fibre content– low in fat

Kapur K et al 2004




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Healthy versus unhealthy foodchoices?

Food groups Green zone Yellow zone Red zone

Rice Steamed rice Pulao Fried rice/biryani

Bread Whole wheatbread

White bread Croissants andcakes

Noodles Steamed

noodles

Deep fried noodles

Indianbreads

Chappati Naan Butter naan/puri

Potatoes Baked potato French fries

Vegetables Steamedvegetable

Sauteedvegetable

Deep friedvegetable

Salad Green salad Salad withmayonnaise

Sauce Tomato based Cream based

Fish Steamed fish Fish curry Fried fish

Chicken Grilled chicken Pan fried Butter chicken






Green Yellow RedCereals

Bread

Chicken

Fish

Vegetables

Dessert




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Signal system – advantages

• A simple tool – easy to understand

• A useful tool for less motivated

people

• Useful for mass communication

• Encourages healthy eating by

focusing on high-fibre, low-fat foods

with a low glycaemic index

• Processing and cooking form an

integral part of its recommendations

d




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Zimbabwe hand jive

Carbohydrates (starch andfruit): choose an amountequivalent to the size of two

fists. For fruit use one fist.

Protein: choose an amountequivalent to the size of

the palm of your hand andthe thickness of your littlefinger

Reprinted with permission from Can J Diabetes 2003; 27(suppl 2): S130

Di d i




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Zimbabwe hand jive

Vegetables: choose as muchas you can hold in bothhands. These should be lowcarbohydrate vegetables –

green or yellow beans,cabbage or lettuce.

Fat: limit fat to an amountthe size of the tip of yourthumb. Drink no more than250 ml of low-fat milk with ameal

Reprinted with permission from Can J Diabetes. 2003;27(suppl 2):S130

Di t d ti




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Plate model

Vegetable

Milk/yoghurt

Fruit

Vegetable

Protein

Starch/cereal

Di t d ti






Draw on a paper plate either:

• The recommended proportions of

foods from your region

• The proportions of what you ate

last night

Di t d ti




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Plate model

Useful as a first-stage teaching tool forpeople who:

• Have recently been diagnosed

• Want a simple plan or find it difficult to

implement other advanced plans

• Have difficulty reading or dealing withnumbers

• Learn better by visualizing

• Eat out frequently

• Want to reduce the amount of proteinsor carbohydrates they ingest

Di t d ti




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The plate model, the Zimbabwe

hand jive and the signal systemare simple ways to offer dietaryadvice.

Educational tools – summary

Dietary education




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What to teach and when?

Level 1

• Basic information aboutnutrition

• Nutrient requirements

• Healthy eating guidelines

• Making healthy food choices• Self-management training and

use of educational tools

Dietary education




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Level 2

• How to prepare a structuredmeal plan

– counting carbs, foodexchanges, glycaemic index

• How to deal with specialsituations

• Complications

What to teach and when?

Dietary education




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Evaluation

• Individual or personal outcomes

• Process outcomes

Dietary education




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Fad diets

• Promise easy, painless weight loss

• Exploit people’s vulnerablepsychological state

• Place severe restrictions on somefoods

• Claim that counting calories is not

important

• Work in the short term – low incalories

Roberts DC, Med J Aust. 2001

Dietary education




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Some popular fad diets• Mono-food diets (grapefruit, rice,

banana diets)

• Scarsdale, cabbage soup diet• High-carbohydrate, very low-fat

diets (Pritikin diet)

• Low-carbohydrate, high-fat diets

(Atkins diet)

• Low-carbohydrate, high-proteindiets (zone diet)

• South Beach diet

Fad diets

Dietary education




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Fad diets

Low-carbohydrate diets tend toproduce:

• Greater initial weight loss

• Improvements in lipid markers

• Improved insulin sensitivity

But:

• No evidence of sustained resultsin the long term

• No long-term data on safety

Dietary education




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Dietary myths: good and badfoods for people with diabetes

• The bad foods

– fruits, especiallybananas

– sugar

– artificialsweeteners

– rice

– carrots, plantain,potatoes, sweetpotatoes

• The good foods

– vegetarian food

– molasses, honey

– three meals andsnacks

– bread, wheat– fasting

Dietary education






Dietary myths

• What are the dietary myths inyour region?

