SESSION ONE: Welcome to Nuestra Program Vida Participant ... · Being overweight, especially having...

Nuestra Vida

SESSION ONE: Welcome to the Nuestra Vida Diabetes Prevention Program

Participant Handout 1

McCurley JL, Fortmann AL, Gutierrez AP, Gonzalez P, Euyoque J, Clark T, Gallo LC. (2017). Pilot Test of a Culturally Appropriate Diabetes Prevention Intervention for At-Risk Latina Women. Diabetes Educ., 43(6), 631–640. https://doi.org/10.1177/0145721717738020

Research supported by: NIH/NLBI R56 HL081604-01A1 (Gallo); NCRR-1U54RR025204-01 (Topol); NCRR (ARRA) UL1 RR025774 (Topol); Scripps Clinic Medical Group. For more information, please contact Athena Philis-Tsimikas, ([email protected])

These materials are a part of the Compendium of Culturally and Linguistically Tailored Resources for Type 2 Diabetes Prevention, assembled by NORC at the University of Chicago under contract with the Centers for Medicare & Medicaid Services Office of Minority Health.

Session 1 – Overview

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SESSION 1: OVERVIEW Welcome!

You are here because you want to reduce your risk for type 2 diabetes, heart disease, and other health problems, and we’re glad to have you. We will work together toward two goals: Losing weight. Being more active. You’ll lose weight through healthy eating and 150 minutes of brisk physical activity each week.

We Will Work Together as A Team Throughout this program, you will rely on the group in different ways to learn and grow. I will count on you to do the items listed below:

• Come to sessions and bring your Participant Notebook. • Call 24 hours ahead if you must miss a session. • Do your best to reach your eating and activity goals. This includes doing home activities to

practice what you learn. • Keep track of your eating and activity 7 days a week. • Be honest. • Keep track of your weight at home. • Let me know if you have any problems by calling or e-mailing me. • Stay willing and open to change. Always hang in there.

You can count on your Lifestyle Coach and the group to do the items listed below:

• Notice what you are doing well and what can be improved. • Answer your questions; share solutions and ideas, while learning together. • Be honest. • Stand by you during hard times. • Believe you can reach your eating and activity goals. • Support and help you always. The group will hang in there with you.


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What is Diabetes?

What is diabetes? Diabetes is a lifelong disease. It affects how your blood sugar level is controlled in your body. If your blood sugar stays too high it can affect your health. Eat healthy foods, exercise and take your medications to help your blood sugar level stay healthy. Walking, swimming, strength training and riding a bike are examples of exercise.

Pre-Diabetes

(high risk for type 2 diabetes)

Type 1 Type 2 Gestational

Physiological Causes

Exact cause

unknown (possible causes could be risk factors for

diabetes)

Exact cause unknown

(possible causes include:

injury to beta cells or

virus)

Insulin resistance, and

or insulin deficiency

Hormones of pregnancy

cause insulin resistance

Body Type

Abdominal obesity

Generally thin or athletic

build

Abdominal obesity 80% are overweight

Pregnant, overweight

Onset of Symptoms

There may not be

any symptoms

Rapid onset, days to

weeks in children and

weeks to months in adults

Slower onset; weeks

to months

Usually occurs after the

26th week of pregnancy.

Related to a rise in

placental hormones

Treatment

Nutrition and

increased physical activity

Insulin therapy, healthy

eating patterns and

physical activity

Meal planning, regular

physical activity, diabetes pills and/or

insulin therapy

Meal planning, and

physical activity, and/or

diabetes pills or insulin

therapy


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Signs and Symptoms of Diabetes Symptoms of High Blood Sugar (hyperglycemia) Causes: Too much food, not enough medication, illness, surgery, stress, pain, infection or steroids. Onset: Gradual. May progress to diabetic coma. Blood Sugar: Above 180 mg/dl

Symptoms

Nausea Drowsiness Blurred Vision Dry Skin

Hunger Extreme Thirst Frequent Urination

Recommended Action

Check your blood sugar. If your blood sugar is above 250 mg/dl for two days, call your doctor.


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Symptoms of Low Blood Sugar (hypoglycemia) Causes: Too little food, more than five hours from last meal, too much insulin or diabetes medicine, too much physical activity or alcohol. Onset: Sudden. May pass out if untreated. Blood sugar: Below 70 mg/dl

Symptoms

Shaking Sweating Rapid Heartbeat Headache Hunger

Weakness, Fatigue Impaired Vision Anxious Irritable Dizziness

Reccomended Action

Check your If it is below 70 drink Check your blood Eat a snack or blood sugar. one-half to one cup juice, sugar in 15 minutes. meal within skim milk or regular soda, If still below 70, 30 minutes. or chew five to six hard take more sugar. candies or four glucose If symptoms don’t tablets, or swallow stop, call your doctor. one tube of glucose gel.


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Risk Factors for Developing Obesity and Type 2 Diabetes

Risk Factors for Developing Obesity and Type 2 Diabetes.

How many risk factors apply to you? (check off the ones that apply) Having GDM during pregnancy (this can raise your risk right after giving birth and years later in

midlife)

Having a relative who has (or had, if deceased) diabetes

Being of Latino, Native American, African American or Pacific Islander descent

Being over the age of 55 and/or being post-menopause

Giving birth to a baby weighing over 9 lbs

Being overweight, especially having extra weight at the waistline/abdomen (we will go over this

specifically in another class, when we calculate BMI)

Having an inactive lifestyle (such as sitting all day for work, not getting regular exercise)

Darkened skin pigmentation under the arms, around the neck, and in other skin fold areas (i.e.,

Acanthosis nigricans)

Having irregular menstrual periods

Gaining weight (10 lbs or more) in a short time period


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Tipping the Calorie Balance

Tipping the Balance How many calories and how much physical activity is needed to tip the balance in favor of losing weight? The amount varies from person to person. This program has many tools to help you tip the balance in the healthy direction. Just remember, the best way to tip the blalance is to both reduce the amount we eat and drink and increase the time we are physically active. The Calorie Balance Calorie balance means that the calories we take in through eating and drinking should equal the calories we use through physical activity and our body’s other energy needs (for example, breathing, digesting food, sleeping).

1. Your weight can stay the same.

Calories in (food) are the same as calories out (physical activity).

2. You will gain weight.

Calories in are greater than calories out.

3. You will lose weight.

Calories in are less than calories out. 4. You can reach a new balance at a new weight.

Calories in are the same as calories out.


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Self-Monitoring Keeping Track

Start keeping track of what you eat and drink each day. Write down everything you eat and drink. It’s the most important part of changing your behavior. Spelling is not important. What is important is to –

• Be honest. Write down what you really eat. Write down if you are physically active. • Be accurate. Measure portions and read labels. Describe which physical activity you do. • Be complete. Include every last scrap you eat. Include how long each physical activity lasts.

Start keeping track of your activity, and what you eat and drink each day!

Date Activity Duration

Date Food or Drink Amount


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SMART GOALS

Use the SMART goal method to make gradual changes each week in order to achieve a healthy weight by eating healthy and being physically active! SMART Stands for: “S” stands for specific. Your goal is targeted. “M” stands for measurable.

This means that your goal can be measured in some way (for example, in minutes or in serving sizes).

“A” stands for achievable.

Your goals can be accomplished. “R” stands for realistic. Your goal is practical. “T” stands for time-based.

Your goal will be met within a certain timeframe (for example, within 3 days, 1 week, or 2 weeks).


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WEEKLY SMART GOAL-SETTING Week of:__________ Session:___________ Is my goal: Specific Measurable Attainable Realistic Time-based

My SMART goal for being more PHYSICALLY ACTIVE this week is:

______________________________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________

I will achieve this by doing the following:

_________________________________________________________________________________

_________________________________________________________________________________

______________________________________________________________________________

My SMART goal for HEALTHY EATING this week is:

_________________________________________________________________________________

_________________________________________________________________________________

______________________________________________________________________________

I will achieve this by doing the following: _________________________________________________________________________________

_________________________________________________________________________________

______________________________________________________________________________


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To-Do Next Week During the next week, I will – Write down every little thing I eat and drink every day.

• Include the time when I eat each item. • Include the amount of food, the name of the food, and a

description. • Skip the other columns for now. • Use one line for each food. For example, instead of writing

“sandwich,” write all the things that are in the sandwich, one on each line.

2 slices whole wheat bread 1 slice American cheese 1 slice turkey 1 tsp mayonnaise

“Toast with butter” should be on two different lines: 1 slice whole wheat toast 1 tsp butter Circle the foods or drinks I think are high in fat and calories.

• Keep track of my activity and what I eat, using my Food and Activity Tracker. • Do my best in working toward my first SMART goal this week. • Bring my Food and Activity Tracker to the next session.


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Weight and BMI Tracker

Height_____ in

Class #

Date Weight +/- BMI Comments

1 2 3 4 5 6 7 8 9

10 11 12

Nuestra Vida

SESSION TWO: Healthy Eating 1


Session 2– Healthy Eating 1

2 1/27/15

Session 2: Overview

Be a Fat and Calorie Detective Reducing the fat and calories in our meals is one of the most important steps we can take to improve our health. To reach healthy eating goals, we need to track our weight and how much we eat. Our role as a “fat and calorie detective” is to find the high-fat, high-calorie foods in our meals and figure out ways to make them healthier.

Monitor Our Food and Weight

Monitoring what we eat is a smart way of making sure we make healthy choices. Monitoring what we do is the most important part of changing our behavior. Therefore, and important part of this program is to write down everything you eat and drink in your Food and Activity Tracker.

How Am I Doing?

Use the “How Am I Doing? Weight Chart to track your weight at home and before each session. This chat is important because it shows how your weight is changing over time.

Quick Fact Why does it matter if I get type 2 diabetes? People with diabetes are twice as likely as people without diabetes to die early. The good news is that by making smart choices in eating and physical activity, you can delay or prevent type 2 diabetes. But there’s more good news. Even with diabetes, people can lower their chances of blindness, kidney disease, heart attack, and stroke by eating healthy and getting regular physical activity.)


3 1/27/15

Weight Tracking My Weight Tracker “My Weight Tracker” will help you track your weight loss. It will show you your current weight and your goal weight, according to your weight loss goal. Each week we will record your weight so you can see the changes in your weight from week to week. Starting Weight__________________ lbs. Goal Weight_________________ lbs. Weeks 1 2 3 4 5 6 7 8 9 10 11 12


4 1/27/15

BMI Chart: Tracking Your BMI

To track your BMI, locate your height on the left hand column. Scroll across that row to locate your current weight. Then, look at the corresponding BMI number on the top row. This is approximately your Body Mass Index.


5 1/27/15

Goal Weight Chart

Goal Weights This chart shows starting weight and goal weight with a 7% loss. Find your current weight, and then your goal weight to achieve during this program. Starting weight:_________________ Goal Weight:__________________


6 1/27/15

Goal Weights (continued)


7 1/27/15

Goal Weights (continued)


8 1/27/15

MyPlate

MyPlate

• Grains- Make at least half of the grains you eat whole grains. • Vegetables- Vary your veggies. • Fruits- Focus on fruits. • Dairy- Get your calcium-rich foods. • Proteins- Go lean with protein.


9 1/27/15

Tips for Healthy Eating

Tip 1: Eat a regular pattern of meals. Try to eat 3 meals each day. This will keep you from

getting too hungry and losing control. Tip 2: Attentive eating. Eat slowly… and attentively! This means paying attention to eating

and not to other things while you eat.

• Choose food you enjoy that nourishes your body.

