passport to health booklet - university of hawaii · passport to health booklet. ... my plan is to...

Instructions for printing thePassport to Health booklet.

The Passport to Health Booklet yields two bookletsper 8.5” x 11” page; when cut widthwise.

Please note that the COVER pages are to beprinted back-to-back, tops aligned, on a heaviergauge paper (card stock).(suggestion: Hammermill 80# Cover Cream or IVORY)

The INSIDE pages are to be printed on bondweight paper. ODD pages should be printedback-to-back with EVEN pages; with tops aligned.(suggestion: Color Laser or Color Copy #20 or #24)

• go to File>Page Setup• in the pull-down menu for Page Scaling

select None• be sure that there is a “ ” in the box

next to Auto Rotate and Center• be sure that your paper is oriented to Portrait

If you would rather have the booklets printed,collated, cut and bound for you, there is an order formon the next page.

Instructionsfor orderingPassport to HealthBooklets:This is a fillable PDF form.Print and fax completed order form to Tom Terrific’s.

Tom Terrific’s already has the electronic files andinstructions for printing. Each booklet will costapproximately $2.00 plus 4.712% tax.

Please make your own arrangementsto pick-up and pay for your orders.All orders will be C.O.D.Allow 3 to 4 days for order completion.

Vendor: Tom Terrific’s2961 E. Manoa RoadSuite DHonolulu, HI 96822

Attn: Carolyn Borges

Email: [email protected]: 988-1556Fax: 988-1937

Fax No.:

Fax To: Tom Terrific’sAttn: Carolyn Borges

Email: [email protected]: 988-1937

Ordered By:

Phone No.:

Please email when the booklets are finished.

Number of Booklets Needed:

Date Needed By:

Please call when the booklets are finished.

Name of Organization:

Email Address:

ORDER FORM

PILI Lifestyle ProgramPassport to Health

Member Information

Name:

Address:

Phone:

Date Enrolled:

Photo

Member Information

Name:

Address:

Phone:

Date Enrolled:

Photo

• The PILI Lifestyle Program is a 3-month weight loss programfollowed by a 6 month weight maintenance follow-upprogram specifically designed for Native Hawaiians, Samoans,Filipinos, and Chuukese.

• The first phase of the program will focus onmaking lifestyle changes around eating healthy andbeing more physically active.

• The follow up program will focus on ways to maintainyour weight loss and continue your progress.

• The PILI Lifestyle Program consists of 8 lessonswhich will be given over 3 months.

• You will meet as a group once a week for the first 4 weeksand then once every other week for the remaining 8 weeks.

• After finishing the 8 lessons inthe PILI Lifestyle Programyou will continue to follow upwith us once a monthfor 6 months.

What is the PILI Lifestyle Program?

1

Notes

32

Notes

32

• The PILI Lifestyle Program is a 3-month weight loss programfollowed by a 6 month weight maintenance follow-upprogram specifically designed for Native Hawaiians, Samoans,Filipinos, and Chuukese.

• The first phase of the program will focus onmaking lifestyle changes around eating healthy andbeing more physically active.

• The follow up program will focus on ways to maintainyour weight loss and continue your progress.

• The PILI Lifestyle Program consists of 8 lessonswhich will be given over 3 months.

• You will meet as a group once a week for the first 4 weeksand then once every other week for the remaining 8 weeks.

• After finishing the 8 lessons inthe PILI Lifestyle Programyou will continue to follow upwith us once a monthfor 6 months.

What is the PILI Lifestyle Program?

1

PILI Lifestyle Lesson Schedule

Date:

Topic:

Lesson 1

Date:

Topic:

Lesson 2

Date:

Topic:

Lesson 3

Date:

Topic:

Lesson 4

2


Date:

Topic:

Lesson 1

Date:

Topic:

Lesson 2

Date:

Topic:

Lesson 3

Date:

Topic:

Lesson 4

2

Stress Reduction Tips

Take breaks during the dayeven if only for 10 minutes;

to clear your headand to catch your breath.

