CHAPTER 10  Community Nutrition:Promoting Healthy Eating Eleanor D. Schlenker    Copyright © 2011, 2007 by Mosby, Inc., an...
Implementing Nutrition EducationFramework for Wellness   • World Health Organization definition     includes physical, emo...
Implementing Nutrition Education           – Cont’dFramework for Nutrition Education Nutrition education       Often inv...
Implementing Nutrition Education           – Cont’dPerson-Centered Goals Family counseling must be person-centered Nutri...
Model for Nutrition Counseling   Getting started     Build a relationship     Create a positive climate     Develop co...
Model for Nutrition Counseling –            Cont’d   Short-term versus long-term goals   Cost and insurance reimbursemen...
Model for Nutrition Counseling –            Cont’d   Communication as a process     Sender     Receiver     Message   ...
Model for Nutrition Counseling –            Cont’d   Theories for behavior change     Health belief model     Self-effi...
Learning and Behavior   Learning is ultimately measured by a change in    behavior   Three basic laws of learning    1. ...
Learning and Behavior – Cont’d   Individuality     Motivation     We retain what we think we need     Hands-on applica...
Learning and Behavior – Cont’d   American Dietetic Association’s four nutrition    principles for helping individuals imp...
The Ecology of Malnutrition   The Food Environment and Malnutrition     Our food habits are linked to our environment   ...
The Ecology of Malnutrition –              Cont’d   Worldwide prevalence of malnutrition     Global unequal distribution...
The Ecology of Malnutrition –              Cont’d   Worldwide prevalence of malnutrition – cont’d     Almost 12% of U.S....
The Ecology of Malnutrition –               Cont’d   For the epidemiologist a triad of variables    influences health and...
Problem of Poverty   Hopelessness     Acquired food may have been discarded by others      or carry the risk of foodborn...
Problem of Poverty – Cont’d   Isolation   Powerlessness   Insecurity             Copyright © 2011, 2007 by Mosby, Inc.,...
Problem of Poverty – Cont’d   Role of the Health Professional     Understand individual’s situation and view of problems...
Family Economic NeedsU.S. Department of Agriculture (USDA) Food  Assistance Programs USDA food assistance programs are  d...
Family Economic Needs – Cont’dUSDA Food Assistance Programs – Cont’d Some food assistance programs are  entitlement progr...
Family Economic Needs – Cont’dFood Stamps (Supplemental Nutrition  Assistance Program, SNAP) Increases the food-buying po...
Family Economic Needs – Cont’dMeal Programs School Nutrition Program   Supervised by USDA   Nutritious lunch at moderat...
Food Distribution Programs   Special Supplemental Nutrition Program for    Women, Infants, and Children (WIC)       Mone...
Programs for Older Americans   Nutrition Program for the Elderly (NPE)     Enacted under the Older Americans Act     Op...
Nutrition Education Opportunities   WIC   School food programs   NPE              Copyright © 2011, 2007 by Mosby, Inc....
EFNEP / SNAP-ED   Expanded Food and Nutrition Education    Program (EFNEP)       For all families below the federal pove...
Social Marketing   Application of commercial marketing strategies to    social and health programs   Target specific seg...
Food PurchasingFood Expenditures Influenced by size and composition of a household Those with higher incomes purchase mo...
USDA Food Plans   Establish the minimum amounts of money    required to purchase food that will meet the    DRIs and Diet...
Developing a Family Food Plan   Identify food resources and skills     Family income     Food produced or preserved in ...
Developing a Family Food Plan –            Cont’d   Food needs and preferences     Family traditions     Special dietar...
Food Shopping   Making choices       Supermarket tours can be effective strategies for        developing decision-making...
Food Shopping – Cont’d   Planning ahead     Plan meals for the week and then develop a      shopping list     Review fo...
Food Shopping – Cont’d   Buying wisely       Food product labels provide important information        about food quality...
Food Shopping – Cont’d   Buying wisely – cont’d     Unit pricing     Open dating     Package weight or volume     Lis...
Food Shopping – Cont’d   Storing food safely     Conserve food using covered containers or      sealable bags     Keep ...
Food Shopping – Cont’d   Cooking food well     Preparation and cooking methods for fruits and      vegetables that retai...
MyPyramid Food Plan   Consider each food group       Vegetables and fruits provide vitamins, minerals,        phytochemi...
MyPyramid Food Plan – Cont’d   Consider each food group – cont’d       Grain foods provide complex carbohydrates,       ...
MyPyramid Food Plan – Cont’d   Consider each food group – cont’d     Dried beans and peas and nuts are good sources     ...
MyPyramid Food Plan – Cont’d   Consider each food group – cont’d       Fat and oils supply essential fatty acids        ...
Food Shopping Locations   Supermarkets and supercenters       Carry a wide variety of fresh and processed foods at      ...
Sources of Groceries   Food discount stores       Stock fresh and processed foods, paper goods,        and cleaning supp...
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Ch 10 ppt

  1. 1. CHAPTER 10 Community Nutrition:Promoting Healthy Eating Eleanor D. Schlenker Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
  2. 2. Implementing Nutrition EducationFramework 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2
  3. 3. Implementing Nutrition Education – Cont’dFramework 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3
  4. 4. Implementing Nutrition Education – Cont’dPerson-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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4
  5. 5. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5
  6. 6. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6
  7. 7. Model for Nutrition Counseling – Cont’d Communication as a process  Sender  Receiver  Message  Possible interference Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7
  8. 8. Model for Nutrition Counseling – Cont’d Theories for behavior change  Health belief model  Self-efficacy model  Stages of change Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8
  9. 9. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9
  10. 10. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10
  11. 11. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11
  12. 12. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12
  13. 13. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13
  14. 14. The Ecology of Malnutrition – 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14
  15. 15. The Ecology of Malnutrition – 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15
  16. 16. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16
  17. 17. Problem of Poverty – Cont’d Isolation Powerlessness Insecurity Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17
  18. 18. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18
  19. 19. Family Economic NeedsU.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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19
  20. 20. Family Economic Needs – Cont’dUSDA Food Assistance Programs – Cont’d Some food assistance programs are entitlement programs, which means there are specific income guidelines that determine eligibility Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20
  21. 21. Family Economic Needs – Cont’dFood 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21
  22. 22. Family Economic Needs – Cont’dMeal 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22
  23. 23. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23
  24. 24. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24
  25. 25. Nutrition Education Opportunities WIC School food programs NPE Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25
  26. 26. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26
  27. 27. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27
  28. 28. Food PurchasingFood 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28
  29. 29. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29
  30. 30. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30
  31. 31. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31
  32. 32. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32
  33. 33. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33
  34. 34. Food Shopping – Cont’d 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34
  35. 35. Food Shopping – Cont’d Buying wisely – cont’d  Unit pricing  Open dating  Package weight or volume  List of ingredients  Convenience foods Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35
  36. 36. Food Shopping – Cont’d 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36
  37. 37. Food Shopping – Cont’d 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37
  38. 38. MyPyramid Food Plan Consider each food group  Vegetables and fruits provide vitamins, minerals, phytochemicals, and fiber • Variety • Fresh versus frozen • Home gardening Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38
  39. 39. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39
  40. 40. MyPyramid Food Plan – Cont’d Consider each food group – cont’d  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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40
  41. 41. MyPyramid Food Plan – Cont’d Consider each food group – cont’d  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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41
  42. 42. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 42
  43. 43. 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 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 43

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