Ch 10 ppt

CHAPTER 10

Community Nutrition:

Promoting Healthy Eating

Eleanor D. Schlenker

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Implementing Nutrition Education

Framework for Wellness

• World Health Organization definition

includes physical, emotional, social,

environmental, and spiritual wellness

• Center for Disease Control and Prevention

concept of “Healthy Days”

• Art and science of helping individuals and

families make positive lifestyle changes to

improve nutrition and well-being



– Cont’d

Framework for Nutrition Education

Nutrition education

Often involves group education

School class, group weight loss program, etc.

Nutrition counseling

Prevention or treatment of a disease condition

Often involves medical nutrition therapy

Health care facility, outpatient clinic, public health

program, school programs

Usually one-on-one with the counselor and

individual or family



– Cont’d

Person-Centered Goals

Family counseling must be person-centered

Nutrition counselors have three main goals: 1. To obtain information about the individual or

family as related to nutrition and health needs

2. To provide the knowledge and practical skills to help meet those needs

3. To support the individual or family with encouragement, caring, reinforcement, and referral


Model for Nutrition Counseling

Getting started

Build a relationship

Create a positive climate

Develop constructive attitudes

Counseling as a process

Establish the need

Set the goal

Determine the information or resources required

Plan a course of action

Evaluate progress and readjust


Model for Nutrition Counseling –

Cont’d

Short-term versus long-term goals

Cost and insurance reimbursement often limit

intervention

Interpersonal communication skills

Appropriate language

Information that is easy to remember

Examples applicable to the listener



Cont’d

Communication as a process

Sender

Receiver

Message

Possible interference



Cont’d

Theories for behavior change

Health belief model

Self-efficacy model

Stages of change


Learning and Behavior

Learning is ultimately measured by a change in

behavior

Three basic laws of learning

1. Learning is personal in response to individual need

2. Learning is developmental and builds on prior

knowledge and experience

3. Learning brings change


Learning and Behavior – Cont’d

Individuality

Motivation

We retain what we think we need

Hands-on application

Point of contact

Learning begins at the point of contact between

prior experience and knowledge and new

concepts being presented

Build on clients’ needs and goals


Learning and Behavior – Cont’d

American Dietetic Association’s four nutrition

principles for helping individuals improve

their diets: 1. Total diet, not one meal or one food

2. All foods fit into a healthy diet in appropriate

amounts

3. Balance, variety and moderation

4. Positive approach to food


The Ecology of Malnutrition

The Food Environment and Malnutrition

Our food habits are linked to our environment

Ecology comes from the Greek word oikos, which

means “house”

Malnutrition is more common among limited

resource families


The Ecology of Malnutrition –

Cont’d

Worldwide prevalence of malnutrition

Global unequal distribution of food

1/5 world population is chronically undernourished

More than half of child deaths worldwide are

associated with malnutrition

Iron deficiency in women and vitamin A deficiency

in young children

Problems in food and income distribution rather

than lack of available food



Cont’d

Worldwide prevalence of malnutrition – cont’d

Almost 12% of U.S. households are food insecure

Food insecurity is most likely in households:

• With incomes below the federal poverty level

• Headed by single parents

• Headed by an African American or Hispanic

• Living in cities or in the southern or western regions of

the United States

Affects emotional and physical health



Cont’d

For the epidemiologist a triad of variables

influences health and disease:

Agent: a lack of food

Host: the individual—the infant, child, or adult who

has malnutrition

Environment: environmental factors such as clean

water, poor sanitation, cultural beliefs, poor

agricultural potential, agricultural and government

policies, land management and erosion,

government subsidies, water distribution, and

pesticide use influence malnutrition


Problem of Poverty

Hopelessness

Acquired food may have been discarded by others

or carry the risk of foodborne illness such as

dented cans

Purchase staple foods high in kcalories and low in

cost

• Also tend to be low in micronutrients

• Limited fresh fruits and vegetables

Energy-dense foods and tendency to eat more

when food is available contribute to obesity


Problem of Poverty – Cont’d

Isolation

Powerlessness

Insecurity


Problem of Poverty – Cont’d

Role of the Health Professional

Understand individual’s situation and view of problems

Genuine helpfulness and kindness

Work with other team members

• Physician, social worker, psychologist, nurse, pharmacist,

physical therapist, and occupational therapist


Family Economic Needs

U.S. Department of Agriculture (USDA) Food

Assistance Programs

USDA food assistance programs are

designed to provide a food “safety net” for

low-income Americans

Goals of these programs are to: 1. Provide access to food

2. Promote a healthy diet

3. Implement nutrition education


Family Economic Needs – Cont’d

USDA Food Assistance Programs – Cont’d

Some food assistance programs are

entitlement programs, which means there are

specific income guidelines that determine

eligibility



Food Stamps (Supplemental Nutrition

Assistance Program, SNAP)

Increases the food-buying power of low-

income families

Entitlement program

Many recipients still run out of food before the

end of the month and rely on food pantries

Also provides nutrition education to food

stamp recipients



Meal Programs

School Nutrition Program

Supervised by USDA

Nutritious lunch at moderate cost

Free or reduced-cost for low-income

families

National School Breakfast Program

Summer programs


Food Distribution Programs

Special Supplemental Nutrition Program for

Women, Infants, and Children (WIC)

