friend   Lesli Staton, MS,RD,CDE Dining OUT or FOE diabetes and
 
First Course AWARENESS
Once upon a time…… <ul><li>Americans only dined out  </li></ul><ul><li>for special occasions………….. </li></ul><ul><li>to ce...
Not today!!!! <ul><li>The average American eats  </li></ul><ul><li>four meals away from home each week. </li></ul><ul><li>...
Dining Out………. <ul><li>Employs 12.5 million Americans </li></ul><ul><li>Economic impact exceeds $1.3 trillion </li></ul><u...
Obesity and Diabetes,  <ul><li>Diabetes </li></ul><ul><ul><li>20 million Americans have diabetes </li></ul></ul><ul><ul><l...
Diabetes and Dining out… <ul><li>Your Health </li></ul><ul><ul><li>Blood Sugar </li></ul></ul><ul><ul><li>Weight Control <...
It’s even Therapeutic Food is Healing Food is Nourishing
Dining out can be fattening <ul><li>NIH study proves that eating at fast food restaurants more than twice per week is asso...
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data  <10%  10%–14%  ...
Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data  <10%  10%–14%  ...
(*BMI   30, or ~ 30 lbs overweight for 5’4” person) <10%  10%–14%   15%–19%  20%–24%  ≥25% (*BMI ≥30, or ~ 30 lbs overwei...
Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) <10%  10%–14%   15%–19% ...
Obesity Trends* Among U.S. Adults BRFSS, 2004 <10%  10%–14%   15%–19%  20%–24%  ≥25% (*BMI ≥30, or ~ 30 lbs overweight for...
S a n  A n t o n i o The  Alamo 2005 NBA Champs The 10 th   fattest  city in  America The Riverwalk
Dining Out <ul><li>Carbohydrates </li></ul><ul><li>Fat </li></ul><ul><li>Calories </li></ul><ul><li>Sodium </li></ul><ul><...
Portion   distortion
Portion   distortion What are we  accustomed to?
Carbs and Calories….. weight loss 1200-1500  cal/day 30-45g  carb/meal maintenance  1500-2000  cal/day 45-60g  carb/meal W...
Second Course Pitfalls
Welcome to   WHATABURGER,  may I take your order……..
WHATABURGER ……   friend   or   FOE ? Whataburger…………. Fries…………………….. Drink……………………. Calories  Carbs 705 53 265 33 Whatasi...
Whataburger. . . . . . . . . . 605 53 Grilled Chicken . . . . . . . . 495 49 Kids Meal . . . . . . . . . . . .  563   63 G...
How much insulin do I need  to‘what-a-size’ my order?
646 60g 148 13g 181 30g 171 21g 129 22g El Grande Total  2 Cheese Enchiladas . . . . . . . .  1 Crispy Beef Taco . . . . ....
Breakfast Taco 250   22g* A l a   C a r t e Grilled Chicken . . . . . . . . . . . . Spanish Rice . . . . . . . . . . . . ....
<ul><li>Lettuce Wraps </li></ul>Carbs    92g Calories 630 Orange Peel Chicken Carbs  73g Calories 1090 Changs Fried Rice G...
<ul><li>Lettuce Wraps </li></ul><ul><li>Orange Peel Chicken </li></ul><ul><li>Changs Fried Rice </li></ul><ul><li>Great Wa...
Hot and Sour Soup  56  2g Cantonese Shrimp 380 17g Buddahs Feast Vegetables 200 44g Wild Alaskan Salmon Salad 470 18g Moo ...
The   Anatomy   of   Bill Miller’s   “Sweet Tea” Recipe 1 Lipton Family Size Tea  Bag • 6 cups cold water • 1 cup hot (boi...
Third Course Healthy Dining
<ul><li>Share with a friend </li></ul><ul><li>Ask for take-home box when food is served </li></ul><ul><li>Order from child...
<ul><li>Eat every 4-6 hours </li></ul><ul><li>Know your limits (carbs and calories) </li></ul><ul><li>Make special request...
What About <ul><li>Fats have very little effect  </li></ul><ul><li>on blood sugar, but they are  </li></ul><ul><li>loaded ...
More About  FAT <ul><li>Select meats that are grilled,  </li></ul><ul><li>broiled, baked </li></ul><ul><li>Ask for steamed...
M e x i c a n <ul><li>Order ala carte rather than full dinner </li></ul><ul><li>Choose corn tortillas over flour </li></ul...
Asian <ul><li>Choose white rice over fried  </li></ul><ul><li>and limit </li></ul><ul><li>Ask kitchen to use less fat </li...
Italian <ul><li>Start with soup </li></ul><ul><li>Choose red marinara sauce  </li></ul><ul><li>over creamy alfredo sauces ...