• Turn to all your senses to find pleasure in your food (smelling, chewing, tasting, swallowing, and savoring each bite).

• Pause between bites, put down your utensils, and enjoy the taste of your food and the people you are with.

• Be aware of your level of hunger and fullness.

Tip 3: Pay attention to portion control. Don’t worry about cleaning your plate. The greatest

waste of food is to eat more than you want or need. Practice serving yourself a little less to begin with… pay attention to portion size!


10 1/27/15

Portion Control

Estimating Portion Sizes

Fist = 1 cup Example: three servings of pasta or two servings of oatmeal (one cup pasta = three servings)

Palm or Deck of cards = 3 oz. Example: a cooked serving of

meat

Thumb Tip = 1 teaspoon Example: a serving of mayonnaise or margarine

Handful = 1 or 2 oz. snack food Example: 1 oz. nuts = 1 handful; 2 oz. pretzels = 2 handfuls

Thumb = 1 oz. Example: a piece of cheese


11 1/27/15

Daily Recommended Food Group Portions

Following these recommendations will help you get the right amount of each food group your body needs. Food Group How many daily

portions? One portion equals:

Vegetables 2 ½ portions One cup of raw or cooked vegetables or vegetable juice, or two cups of raw leafy greens

Fruits 1 ½ to 2 portions One cup of fruit or 100% fruit juice, or ½ cup of dried fruit

Grains 6 portions (at least half of those – 3 portions – should be whole grains)

One slice of bread, one cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal

Protein 5 – 5 ½ portions One ounce of meat, poultry or fish, ¼ cup cooked beans, one egg, one tablespoon of peanut butter, or ½ ounce nuts or seeds

Dairy 3 portions (choose low-fat or fat-free options)

One cup of milk, yogurt, or soymilk, one ounce of cheese

Oil 5-6 portions (maximum) One teaspoon of cooking oil, mayonnaise, butter, lard

Avoid eating solid or saturated fats as much as possible!


12 1/27/15

Rate My Plate Log

Rate My Plate Name: __________________________ Week #: ______________ My healthy eating goal for this week is to ___________________________________________. Check the box for every serving that you ate from the MyPlate food groups. The shaded boxes show you the number of portions recommended each day. Remember to look back at your Nuestra Vida notebook if you need help with a food group or portion size. Monday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages

Tuesday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages

Wednesday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages


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Thursday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages

Friday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages

Saturday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages

Sunday Vegetables Fruits Whole grains Lean protein Dairy Fats and sweets Sugar sweetened beverages


14 1/27/15



________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________


________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________


________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I will achieve this by doing the following: ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________


15 1/27/15

To-Do Next Week During the next week, I will – Keep track of my weight in the Food and Activity Tracker

• Weigh myself at home every day, or every few days, at this time of day ___________. • Record my weight on the back of the Food and Activity Tracker.

Keep track of what I eat and drink

• Write down everything I eat and drink in the Food and

Activity Tracker. • Use the Fat and Calorie Counter to figure out how

much fat is in each item I eat. • Write down the fat grams in the Food and Activity

Tracker. • Keep a running fat gram total throughout the day. • Come as close to my fat gram goal as I can.

- Keep track of my activity and what I eat, using my Food and Activity Tracker.

- Do my best in working toward my SMART goal(s). - Practice what I learned about portions at home with my

family, friends, co-workers and/or neighbors. Bring my Food and Activity Tracker to the next session.

Nuestra Vida

SESSION THREE: Three Ways to Eat Less Fat and Fewer Calories


Session 3– Three Ways to Eat Less Fat and Fewer Calories

2 2/1/2015

Session 3: Overview

Weighing and Measuring Food

Weighing and measuring food are important ways of knowing what we eat. Measuring helps us make healthier choices. Eating even a slightly smaller amount can make a big difference in fat grams and calories. Many people feel they do not need to weigh or measure their food because they think they know how much they eat. But most of us are surprised when we actually do measure. Our eyes can play tricks on us!

Estimating Fat and Calorie Content It is hard to know the amount of fat and calories in our food, but with practice, we can make a good guess.

Quick Fact

Eating too much fat can cause heart disease and type 2 diabetes.

Eating a lot of fat can increase the amount of cholesterol in our blood.

The higher our cholesterol, the greater our chances of having a heart attack.

Eating a lot of fat also increases our chances of getting type 2 diabetes.


3 2/1/2015

The Food Guide THE FOOD GUIDE BOOK Your stop-light food intake guide

Green- Light foods Are foods that you should eat more of! Yellow- Light Foods Are foods you should eat in moderation. Red-Light Foods Are foods you will want to eat less of or avoid!

Terms to know Nutrients

• Help you grow healthy • Give you energy for all your activities • Protect you against chronic disease

Calories

• Are energy you eat • A calorie is a calorie no matter where it comes from • They come from

o Fat, carbohydrates, protein, and alcohol • But in different quantities

Recommended: eat foods with more nutrients and less calories

• Try to eat a balanced diet • Include different food groups in your plate

Like: Vegetables Whole grains Fruits Protein Dairy


4 2/1/2015

FOODS TO EAT MORE OF Colorful Vegetables Dark green vegetables Broccoli, spinach, kale, chard, Beets, greens, cilantro Orange and Red Vegetables Winter squash, carrots, beets, red cabbage, red peppers, sweet potatoes, pumpkin, tomatoes Beans and peas Black beans, kidney beans, pinto beans, garbanzo beans, red beans, green beans, black-eyed-beans, lentils


5 2/1/2015

Starchy Vegetables Corn, chamote, white yam, cassava/yucca, plantains

Other Vegetables Avocado, chayote, zucchini, cucumber, celery, jicama, nopales, peppers, onions, artichokes, mushrooms


6 2/1/2015

How to eat more of these

1. Serve yourself (and your spouse/family) different vegetables each week

2. Eat different colored vegetables

3. Use fresh, frozen, dried/dehydrated, or canned

Don’t add fat to your vegetables by frying or dipping in high-fat dressings! Whole Grains


7 2/1/2015

Whole wheat tortillas, bread, and pasta

Brown or wild rice Popcorn (low on butter and salt), oatmeal, whole cornmeal Other foods, such as corn tortillas may be made from whole or refined grains, so check the label! Whole grains are different from refined grains Whole grains

• Have nutrients and dietary fiber that help you feel full Refined grains

• Have had many of the nutrients removed • Avoid


8 2/1/2015

Colorful Fruits Oranges, apples, mangos Guavas, bananas, papaya Pineapple, watermelon, melon

All types of berries and grapes How to add to your diet

1. Eat them as snacks

2. Try fresh, home-squeezed or frozen juices, smoothies

3. Fruit salsas

4. On your yogurt


9 2/1/2015

Lean Protein Beans, lentils, soy Nuts

White meat poultry Fish

Low fat/non-fat dairy products (milk, yogurt) Egg Whites

Dairy Choose low fat or non-fat dairy options

• Cheeses- fresco, Oaxaca • Yogurt • Milk

- These low fat/non-fat products allow you to get your dairy nutrients without having all the

grams of fat


10 2/1/2015

FOODS TO EAT LESS OF DIETARY FAT

• We need fat to give the body energy, support growth and protect our organs, BUT in moderation

• If we eat more fat than what we need, the body stores what is left over as body tissue • Fat has the highest amount of calories • Each gram of fat has 9 calories

How to reduce fat

1. Be a fat detective by watching out for

• Red meats and pork • Full fat dairy products

o Whole milk, sour cream, regular cheese, cream cheese, butter/margarine, and ice cream

• Snacks: potato chips, tortilla chips, pork rinds, Cheetos • Gravy, mayonnaise, salad dressing, cream sauces • Baked goods • Fat added through cooking (especially deep-frying): oil, lard,

shortening

2. And plan to cut back on

• High fat and high calorie foods o Eat your favorite high fat, high calorie food only once per week instead of every day

• Eat smaller amounts of high fat and high calorie foods o Share with someone o Save some for later

• Substitute with low calorie, low fat foods instead o Fruit, tomato salsa, or lime/lemon juice instead of salad dressing


11 2/1/2015

SALT (SODIUM)

• Choose foods low in salt • Eat less than 1 teaspoon of salt per day • Salty food examples

o Soups, salad dressings, sauces o Tortilla, potato chips o Flour tortillas o Chorizo o Cheesy dishes

How to reduce your salt intake

• Take the salt-shaker off the table where you eat • When adding salt to food, pour it into your hand first, instead of directly into your food • Use herbs and other spices to add flavor instead of salt • Buy low or reduced sodium foods • Use fresh instead of canned meats

o If using canned meats, rinse before using SUGAR

• Has absolutely no nutrients, but lots of calories • Your body doesn’t even need sugars to work well • Too much sugar makes you gain weight, and leads to insulin resistance

How to cut down on the sugars we eat

• Eat fruits and low-salt nuts instead of candy • Serve fruit instead of cookies or ice cream • Eat sugar free desserts • Try whole grain breakfast cereal (watch for the amount of sugar) • Instead of flavored yogurt, buy plain and just add honey or jam • Avoid sodas, slurpees, blended coffee drinks – drink water or

unsweetened tea or iced tea instead • Add lemon, lime to water (or soda water) • Mix 50/50 water and fruit juice • Drink diet instead of regular sodas • Flavor your coffee or tea with artificial sweeteners instead of sugar

Other foods to watch out for

• Flour tortillas • Couscous


12 2/1/2015

• White rice • White bread • Most pasta noodles Reading the Nutrition Label Eating Packaged Foods This is a sample of a nutrition label that you see on many packaged foods. This label shows information about the fat, calories, and other nutrients in the food.


13 2/1/2015

Find the serving size, and decide is that is the amount you ate. Maybe you ate more or less.

Find the calories per serving Find the total fat grams per serving Keep this in mind: If you eat a larger serving than the size on the label, you will be eating more calories and more fat grams than are given on the label. Reading The Food Label In order to lose weight and have a healthy weight,

it’s important to know what’s in our food. Here are general nutrition facts that you can find on a food

label and some guidelines to follow when choosing foods.


14 2/1/2015

Serving size: The amount of food that makes one serving. The nutrition facts listed on the label are

“per serving” – meaning that all of the numbers listed on the label are the amounts in one serving.

Total Fat/Cholesterol: This tells you how many grams of fat are in each serving. To follow a low-fat

diet, choose foods that are 3 grams or less per serving. Meats and cheeses should be 5 grams or

less fat per serving. Choose foods with less than 1/3 of the fat as saturated fat and zero trans-fat.

Sodium: Tells you how many grams of salt in the food. To follow a low sodium diet, choose foods

that have 5% or less of the Daily Value of Sodium; 20% or more is considered a high sodium food.

Total Carbohydrate: This is the number of grams you should look at to determine how many

carbohydrate servings this food equals. Remember, one carbohydrate = 15 grams of total

carbohydrate.

Dietary Fiber: Aim for 25 grams of dietary fiber daily.

Sugars: The number of grams of sugar is already included in the “Total Carbohydrate”. Do not use

this number for calculating carbohydrate servings.

Vitamins and Minerals: Your goal is 100% of each for the day. Eating a variety of foods daily will

help you reach this goal.

Make sure to check whether a product is really a whole grain. Look for corn tortillas that list ‘whole

corn’ as the first ingredient. Be sure there is no hidden sugar – avoid foods with “sucrose” or

“fructose.”



15 2/1/2015


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16 2/1/2015

To-Do Next Week Next week, I will – Keep track of my weight and what I eat.