Rise earlyReserve an hour before

the family wakesto get organized for the day.

Set aside timeto do physical activities.

Learn to say ”No”to tasks that

you cannot do.

Give yourselfpermission to be

Share your workloadwith family and coworkers.

Don’t take ontoo much at once.

Develop a forgivingattitude. Relax with some music.

31

Stress Reduction Tips

Take breaks during the dayeven if only for 10 minutes;

to clear your headand to catch your breath.

Rise earlyReserve an hour before

the family wakesto get organized for the day.

Set aside timeto do physical activities.

Learn to say ”No”to tasks that

you cannot do.

Give yourselfpermission to be

Share your workloadwith family and coworkers.

Don’t take ontoo much at once.

Develop a forgivingattitude. Relax with some music.

31

Healthy Exercise Habits

Use the stairsinstead of escalators

or elevatorsespecially if you have

to walk out of your wayto find the stairs.

Healthy Exercise Habits

Park your car atthe end of

the parking lotand walk

to the entrance of themall or grocery store.

Walk or ride your bikeinstead of driving

for short distances;like to the store or clinic.

Take awalkwith

a friend.

Do chores such asyard work or house work.

Exercise with familygo for routine family walks

or bike rides in yourneighborhood or local park.

30


Date:

Topic:

Lesson 5

Date:

Topic:

Lesson 6

Date:

Topic:

Lesson 7

Date:

Topic:

Lesson 8

3


Date:

Topic:

Lesson 5

Date:

Topic:

Lesson 6

Date:

Topic:

Lesson 7

Date:

Topic:

Lesson 8

3

Use the stairsinstead of escalators

or elevatorsespecially if you have

to walk out of your wayto find the stairs.

Park your car atthe end of

the parking lotand walk

to the entrance of themall or grocery store.

Walk or ride your bikeinstead of driving

for short distances;like to the store or clinic.

Take awalkwith

a friend.

Do chores such asyard work or house work.

Exercise with familygo for routine family walks

or bike rides in yourneighborhood or local park.

30

PILI Lifestyle Program VISA

Lesson 1 Lesson 2

Lesson 3 Lesson 4

4


Lesson 1 Lesson 2

Lesson 3 Lesson 4

4

Ask questions whenordering your food

to get morespecific informationabout menu items.

Tips for Eating Out

Choose a green saladwith light dressing

instead of macaroni salad.

Choose a mini plate lunchor eat half of a

regular plate lunchand save the other half

for another meal.

Plan aheadBalance a larger,

high fat meal by choosinglow-fat foods

for the rest of the day’smeals and snacks.

Choosefresh fruit

fordessert.

Choose raw, steamed,stir-fried, boiled,

or baked vegetablesinstead of creamed,

scalloped, au gratin, friedor with butter or sauces.

Choose entrees thathave not been fried

such as beef broccoli,shoyu or garlic chicken,beef stew, or teri beef,

instead of fried items likechicken katsu or fried fish.

29

Ask questions whenordering your food

to get morespecific informationabout menu items.

Tips for Eating Out

Choose a green saladwith light dressing

instead of macaroni salad.

Choose a mini plate lunchor eat half of a

regular plate lunchand save the other half

for another meal.

Plan aheadBalance a larger,

high fat meal by choosinglow-fat foods

for the rest of the day’smeals and snacks.

Choosefresh fruit

fordessert.

Choose raw, steamed,stir-fried, boiled,

or baked vegetablesinstead of creamed,

scalloped, au gratin, friedor with butter or sauces.

Choose entrees thathave not been fried

such as beef broccoli,shoyu or garlic chicken,beef stew, or teri beef,

instead of fried items likechicken katsu or fried fish.

