health professional manual - lwwcopd...cue card: maintain a healthy body weight additional resources...

Health Professional Manual

Session: Healthy Eating

➤ COPD and healthy eating➤ General healthy eating advice➤ Getting the most out of every meal

Adapted from the “Living Well with COPD” program (2nd edition), Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland – 2011.

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HEALTHY EATINGSESSION SUMMARY


Education Plan and MethodsSession Length: 15 minutes

• Working Phase 1. COPD and Healthy Eating. Group Discussion. 2. General Healthy Eating Advice. Interactive lecturing. 3. Getting the most out of every meal. Interactive lecturing. 4. Summary of the session and assessment of participants’ understanding and self-efficacy. Group discussion.• Closing of the session

Human Resources 1. One healthcare professional (recommended facilitator: dietitian)

Living Well with COPD™ for Pulmonary Rehabilitation Resources 1. Patient Information Booklet (Pages 40 to 41) 2. Key messages: Healthy Eating 3. Educational Posters:

• Maintainahealthybodyweight 4. Cue card: Maintain a healthy body weight

Additional Resources 1. Board / Flipchart

Environment 1. Use a quiet and comfortable room for 10 to 15 people. Ensure proper ventilation. 2. Place the chairs in a semi-circle around the board.

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HEALTHY EATINGGROUP INTERVENTIONS FOR EACH PHASE OF THE SESSION


Introduction• Presentation of the Facilitator.• Outline the goals of this session.• Review the key messages from the last session and link them to this session.

Working Phase – Educational Interventions

1. COPD and Healthy Eating

Use the poster “Maintain a healthy body weight” and Attachment 1 (Cue card: Maintain a healthy body weight) to support your teaching.

1.1.1 Present the goal and benefits of healthy eating in COPD to the participants.

Suggested question:• WhydoyouthinkhealthyeatingisimportantwhenyouhaveCOPD?

Suggested script for the Facilitator:• Eatingahealthydietisanimportantpartofyoureverydaylife.Whenyouhave

COPD you may find that your appetite is poor or that you feel too tired to prepare and eat meals. However, in order to breathe, your body requires a lot of energy or fuel. In fact, a person with COPD can use up to 50% more energy on breathing compared to a person who does not have a lung disease.

Goal:• Tomaintainahealthybodyweightthroughabalanceddiet

Benefits:• Enhancesgeneralwell-being• Helpsyoudoyournormalactivities• Helpspreventsinfections

1.1 PRESENTATION OF THE IMPORTANCE OF HEALTHY EATING IN COPD

Present this section using Group Discussion

LifeExperiences

Note to the facilitator: This education session is not designed to replace individualised interventions with a dietitian. It can be used, however, to help identify “at risk” patients who may require one-to-one input from a dietitian.

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1.1.2 Present the body mass index to the participants.

Suggested question: • Whatisahealthybodyweight?Suggested script for the Facilitator:

Body mass index (BMI) is a simple tool for use with the general population. It takes into account height as well as weight. BMI = weight in kg

Note to the facilitator: The following criteria could be used to help identify patients “at risk” who require referral to a dietitian for one-to-one input:

1. Patients with a BMI less than 18.5kg/m2 or greater than 30kg/m2

2. Patients with a BMI less than 20kg/m2 and unintentional weight loss greater than 5% within last 3-6 months

3. Patients with unintentional weight loss of greater than 10% within last 3-6 months

4. Patients who have been eating less than half of their normal amount of food within last 10 days

5. Patients who have had several courses of corticosteroids

Please note the patient must have verbally consented to have their details and BMI shared with the dietitian.

(height in m)2

BMI Weight Category

>3126-3020-25<19

ObeseOverweight Normal rangeUnderweight

If anyone would like their BMI calculated please speak to a member of the pulmonary rehabilitation team at the end of the session (attachment 1).

Points to remember:

• Ifyouareunderweight,youcanlackenergyandyoumayneedtoeatmoreorincrease the energy and protein content of your diet.

• Ifyouareoverweight,itmakesitharderforyourmusclestoworkandcanworsenyour shortness of breath. A healthy diet can help you achieve gradual weight loss.

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2. General Healthy Eating Advice

Use the poster “Maintain a healthy body weight” to support your teaching.

Present the strategies to improve general healthy eating habits to participants.

Suggested question: • Whatdoyouthinkisabalancedandhealthydiet?Suggested script for the Facilitator:

The Eatwell plate© shows how much of what you eat should come from each food group. This includes everything you eat during the day, including snacks.

Try to eat: • Plentyofvegetablesandfruit.Trytoeatatleastfiveportionsofavarietyof

vegetables and fruit every day. • Plentyofpotatoes,bread,rice,pastaandotherstarchyfoods.Choosewholegrain

varieties whenever you can. • Somemilkanddairyfoods • Somemeat,fish,eggs,beansandothernon-dairysourcesofprotein • Onlyaverysmallamountoffoodsanddrinkshighinfatand/orsugar,sincethey

have little or no nutritional benefitsTry to choose options that are lower in salt when you can.

