March is National Nutrition Month

In that spirit we hope the following article, along with the available downloadable worksheets, will help you reach out to your clients struggling with this issue. Much of the information is excerpted from the Nutrition chapter in Physical Well-Being Workbook by John Liptak, PhD, and Ester R.A. Leutenberg.

In today’s world one would think that with information provided by schools, health care professionals, and social media everyone would be aware of what to eat and what not to eat: The basics of good nutrition. Not so. The U.S. Department of Health and Human services offers the following information about the nutritional status of our citizens.

(Retrieved from https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html on March 7, 2018).

• Typical American diets exceed the recommended intake levels or limits in four categories: calories from solid fats and added sugars; refined grains; sodium; and saturated fat.
• Americans eat less than the recommended amounts of vegetables, fruits, whole-grains, dairy products, and oils.
• About 90% of Americans eat more sodium than is recommended for a healthy diet.
• Reducing the sodium Americans eat by 1,200mg per day on could save up to $20 billion a year in medical costs.
• Food available for consumption increased in all major food categories from 1970 to 2008. Average daily calories per person in the marketplace increased approximately 600 calories.
• Since the 1970s, the number of fast food restaurants has more than doubled.
• More than 23 million Americans, including 6.5 million children, live in food deserts – areas that are more than a mile away from a supermarket.
• In 2008, an estimated 49.1 million people, including 16.7 million children, experienced food insecurity (limited availability to safe and nutritionally adequate foods) multiple times throughout the year.
• In 2013, residents of the following states were most likely to report eating at least five servings of vegetables four or more days per week: Vermont (68.7%), Montana (63.0%) and Washington (61.8%). The least likely were Oklahoma (52.3%), Louisiana (53.3%) and Missouri (53.8%). The national average for regular produce consumption is 57.7%.
• Empty calories from added sugars and solid fats contribute to 40% of total daily calories for 2–18 year olds and half of these empty calories come from six sources: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.
• US adults consume an average of 3,400 mg/day [of sodium], well above the current federal guideline of less than 2,300 mg daily.
• Food safety awareness goes hand-in-hand with nutrition education. In the United States, food-borne agents affect 1 out of 6 individuals and cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year.
• US per capita consumption of total fat increased from approximately 57 pounds in 1980 to 78 pounds in 2009 with the highest consumption being 85 pounds in 2005.
• The US percentage of food-insecure households, those with limited or uncertain ability to acquire acceptable foods in socially acceptable ways, rose from 11% to 15% between 2005 and 2009.

National Nutrition Month – Seven Steps and Downloadable Worksheets

In their book the Physical Well-Being Workbook Ester Leutenberg and John Liptak, PhD, offer a seven step plan to foster better nutrition among our clients. Downloadable worksheets for each step are available by clicking here.

The first step is to assess the level of the client’s knowledge about nutrition and what habits they have – good or bad – that can be identified. A downloadable assessment tool is attached to this article that asks questions such as do you start your day with a good breakfast? Do you make good low-fat food choices? What kind of snacks do you eat? Do you plan your meals ahead or wing it? How much salt do you consume? Do you limit the amount of sugar consumed each day? The tool is quite comprehensive and can be scored by the client. A range of scores and what they might mean is included.

The next suggestion is to develop a group of people who will support the client upon his or her journey. Not all friends will do so. We all know folks who say things such as oh come on, one more bite or beer or piece of pizza or chocolate or cookie or cake or whatever won’t hurt. It’s just one more. Finding people who are supportive is one of the most important steps. Just as AA provides sponsors for recovering alcoholics, those recovering from bad nutritional habits need someone to call when their resistance is low, when the call of that chocolate cake becomes too much to withstand.

Step number three is to begin a nutritional journal. Questions such as the following, among others, can be pondered and answered by the client:

• How can I improve my all over plan?
• How can I plan better meals?
• How can I choose healthier but satisfying snacks?

Next the client is asked to set goals for themselves. Using the SMART acronym (specific, measureable, attainable, realistic, and time-specific) goals are selected. How will the goal be measured, how attainable and/or realistic is it, within what deadline will it be accomplished, and how will this help are entered in a chart that can be posted in a handy place to remind the client of where they are going. There is a tip chart supplied for those who are having trouble identifying their goals.

In step five the client is guided through the process of monitoring their success. Both by charting and journaling the client explores what they are doing, what they accomplished, and how they felt when they accomplished a goal. Reminding ourselves of what we’ve done right and how that made us feel is important to being willing to take the next step. When we are dying for a taste of a Mimosa for breakfast on a Sunday morning we need to remember how it felt last week when we didn’t have one but ate a fresh orange instead. A ripe, tasty orange, fresh and full of juice, can be satisfying. Remind your clients to record the tactile sense of what they are doing as they accomplish their goal. How did the orange smell, look, and feel in their hand as they peeled it? Did they see the squirts of juice reflected in the sunshine coming in the window? Did they get sticky from the juice? Was is sweet or sour?

When having difficulty sticking to the next goal, advise the client to re-read their journal and/or behavioral change chart. Suggest that they sit quietly and remember the sensations they recorded and experience them again. It will give them the strength to step up to the plate again.

Rewarding oneself is next. What kind of rewards will work the best for the individual client? Ask them to brainstorm what they would find fun yet still within the pursuit of better nutrition. Perhaps tickets to the local pro team might not be a good choice if the client has indicated that part of going to a game is to pig out on hot dogs and beer. The same would hold true for a trip to the symphony concert if it includes cocktails and dessert following the concert.

What small rewards would work? Large rewards? Things they can do alone and still be fun? Things they can do with others who are also seeking to improve their nutrition. Remind them that affordability is important.

Self-affirmations are also good rewards. A list is given of possible phrases such as I shopped today for the whole week, or I drank more water today. The client is asked to write them down on sticky notes and paste them where they will frequently be seen.

The final step gives tips for motivating behavior modification as the client seeks to improve their nutritional planning habits. Many of these seem quite simplistic, but not many of us observe them all, all of the time. Here’s a sample list:

• Read food labels
• Rely on your social network created in step two.
• Wash your hands before and after handling food.
• Keep your fridge clean, store food in the wrappers in came in or other suitable containers.
• Use paper towels to dry food off and throw them away afterwards.
• Don’t leave food sitting out. Put it in the fridge.
• Pack a good lunch that you like to avoid the pitfalls of fast food.
• Plan, plan, plan!
• Avoid too much salt.
• Avoid too much fat, saturated fat, and cholesterol.
• Drink plenty of water.
• Eat low fat evening snacks such as popcorn, yogurt, fresh fruit
• Plan a balanced diet
• If you drink alcohol, do so in moderation.
• Use the internet to find reliable and complete food information.

If your clients follow these seven steps (download worksheets here) they will find the path to better nutrition. Here is another great source for good nutritional information: https://www.hhs.gov/fitness/eat-healthy/how-to-eat-healthy/index.html.