Money for food and infant formula

For low-income mothers who are pregnant,

postpartum, or breast-feeding and infants and

children up to age 5 who are at nutritional risk

Low income does not guarantee participation


Programs for Older Americans

Nutrition Program for the Elderly (NPE)

Enacted under the Older Americans Act

Open to all adults age 60+

Targets those in social and economic need

Meals are served in congregate settings or home

delivered at noon, 5 days a week

Must be certified homebound to receive home-

delivered meals

Donations are encouraged


Nutrition Education Opportunities

WIC

School food programs

NPE


EFNEP / SNAP-ED

Expanded Food and Nutrition Education Program (EFNEP) For all families below the federal poverty line

Supplemental Nutrition Assistance Program-Nutrition Education Program (SNAP-ED) For families receiving food stamps

Both provide experiential lessons and hands-on opportunities to practice skills in food preparation, food safety, and food budgeting

Group classes, media methods, one-on-one instruction, and educational mailings


Social Marketing

Application of commercial marketing strategies to

social and health programs

Target specific segments of society and their

values, needs, and goals

Programs to increase fruit and vegetable servings

or physical activity, food safety messages


Food Purchasing

Food Expenditures

Influenced by size and composition of a household

Those with higher incomes purchase more

expensive foods, eat more convenience food, and

eat out more often, but spend a smaller percentage

of their income for food than those with lower

incomes


USDA Food Plans

Establish the minimum amounts of money

required to purchase food that will meet the

DRIs and Dietary Guidelines for Americans

for each age and gender group

Liberal, moderate, low, and thrifty

Thrifty plan is used to calculate the dollar

value of food stamps

Market basket for each food plan


Developing a Family Food Plan

Identify food resources and skills

Family income

Food produced or preserved in the home

Access to food assistance programs

Access to a well-stocked grocery store with

competitive prices

Time for food shopping

Skills and experience in food management—

planning, buying, preparation

Facilities to cook and store food


Developing a Family Food Plan –

Cont’d

Food needs and preferences

Family traditions

Special dietary needs

Amount and kind of entertaining

Meals away from home

Value placed on food and eating


Food Shopping

Making choices

Supermarket tours can be effective strategies for

developing decision-making skills

Develop awareness of marketing tactics that draw

attention to expensive, low-nutrient items


Food Shopping – Cont’d

Planning ahead

Plan meals for the week and then develop a

shopping list

Review food on hand and plan use of perishable

items to avoid waste

Check local newspapers or store flyers for

specials

A shopping list can help avoid impulse buying and

extra shopping trips

Avoid shopping when hungry or rushed

Limit shopping to once a week



Buying wisely

Food product labels provide important information

about food quality, quantity, and safety

Comparing one food product with another helps

consumers get the best value for their food dollar



Buying wisely – cont’d

Unit pricing

Open dating

Package weight or volume

List of ingredients

Convenience foods



Storing food safely

Conserve food using covered containers or

sealable bags

Keep open packages at the front of the shelf

Labels provide directions for preventing spoilage

and contamination



Cooking food well

Preparation and cooking methods for fruits and

vegetables that retain vitamins and minerals

Thorough cooking and time-sensitive storage of

protein foods to prevent foodborne illness

Use of herbs and spices rather than salt

Cutting down on added sugar and fat

Using broiling, grilling, and baking rather than

frying

Planning menus for appealing and healthful meals


MyPyramid Food Plan

Consider each food group

Vegetables and fruits provide vitamins, minerals,

phytochemicals, and fiber

• Variety

• Fresh versus frozen

• Home gardening


MyPyramid Food Plan – Cont’d

Consider each food group – cont’d

Grain foods provide complex carbohydrates,

important vitamins and minerals

• Whole grains are rich in fiber and trace minerals

• At least three daily servings should be whole grains

Meat, fish, poultry, and eggs are complete

proteins and contain B complex vitamins and trace

minerals

• Eggs are inexpensive high-quality protein

• Fish adds n-3 fatty acids

• Trim visible fat and skin from meat and poultry




Dried beans and peas and nuts are good sources

of amino acids

• Combine with other plant proteins or animal foods

• Legumes are low in fat, high in fiber and resistant starch

• Soy protein and soybeans

Dairy foods provide protein and calcium and most

milk and yogurt are fortified with vitamin D

• Low-fat dairy foods are lower in kcalories and saturated

fat




Fat and oils supply essential fatty acids

• Polyunsaturated and monounsaturated oils are best

• Hydrogenated fats often include trans fatty acids

• Read nutrition labels carefully

• Limit butter, high in saturated fat and a source of

cholesterol


Food Shopping Locations

Supermarkets and supercenters

Carry a wide variety of fresh and processed foods at

reasonable prices

Farmers’ markets

Local produce is directly available to consumers at

prices that are often lower than those at supermarkets

Consumer cooperatives

Offer high-quality foods at the lowest possible price;

often expect some volunteer time from members


Sources of Groceries

Food discount stores

Stock fresh and processed foods, paper goods,

and cleaning supplies at discount prices

Food banks

Warehouses that collect and store donations of

food from supermarkets, food processors, food

distributors, and growers and make them available

at no cost to low-income and destitute families

Health & Medicine

Ch 10 ppt