2.1 PRESENTATION OF GENERAL HEALTHY EATING ADVICE

Present this section in an Interactive Way

LifeExperiences

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3. Getting the most out of every meal

Explore the effect COPD has had on the participants’ eating habits.

Suggested question:

• Whatstopsyoufromeatingproperly?

Suggested script for the Facilitator:

You may find that COPD makes eating more difficult, because you may:

• Feelbreathlessorfatiguedwhileeating

• Feelbreathlessorfatiguedwhenpreparingmeals

• Feelbloatedand/orgetwind

• Feelveryfullquickly

• Feelconstipated

3.2.1 Discuss with participants the strategies that could be used to prevent shortness of breath and fatigue during meals

Suggested question: • Whatstrategiescouldyouusetopreventshortnessofbreathorfatigue whileeating?Answers expected from the participants:

• Takeyourtime.Tryputtingyourknifeandforkdownbetweenbitestoslowdown your eating.

• Cutfoodintosmallbite-sizepieces

• Buytendermeatsandfoodswhichdon’trequiremuchchewing

3.1 IMPACT OF COPD ON THE PARTICIPANTS’ EATING HABITS


3.2 STRATEGIES TO IMPROVE EATING HABITS


LifeExperiences

LifeExperiences

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• Relaxbeforeandaftermeals

• Situpright

• Useyourshortactingbronchodilator(reliever)andyourairwayclearance techniques before meals.

3.2.2 Discuss with participants the strategies that could be used to prevent shortness of breath and fatigue when preparing meals

Suggested question: • Whatstrategiescouldyouusetopreventshortnessofbreathorfatiguewhen preparingmeals?Answers expected from the participants:

• Usefastandeasyrecipes.

• Cookmorethanonemealatatime.Freezewhatyoudonoteatandsaveitfor later.

• Eatearlyinthedaywhenyoufeelyouhavethemostenergy.

• Sitdownwhenpeelingandcutting

• Keeputensilsandsaucepansineasyreach

• Restbeforeandaftermealstoconserveyourenergy

• Getafamilymemberorfriendtohelpyoupreparethemeals

• Useconvenientreadymademeals,buttrytoavoidthosehighinsaltandfat.

• Takeadvantageofservicessuchasmealsonwheels

3.2.3 Discuss with participants the strategies that could be used to prevent feeling bloated


Eating too much of some foods can leave you feeling bloated. This makes it harder to breathe.

Suggested question: • Whatstrategiescouldyouusetoavoidfeelingbloated?Answers expected from the participants:

• Eatslowlyandchewfoodwell.

• Avoidfizzydrinksandfoodwhichencouragesbloating,e.g.beans,cabbage,onions, grapes, peas, corn and dried fruit.

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3.2.4 Discuss with participants the strategies that could be used to prevent feeling full too quickly.

Suggested Question: • Whatstrategiescouldyouusetoavoidfeelingfulltooquickly?Answers expected from the participants:

• Drinkfewerliquidsduringmeals.Instead,siponfluidsanhourbeforemeals.

• Eatingsixsmallermealsratherthanthreelargermealsmeansyourstomachis never overly full. A full stomach will prevent your lungs from expanding fully.

• Eatcoldfoods,whichprovidelessofasenseoffeelingfullthanhotfoods.

3.2.5 Discuss with participants the strategies that could be used to prevent constipation.

Suggested Question: • Whatstrategiescouldyouusetohelppreventconstipation?Answers expected from the participants:

• Eatfoodsthatarehighinfibre,e.g.brownrice,branoroatcereals,wholemeal bread.

• Drinkatleast8glassesofwateraday(ifyouhavenorestrictions).

• Exerciseregularlyaccordingtoyourability.

Note to the facilitator: The following criteria could be used to help identify patients “at risk” who require referral to a dietitian for one-to-one input:

1. Patients with a BMI less than 18.5kg/m2 or greater than 30kg/m2

2. Patients with a BMI less than 20kg/m2 and unintentional weight loss greater than 5% within last 3-6 months

3. Patients with unintentional weight loss of greater than 10% within last 3-6 months

4. Patients who have been eating less than half of their normal amount of food within last 10 days

5. Patients who have had several courses of corticosteroids

Please note the patient must have verbally consented to have their details and BMI shared with the dietitian.

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4. Summary of the session and assessment of participants’ understanding and self-efficacy

Evaluate participants’ understanding and self-efficacy to eat a healthy and balanced diet. Use this opportunity to cover the key messages from the session.

Use Attachment 2 (Key messages: Healthy Eating) to support your teaching.

Suggested questions:

• Howwelldoyouunderstandtheimportanceofhealthyeatingforpeoplewith COPD?

• Howconfidentareyouthatyoucaneatahealthyandbalanceddiet?


• EatinghealthyisimportantforCOPD.Itprovidesyourbodywithenergytodoyour normal daily activities and helps prevent infections. It also improves your general well-being.