• Keep track of all the fat grams I eat each day. • Come as close as I can to my fat gram goal.

Make a plan to eat less fat and follow it.

• In the table below, write down five foods you eat that are high in

fat. Circle one. • Pick one of the three ways to eat less fat from the food you

circled. Write down in the space below how you will cut fat next week. Be sure you write something you can do.

My top 5 High fat foods

The 3 ways to Eat Less Fat

I will eat it less often:

I will eat a smaller

amount:

I will eat a lower-fat

food instead:

What I will need to do to carry out this plan:

________________________________________________________________________________

________________________________________________________________________________


17 2/1/2015

To-Do Next Week (continued) Problems I might have cutting down on these foods, and what I will do to solve them: ________________________________________________________________________________

________________________________________________________________________________

Before the next session answer these questions:

1. Did you follow your plan? Yes____ No____ Almost_____

2. What did you do well? ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

3. What problems did you have following your plan?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

4. What could you do differently next week?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

• Keep track of my activity and what I eat, using my Food and Activity Tracker. • Do my best in working toward my SMART goal(s). • Practice what I learned about portions at home with family or friends and co-

workers. • Bring my Food and Activity Tracker to the next session.


18 2/1/2015

Nuestra Vida

SESSION FOUR: Healthy Eating Overview


Session 4– Healthy Eating Overview

2 2/1/15

Session 4: Overview Healthy Eating Healthy eating is determined both by what we eat and the way we eat. To eat healthier, try to eat at regular times. Eat slowly to digest food better. Eating slowly also makes us more aware of what we are eating. And, don’t worry about cleaning your plate. These are just a few of the many tricks for changing how we eat. Find out more! MyPlate MyPlate is a general guide to healthy eating. It is based on the latest research about nutrition and health. It was developed by the U.S. Department of Agriculture and has suggestions for how much people should eat, depending on their sex, age, and level of physical activity. The plate image on page 3 shows us the amount we need of each food group. Go to choosemyplate.gov to learn more about this useful tool. The suggestions offered in MyPlate can help us make better food choices. They give us ideas for changing the way we eat. During the week, use the MyPlate information found in these handouts and on the website to practice changing how you eat.

Quick Fact To prevent type 2 diabetes, should you avoid eating starchy foods such as bread, potatoes, and pasta? No. Starchy foods are part of a healthy meal plan for people with or without diabetes. What is important is the amount we eat. Whole grain breads, cereals, pasta, rice, and starchy vegetables like potatoes, yams, peas, and corn can be part of your meals and snacks. The key is the amount. For most people with diabetes having 3 or 4 servings of bread, fruit, or starchy foods is about right. Whole grain starchy foods are also a good source of fiber. They help keep your gut healthy.


3 2/1/15

Stretching Your Fruit and Vegetable Budget Here are some recommendations for eating healthy on a budget:

- Cook enough for several meals and freeze

the leftovers.

- You can also create a meal plan for the week

that uses similar fruits and vegetables,

prepared in different ways. This will help you

make the most out of the produce you buy.

- Look for sales and deals on fruits and

vegetables at the grocery store or through

coupons. Buy fruits and vegetables that are in

season at the grocery store or your local

farmers’ markets.

- Frozen fruit and vegetables store well in the

freezer until you’re ready to add them to a meal.

- Canned fruits and vegetables will last a long

time (choose canned vegetables that have no

added salt and fruit that is canned in 100% fruit

juice).

- Grow your own vegetables.


4 2/1/15

How to Find Community Resources For Healthy Eating [In this section, include information on local/state resources related to healthy eating. This may include details (e.g., websites, addresses, contact information, etc.) for organizations like: local food cooperatives, food stamp programs, food banks, farmers markets, and community gardens]


5 2/1/15

Cooking Wisely Recommendations for healthy cooking

- Steam, microwave, or boil vegetables in a small amount of water – be careful not to overcook because they might lose their nutrients!).

- Poach, boil, or scramble eggs or egg whites with vegetable cooking spray.

- Bake, roast, broil, barbeque, or grill meats.

- Remove skin from chicken and turkey (before or after cooking).

- Trim all the fat you can see.

- Drain off fat after cooking (blot using paper towel; drain and rinse ground beef).

- Spoon off the fat before using broth or sauces.

- Do not use salt in cooking, or use half the amount you normally would. Remember what we

learned about reducing sodium last week! Recipe Modification Changing or modifying your recipes to make healthier meals is a great option for healthy cooking. Try these recommendations:

• Leave out a high-fat or high calorie ingredient (example: don’t add cheese!)

• Use less of a high-fat or high calorie ingredient. Use half the amount of cheese.

• Use a lower fat/calorie ingredient instead. Use low-fat or fat-free cheese.

• Add liquid (i.e., water, fruit juice, skim milk, or broth) when you remove fat.

• Make healthy seasoning choices. Use hot peppers, fresh herbs/spices, garlic, onions, lemon juice, and wine.


6 2/1/15

Add Flavor Without Fat To avoid adding fat to foods, make healthy seasoning choices! Use hot peppers, fresh herbs and

spices, garlic, onions, lemon juice, and wine! Here are some suggestions for healthy seasoning

options for a variety of foods.

Food to Flavor

Low-Fat Flavoring Options

Potatoes and Vegetables

Use a small amount of low-fat margarine, nonfat sour

cream, broth with the fat removed, low-fat or fat-free

plain yogurt, salsa, herbs, mustard, and lemon juices!

Bread

Try Nonfat cream cheese, a small amount of low-fat

margarine, or all fruit jams!

Pancakes

Top with fruit, low-calorie syrup, unsweetened

applesauce, crushed berries.

Salads

Make a nonfat or low-fat salad dressing, lemon juice, or

vinegar.


7 2/1/15

Activity – Cooking Demonstration Today we will be cooking ___________________________________________________________ Write in the ingredients and steps as we go along! Remember we’ll be focusing on following the recommendations you learned about cooking wise and modifying your recipe to make a healthier meal! Ingredients:

Usual Ingredients

Healthy Modifications (if they apply)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Instructions: Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

Step 6:


8 2/1/15

Healthy Recipes Fruit and Yogurt Smoothies If you’re recovering from a cold or stomach upset, try this fruit and yogurt smoothie. In cases of digestive problems or when you have been taking antibiotics, yogurt with live cultures of Lactobacilli helps restore beneficial organisms in the intestines. Check the label to be certain that the yogurt you eat has live active cultures. Makes 3 portions of ¾ of a cup each 1 medium-sized fruit without the peel: peach, ripe banana or nectarine, or ¾ cup of strawberries, raspberries, blackberries, papaya, or ripe mango 1 cup of low-fat plain or flavor of your choice yogurt, sugar-free 1 cup of fat-free milk ¼ t of vanilla extract 4 crushed ice cubes ½ t of lime juice (if you are using mango) Corn Salad This is a very colorful dish to serve during the summer. 4 portions of ½ cup each 1 cup of corn either fresh or frozen ½ cup sweet red, chopped paprika ½ cup of sweet green, chopped paprika ¼ cup of white onion chopped finely 1 diced tomato 1T of olive oil 1t of lime juice Black ground pepper to taste Mix all the ingredients as listed and refrigerate for 30 minutes before serving.

Exchanges ½ Fruit ½ Non-fat milk Calories………………89 Calories from Fat…… 1 Total Fat…………….. 0g Saturated Fat………... 0g Cholesterol………….. 3mg Starch………………105mg Carbohydrates………. 15g Dietary fiber………… 1g Sugars………………. 13g Protein……………… 6g

Exchanges: 1 Starch ½ Fat Calories………….. 82 Calories from Fat…. 31 Total Fat………… 3g Saturated Fat……… 1g Cholesterol……….. 0 Sodium……………..7mg Carbohydrates…….13g Dietary fiber……… 2g Sugars……………. 3g Protein…………… 2g


9 2/1/15

Rice with Black Beans & Bacon (Cuba) 4 portions of 1 cup each:

2 cups of water 1T of canola oil ¼ cup of finely chopped onion 3 cloves of diced garlic ¼ cup of sweet red and/or green pepper 2T of chopped cilantro 1 cup of long grain rice ¼ cup of tomato sauce 1 cup of canned black beans, rinsed and drained ½t of salt 4 slices of bacon cooked, drained and chopped 6 strips of Spanish bell pepper

1. Bring water to a boil. In a medium skillet, heat oil to medium heat. Sauté onion, garlic, pepper,

cilantro and rice for 2-3 minutes. 2. Add tomato sauce and beans. Mix and cook for 2-3 minutes. Add the boiling water, salt, and bacon,

and cook over moderate heat until most of the water has evaporated. 3. Cover and cook for 10 minutes, stirring only once or twice, until the rice is tender. Garnish with

strips of Spanish bell pepper. Carnitas (Mexico) Traditionally, the meat is boiled first and then baked, but it is still delicious even when the meat is not baked. 8 portions of ½ cup each:

2 lbs of boneless pork loin ½/t of cumin ½t of coriander/cilantro ½t of oregano 2 whole garlic cloves 3-4 whole black peppercorns 1 medium onion, peeled and coarsely chopped 1 medium carrot coarsely chopped

1. Place all ingredients into a large casserole and add water to cover. Bring to a boil, cover, lower to

medium heat, and simmer for 1-1½ hours 2. Shred the meat or cut into strips. Use for tacos or enchiladas 3. The meat can be placed in containers and stored in the freezer in individual portions that can then

be reheated in a microwave oven.

Exchanges 4 Starch 1 Fat Calories…………….350 Calories from Fat…. 67 Total Fat…………… 7g Saturated Fat……… 1g Cholesterol………… 5mg Sodium……………..583mg Carbohydrates…….. 58g Dietary fiber……….. 8g Sugars……………… 4g Proteins……………. 12g

Exchanges 3 very lean, low in fat meat ½ Fat Calories………………136 Calories from Fat…… 37 Total Fat…………….. 4g Saturated Fat…………. 1g Cholesterol……………65mg Sodium………………. 47mg Carbohydrates………. 0g Dietary fiber…………. 0g Sugars………………… 0g Protein…………………24g


10 2/1/15



_________________________________________________________________________________

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_________________________________________________________________________________

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I will achieve this by doing the following: _________________________________________________________________________________

_________________________________________________________________________________

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11 2/1/15

To-Do Next Week During the next week, I will –

1. Keep track of my activity and what I eat, using my Food and Activity Tracker!

2. Do my best in working toward my SMART goal(s).

3. Answer these questions before the next session:

a. Did you make any changes during the week to what you ate? If yes, what were they?

b. What problems did you have? How did you solve them?

4. Begin next session by sharing my progress/experience with my SMART goal.

Bring my Food and Activity Tracker to the next session.

Nuestra Vida

SESSION FIVE: Physical Activity


Session 5– Physical Activity

2 2/26/15

Session 5: Overview Move Those Muscles The physical activity goal for this program is 150 minutes, or 2 ½ hours, each week. You can do the activity in several ways (for example, 30 minutes for five days) or however else you want to do it! The important thing to remember is that you will work up to 150 minutes a week. It’s a goal. We will start with where you are and we will increase your activity level slowly, steadily, and safely. The Importance of Being Active Being physically active has many benefits. It helps improve our general well-being by keeping weight off, improving our mood, increasing our energy and ability to get around, and reducing stress. It also improves muscle tone and helps us sleep better. Physical activity makes our heart, lungs, and bones stronger, and it may reduce back pain and injuries. Being physically active also helps lower our risk for heart disease and some kinds of cancer. It can lower our risk for heart disease and some kinds of cancer. It can lower blood pressure and may help prevent type 2 diabetes.