29


Lesson 5 Lesson 6

Lesson 7 Lesson 8

5


Lesson 5 Lesson 6

Lesson 7 Lesson 8

5

Tips for Healthier Eating

Instead of Try this:

Fried FoodsCook by baking, steaming,boiling, grilling, broiling, or

microwaving foods

Smoked, cured,salted, or canned

meat, poultry and fish

Unsalted fresh orfrozen meat,

poultry, and fish

White bread, rice,or cereals made of

white flour

100% whole wheat bread,brown rice, and

whole grain cereals

Whole MilkDrink 2%, 1%, or skim milk

for everyoneover 2 years of age

Regular Cheese Eat low fat or non-fat cheese

Butter or stick MargarineUse soft low fat or

non-fat butter or margarine,including tub margarine

Potato chips,corn chips, orcheese chips

Eat pretzels,low fat popcorn,or baked chips

28

Tips for Healthier Eating

Instead of Try this:

Fried FoodsCook by baking, steaming,boiling, grilling, broiling, or

microwaving foods

Smoked, cured,salted, or canned

meat, poultry and fish

Unsalted fresh orfrozen meat,

poultry, and fish

White bread, rice,or cereals made of

white flour

100% whole wheat bread,brown rice, and

whole grain cereals

Whole MilkDrink 2%, 1%, or skim milk

for everyoneover 2 years of age

Regular Cheese Eat low fat or non-fat cheese

Butter or stick MargarineUse soft low fat or

non-fat butter or margarine,including tub margarine

Potato chips,corn chips, orcheese chips

Eat pretzels,low fat popcorn,or baked chips

28

1. When making changes rememberthe 5 key things . . .

• Be Realistic

• Be Flexible

• Be Specific

• Keep it Doable

• Make it Enjoyable

2. Stay on track by . . .

• Keeping your thoughts positive

• Learn from what happened

• Regain control as soon as you can

• Talk with your support person

• Focus on the positive changes

PILI Lifestyle Goals: Lesson 1.

6

1. When making changes rememberthe 5 key things . . .

• Be Realistic

• Be Flexible

• Be Specific

• Keep it Doable

• Make it Enjoyable

2. Stay on track by . . .

• Keeping your thoughts positive

• Learn from what happened

• Regain control as soon as you can

• Talk with your support person

• Focus on the positive changes


6

Practice the Plate Method

levelamount ofstarches

levelamount of

meats

right amountof fruits andvegetables

27

Practice the Plate Method

levelamount ofstarches

levelamount of

meats

right amountof fruits andvegetables

27

The person I will turn to for support is . . .

I will handle the roadblocks by . . .

What are the things that might get in the way?The roadblocks that might come up are . . .

Set a start date within the next week.I will do it starting on . . .

What is the first thing you need to do to make it happen?I will need to . . .

Which of the strategies we just talked about can you use?I plan to keep on track by . . .

What small eating or activity change do you plan to make?My plan is to . . .

Change? It’s No Big Thing.Lesson 1 Action Plan

7

The person I will turn to for support is . . .

I will handle the roadblocks by . . .

What are the things that might get in the way?The roadblocks that might come up are . . .

Set a start date within the next week.I will do it starting on . . .

What is the first thing you need to do to make it happen?I will need to . . .

Which of the strategies we just talked about can you use?I plan to keep on track by . . .

What small eating or activity change do you plan to make?My plan is to . . .

Change? It’s No Big Thing.Lesson 1 Action Plan

7

Healthy Eating Habits

Choose beans, tofu, fish,or white meat

(chicken or turkey without skin)more than red meat

(pork or beef).

Use oil, mayonnaise,butter, and margarine

sparingly

Drink lots of waterevery day

Drink water morethan soda,

sweetened juice,and caffeinated drinks.

Find healthy alternativesfor between-meal snacks:• fruits & vegetables• graham crackers instead

of cookies• low fat popcorn or pretzels

instead of chips

Don’t deprive yourselfof something you are craving.

It is better to eatsomething unhealthyin moderation than toskip it and binge later.

Do not skip mealsMake sure

you are eating three balanced,healthy meals each day.