– Vary your diet and eat food from each of the basic food groups. Try to eat: – Plenty of vegetables and fruit. Try to eat at least five portions every day. – Plenty of potatoes, bread, rice, pasta and other starchy foods.

Choose wholegrain varieties. – Some milk and dairy foods – Some meat, fish, eggs, beans and other non-dairy sources of protein – Only a very small amount of foods and drinks high in fat and/or sugar. – Try to choose options that are lower in salt when you can.• Therearestrategiesyoucanusetogetthemostofeverymeal: – Eat six smaller meals rather than three large meals. – Eat slowly and chew food well. – Sit down when preparing and eating meals – Get help preparing meals.• Pleasespeaktoamemberofthepulmonaryrehabilitationteamifyou: – are worried about your weight – have had sudden weight loss – have difficulty preparing or eating meals – are taking long-term steroids

4.1 SUMMARY OF THE SESSION AND ASSESSMENT OF PARTICIPANTS’ UNDERSTANDING AND SELF-EFFICACY

Present this section using Group Discussion

LifeExperiences

HEALTHY EATINGATTACHMENTS

Adapted from the “Living Well with COPD” program (2nd edition), Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland – 2011.10



Note to the facilitator: Inform participants that the key messages from this session are summarised on their key messages sheet and additional information can be found in their information booklets (Pages 40 to 41).

If participants feel capable to eat a healthy diet, ask them to continue applying the techniques taught in this session.

If some participants do not feel capable to eat a healthy diet, make sure to refer these participants to their resource person to see them in an individual basis to investigate the reasons and reinforce the use of the techniques taught in this session.

Closing the session

• Answerthequestionsoftheparticipants.

• Learning contract: Ask the participants to complete Attachment 3 to review what they eat over a 24 hour period and then use the Eatwell plate to see if they are eating a healthy and balanced diet.

• Evaluatethesatisfactionoftheparticipantswithregardstothe present session.

CONTRACT

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Attachment 1:

www.livingwellwithcopd.com

Would you like your weight or Body Mass Index (BMI) checked today?

Ask a member of the pulmonary rehabilitation team.

Maintain a healthy body weight

BMI Weight Category

>31

26-30

20-25

<19

Obese

Overweight

Normal range

Underweight

Body mass index (BMI) =


Adapted from the “Living Well with COPD” program (2nd edition), Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland – 2011.12



Attachment 2:

Healthy Eating


• EatinghealthyisimportantforCOPD.Itprovidesyourbodywithenergytodoyournormaldailyactivitiesandhelpspreventinfections.Italsoimprovesyourgeneralwell-being.

• Varyyourdietandeatfoodfromeachofthebasicfoodgroups.Trytoeat:– Plentyofvegetablesandfruit.Trytoeatatleastfiveportionseveryday.– Plentyofpotatoes,bread,rice,pastaandotherstarchyfoods.Choose

wholegrainvarieties.– Somemilkanddairyfoods– Somemeat,fish,eggs,beansandothernon-dairysourcesofprotein– Onlyaverysmallamountoffoodsanddrinkshighinfatand/orsugar.– Trytochooseoptionsthatarelowerinsaltwhenyoucan.

• Therearestrategiesyoucanusetogetthemostofeverymeal:– Eatsixsmallermealsratherthanthreelargemeals.– Eatslowlyandchewfoodwell.– Sitdownwhenpreparingandeatingmeals– Gethelppreparingmeals.

• Pleasespeaktoamemberofthepulmonaryrehabilitationteamifyou:– areworriedaboutyourweight– havehadsuddenweightloss– havedifficultypreparingoreatingmeals– aretakinglong-termsteroids

Key Messages

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Attachment 3:

A healthy diet is a matter of balance and variety

What are you currently eating?

Breakfast

Snack

Lunch

Snack

Dinner

Snack

http://www.food.gov.uk

ACKNOWLEDGEMENTSLiving Well with COPD was developed in coordination with

health professional educators on COPD and patients with COPD.Adaptation from the “Living Well with COPD” program (2nd edition),

Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland – December 2011

Participating Institutions

University of Ulster, Northern Ireland

Belfast Health and Social Care Trust, Northern IrelandMontreal Chest Institute, McGill University Health Center, Canada

Belfast Health andSocial Care Trust

Public HealthAgency


Authors:

Northern Ireland: B.O’Neill,PhD,BSc,MCSP•D.Cosgrove,PhD,BSc,MCSP•

J.MacMahon,FRCP•J.M.Bradley,PhD,BSc,MCSP

Canada: M.Lebel,RN,BSc•M.Sedeno,BEng,MM•D.Nault,RN,MSc•

J. Bourbeau, MD, MSc, FRCPCThe Living Well with COPD programme for pulmonary rehabilitation has been endorsed by:

The Association of Chartered Physiotherapists in Respiratory Care

The Northern Ireland Regional Respiratory Forum

health professional manual - lwwcopd...cue card: maintain a healthy body weight additional resources...

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