• How would you approach theperson who has incorrect beliefsabout certain foods?

Dietary education




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Eating out

Problems eating out:

• Large amounts of fat used incooking

• Unhealthy cooking methods (frying)

• Large portion sizes

• Rich dressings on salad• Rich in salt

• Lack of healthy choices

Dietary education




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Some healthy strategies:

• Be selective

• Avoid buffets

• Understand portion sizes

• If possible make special request

• Ask for fruit desserts or eat halfthe quantity

Eating out

Dietary education




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Choose foods which are:

• Steamed

• Broiled

• Baked

• Roasted

• Poached

• Lightly sauteed or stir-fried

Eating out

Dietary education




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More clinical trials are necessary

to evaluate the dietary education

tools described in this module.

Dietary education




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“Helping others is good, teaching

them to help themselves is

better.”

George Orwell

Dietary education




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Review question

1. Which food is at the base of thefood pyramid?

a. Apple

b. Cheese

c. Spinach

d. Bread



Dietary education




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3. In a plate model, half the plate shouldbe filled with which food?

a. Fruit

b. Vegetables

c. Milk

d. Grains/cereals

Review question

Dietary education



eta y educat oCurriculum Module III-5

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4. Which of the following is thehealthiest option?

a. Steamed fish

b. Fried fish

c. Butter chicken

d. Chocolate cake

Review question

Dietary education



yCurriculum Module III-5

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5. Are the following statements true orfalse?

a. Non-vegetarian food is not good forpeople with diabetes

b. Banana is not good for people withdiabetes

c. The amount we eat is important tocontrol diabetes

d. Sweets are good for your health

Review question

Dietary education




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Answers

1. d

2. a

3. b

4. a

5. A=T; b=F; c=T; d=F

Dietary education




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References

1. The Australian Guide to Healthy eating. Australian Government Department ofHealth and Ageing, Population Health Division, Commonwealth Copyright 1998.www.health.gov.au.pubhlth/strateg/food/guide/guide2.htm

2. Health Canada. Healthy Eating Canadian Food Guide. 1997 (cited 2004 Nov 14)(1 page) Available from www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/food_guide_rainbow_e.html

3. The UK Food Guide, Balance of Good Health.www.healtheschool.org.uk/nutrition/pdfs.balanceofgoodhealth.balanceofgoodhealth.pdf

4. ADA Food Pyramid (cited 2004 Nov 14) (1 page). Available fromwww.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp

5. Kapur K, et al. Making Healthy Food Choices, Novo Nordisk EducationFoundation, 2004. http://www.diabeteseducation.org/signal1.htm

6. Jimbabwe Hand Jive. Can J Diab 2003; 27(suppl 2): S130.

7. To help you plan for healthy eating. Can J Diab 2003; 27(suppl 2): S132.

8. Glycaemic Index Explained (cited 2004 Nov 14) (23 pages). Available fromwww.diabetes.ca/Files/Glycaemic%20Index%20Presentation.pdf

Dietary education




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9. Brand Miller J, Foster-Powell K, Colagiuri S, Leeds A. The GI factor. Hodder 1998.

10. Novo Nordisk India. Indian food pyramid (cited 2004 Nov 14) (1 page). Availablefrom www.novonordisk.co.in/otherint/Nina1/pyramid.asp?pageval=3

11. Franz M, Montz A, Bergenstal R, et al. Outcomes and Cost effectiveness of MedicalNutrition Therapy for non-insulin dependent diabetes mellitus. Diabetes Spectrum1996; (2): 122-7.

12. Powers MA. Medical Nutrition Therapy for Diabetes, Handbook of Diabetes MedicalNutrition Therapy, Aspen Publication 1996.

References

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