Quick Fact How important is physical activity? Physical activity helps us in many ways. It helps control our blood glucose, weight, and blood pressure. It raises our “good” cholesterol and lowers our “bad” cholesterol. It helps prevent problems with our heart and blood flow. And, most importantly, for people with diabetes, it lowers the risk for heart disease and nerve damage.


3 2/26/15

Benefits of Physical Activity

Being active has many benefits: Physical activity can improve your general well-being by –

• Helping you lose weight and keep it off • Perking up your mood and self-esteem • Helping with depression and anxiety • Giving you more energy • Making it easier for you to do things such as climb stair and carry groceries • Helping reduce stress • Helping you sleep better

Physical activity can improve your physical fitness by –

• Improving muscle tone and body shape • Strengthening you heart, lungs, bones, and muscles • Making your joints more flexible • Lowering your risk for back pain and injuries

Physical activity can improve your health by –

• Lowering your risk for heart disease and some kinds of cancer • Raising your HDL cholesterol (the “good” kind) • Lowering your triglycerides (the amount of fat in the blood) • Lowering your blood pressure

Physical activity may lower your risk for type 2 diabetes by –

• Making your body better able to use insulin and therefore lower the level of sugar in your blood


4 2/26/15

The Many Benefits of Physical Activity! Being physically active will help you:

1. Lose weight and keep it off by having healthy diet AND being more active!

2. Feel and look better. Many people say that they simply feel good when they’re more active!

• Improves your mood • Helps reduce stress • Helps you sleep better • Improves your self-esteem • Counters depression and anxiety • Give you more energy • Improves your muscle tone and body measurements • Is a way to meet new friends

3. Be more physically fit.

• Strengthens your heart, lungs, bones and muscles • Makes it easier for you to do your household chores (sweeping, mopping, deep

cleaning) • Reduces back pain and injuries • Makes your joints more flexible • Makes it easier for you to do your daily work, like climbing stairs and carrying groceries

4. Lower your risk for heart disease and diabetes.

• Raises good cholesterol (HDL), lowers triglycerides and blood pressure- helps reduce

the risk of heart disease. • Reduces the risk for type 2 diabetes by lowering blood sugar. Your body will be more

sensitive to insulin, which means that your body will use insulin more efficiently.

5. Be a Role Model for Friends and Family

• Discuss your progress with friends and family and get them to understand that they can start to live a healthier lifestyle too.

• The healthier their lifestyle is, the lower the risk for them to develop obesity and Type 2 Diabetes.


5 2/26/15

YOU CAN DO IT! Meet the Goal. Reaching your physical activity goal is

doable when you:

1. Pick activities you LIKE. Develop a

lifelong habit of being active by

choosing activities that you enjoy

and that are convenient for your life.

2. Choose moderate kinds of activity,

like brisk walking.

3. Work up to this goal slowly. Work up

to a weekly total of 150 minutes or 2

½ hours. Start slowly and spread it

out over the week so you don’t get

hurt and so you enjoy yourself!

4. Reach 150 minutes in many

different ways. For example, you

might do 30 minutes for five days.

Or you can even break down the 30

minutes into three 10-minute or two

15-minute periods.


6 2/26/15

Types of Physical Activity and Levels of Intensity There are many different types of physical activity that differ by how hard you work to complete the activity (“level of intensity”). Try the “talk test” to find out how intense an activity is:

Level of Intensity What you will be able to do

Low talk and sing

Moderate talk, but not sing

High can’t say more than a few words without pausing

Examples of activities of different intensities Low (easy) Intensity

• Walking casually

• Taking care of small grandchildren

• Walking your dog

• Gardening

• Light Housework (cooking, washing

dishes)

Moderate Intensity

• Walking briskly (~3 miles per hour)

• Stair walking, climbing

• Dancing

• Bicycling slower than 10 miles per hour

• Doing moderate household chores

(sweeping, mopping, deep cleaning)

Vigorous Intensity

• Race walking, jogging, or running

• Swimming laps

• Playing tennis

• Jumping ropes


7 2/26/15

Safety and Physical Activity Be sure to follow these safety tips during physical activity in order to enjoy yourself and not get hurt.

1. Wear proper athletic shoes that fit well and provide good support to the feet. Wearing proper

shoes that will also help prevent you from hurting yourself. Avoid wearing plastic, canvas, or

“flip-flop” footwear.

2. Wear appropriate clothes that keep you cool (are light in weight and color and absorb sweat)

and let you move comfortably.

3. Avoid wearing rubber or plastic suits or belts – these will make you too hot and can lead to

overheating and dehydration (not enough fluids in your body).

4. Pace yourself! Trying to do too much, too soon can lead to feeling down and/or getting injured.

5. Warm up and stretch your muscles and joints at the beginning of each physical activity session

to keep muscles and joints flexible and prevent injury.

6. Cool down at the end of your activity. Try walking for 5 minutes to bring your heart rate back

down slowly.

7. Drink water to replace the fluids that your body used during your activity.

8. Avoid physical activity when you are not feeling well, or during extreme weather.


8 2/26/15

9. Stop physical activity right away if you have chest pain or shortness of breath, and call your

doctor.

10. For questions about whether you should do a certain type of activity please contact your

doctor.

Wearing the Right Shoes The type of shoes you wear is important. Here are some tips for making sure you have the best shoes for your needs.

• Buy new shoes only if you need them

You do not need to buy special shoes, if you have shoes now that fit well and support your feet. If you plan to buy shoes, here are some helpful hints:

o Visit one or more stores you trust. o Try on different styles and brands. o Ask the salesperson to help you find a good fit. o Ask the salesperson to help you choose the shoe best suited for the kind of activity

you want to do.

• Look for a good fit

Wear the kind of socks you will wear when you are active. Cotton is best. If possible, go to the store right after you have been active for a while. That way, your feet

will be the size they are when you are warmed up. The shoes should feel good right away. Try them on and walk around. They should NOT

need to stretch out later. One thumb should fit in the space between your longest toe and the end of the shoe. The heel should NOT pinch or slip around when you walk. The shoes should bend easily at the ball of your feet (just behind your toes).

• Get the kind of support you need

Shoes should match the shape of your foot and the way your feet strike the ground. Take your old shoes with you to the store. Ask the salesperson to look at the pattern of

wear. This pattern can show the kind of support you need. For example, if the back of the


9 2/26/15

shoe is worn down uneven on the bottom, you may need extra support for arches or flat feet.

Keep it Safe Being active is usually safe, but sometimes problems can come up. The best way to avoid problems is to prevent them. Here are some ways to prevent common minor injuries,

• Prevent sore muscles or cramps

Increase only a little at a time how often, how intensely, and how long you are active.

Drink plenty of fluids (especially water) before, during, and after being active.

Warm-up before every activity, and cool-down afterwards.

• If you do get a muscle cramp, treat it this way:

Stretch the muscle, and then massage it. Repeat until the cramp goes away.

If you still have pain, put ice on the pain for a few minutes. Then repeat the stretching and massaging.

• Stretch those muscles!

Stretching is one of the best ways to keep muscles from becoming sore, cramped, or

injured.

Stretching also helps you be more flexible and feel relaxed.

Warming up and cooling down should take only 5 to 10 minutes. Do your planned activity, but more slowly or at a lower intensity for 5 to 10 minutes. Do a few minutes of gentle stretching.


10 2/26/15

Important!

Never stretch if you have pain before you begin. If a stretch causes pain, stop doing it. Listen to your body!

How to stretch

1. Do a short warm-up before stretching.

2. Move slowly until you feel the muscle stretch. A safe stretch is gentle and relaxing.

3. Hold the stretch steady for 15 to 30 seconds. Do not bounce.

4. Relax. Then repeat 3 to 5 times.

5. Stretch within your own limits. Do not push yourself.

6. Breathe slowly and naturally. Do not hold your breath.


11 2/26/15

Safe and Easy Stretches Here are some safe and easy stretches. Arm Reaches

1. Stand up straight with your feet shoulder-width apart. 2. Counting to 5, stretch your right arm to the ceiling while keeping your

feet flat on the floor. 3. Repeat with your left arm. 4. Do this 10 times. Then shake out your arms.

Arm Circles

1. Stand with feet shoulder-width apart, knees slightly bent. 2. Extend your arms straight out from the shoulders with

your fingers spread and palms down. Keep your buttocks and stomach tight.

3. Rotate your arms in circles 10 times forward and then 10 times backward. Then shake out your arms.

4. Over time, work up to 20 circles in each direction. Waist Bends

1. Stand up tall with your feed shoulder-width apart. 2. Bend to the right, bringing your right arm down the side of your

body and left arm over your head. Look straight ahead and count to ten. Slowly return to the straight-up position.

3. Repeat the exercise, bending to the left side. 4. Over time, work up to 5 of these.


12 2/26/15

Safe and Easy Stretches (continued) Sitting Toe Touch

1. Sit on the floor with your feet placed flat against a wall, knees slightly bent. Reach out your hands and slowly stretch them toward your toes. Keep breathing.

2. Repeat 2 to 3 times to start. 3. Over time, work your way up to 10 of these.

Back Press

1. Lie on your back with your knees bent and your hands clasped behind your neck. Keep your feet flat on the floor. Take a deep breath and relax.

2. Press the small of your back against the floor and tighten your stomach and buttock muscles. This should cause the lower end of the pelvis to rotate forward and flatten your back against the floor.

3. Hold for 5 seconds. Relax. Back Stretch

1. Lie on your back with your knees bent and your arms flat on the floor at your sides. Keep your feet flat on the floor. Take a deep breath and relax.

2. Grasp the back of one knee (not the top of the knee) with both hands and pull as close to your chest as possible. Return to the starting position.

3. Repeat with the other leg.


13 2/26/15

Safe and Easy Stretches (continued) Heel Cord (Achilles) Stretch

1. Stand facing a wall an arm’s distance away, with your knees straight and your heels flat on the floor.

2. With your hands resting on the wall, allow your body to lean forward by bending your elbows slowly. Keep your legs and body straight and your heels on the floor.

Calf Stretch

1. Stand straight with feet shoulder-width apart. 2. Step forward with your right foot, slightly bending your right

knee. The front of your knee should be lined up with the front of your toes. Your left leg should stay fairly straight and your left heel should remain on the floor. Hold for 10-20 seconds.

3. Slightly bend your left knee. Hold for 10-20 seconds. 4. Repeat for the other side.


14 2/26/15

When to Stop Exercising Being active is usually safe, but you should be aware of some signs and symptoms that mean you should stop exercising.

• Chest pain or discomfort

What is it?

Tight feeling of pressure, pain, squeezing, or heaviness in the chest

Where in the chest? The pain could be –

- In the center of the chest - Spread throughout the front of the chest - Radiating to the shoulders, arms, neck, or

back

What should I do? Stop exercising, Sit or lie down.

- If the pain does not go away after 2 to 4

minutes, go to a hospital emergency room. - If the pain goes away but returns each time

you exercise, see your doctor.

• Severe nausea, shortness of breath, sweating, or feeling faint

What should I do?

Call your doctor!

These symptoms may indicate something serious. However, sweating alone is not usually a concern. Severe sweating plus other symptoms should not be ignored.


15 2/26/15



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16 2/26/15

To-Do Next Week During the next week I will –

• Be active for __________________________________ minutes.

I will set aside one 20 to 30-minute block of time every day. Or I will find two or more periods of 10 to 15 minutes each.

