Slides current until 2008

Dietary education
Dietary education
Curriculum Module III-5
Slide 2 of 47

Slides current until 2008
Why educate?

People with diabetes need to
develop the appropriate skills,
decision-making and self-care
strategies to maintain good health
Ongoing practical learning,
behaviour-change strategies and
motivation are the keys
Theoretical information alone is not
enough
Dietary education
Curriculum Module III-5
Slide 3 of 47

Slides current until 2008
Approach to meal planning
A uniform approach to meal
planning does not work for
everyone
A flexible plan or a variety of
approaches is required to deal
with differing needs


Dietary education
Curriculum Module III-5
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Slides current until 2008
Before deciding on an approach to
meal planning it is necessary to:
Understand the person with
diabetes, their background and
preferences
Be aware of their willingness to
learn and readiness to change


Approach to meal planning
Dietary education
Curriculum Module III-5
Slide 5 of 47

Slides current until 2008
Meal planning
Before deciding on the content of meal
plans, consider:
Previous experience, knowledge and
skills
Current clinical, psychological and
dietary status
Appropriate clinical and nutritional
goals
Lifestyle factors

Dietary education
Curriculum Module III-5
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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
Dietary education
Curriculum Module III-5
Slide 7 of 47

Slides current until 2008
Dietary education: strategies
Stage 2
Food exchange system
Carbohydrate counting
Glycaemic Index

Dietary education
Curriculum Module III-5
Slide 8 of 47
ACTIVITY

Slides current until 2008
Give examples of education
methods in your culture and
practice.
Dietary education
Curriculum Module III-5
Slide 9 of 47

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Healthy eating

Australian food guide
Dietary education
Curriculum Module III-5
Slide 10 of 47

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Healthy eating

Grain
products
Vegetables
and fruits
Milk
products
Meat and
alternatives
Canadian
Food Guide
Health Canada, 1997 Reproduced with permission of the Minister of
Public Works and Government Services Canada 2004
Dietary education
Curriculum Module III-5
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Slides current until 2008
Balance of good health

Bread, cereals and potatoes
Milk and dairy products
Foods rich in sugars and fat
Meat, fish and
protein alternatives
Fruits and vegetables
Reproduced with kind permission of the Food Standards Agency
UK food guide
Dietary education
Curriculum Module III-5
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Slides current until 2008
Food pyramid
Bread, rice, wheat, potato, pasta,
couscous, polenta, corn, sorghum
Fruit Vegetables
Meat,
fish,
egg,
cheese
Milk,
yoghurt,
dairy
products
Fats,
oils,
sweets,
confectionery
Dietary education
Curriculum Module III-5
Slide 13 of 47
ACTIVITY

Slides current until 2008
Food pyramid
Develop a food pyramid
including appropriate food
from your country
Dietary education
Curriculum Module III-5
Slide 14 of 47

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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 Diabetes
Research Centre, Chennai, India
Food pyramid
Dietary education
Curriculum Module III-5
Slide 15 of 47

Slides current until 2008
Diabetes food pyramid
American
Diabetes
Association
Dietary education
Curriculum Module III-5
Slide 16 of 47

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Diabetes food pyramid
Cereals, whole
grains and starch:
6-11 servings
Fruits: 1-
2 servings
Vegetables:
3-4 servings
Low fat milk and milk
products: 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
Dietary education
Curriculum Module III-5
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Slides current until 2008
Signal system
The signal system is based on a traffic lights
concept:
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 content
Green foods (healthy choice)
low glycaemic index
high fibre content
low in fat
Kapur K et al 2004
Dietary education
Curriculum Module III-5
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Healthy versus unhealthy food
choices?
Food groups Green zone Yellow zone Red zone
Rice Steamed rice Pulao Fried rice/biryani
Bread Whole wheat
bread
White bread Croissants and
cakes
Noodles Steamed
noodles
Deep fried noodles
Indian
breads
Chappati Naan Butter naan/puri
Potatoes Baked potato French fries
Vegetables Steamed
vegetable
Sauteed
vegetable
Deep fried
vegetable
Salad Green salad Salad with
mayonnaise
Sauce Tomato based Cream based
Fish Steamed fish Fish curry Fried fish
Chicken Grilled chicken Pan fried Butter chicken
Dietary education
Curriculum Module III-5
Slide 19 of 47
ACTIVITY

Slides current until 2008
Green Yellow Red
Cereals
Bread
Chicken
Fish
Vegetables
Dessert
Dietary education
Curriculum Module III-5
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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


Dietary education
Curriculum Module III-5
Slide 21 of 47

Slides current until 2008
Zimbabwe hand jive
Carbohydrates (starch and
fruit): choose an amount
equivalent to the size of two
fists. For fruit use one fist.
Protein: choose an amount
equivalent to the size of
the palm of your hand and
the thickness of your little
finger
Reprinted with permission from Can J Diabetes 2003; 27(suppl 2): S130
Dietary education
Curriculum Module III-5
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Zimbabwe hand jive
Vegetables: choose as much
as you can hold in both
hands. These should be low
carbohydrate vegetables
green or yellow beans,
cabbage or lettuce.
Fat: limit fat to an amount
the size of the tip of your
thumb. Drink no more than
250 ml of low-fat milk with a
meal

Reprinted with permission from Can J Diabetes. 2003;27(suppl 2):S130
Dietary education
Curriculum Module III-5
Slide 23 of 47

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Plate model
Vegetable
Milk/yoghurt
Fruit
Vegetable
Protein
Starch/cereal
Dietary education
Curriculum Module III-5
Slide 24 of 47
ACTIVITY