Fast  Food <ul><li>Ask for nutrition information </li></ul><ul><li>Order kids meal </li></ul><ul><li>Avoid fries, or share...
What about Alcohol? <ul><li>High in Calories </li></ul><ul><li>Risk for Hypoglycemia </li></ul>Carb Calories Beer (12 oz) ...
Balancing Dining Out <ul><li>Rapid acting insulin – wait until  </li></ul><ul><li>meal is served before dosing </li></ul><...
<ul><li>Respect your body </li></ul><ul><li>Good nutrition is undervalued </li></ul><ul><li>Learn to identify hunger cues ...
How to get   <ul><li>Internet. ADA Website. </li></ul><ul><li>Some chain restaurants </li></ul><ul><li>have listings.  </l...
New Rule………… If your food is served on a turkey platter, it’s probably too much.
New Rule……. Don’t drink anything larger than an infant!
friend   Lesli Staton, MS,RD,CDE Diabetes Care Consultant dining OUT or FOE
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Diabetes And Dining Out Friend Or Foe

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  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • Diabetes And Dining Out Friend Or Foe

    1. 1. friend Lesli Staton, MS,RD,CDE Dining OUT or FOE diabetes and
    2. 3. First Course AWARENESS
    3. 4. Once upon a time…… <ul><li>Americans only dined out </li></ul><ul><li>for special occasions………….. </li></ul><ul><li>to celebrate a birthday, </li></ul><ul><li>Mother’s day, </li></ul><ul><li>an anniversary, </li></ul><ul><li>or a special date </li></ul>
    4. 5. Not today!!!! <ul><li>The average American eats </li></ul><ul><li>four meals away from home each week. </li></ul><ul><li>Why? </li></ul><ul><li>Fast paced life </li></ul><ul><li>Convenience </li></ul><ul><li>Lives alone </li></ul><ul><li>Does not like to cook </li></ul><ul><li>No messy cleanup </li></ul><ul><li>Socializing </li></ul><ul><li>Tastes Yummy </li></ul>
    5. 6. Dining Out………. <ul><li>Employs 12.5 million Americans </li></ul><ul><li>Economic impact exceeds $1.3 trillion </li></ul><ul><li>Avg. household expenditure for food away from home in 2004 was $2434 </li></ul><ul><li>Avg. American spends half of every food dollar on food eaten away from home </li></ul>Restaurant industry sales (Billions of current dollars*) it’s here to stay! Billions of current dollars)                                       
    6. 7. Obesity and Diabetes, <ul><li>Diabetes </li></ul><ul><ul><li>20 million Americans have diabetes </li></ul></ul><ul><ul><li>41 million Americans have pre-diabetes </li></ul></ul><ul><ul><li>Increase of 50% in 10 yrs </li></ul></ul><ul><ul><li>More than 80% type 2 </li></ul></ul><ul><ul><li>5 th leading cause of death </li></ul></ul><ul><ul><li>60% are overweight </li></ul></ul><ul><li>Obesity </li></ul><ul><ul><li>64% ( 129 million) Americans are </li></ul></ul><ul><ul><li>overweight or obese </li></ul></ul><ul><ul><li>Surpasses tobacco as the most preventable health epidemic of the </li></ul></ul><ul><ul><li>21 st century! </li></ul></ul>an epidemic here to stay, too. Diet Obesity Diabetes
    7. 8. Diabetes and Dining out… <ul><li>Your Health </li></ul><ul><ul><li>Blood Sugar </li></ul></ul><ul><ul><li>Weight Control </li></ul></ul><ul><ul><li>Cholesterol </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><li>Restaurant food is high in </li></ul><ul><li>calories, fat, carbs and sodium </li></ul><ul><li>Food is often low in </li></ul><ul><li>nutrients and fiber </li></ul><ul><li>Lacks purity </li></ul><ul><li>No food labels </li></ul>what are the concerns?
    8. 9. It’s even Therapeutic Food is Healing Food is Nourishing
    9. 10. Dining out can be fattening <ul><li>NIH study proves that eating at fast food restaurants more than twice per week is associated with more weight gain and insulin resistance in otherwise healthy young adults. </li></ul>But it doesn’t have to be……….
    10. 11. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%
    11. 12. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    12. 13. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20
    13. 14. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2000
    14. 15. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25%
    15. 16. Obesity Trends* Among U.S. Adults BRFSS, 2004 <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
    16. 17. S a n A n t o n i o The Alamo 2005 NBA Champs The 10 th fattest city in America The Riverwalk
    17. 18. Dining Out <ul><li>Carbohydrates </li></ul><ul><li>Fat </li></ul><ul><li>Calories </li></ul><ul><li>Sodium </li></ul><ul><li>Fiber </li></ul><ul><li>Insulin and Meds </li></ul><ul><li>Alcohol </li></ul><ul><li>Portions Sizes </li></ul><ul><li>No Nutrition Labels </li></ul><ul><li>Inflammation </li></ul>Dilemmas
    18. 19. Portion distortion
    19. 20. Portion distortion What are we accustomed to?