I will plan other activities I like to do.

I will warm up, cool down, and stretch.

• Plan my activities for the week.

Day What I will do When Minutes

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total minutes for the week:

In my Food and Activity Tracker, I will record only the time that I am actually doing an activity. I will not record activities that last less than 10 minutes.

Keep track of my activity and what I eat, using my Food and Activity Tracker! Do my best in working toward my SMART goal(s). Wear clothes and shoes that are appropriate to participate in our group walk session

next week. Bring my Food and Activity Tracker to the next session.

Nuestra Vida

SESSION SIX: Overview


Session 6– Physical Activity II

2 3/9/15

Session 6: Overview Be Active – It’s Your Choice! This session focuses on how to become more physically active as a lifestyle choice. We have lots of choices in life, and each of us can choose a healthy lifestyle if we want to. However, we have busy lives, and changing is not simple. Finding the Time Time is something we never seem to have enough of. This session will help you find time to be more physically active. If you struggle with finding the time, you may surprised at all the simple ways that you can include physical activity in your day. Choosing an Active Lifestyle Having an active lifestyle means making choices to move instead of to sit. For example, an active choice is to take the stairs instead of the elevator. An example of a not-so-active choice is to park your car as close to the entrance as you can. An active choice would be to park far away and walk to the entrance. These choices take an extra minute or two, but they all make a difference and add up to a more active you.

Quick Fact Why should I work to control my blood pressure? By controlling our blood pressure, we can lower our risk for heart disease and stroke by one-third to one-half. We can also lower our risk for eye, kidney, and nerve diseases by almost one-third.


3 3/9/15

Being Active: A Way of Life. You can find the time to be active. Set aside one block of time every day to be active.

• When can you set aside 20 to 30 minutes to do an activity you like?

________________________________________________________

Look for free time (10 to 15 minutes) during the day. Use the time to be active.

• When during the day might you have some free time (10 to 15 minutes)?

________________________________________________________ Lifestyle Activity Make active choices throughout the day. Every minute adds up to a “more active you.”

Inactive Choice (Limit)

Active Choice

When you shop, park your car as close as you can to the entrance of the store.

Park your car further away and walk.

Turn inactive into active time: Try cutting your TV time in half. Walk instead. Or be active while you watch TV (e.g., ride an exercise bike, lift weights).


4 3/9/15

Keep it Safe Being active is usually safe, but sometimes problems can come up. The best way to avoid problems is to prevent them. Here are some ways to prevent common minor injuries,

• Prevent sore muscles or cramps

Increase only a little at a time how often, how intensely, and how long you are active.

Drink plenty of fluids (especially water) before, during, and after being active.

Warm-up before every activity, and cool-down afterwards.

• If you do get a muscle cramp, treat it this way:

Stretch the muscle, and then massage it. Repeat until the cramp goes away.

If you still have pain, put ice on the pain for a few minutes. Then repeat the stretching and massaging.

• Stretch those muscles!

Stretching is one of the best ways to keep muscles from becoming sore, cramped, or

injured.

Stretching also helps you be more flexible and feel relaxed.

Warming up and cooling down should take only 5 to 10 minutes. Do your planned activity, but more slowly or at a lower intensity for 5 to 10 minutes. Do a few minutes of gentle stretching.


5 3/9/15

Important!

Never stretch if you have pain before you begin. If a stretch causes pain, stop doing it. Listen to your body!

How to stretch

1. Do a short warm-up before stretching.

2. Move slowly until you feel the muscle stretch. A safe stretch is gentle and relaxing.

3. Hold the stretch steady for 15 to 30 seconds. Do not bounce.

4. Relax. Then repeat 3 to 5 times.

5. Stretch within your own limits. Do not push yourself.

6. Breathe slowly and naturally. Do not hold your breath.


6 3/9/15



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7 3/9/15








Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday





Nuestra Vida

SESSION SEVEN: Take Charge of What’s Around You


Session 7– Take Charge of What’s Around You

2 3/15/15

Session 7: Take Charge of What’s Around You Session 7: Overview Understanding Cues We often eat or drink because something triggers our desire for food. These triggers are called cues. Food cues affect how much we eat, and activity cutes affect how much we move. Some cues are positive and lead to a healthy behavior. Other cues are a problem and lead us to overeat or be less active. What Make Us Eat? Hunger is the most obvious one. But there are other triggers. Seeing other people eat makes some of us want to eat too. Maybe it’s the sight or smell of food or the way we feel. Or maybe it’s certain activities such as watching TV or movie. Taking Charge When we respond to a food cue in the same way over and over again, we build a habit. When faced with the food cue, we respond without thinking. Once a habit forms, it becomes hard to break. Changing behavior requires us to take control and stay in control.

Quick Fact What is pre-diabetes? We have pre-diabetes when the glucose in our blood is higher than normal but not high enough for type 2 diabetes. In the United States, 79 million adults have pre-diabetes, and 26 million have diabetes.


3 3/15/15

Finding The Time To Be Active The Challenge: We have many demands on us every day so finding the time to be active can be challenging. The Goal: Find ways to make time. Here’s how:

1. Plan to be active

Schedule physical activity into your day.

Set aside a block of time for an activity and make being active a regular part of your daily routine.

When can you set aside 20 to 30 minutes to do an activity you like?

2. Be on the lookout during the day for 10 to 15 minutes of free time

Some people can’t find one big block of time to be active because they’re so busy.

If this is true for you, take a 10-minute break between chores, other home activities, or between

meetings at work, and go for a brisk walk. Then later, take another 10-minute walk after lunch. In

the evening, if possible, walk your pet to the park or if you help babysit your grandchildren you can

also walk with them to the park or out for a walk with you for at least ten minutes. By the end of

the day you’ve done 30 minutes of activity!

3. Take advantage of the opportunity!

Think ahead about when to be looking out for free moments and take advantage. Arrive early to

any appointments or daily activities you attend so that you can take 10 minutes take a brisk walk

before entering. If you drive, park your car farther away so that you can get in some extra walking

to your destination. If you take the bus, get off a “stop” or two early to get some extra walking in.

When you have 10 or 15 free minutes? How can you add activity during these times?


4 3/15/15

What “Cues” You To Be More Or Less Physically Active? Many things around us lead us to not being active. For example, after dinner, you may always sit

down in front of the TV. This could be because the end of dinner and TV has been paired together

many times in the past.

Remember – you DO have a choice! Choose to take a walk after dinner instead!

Add “cues!” – To be active more often, it is important to add signals (or “cues”) for physical activity

to your life.

Make a new habit – Over time, the signals (like the end of dinner) will become paired with being

active (like taking a walk), and you will make new activity habits that will happen more and more

often.

Add Activity “Cues” To Your Life! What are some activity cues that you can add to your living room, kitchen, bedroom, bathroom (etc.)?

1. Keep exercise clothes and shoes out where you can see them, and not in the closet.

2. Hang a photo or poster of people being active in a place you see a lot.

3. Put a note on the TV saying that a half hour of TV time could be used for a walk instead.

4. One suggestion is to post photos that motivate you, pictures of the outdoors, or reminders to be active on the refrigerator.

5. One example of how to add signals to be physically active is to post a reminder on the mirror

to take a walk before breakfast.


5 3/15/15

Add Social “Cues” To Your Life! What are social cues? They are what other people say or do that affect your activity. Problem social cues:

1. Seeing other people around you not being active. For example, you come home and see

someone you live with sitting on the couch, relaxed, watching TV.

2. Being invited to do something that is not active. For example, you friend asks you to come over

to watch a movie.

3. Being nagged. Some people may think nagging is helpful, but actually it tends to make people

more inactive.

4. Hearing complaints. For example, your spouse says, “You’re always outside walking. You

never have time for the family anymore.”

Good social cues:

1. Seeing other people being active. For example, you go to a neighborhood park and see people

walking or running.

2. Being invited to do something active. For example, your family member, friend, co-worker or

neighbor invites you to go for a walk.

3. Being praised. When someone gives you praise for being active it’s encouraging!

4. Hearing compliments. For example, your spouse says, “You’ve really committed to walking

every day. I’m proud of you.”

Add more positive cues:

1. Stay away from the problem cue, if you can.

2. If you can’t avoid the cue, change it!

a. Talk about the problem.

b. Be willing to make changes to find a solution that will work for everyone.

c. Tell people about the Nuestra Vida, your efforts to lose weight and be more active, and

why this is important to you. Many people will be willing to help if they understand that

you are trying to change your eating and activity and why.

d. Ask others to praise your efforts and ignore your slip-ups.


6 3/15/15



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7 3/15/15








Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday





Nuestra Vida

SESSION EIGHT: Overview


Session 8– Stress

2 3/23/15

Session 8: Overview What is stress? Stress is a part of life and occurs when we tense up in response to pressure. Stress is what happens to us when we allow events or situations to overwhelm our ability to cope with them. Any change, good or bad, big or small, can cause stress. What causes stress? Stress can be caused by many events and situations. Getting married or divorced, a serious illness or health problem, caring for grandchildren or aging family member, moving, and changing jobs can all cause stress. Losing keys, having a birthday, having a flat tire, or losing a loved one can also cause stress. An ounce of prevention… The old saying “An ounce of prevention is worth a pound of cure” is certainly true when it comes to stress. It’s best to avoid stress whenever we can. However, if we cannot avoid stress, there are ways to cope.

Quick Fact What does it feel like to have diabetes? People with type 2 diabetes usually have no clear symptoms. In fact, millions of people have type 2 diabetes and do not know it. Symptoms develop so slowly that people often are unaware of them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, frequent urination, blurred vision, and a feeling of being tired most of the time for no apparent reason.

Session 8– Stress

3 3/23/15

What Causes Stress? Stress can be caused by many events and situations. Getting married or divorced, a serious illness or

health problem, caring for grandchildren or aging family member, moving, and changing jobs can all

cause stress. Losing keys, having a birthday, having a flat tire, or losing a loved one can also cause

stress.

Stress and Your Health

Why are we talking about stress in this program? Many people react to stress by changing their

eating and activity habits. Some people eat and drink too much as a way to deal with stress, and

others may stop eating. Some people become very inactive and withdrawn.

We understand that it is stressful even to attend this program and to think about all the lifestyle

changes we suggest. Changing behavior and asking your family to make changes to help you can

create stress.

Session 8– Stress

4 3/23/15

What are the symptoms of stress? Stress can affect all aspects of your life, including your emotions, behaviors, thinking ability, and physical health. No part of the body is immune to stress, but because people handle stress differently, symptoms of stress can vary. Some symptoms can be the same as those caused by medical conditions. So it is important to discuss them with your doctor. You may experience any of the following symptoms of stress. Emotional symptoms of stress include:

• Becoming easily agitated, frustrated, and moody • Feeling overwhelmed, like you are losing control or need to take control • Having difficulty relaxing and quieting your mind • Feeling bad about yourself (low self-esteem), lonely, worthless, and depressed • Avoiding others

Physical symptoms of stress include:

• Low energy • Headaches • Upset stomach, including diarrhea, constipation, and nausea • Aches, pains, and tense muscles • Chest pain and rapid heartbeat • Insomnia • Frequent colds and infections • Loss of sexual desire and/or ability • Nervousness and shaking, ringing in the ear, cold or sweaty hands and feet • Dry mouth and difficulty swallowing • Clenched jaw and grinding teeth

Cognitive symptoms of stress include:

• Constant worrying • Racing thoughts • Forgetfulness and disorganization • Inability to focus • Poor judgment • Being pessimistic or seeing only the negative side

Behavioral symptoms of stress include:

• Changes in appetite – either not eating or eating too much • Procrastinating and avoiding responsibilities • Increased use of alcohol, drugs, or cigarettes • Exhibiting more nervous behaviors such as nail biting, fidgeting and pacing

Session 8– Stress

5 3/23/15

How do you feel stress?