Slides current until 2008
Draw on a paper plate either:
The recommended proportions of
foods from your region
The proportions of what you ate
last night
Dietary education
Curriculum Module III-5
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Plate model
Useful as a first-stage teaching tool for
people who:
Have recently been diagnosed
Want a simple plan or find it difficult to
implement other advanced plans
Have difficulty reading or dealing with
numbers
Learn better by visualizing
Eat out frequently
Want to reduce the amount of proteins
or carbohydrates they ingest
Dietary education
Curriculum Module III-5
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Slides current until 2008
The plate model, the Zimbabwe
hand jive and the signal system
are simple ways to offer dietary
advice.
Educational tools summary
Dietary education
Curriculum Module III-5
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What to teach and when?
Level 1
Basic information about
nutrition
Nutrient requirements
Healthy eating guidelines
Making healthy food choices
Self-management training and
use of educational tools
Dietary education
Curriculum Module III-5
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Slides current until 2008
Level 2
How to prepare a structured
meal plan
counting carbs, food
exchanges, glycaemic index
How to deal with special
situations
Complications

What to teach and when?
Dietary education
Curriculum Module III-5
Slide 29 of 47

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Evaluation
Individual or personal outcomes
Process outcomes

Dietary education
Curriculum Module III-5
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Fad diets
Promise easy, painless weight loss
Exploit peoples vulnerable
psychological state
Place severe restrictions on some
foods
Claim that counting calories is not
important
Work in the short term low in
calories
Roberts DC, Med J Aust. 2001
Dietary education
Curriculum Module III-5
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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-protein
diets (zone diet)
South Beach diet
Fad diets
Dietary education
Curriculum Module III-5
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Slides current until 2008
Fad diets
Low-carbohydrate diets tend to
produce:
Greater initial weight loss
Improvements in lipid markers
Improved insulin sensitivity
But:
No evidence of sustained results
in the long term
No long-term data on safety

Dietary education
Curriculum Module III-5
Slide 33 of 47

Slides current until 2008
Dietary myths: good and bad
foods for people with diabetes
The bad foods
fruits, especially
bananas
sugar
artificial
sweeteners
rice
carrots, plantain,
potatoes, sweet
potatoes

The good foods
vegetarian food
molasses, honey
three meals and
snacks
bread, wheat
fasting

Dietary education
Curriculum Module III-5
Slide 34 of 47
ACTIVITY

Slides current until 2008
Dietary myths
What are the dietary myths in
your region?
How would you approach the
person who has incorrect beliefs
about certain foods?

Dietary education
Curriculum Module III-5
Slide 35 of 47

Slides current until 2008
Eating out
Problems eating out:
Large amounts of fat used in
cooking
Unhealthy cooking methods (frying)
Large portion sizes
Rich dressings on salad
Rich in salt
Lack of healthy choices




Dietary education
Curriculum Module III-5
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Slides current until 2008
Some healthy strategies:
Be selective
Avoid buffets
Understand portion sizes
If possible make special request
Ask for fruit desserts or eat half
the quantity

Eating out
Dietary education
Curriculum Module III-5
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Choose foods which are:
Steamed
Broiled
Baked
Roasted
Poached
Lightly sauteed or stir-fried

Eating out
Dietary education
Curriculum Module III-5
Slide 38 of 47

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More clinical trials are necessary
to evaluate the dietary education
tools described in this module.
Dietary education
Curriculum Module III-5
Slide 39 of 47

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Helping others is good, teaching
them to help themselves is
better.
George Orwell

Dietary education
Curriculum Module III-5
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Review question
1. Which food is at the base of the
food pyramid?
a. Apple
b. Cheese
c. Spinach
d. Bread
Dietary education
Curriculum Module III-5
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2. Which food, at the top of the food
pyramid, should be taken in restricted
amounts?
a. Chocolates
b. Carrots
c. Grilled fish
d. Yoghurt


Review question
Dietary education
Curriculum Module III-5
Slide 42 of 47

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3. In a plate model, half the plate should
be filled with which food?
a. Fruit
b. Vegetables
c. Milk
d. Grains/cereals

Review question
Dietary education
Curriculum Module III-5
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4. Which of the following is the
healthiest option?
a. Steamed fish
b. Fried fish
c. Butter chicken
d. Chocolate cake

Review question
Dietary education
Curriculum Module III-5
Slide 44 of 47

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5. Are the following statements true or
false?
a. Non-vegetarian food is not good for
people with diabetes
b. Banana is not good for people with
diabetes
c. The amount we eat is important to
control diabetes
d. Sweets are good for your health

Review question
Dietary education
Curriculum Module III-5
Slide 45 of 47

Slides current until 2008
Answers
1. d
2. a
3. b
4. a
5. A=T; b=F; c=T; d=F






Dietary education
Curriculum Module III-5
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References
1. The Australian Guide to Healthy eating. Australian Government Department of
Health 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.balanceofgoodheal
th.pdf
4. ADA Food Pyramid (cited 2004 Nov 14) (1 page). Available from
www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp
5. Kapur K, et al. Making Healthy Food Choices, Novo Nordisk Education
Foundation, 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 from
www.diabetes.ca/Files/Glycaemic%20Index%20Presentation.pdf

Dietary education
Curriculum Module III-5
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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). Available
from www.novonordisk.co.in/otherint/Nina1/pyramid.asp?pageval=3
11. Franz M, Montz A, Bergenstal R, et al. Outcomes and Cost effectiveness of Medical
Nutrition Therapy for non-insulin dependent diabetes mellitus. Diabetes Spectrum
1996; (2): 122-7.
12. Powers MA. Medical Nutrition Therapy for Diabetes, Handbook of Diabetes Medical
Nutrition Therapy, Aspen Publication 1996.


References