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![Page 1: Ch 10 ppt](https://reader034.fdocuments.us/reader034/viewer/2022051817/547c8627b479599d508b46d3/html5/thumbnails/1.jpg)
CHAPTER 10
Community Nutrition:
Promoting Healthy Eating
Eleanor D. Schlenker
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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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
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3 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Implementing Nutrition Education
– 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
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4 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Implementing Nutrition Education
– 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
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5 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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6 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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7 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Model for Nutrition Counseling –
Cont’d
Communication as a process
Sender
Receiver
Message
Possible interference
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8 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Model for Nutrition Counseling –
Cont’d
Theories for behavior change
Health belief model
Self-efficacy model
Stages of change
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9 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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10 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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11 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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12 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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13 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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14 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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15 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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16 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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17 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Problem of Poverty – Cont’d
Isolation
Powerlessness
Insecurity
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18 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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19 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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20 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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21 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Family Economic Needs – Cont’d
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
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22 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Family Economic Needs – Cont’d
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
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23 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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24 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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25 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Nutrition Education Opportunities
WIC
School food programs
NPE
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26 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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27 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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28 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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29 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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30 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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31 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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32 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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33 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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34 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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35 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Food Shopping – Cont’d
Buying wisely – cont’d
Unit pricing
Open dating
Package weight or volume
List of ingredients
Convenience foods
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36 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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37 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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38 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
MyPyramid Food Plan
Consider each food group
Vegetables and fruits provide vitamins, minerals,
phytochemicals, and fiber
• Variety
• Fresh versus frozen
• Home gardening
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39 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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40 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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41 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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42 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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
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43 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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