What situations make you feel stressed?

How do you feel, physically and mentally, when you are stressed?

What do you do differently when you get stressed?

Session 8– Stress

6 3/23/15

How Can We Prevent (Avoidable) Stress?

An ounce of Prevention…

The old saying “An ounce of prevention is worth a pound of cure” is certainly true when it comes to stress. It’s best to avoid stress whenever we can. However, if we cannot avoid stress, there are ways to cope.

Ways to Prevent Stress

Practice these tips to prevent stress: Say “No” when asked to do something you do not want to do.

• Try to say “Yes” only to important matters. Share some of your workload with others.

Set goals you can reach in a realistic time.

Take charge of your time.

• Make realistic schedules. • Get organized.

Use problem-solving techniques.

• Describe the problem in detail. • Think of all your options. • Pick one option to try. • Make an action plan. • Try the plan. See how it goes.

Plan ahead.

• Think of all the good things in your life. • Remember why you joined this program.

Keep things in perspective. Remember your purpose.

• Think of all the good things in your life. • Remember why you joined this program.

Reach out to people for support.

Be physically active. Physical activity is a great stress reducer.

Session 8– Stress

7 3/23/15

How We Can Prevent Stress That is Out of Our Control When you cannot avoid stress Despite your best attempts, you cannot always avoid stress. However, several actions can help you cope with the stress. When you cannot avoid stress:

• Learn to be aware of the signs that show you are getting stressed.

My signs of stress:

1. _________________________________________________

2. _________________________________________________ 3. _________________________________________________

• Stop yourself as soon as you realize you are stressed.

• Move those muscles. Go for a walk, a bike ride, or do another activity you enjoy.

• Pamper yourself. Do something you enjoy doing just for yourself.

• Breathe. Take a full, deep breath. Count to five. Then let go of your breath slowly. Let

the muscles in your face, arms, legs, and body go completely loose.

Catch the stress early

Take a 10-minute time-out

Session 8– Stress

8 3/23/15

Relaxation Exercise

Try this Relaxation activity. It will take you about 20 minutes! Sit on a chair or on whatever you can sit upright with both feet flat on the ground. Do the following exercises in a quick order to learn the order and how to do it. Before you start, close your eyes and enjoy the rest for a minute or so. Clear your mind.

1. Right hand and forearm: Make a fist; Release 2. Right upper arm: Bend the arm and “show off your muscles”; Release 3. Left hand and forearm: Make a fist; Release 4. Left upper arm: Bend the arm and tighten the muscles; Release 5. Forehead: Raise your eyebrows; Relax your face 6. Eyes and Cheeks: Squeeze your eyes; Relax 7. Mouth and Jaw: Clench your teeth and pull the corners of the mouth back; Relax 8. Shoulder and Neck a little pre-training first: Lock your hands behind the neck and push back

that head against this resistance (the head does not alter its position) – got the idea? That’s how this should feel: pull up your shoulders and press your head back against their resistance (horizontally – not like when you look up) let your shoulders hang; Relax

9. Chest and Back: Breathe in deeply and hold your breath pressing the shoulders together at the back at the same time; Let your shoulders hang; Breathe normally

10. Belly: Tighten the abdominal muscles )or draw in the belly); Release 11. Right thigh: Shovel the right foot forward against resistance (while it keeps its position);

Release 12. Right calf: Lift up the right heel (be careful not to cramp); Release 13. Right foot: Crook the toes; Release 14. Left thigh: Shovel the left foot forward against resistance (while it keeps its position); Release 15. Left calf: Lift up the left heel (be careful not to cramp); Release 16. Left foot: Crook the toes; Release Repeat this exercise once in a quick succession then repeat by memory. Tighten each group of muscles and hold the tension for about 5 seconds then relax for about 30 seconds. Repeat each exercise. At the end, keep your eyes closed for a short time and enjoy the relaxation a little longer. Breathe in deeply and move your fingers and toes playfully. Breathe in deeply again and stretch yourself. Breathe in deeply and open your eyes. Do this at the end of each session. This breathing and stretching will make sure that your circulation is reactivated. Usually you will feel quite refreshed afterwards.

Session 8– Stress

9 3/23/15

Sources of Community Help

Emotions and Diabetes Having fears about diabetes is normal. You can’t change the fact that you have been diagnosed with diabetes or prediabetes, or another health concern, but you can choose to make your emotional healthy a priority. Living well takes time and effort. Health concerns can be tough to handle. Do you feel any of the following about the daily hassles of managing your health?

• Overwhelmed • Angry • Unmotivated • Sad • Frustrated

• Scared • Burned out

Addressing these emotional aspects of your health is important for long-term success. Think about ways you can take care of your whole self (mind, body and spirit). Some suggestions include talking to your doctor about your feelings, taking your medications every day and attending a support group (see resource page or contact Scripps Whittier Diabetes Institute (1-858-626-5672) or Behavioral Diabetes Institute (1-858-336-8693) for additional information). In addition, avoid alcohol and drugs. Take time to relax by:

• Walking • Dancing • Yoga • Deep breathing • Daily sunlight • Spend time with family and friends

I like to: _____________________________________________________________

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

Session 8– Stress

10 3/23/15

Coping with Stress Resource List • helpguide.org

This site helps in identifying sources of stress, techniques on how to cope with the stress and also provides other resources and references. http://www.helpguide.org/articles/stress/stress-management.htm#identify

• www.familydoctor.org • Specific section for Mental Health:

o http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health.html

• www.es.familydoctor.org o http://es.familydoctor.org/familydoctor/es/prevention-wellness/emotional-

wellbeing/mental-health.html

Women’s Health

• http://www.womenshealth.gov • http://www.womenshealth.gov/espanol

Home Page A-Z topics “Stress and your health” • http://www.womenshealth.gov/publications/our-publications/fact-sheet/stress-your-

health.html?from=AtoZ

• El estrés y su salud http://www.womenshealth.gov/espanol/publicaciones/nuestras-publicaciones/hojas-datos/estres-su-salud.html

http://www.helpguide.org/articles/stress/stress-management.htm#identify

http://www.familydoctor.org/

http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health.html

http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health.html

http://www.es.familydoctor.org/

http://es.familydoctor.org/familydoctor/es/prevention-wellness/emotional-wellbeing/mental-health.html

http://es.familydoctor.org/familydoctor/es/prevention-wellness/emotional-wellbeing/mental-health.html

http://www.womenshealth.gov/

http://www.womenshealth.gov/publications/our-publications/fact-sheet/stress-your-health.html?from=AtoZ

http://www.womenshealth.gov/publications/our-publications/fact-sheet/stress-your-health.html?from=AtoZ

Session 8– Stress

11 3/23/15

Your Stress Plan Your Plan for Stress

1. What are your major sources of stress?

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

2. Choose one source of stress. Make a positive action plan:

I will:___________________________________________________________________________________________________________ When?________________________________________________________________________________________________________ I will do this first:_____________________________________________________________________________________________ Roadblocks that might come up: I will handle them by: ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________

I will do this to make my success more likely: _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________

Session 8– Stress

12 3/23/15



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Session 8– Stress

13 3/23/15


• Keep track of my weight, eating, and physical activity. • Try my action plan for managing stress. • Answer these questions:

Did my action plan work? _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ If not, what went wrong? _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ What could I do differently next time? _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________

• Keep track of my activity and what I eat, using my Food and Activity Tracker! • Do my best in working toward my SMART goal(s). • Bring my Food and Activity Tracker to the next session.

Nuestra Vida

SESSION NINE: Negative Thoughts and Emotions


Session 9– Negative Thoughts and Emotions

2 3/23/14

Session 9: Overview Overcoming Negative Thoughts Positive thoughts are thoughts that make us feel good about our progress. Negative thoughts cause us to lose hope or stand in the way of our progress. A negative thought is usually a criticism of ourselves. We become angry with ourselves for something as simple as eating a piece of cake or not going for a walk. We are all human, so we all have negative thoughts from time to time. However, we must try to overcome them because they often lead us into doing even more eating and less activity rather than the reverse. The Negative Spiral Suppose you come home after a hard day at work. You think to yourself, “I am tired of working so hard. I am sick of this program. I can never eat what I want.” This negative thought might lead you to eat some potato chips. And then you think, “I did it again. I will never lose weight.” So you go on to eat more chips. Does this sound familiar? We’ve all done this, so please don’t give up because you ate one or two unhealthy items. If you begin to lose hope because of this chain of thoughts and unhealthy actions, take a deep breath and start again. You are worth it!

Quick Fact Is it true that diabetes is linked to Alzheimer’s disease? Recent studies show that the risk for Alzheimer’s disease is much higher for people with diabetes than for people without diabetes, especially for people with type 2 diabetes. The link between diabetes and Alzheimer’s disease may contribute to the loss of memory that people with chronic diabetes often suffer from.


3 3/23/14

Myths and Attitudes about Diabetes Some common myths about how diabetes develops and whether or not it can be prevented are:

1. If I get diabetes: • It is a punishment from God • No matter what doctors or nurses tell me, I am meant to get diabetes • No matter what I eat or if I exercise, I am meant to get diabetes

2. A traumatic experience can cause diabetes, for example:

• Being shocked or frightened by something • Pent up anger • A traumatic impression

3. Diabetes medication:

• Insulin causes blindness, addiction, amputation or cancer • Herbs can be used to cure diabetes • Eating nopales and aloe vera is a good treatment for diabetes • Drinking urine is a cure for diabetes

Have you heard any of these statements before? Do you believe that any of these are true? Know The Facts Be sure to know the facts and correct information. It will make a difference! Believing the wrong information can be unhelpful and potentially harmful.


4 3/23/14

The Habit of Negative Thoughts Negative thinking can become a habit. For many of us, negative thoughts occur automatically. We tend to believe and act on our negative thoughts without being aware that we are doing so. One goal of this program is to help you recognize negative thoughts as they occur and to teach you to talk back to them. Negative Thoughts Everyone has negative thoughts. This table helps explain the different types of negative thoughts.

Type of Negative Thought Example Good or Bad • Divides the world into

good or bad foods • Sees self as a success or

failure • Is on or off the program

“Look at what I did. I ate that cake. I will never be able to do well in the program.”

Excuses • Blames others for problems

• Claims to not be able to help or control situations

“I have to buy these cookies just in case friends drop in.”

Should • Expects to always make the right choice

• Gets set-up for failure • Leads to anger

“I should have eaten less dessert.”

Not As Good As • Compares self to someone else

• Blames self for not doing as well as someone else

“Martin lost two pounds this week, and I only lost one.”

Give Up • Beat oneself up • Often follows the other

kinds of negative thoughts

“This program is too hard. I might as well forget it.”


5 3/23/14

Talking Back to Negative Thoughts We can talk back to negative thoughts. Here are some examples of how it works for the

different types of negative thoughts. General way to stop negative thoughts:

1. Catch yourself. Think, “I am being negative about myself.” 2. Say “Stop!” to yourself. Say it loud. Picture a huge, red stop sign.

Negative Thought

Talk back with a positive thought

Foods are either “good” or “bad” “I can never eat dessert again.” “Look at what I did. I ate that cake. I will never do well.”

Work toward balance “I can eat dessert and cut back on something else.” “One slip-up is not the end of the world. I can get back on track.”