    20. 21. Carbs and Calories….. weight loss 1200-1500 cal/day 30-45g carb/meal maintenance 1500-2000 cal/day 45-60g carb/meal Women weight loss 1500 - 1800 cal/day 45 - 60g carb/meal maintenance 1800 -2400 cal/day 60 - 75g carb/meal Men How much is enough?
    21. 22. Second Course Pitfalls
    22. 23. Welcome to WHATABURGER, may I take your order……..
    23. 24. WHATABURGER …… friend or FOE ? Whataburger…………. Fries…………………….. Drink……………………. Calories Carbs 705 53 265 33 Whatasize me? 140 37 Meal total 1110 123g 1567 212g (Large fries and drink)
    24. 25. Whataburger. . . . . . . . . . 605 53 Grilled Chicken . . . . . . . . 495 49 Kids Meal . . . . . . . . . . . . 563 63 Grilled Chicken Salad . . . . 240 18 Fajita . . . . . . . . . . . . . . . 350 35 Whataburger Jr . . . . . . . . 315 29 Whatacatch. . . . . . . . . . . 495 45 Water, Tea, Diet Drink. . . 0 0* friends be Lets Calories Carbs Better choices
    25. 26. How much insulin do I need to‘what-a-size’ my order?
    26. 27. 646 60g 148 13g 181 30g 171 21g 129 22g El Grande Total 2 Cheese Enchiladas . . . . . . . . 1 Crispy Beef Taco . . . . . . . . . Spanish Rice . . . . . . . . . . . . . Refried Beans . . . . . . . . . . . . . Flour Tortilla . . . . . . . . . . . . . 1275 cal 146g Combo Dinner Friend or Foe? Calories Carbs
    27. 28. Breakfast Taco 250 22g* A l a C a r t e Grilled Chicken . . . . . . . . . . . . Spanish Rice . . . . . . . . . . . . . . Borracho Beans . . . . . . . . . . . . Corn Tortilla . . . . . . . . . . . . . . Meal Total . . . . . . . . . . . . . . Calories Carb 295 0 181 21 108 17 70 11 654 49g Crispy Beef or Chicken Taco 150 13g Beef Fajita 245 22g Chicken Fajita 200 22g Better Choices
    28. 29. <ul><li>Lettuce Wraps </li></ul>Carbs 92g Calories 630 Orange Peel Chicken Carbs 73g Calories 1090 Changs Fried Rice Great Wall of Chocolate Carbs 144g Calories 960 Carbs 325g Calories 1883
    29. 30. <ul><li>Lettuce Wraps </li></ul><ul><li>Orange Peel Chicken </li></ul><ul><li>Changs Fried Rice </li></ul><ul><li>Great Wall of Chocolate </li></ul>4563 Calories 635g Carb
    30. 31. Hot and Sour Soup 56 2g Cantonese Shrimp 380 17g Buddahs Feast Vegetables 200 44g Wild Alaskan Salmon Salad 470 18g Moo Goo Gai Pan 610 32g Chicken with Black Bean Sauce 640 31g Ginger Chicken 620 43g Shrimp with Lobster Sauce 490 21g Beef with Broccoli 760 23g* Calories Carbs Better choices
    31. 32. The Anatomy of Bill Miller’s “Sweet Tea” Recipe 1 Lipton Family Size Tea Bag • 6 cups cold water • 1 cup hot (boiling) water • 1 cup sugar • 4 cups bag (commercial) ice 32 oz Serving 92g carb 342 calories
    32. 33. Third Course Healthy Dining
    33. 34. <ul><li>Share with a friend </li></ul><ul><li>Ask for take-home box when food is served </li></ul><ul><li>Order from child or senior menu </li></ul><ul><li>Request lunch or </li></ul><ul><li>small portion </li></ul><ul><li>Order appetizer or </li></ul><ul><li>salad as an entrée </li></ul><ul><li>Order ala carte </li></ul>HEALTHY eating for Strategies Reduce Portion Sizes
    34. 35. <ul><li>Eat every 4-6 hours </li></ul><ul><li>Know your limits (carbs and calories) </li></ul><ul><li>Make special requests </li></ul>HEALTHY eating for Strategies
    35. 36. What About <ul><li>Fats have very little effect </li></ul><ul><li>on blood sugar, but they are </li></ul><ul><li>loaded with calories </li></ul><ul><li>Ask how it is prepared </li></ul><ul><li>Look for fat words like saute, </li></ul><ul><li>fried, golden, crispy, </li></ul><ul><li>pan fried, creamed, cheesy… </li></ul><ul><li>Avoid these. </li></ul>FAT?