Practice portion controleven with fat-free

or diet foods.

Eat healthy fast foodEven fast food placeshave healthy options.Read a nutrition chart,

if available.

Practicethe plate method

at each meal

26

Healthy Eating Habits

Choose beans, tofu, fish,or white meat

(chicken or turkey without skin)more than red meat

(pork or beef).

Use oil, mayonnaise,butter, and margarine

sparingly

Drink lots of waterevery day

Drink water morethan soda,

sweetened juice,and caffeinated drinks.

Find healthy alternativesfor between-meal snacks:• fruits & vegetables• graham crackers instead

of cookies• low fat popcorn or pretzels

instead of chips

Don’t deprive yourselfof something you are craving.

It is better to eatsomething unhealthyin moderation than toskip it and binge later.

Do not skip mealsMake sure

you are eating three balanced,healthy meals each day.

Practice portion controleven with fat-free

or diet foods.

Eat healthy fast foodEven fast food placeshave healthy options.Read a nutrition chart,

if available.

Practicethe plate method

at each meal

26

Lesson 8 Action PlanWrapping It Up!

1. What strategy can I use to deal with mynegative emotions?

1. Becoming more active by . . .

• Setting aside one block of time (20-30 minutes)each day to be active

• Looking for free time (10-15 minutes) during the day

2. Eating less fat by . . .

• Eating high fat foods less often

• Eating smaller amounts of high fat foods

• Eating lower fat foods instead


8

1. Becoming more active by . . .

• Setting aside one block of time (20-30 minutes)each day to be active

• Looking for free time (10-15 minutes) during the day

2. Eating less fat by . . .

• Eating high fat foods less often

• Eating smaller amounts of high fat foods

• Eating lower fat foods instead


8

25

Lesson 8 Action Plan

25

Congratulations!You have completed

all 8 lessons of the PILI Lifestyle Program!

You will now be enrolled in either the

PILI ’Ohana Programor

PILI Lifestyle Program

A notice will be sent to youin the mail, that will tell you

which program you will participate infor the next 6 months.

Mahalo!A hui hou!

1. What strategy can I use to deal with mynegative emotions?

Congratulations!You have completed

all 8 lessons of the PILI Lifestyle Program!

You will now be enrolled in either the

PILI ’Ohana Programor

PILI Lifestyle Program

A notice will be sent to youin the mail, that will tell you

which program you will participate infor the next 6 months.

Mahalo!A hui hou!

Getting Started.Lesson 2 Action Plan

To prepare for next week’s topic, think about three activitiesthat you might want to use to replace inactive times.

You can write your three activities here:

1.

2.

3.

Eat this item less often

Eat a smaller portion

Eat a lower-fat food insteadSubstitute:




1.

List Your Top 3High Fat Foods

Ways to Eat Less Fat(check one)

2.

3.





24


24

9

Getting Started.Lesson 2 Action Plan

To prepare for next week’s topic, think about three activitiesthat you might want to use to replace inactive times.

You can write your three activities here:

1.

2.

3.







1.

List Your Top 3High Fat Foods

Ways to Eat Less Fat(check one)

2.

3.




9

1. Get rid of negative thoughts by . . .

• Stopping negative thoughtsand talking back withpositive thoughts

2. Manage negative emotions by . . .

• Talking about your feelings with someone

• Asking ’ohana or friends for support

• Taking more control over your life

• Being active on a regular basis

• Finding new things to do

• Getting outside every day

1. Get rid of negative thoughts by . . .

• Stopping negative thoughtsand talking back withpositive thoughts

2. Manage negative emotions by . . .

• Talking about your feelings with someone

• Asking ’ohana or friends for support

• Taking more control over your life

• Being active on a regular basis

• Finding new things to do

• Getting outside every day

4. How will you practice using this option that you choseto deal better with your problem or barrier?

1. Continue to lower fat in our eating by . . .

• Eating less of the bad fat

• Choosing lower fat foods,such as lean meatsand skinless chicken

• Preparing foods at homein less fat ways,such as broiling orbaking instead of frying