Excuses “It’s too cold to take a walk.” “I do not have the willpower.”

It’s worth a try “I can go for a walk and stop if it gets too cold.” “It is hard to change old habits, but I will give it a try and see how it works.”

Should “I should have eaten less dessert.” “I haven’t written down everything I eat.”

It is my choice “It was my choice. Next time I can decide not to eat so much.” “I’m writing down everything I eat because it helps me eat better.”

Not as good as “Martin lost two pounds this week, and I only lost one.”

Everyone is different “It is not a race. Martin and I can lose weight at different rates and both do well.

Give up “This program is too hard. I might as well forget it.” “I will never get it right.”

One step at a time “I’ve learned something about what is hard for me.” “I will try something different next time.”


6 3/23/14

Practice Talking Back Follow these steps to practice replacing a negative thought with a positive one:

1. Write below the negative thoughts you’ve had.

2. Say each thought out loud. Then say, “Stop!”

3. Talk back, again out loud, with a positive thought. Write down the positive thought.

Negative Thought

STOP!

Positive Thought


7 3/23/14



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8 3/23/14


• Keep track of my weight, eating, and physical activity.

• Catch myself when I have negative thoughts.

I’ll practice stopping the negative thoughts and talking back with positive thoughts.

I’ll write down the positive thoughts in my Food and Activity Tracker.


Nuestra Vida

SESSION TEN: FAMILY HEALTH


Session 10 – FAMILY HEALTH

2 4/1/15

Session 10: Overview One of the biggest health problems that the country and our communities face is obesity. Today, more than 1 in 3 adults, children and adolescents are overweight or obese. Latino and Mexican American children are even more likely to be overweight or obese. Obesity can affect our health in many very serious ways. Too much time spend in front of the television is one of dozens of factors that can increase the chances that we will be overweight or obese. So, how can we change this? We can begin healthy lifestyle habits of our own, so we can inspire our family members, children, and grandchildren to begin their own healthy lifestyle habits!

Quick Fact Is it true that people with diabetes cannot eat sweets? People with diabetes can eat sweets and dessert if those foods are part of a healthy meal plan that is combined with plenty of physical activity. Sugar is not off limits to people with diabetes. But people with diabetes must be careful about how much sugar they eat.


3 4/1/15

Facts about Obesity.

1. About 1/3 of the adults living in the United States and Mexico are obese.

2. Obesity is defined as having excess body weight, or weighing more than is healthy for your height.

3. Obesity is usually measured by the BMI (body mass index), which we discussed in an earlier

session. BMI values can tell us whether we are underweight, normal weight, overweight, or obese. An

adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or

higher is considered obese.

4. Being overweight or obese significantly increases your risk for the following diseases:

• Coronary heart disease

• Type 2 diabetes

• Cancers (endometrial, breast, and colon)

• Hypertension (high blood pressure)

• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)

• Stroke

• Liver and Gallbladder disease

• Sleep apnea and respiratory problems

• Arthritis (degeneration of bones and joints)

• Gynecological problems (abnormal menses, infertility).

BMI Underweight Below 18.5 Normal 18.5–24.9 Overweight 25.0–29.9 Obesity 30.0 and Above


4 4/1/15

What causes obesity?

Our weight is determined by many things – our family genes and body types, our behavior (eating

and physical activity), our environment, our culture, and our economic statues. Being overweight or

obese is usually caused by an energy imbalance – eating too many calories and not getting enough

physical exercise.

Ways to prevent or reduce obesity: • Follow a healthy eating plan. Make healthy food choices and focus on the balance of energy IN and

energy OUT.

• Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions served often are enough for two or three people. Children's portion sizes should be smaller than those for adults. Cutting back on portion size will help you balance energy IN and energy OUT.

• Be active. Make personal and family time active. Find activities that everyone will enjoy. For

example, go for a walk, bike or rollerblade, or play music and dance. • Reduce screen time. Limit the use of TVs, computers, DVDs, and videogames because they limit

time for physical activity. Health experts recommend 2 hours or less a day of screen time that's not work- or homework-related.

• Keep track of your weight and body mass index.


5 4/1/15

Childhood Obesity: How Can I Help? Encourage Healthy Eating Habits

• Serve reasonably-sized portions • Encourage them to drink lots of water • Limit sugar-sweetened beverages • Limit consumption of sugar and saturated fat

What changes can I make to encourage healthy eating habits in my family? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Look for ways to make their favorite dish healthier

• Provide plenty of fruits, vegetables and whole-grain products • Include low-fat or no-fat milk and dairy products • Choose lean meats, poultry, fish, lentils and beans for protein

Which dishes can I make changes to make it healthier? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Help Your Family Stay Active Children and teens should participate in at least 60 minutes of moderate intensity physical activity most days of the week. Here are some examples:

• Brisk walking • Playing tag • Jumping rope • Playing soccer • Swimming • Dancing

Remember that small changes every day can lead to a recipe for success!


6 4/1/15

Menopause

Some common experiences:

• Changes in periods (may become shorter, longer, lighter or heavier than usual)

• Hot flashes and/or night sweats

• Vaginal dryness, which can lead to discomfort or itching and pain during sex

• Sleep problems – having a hard time going to sleep, staying asleep, or sleeping too much

• Tiredness and stiff or painful joints

• Changes in mood, such as feeling down, anxious, or irritable

• Weight gain, especially around the middle

Menopause symptoms, like hot flashes, usually stop on their own over time and may not require

medical treatment. A simple way to cope with hot flashes is to wear appropriate clothing, e.g., wear

lightweight cotton clothes. Lifestyle changes (e.g., exercise, balanced diet) may also help relieve menopause symptoms.

How to stay healthy during menopause? • Increase physical activity - more activity during this time can help reduce weight gain

and reduce risk for diabetes and heart disease. Exercise that is relaxing, such as

walking, stretching, or yoga may be particularly helpful.

• Decrease sitting time, such as TV-watching hours

• Have fewer high-fat foods and sugar-sweetened beverages, such as sodas

• It may helpful to talk to other people you trust about what you are experiencing so they

can be supportive during this time.


7 4/1/15

Reducing Screen Time Studies have shown that decreasing the amount of TV watched led to less weight gain and lower body mass index (BMI).

Healthy TV Habits

• Keep TV’s and internet connections out of bedrooms (especially for children/adolescents)

• Turn the TV off during meals

• Don’t allow kids to watch TV while doing homework

• Treat TV as a privilege to be earned – not a right. Establish and enforce family TV viewing rules, such as TV is allowed only after chores and homework are completed.

• Try a weekday ban – you’ll have more family togetherness time to spend on meals, games,

physical activity and reading during the week.

• Set a good example by limiting the amount of TV you watch Healthy Rewards / Screen-free Things To Do Simply recognizing kids and other family members for good work or healthy behavior is a great motivator and is always appreciated – say “You did a great job!” or “I appreciate your help”. Here are some other non-food rewards:

• Allow children to have a few friends over after school to play sports

• Invite a few of their friends to a play date or sleepover

• Let your child/grandchild help plan a special outing

• Read a bedtime story of the child’s choice, or listen to music

• Have a family game night

• Allow the child or other family member to plan an outdoor game,

sport, or activity that the family will do together

• Keep a box of special toys, games or art supplies for kids that can only be used on special

occasions

• Create a system so children can earn movie tickets, coupons, gift certificates, or discounts

to skating rinks, bowling alleys, and other entertainment outlets


8 4/1/15



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• Follow my action plan for making social cues work for me.

• Answer these questions:

Did my action plan work? ______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________

What could I do differently next time? ______________________________________________________________________________ ______________________________________________________________________________


Nuestra Vida Curriculum

SESSION ELEVEN: The Slippery Slope of Lifestyle Change


Session 11 – The Slippery Slope of Lifestyle Change

2 4/7/15

Session 11: The Slippery Slope of Lifestyle Change Session 11: Overview Slips We know that sometimes change is hard. It is not easy to be the best we can be. What are slips? Slips are times when we do not follow our plans for healthy eating or being active. Slips are normal. If you haven’t already had a slip, you will surely have one in the future. However, no need to worry. Slips do not always hurt our progress. What hurts our progress is the way we react to slips. Why do we slip? We slip because we are human. However, different things cause different people to slip. We talked about cues that make us eat or not be active. Moods or feelings cause many of us to slip from healthy eating. Some of us overeat when we are happy. Some of us overeat when we are bored. What causes us to slip is a habit, something we learned over time.

Quick Fact What does diabetes cost us?

• Having diabetes is expensive, mainly because of the many complications associated with the disease.

• The medical costs for a

person with diabetes average nearly $12,000 a year. That amount is more than double the medical expenses of people without diabetes.

• Each year in the United

States, the costs associated with diabetes total more than $200 billion.


3 4/7/15

The Slippery Slope of Lifestyle Changes Slips are times when we don’t follow our plans for healthy eating or being active. They are –

• A normal part of lifestyle change.

• To be expected.

What causes slips? Ask yourself, how can I react to slips when they happen? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Slips do not hurt our progress. What hurts our progress is the way we react to slips. What causes us to slip is a habit, something that we learned over time. The way we react to slips is also a habit. We can learn a new way to react to slips to get back on our feet again.


4 4/7/15

After a Slip As you go forward with this program, remember two things: slips are normal and are to

be expected. Just about everyone who tries to lose weight and be more active has slips. A slip is not a problem. Just get back on your feet, and continue to work toward your goals.

So after you slip:

1. Talk back to negative thoughts with positive thoughts.

Negative thoughts are your worst enemy. Talk back. “I am not a failure because I slipped. I am back on my feet again.”

2. Ask yourself how the slip happened.

Learn from the slip. Can you avoid the cue in the future? Will you be able to handle this situation better?

3. Regain control immediately. Make your very next meal a healthy one. Get back on schedule with your activity plan right away.

4. Talk to someone supportive. Call your “Peer-Educator” or another friend and discuss your new plan for handling slips. Commit yourself to a new effort.

5. Focus on all the positive changes you made. You are making lifelong changes, and slips are just part of the process.

Overeating once, no matter how extreme, will NOT ruin everything.


5 4/7/15

Slips from Healthy Eating and Physical Activity: Action Plan To avoid slips from your healthy eating, spend a moment thinking about how you slipped in the past, and how you might handle similar situations better in the future.

1. Describe one thing that caused you to slip from healthy eating or physical activity.

___________________________________________________________________________

2. How can you avoid it in the future? If so, how? ___________________________________________________________________________

3. Make a plan for how to get back on your feet the next time you slip:

I will:__________________________________________________________________________ When?________________________________________________________________________ I will do this first:_________________________________________________________________

Barriers that might come up: I will handle them by: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

In order to meet my goal, I will: _____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How can my classmates, family, and my Promotora help me reach my goals: ________________ ______________________________________________________________________________ ______________________________________________________________________________


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• Use my two action plans for handling slips.


Did my action plans work? ______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________



Nuestra Vida

SESSION TWELVE: Review and Ways to Stay Motivated


Session 12 – Ways to Stay Motivated

2 4/10/15

Session 12: Ways to Stay Motivated Session 12: Overview Congratulations! This session is the last week of this 12-week program. From now on, you will have the tools and information to continue your work toward a healthier lifestyle. You will continue to meet as a group with a Lifestyle Coach, but the group will meet only once a month. Reviewing You Progress As we close this part of the program, think about all the great progress you made. Think back to the first session, and be proud of your success. If you have met your goals – GREAT! If you are still working on them – GREAT! Just don’t give up! You have what you need to succeed. Remember, you just finished the most successful program known to science for helping people prevent type 2diabetes.