    36. 37. More About FAT <ul><li>Select meats that are grilled, </li></ul><ul><li>broiled, baked </li></ul><ul><li>Ask for steamed or grilled vegetables </li></ul><ul><li>“ On the side” – salad dressing, sour cream margarine, gravy </li></ul><ul><li>Request low-fat salad dressing </li></ul><ul><li>Avoid heavy creams sauces </li></ul><ul><li>and gravies </li></ul><ul><li>Avoid stacking fat (ie marg, </li></ul><ul><li>cheese, sour cream) </li></ul><ul><li>Limit fried food </li></ul>
    37. 38. M e x i c a n <ul><li>Order ala carte rather than full dinner </li></ul><ul><li>Choose corn tortillas over flour </li></ul><ul><li>Select whole beans over refried </li></ul><ul><li>Limit cheese </li></ul><ul><li>Avoid chorizo, menudo, cheese enchiladas </li></ul><ul><li>Avoid tortilla chips </li></ul><ul><li>4-6 chips = 15g carb </li></ul><ul><li>Fajitas </li></ul><ul><li>Caldo </li></ul><ul><li>Chicken Tacos* </li></ul>Try
    38. 39. Asian <ul><li>Choose white rice over fried </li></ul><ul><li>and limit </li></ul><ul><li>Ask kitchen to use less fat </li></ul><ul><li>Most soups are very low in cal and carb. But, avoid the fried noodles </li></ul><ul><li>Avoid buffets </li></ul><ul><li>Avoid breaded items (GeneralTso) </li></ul><ul><li>Avoid Sweet and Sour items </li></ul><ul><li>Enjoy Sushi! </li></ul>
    39. 40. Italian <ul><li>Start with soup </li></ul><ul><li>Choose red marinara sauce </li></ul><ul><li>over creamy alfredo sauces </li></ul><ul><li>Pizza - eat less – </li></ul><ul><li>order thin crust </li></ul><ul><li>Limit bread or avoid </li></ul><ul><li>Avoid pasta entrees, </li></ul><ul><li>order pasta on the side </li></ul><ul><li>Order low-fat salad </li></ul><ul><li>dressing </li></ul>
    40. 41. Fast Food <ul><li>Ask for nutrition information </li></ul><ul><li>Order kids meal </li></ul><ul><li>Avoid fries, or share </li></ul><ul><li>Stand firm. Do not up-size </li></ul><ul><li>Choose salads with low-fat dressing </li></ul><ul><li>Avoid reg soft drinks </li></ul><ul><li>Opt for diet drinks </li></ul><ul><li>or water </li></ul>
    41. 42. What about Alcohol? <ul><li>High in Calories </li></ul><ul><li>Risk for Hypoglycemia </li></ul>Carb Calories Beer (12 oz) 10g 120 Wine (6 0z) 4-6g 140 Liquor (1 oz) -- 100 Margarita (8 oz) 320 57g Men – limit to 2 Women – limit to 1
    42. 43. Balancing Dining Out <ul><li>Rapid acting insulin – wait until </li></ul><ul><li>meal is served before dosing </li></ul><ul><li>NPH or secretagogues – timing is key </li></ul><ul><li>Allow no more than 4-6 hours between meals. If meal is delayed in kitchen, munch on crackers or carb appetizer. Then eat less carb with meal </li></ul>and Diabetes Meds
    43. 44. <ul><li>Respect your body </li></ul><ul><li>Good nutrition is undervalued </li></ul><ul><li>Learn to identify hunger cues </li></ul><ul><li>Don’t over stuff </li></ul><ul><li>Use the 80/20 plan </li></ul><ul><li>Treat yourself on special </li></ul><ul><li>occasions </li></ul><ul><li>Take it home….enjoy cooking </li></ul><ul><li>Try something new </li></ul>It’s About Health….
    44. 45. How to get <ul><li>Internet. ADA Website. </li></ul><ul><li>Some chain restaurants </li></ul><ul><li>have listings. </li></ul><ul><li>Ask at location </li></ul><ul><li>Bookstore </li></ul>Nutrition Lowdown
    45. 46. New Rule………… If your food is served on a turkey platter, it’s probably too much.
    46. 47. New Rule……. Don’t drink anything larger than an infant!
    47. 48. friend Lesli Staton, MS,RD,CDE Diabetes Care Consultant dining OUT or FOE

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