• Finding hidden fatsin the foods you eat,for example, by readingthe food labels

2. Getting the right amount of physical activity by . . .

• Doing moderate activity for 30 minutes a dayon most days of the week


10

1. Continue to lower fat in our eating by . . .

• Eating less of the bad fat

• Choosing lower fat foods,such as lean meatsand skinless chicken

• Preparing foods at homein less fat ways,such as broiling orbaking instead of frying

• Finding hidden fatsin the foods you eat,for example, by readingthe food labels

2. Getting the right amount of physical activity by . . .

• Doing moderate activity for 30 minutes a dayon most days of the week


10


23

23

Talking It Out!

1. What is the one problem or barrier that often getsin the way of you meeting your healthy lifestyle goals?

3. Which option is most likely to work best for you?

Option 1:

Option 2:

Option 3:

2. What are some of your options or ways of dealingwith your problem or barriers?

4. How will you practice using this option that you choseto deal better with your problem or barrier?

Lesson 7 Action PlanTalking It Out!

1. What is the one problem or barrier that often getsin the way of you meeting your healthy lifestyle goals?

3. Which option is most likely to work best for you?

Option 1:

Option 2:

Option 3:

2. What are some of your options or ways of dealingwith your problem or barriers?


22


22

Get Moving!Lesson 3 Action Plan

1.

What will you need to do this activity? (Equipment? Clothing? A partner?)I will need . . .

Which three activities have you chosen to replace your inactive times?My three activities are . . .1.2.3.Which one of the three would you like to start with first?I will start with . . .

I will do this activity during this inactive time . . .

I will do this activity for this long (length of time) . . .

What will you do if something gets in the way of your plan?My plan B is . . .

Where will you do this activity? Be specific.I will do this activity at . . .

Which three activities have you chosen to replace your inactive times?My three activities are . . .1.2.3.

11

Get Moving!Lesson 3 Action Plan

1.

What will you need to do this activity? (Equipment? Clothing? A partner?)I will need . . .

Which three activities have you chosen to replace your inactive times?My three activities are . . .1.2.3.Which one of the three would you like to start with first?I will start with . . .

I will do this activity during this inactive time . . .

I will do this activity for this long (length of time) . . .

What will you do if something gets in the way of your plan?My plan B is . . .

Where will you do this activity? Be specific.I will do this activity at . . .

Which three activities have you chosen to replace your inactive times?My three activities are . . .1.2.3.

11

1. Problem-Solve with . . .

• 5 Steps

• Describe the problem

• Think of options

• Choose an option

• Make an action plan

• Practice

2. Partner with your Doctor . . .

• Be prepared

• Talk it out!

• Make it happen!

1. Problem-Solve with . . .

• 5 Steps

• Describe the problem

• Think of options

• Choose an option

• Make an action plan

• Practice

2. Partner with your Doctor . . .

• Be prepared

• Talk it out!

• Make it happen!

5 Steps

5 Steps

1. Eating healthy using the 3 R’s . . .

• Eating at the Right Time

• Eating the Right Amount

• Eating the Right Foods

2. Follow the F.I.T.T. plan to strengthenyour heart muscle . . .

• Frequency

• Intensity

• Time

• Type


12

1. Eating healthy using the 3 R’s . . .

• Eating at the Right Time

• Eating the Right Amount

• Eating the Right Foods

2. Follow the F.I.T.T. plan to strengthenyour heart muscle . . .

• Frequency

• Intensity

• Time

• Type


12


21


21

Social Situation:

Day-to-Day Situation:

TriggersBarriers

Old Habit(Usual way of responding)

New Habit(New way of responding)

In the table, write down one of your most challenging socialsituations and one of your most challenging day-to-day situations.

After that, write in the your old or usual way of respondingand then write in a new way to respond to the situation.

The new ways should help you meetyour healthy lifestyle goals.

Social Situation:

Day-to-Day Situation:

TriggersBarriers

Old Habit(Usual way of responding)

New Habit(New way of responding)

In the table, write down one of your most challenging socialsituations and one of your most challenging day-to-day situations.

After that, write in the your old or usual way of respondingand then write in a new way to respond to the situation.

The new ways should help you meetyour healthy lifestyle goals.

1. Deal effectively with challenging situations by . . .

• Changing old habits to new onesto deal with triggers and barriers

2. Take charge by . . .

• Staying away from orchanging the situation

• Just saying “No” nicely

• Planning ahead

• Knowing what triggers yourunhealthy behaviors andreplacing them withhealthy behaviors

• Asking others for help


20

20

Making It Fun!Lesson 4 Action Plan

What times are right for me to eat?

What changes in my eating will I make?

BreakfastLunch

What are the right foods for me to eat?

Vegetable Group Starch Group Protein Group Dairy Group

DinnerSnack Times

What is the right amount for me to eat?Using the Plate Methodselect foods that youwould eat at a mealtime.

Chooseyour own

foods.

13

Making It Fun!Lesson 4 Action Plan

What times are right for me to eat?

What changes in my eating will I make?

BreakfastLunch

What are the right foods for me to eat?

Vegetable Group Starch Group Protein Group Dairy Group

DinnerSnack Times

What is the right amount for me to eat?Using the Plate Methodselect foods that youwould eat at a mealtime.

Chooseyour own

foods.

13


1. Deal effectively with challenging situations by . . .

• Changing old habits to new onesto deal with triggers and barriers

2. Take charge by . . .

• Staying away from orchanging the situation

• Just saying “No” nicely

• Planning ahead

• Knowing what triggers yourunhealthy behaviors andreplacing them withhealthy behaviors

• Asking others for help

Lesson 5 Action PlanKeeping It Going!

Lessons 1-4 Measurements

Date

Weight

BloodPressure

Pulse

Lesson 1 Lesson 2 Lesson 3 Lesson 4

14


Date

Weight

BloodPressure

Pulse


14

19

19

What will you need to make it happen?Eating Idea:

Physical Activity Idea:

How often will you do this?Eating Idea:


What is the one thing you can do to manage theamount of calories you are burning off?

What is the one thing you can do to manage theamount of calories going into your body?

Lesson 5 Action PlanKeeping It Going!

What will you need to make it happen?Eating Idea:


How often will you do this?Eating Idea:


What is the one thing you can do to manage theamount of calories you are burning off?

What is the one thing you can do to manage theamount of calories going into your body?

18

18


Date

Weight

BloodPressure

Pulse


15


Date

Weight

BloodPressure

Pulse


15


APPCRISP

Vegetable Group

Dairy Group

Starch Group

1. Tip the calorie balance by . . .

• Balancing what you eat with your activity

• Eating less and increasing activity(1 pound of body fat is 3,500 calories)

2. The keys to providing healthy mealson a budget are to . . .

• Plan ahead

• Stick to your shopping list

• Save eating out forspecial occasions


APPCRISP

Vegetable Group

Dairy Group

Starch Group

1. Tip the calorie balance by . . .

• Balancing what you eat with your activity

• Eating less and increasing activity(1 pound of body fat is 3,500 calories)

2. The keys to providing healthy mealson a budget are to . . .

• Plan ahead

• Stick to your shopping list

• Save eating out forspecial occasions

_ _

/ _ _

/ _ _

Enter yourstartingweight here

Write-inyour weightin pounds.

My goal weight is:

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

My Weight Chart

16 17

16 17

My Weight Chart

_ _

/ _ _

/ _ _

Enter yourstartingweight here

Write-inyour weightin pounds.

My goal weight is:

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

_ _

/ _ _

/ _ _

passport to health booklet - university of hawaii · passport to health booklet. ... my plan is to...

Documents