Quick Fact: How does my doctor test for diabetes? To find out whether someone has pre-diabetes or diabetes, doctors will probably do a test called the Glycated Hemogolobin (HbA1c) test. This test measures the average percentage of glucose in your blood during the 6 to 8 weeks before the test. You do not have to fast to have the test done.

• If the result is 6.5% or higher, you have diabetes.

• If the result is somewhere from 5.7% to 6.4%, you have pre-diabetes.

Doctors may also do a fasting glucose test to diagnose diabetes.

• If the result is 126 mg/dL or higher, you have diabetes.

• If the result is somewhere from 100 to 125 mg/dL, you have pre-diabetes.


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Staying Motivated A key part of keeping on track with healthy habits is staying motivated. This week, we will review ideas for staying motivated that worked for others. It is important to find out which ideas work best for you. Ways to Stay Motivated

• What did you hope to achieve when you first joined this program?

• Have you reached these goals?

• Were there any benefits to being in the program you did not expect?

• What would you like to achieve during the next 6 months of the program?

• What changes in your eating and activity do you feel proudest of?

• What was easier than you thought it would be? What was harder?

1. Stay aware of the goals you’ve already reached and the goals you plan to reach.

2. Recognize you successes.


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• Post weight and activity graphs on your refrigerator door.

• Mark on a chart your activity milestones toward a specific goal.

• Measure waist or belt size once a month.

• Record your activity daily.

• Record everything you eat every day.

• Record your weight once a week on:_____________________

• How have you varied your activity?

• How do you vary meals and snacks to avoid becoming bored?

• Can you think of some new ways to vary your food choices?

3. Keep visible signs of your progress.

4. Keep track of your weight, eating, and activity.

5. Add variety to your routine.


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• Develop ways to reward yourself when you meet new challenges. Challenges: should be specific, short-term, and realistic. Rewards: something you will do or buy if, and only if, you succeed in your challenge.

• What are some non-food ways you can reward yourself for meeting a challenge?

• Set up a friendly contest that everyone wins. That is, everyone will lose weight, although one person my lose more than others.

• What ideas do you have for a contest?

• If you do slip, focus on how to get back in the game. Stay motivated.

• Call your group leader, fellow group member, or friend for encouragement and support.

6. Identify new ways to challenge and reward yourself.

7. Create some friendly competition.

8. Remember slips are normal.

9. Look to others for help in staying motivated.


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Progress Review

Changes you made to be more active: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Changes you made to eat less fat and fewer calories: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Have you reached your weight goal? ☐ Yes ☐ No Have you reached your activity goal? ☐ Yes ☐ No If you have not met one or both of these goal, what will you do to move closer to them? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________


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A Plan for Staying Motivated

1. Choose one way to stay motivated that would help you now.

_____________________________________________________________________________

1. Make a positive action plan:

I will:______________________________________________________________________ When?____________________________________________________________________ I will do this first:_____________________________________________________________ Roadblocks that might come up: I will handle them by: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

I will do this to make my success more likely: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ How can other program participants or the group leader help you? _____________________________________________________________________________

_____________________________________________________________________________

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Important Things to Remember

Session 1 Review Health risks for Latina women. Latina women ages 45-60 are at risk for developing diabetes, heart

disease, and cancer, but you can reduce your risk greatly if you lead a healthy lifestyle. Risk Factors for Type 2 Diabetes and Strategies for Reducing Your Risk. Women are at a greater

risk to develop Type 2 diabetes if they had GDM during pregnancy, have a relative who has/had it, is of Latino, Native-American, African American, or Pacific Islander descent, over age 45, or deliver a baby over 9 lbs. Reduce your risk by maintaining a healthy weight through “Tipping the Calorie Balance,” and self-monitoring what you eat. Be honest!

Tipping the Calorie Balance. Remember that weight is a function of how many calories you consume and how many you spend through physical activity. If the “calories in” equal the “calories out”, what should you expect to happen? What should you do if you want to lose weight?

Nuestra Vida Lifestyle Goals. The goal of the program is to achieve weight-loss through healthy eating and regular (150 minutes of moderate) weekly physical activity!

SMART Goals. Make goals that are specific, measurable, achievable, realistic, and time-based (SMART).

Session 2 Review

Weight Loss. Aim to lose a moderate amount of your current body weight. Losing weight through

healthy eating and living an active lifestyle reduces your risk for Type 2 diabetes and other health problems. A healthy body weight will also make you feel better! Aim for a Body Mass Index (BMI) between 18.5 and 24.9.

Body Mass Index and Weight. Body Mass Index (BMI) is calculated based on your height and weight. BMI indicates your body fat. BMI categories can be used to classify an individual’s potential risk for health problems. Underweight (<18.5), Normal (18.5-24.9), Overweight (25.0-29.9), Obese (>30)

What You Eat and How You Eat. Follow the example you saw on MyPlate. Colorful vegetables should take up half of your plate, with whole grains and protein taking up the other half (grains should be a bit bigger). Don’t forget a serving of low-fat dairy! Eat meals regularly, eat “attentively”, and use portion control in order to follow a healthy diet. Remember your recommended daily portions!

Self-Monitoring. In order to make healthy eating changes, you must know how and what you are eating. Self-monitor your diet in order to see what you are eating and where you need to make changes!


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Session 3 Review Nutrients. Your body needs Vitamins A, C, and E, zinc, potassium, fiber, B-vitamins, and protein. They

are needed for healthy growth (at all ages), to provide energy and to prevent chronic disease. Calories. Calories are energy. They come from the food you eat, carbohydrates, protein, fat or alcohol. Eat More Of: colorful vegetables, whole grains, colorful fruit, lean proteins and dairy. Eat Less Of: dietary fat, salt (or sodium) and sugar. Nutrition Labels. Know what you are eating by reading the nutrition label. Look for the serving size,

total fat/cholesterol, sodium, carbohydrates, dietary fiber, sugar and vitamins/minerals.

Session 4 Review Eating Healthy on a Budget. Like most people, you may be eating healthy on a budget. Cook and

freeze your food, plan your cooking by the week, look for sales, and grow your own fruits and vegetables whenever possible to reduce waste.

Cooking Wisely. Follow the cooking recommendations you learned to help reduce the amount of fat and salt you consume. What are your favorite methods?

Tips for Family Gatherings and Eating Out. Eating at family gatherings can be challenging when you are avoiding unhealthy foods. Saying “no thank you,” trying a small taste, being honest with the host about your lifestyle changes, and other tips can help.

Eating Cues. What makes you eat or want to eat? “Eating cues” are things around you that make you eat, or make you want to eat. Problem-food cues lead us to eat when we’re not hungry, eat more than we should and eat something that is unhealthy. Problem-food cues lead to unhealthy habits. Build better habits by avoiding unhealthy food cues.

Involve friends and family in your healthy eating plan. Involving others can help you model good health, encourage you to eat healthy, support your goals and make it easier to reach your weight-loss goals!

Session 5 Review

Nuestra Vida Goal for Physical Activity. The goal is moderate physical activity for at least 150

minutes per week. Being physically active will help you lose weight and keep it off. It will help you feel and look better, improve your mood, and give you more energy. It will also help lower your risk for heart disease and diabetes, and it will show your friend or family member that being physically active is great!

You CAN Do It! Meet the physical activity goal by picking moderate activities that you like and by working up to the “150 minutes” slowly.

Intensity level. Your intensity level differs by how hard you have to work to complete an activity. The levels are: Low intensity (walking casually, pushing your grandchild’s stroller), Moderate intensity (brisk walking, dancing) and Vigorous intensity (running, swimming laps).


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Be Safe! Make sure you follow safety precautions when being physically active. Wear appropriate clothes and shoes, stay hydrated, warm-up, stretch, pace yourself and cool down when your activity is done.

Session 6 Review

Walking is a great way to begin physical activity! It can be fun and energizing. Follow safety

precautions and invite a friend or family member! Lifestyle Activity. Making active lifestyle choices is important for meeting your physical activity

goals. What kinds of inactive choices do you make that you can transition into active ones?

Session 7 Review Finding the Time to be Active. One of the MOST common challenges is finding the time to be active.

Because we have so much demanded of us, it is important to find ways to make time to be active. Plan to be active by setting aside a block of time for an activity. Make being active a regular part of your daily routine and be on the lookout during the day for 10 to 15 minutes of free time. Use this time to be active and take advantage of those unexpected opportunities to be physically active – even if it’s only for 10 minutes!

Physical Activity Cues. It is important to add cues to your environment that will “cue” you to be more active. For example, keep exercise clothes and shoes out where you see them, and not in the closet. Hang a photo or poster of people being active in a place you see often. And finally, put a note on the television saying that a half hour of television time could be used for a walk instead! Problem social cues are those that cue you to be inactive. For instance, seeing other people around you not being active, being invited to something that is not active, or being nagged are all examples of problem social cues. Seek out positive social cues, such as being around other people who are active.

Involve Friends and Family in your activity plan. You can encourage each other to be more active and hold each other accountable.

Session 8 Review

Stress. Stress is due to tension and it affects how we feel and think, our behavior and attitudes, and

how we make decisions. Any change, good or bad, big or small, can cause stress. Many people react to stress by changing their eating and activity habits. Some people eat and drink too much as a way to deal with stress, while others may stop eating altogether. On the other hand, some people choose to stop being active and stop socializing

Preventing Stress. The best approach is to prevent stress whenever you can. Try saying “no”, sharing work with others, setting goals you can reach, getting organized and planning ahead in order to prevent stress.


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Ways to Cope with Stress that is Out of Your Control. Catch yourself feeling stressed as early as you can and take a 10-mintue break. Develop a new habit of responding to stress with a break. Exercise, pamper yourself, breathe, do relaxation exercises, keep things in perspective and reach out to your support system.

Establish Your Support System. Having other people who listen to you and help you is a “support system”, a good way to help you manage stress. Ask supportive people to help when you are overwhelmed or need someone to encourage you. Family can be a great support system.

Session 9 Review

Myths and Attitudes About Diabetes. Some common myths and attitudes about the causes and

treatments for Type 2 diabetes can keep you from taking care of yourself properly. Negative Thoughts. Negative thoughts are those that cause you to lose hope or stand in the way of

your health goals. A negative thought is usually a criticism of yourself. The problem with negative thoughts is that they can lead you to overeat or to be inactive, which can lead to even more negative thoughts.

Types of Negative Thoughts. Five types of negative thoughts: Good or Bad thoughts (These make you believe that you are only one thing or the other), Excuses/Rationalizations (These blame something or someone else for your problems and make you “powerless” to change), “Should” thoughts (These expect perfection, and can lead you to disappointment or resentment), “Not as Good” thoughts (These compare you to someone else and then blame yourself for not measuring up to them), & “Give Up” thoughts (These thoughts are self-defeating and often follow the other kinds of negative thoughts).

Talk Back to Negative Thoughts. Once you are able to identify and be aware of these different kinds of negative thoughts, it is important to confront them! Catch yourself having a negative thought, shout “STOP!” to yourself, and react with a positive thought instead!

Session 10 Review

Obesity. About 1/3 of the adults living in the United States and Mexico are obese. Being overweight or

obese significantly increases your risk for heart disease, type 2 diabetes, cancer, hypertension, stroke, and other diseases. Overweight and obesity is often caused by an energy imbalance – eating too many calories and not exercising enough. We can reduce or prevent obesity by eating a healthy diet, being active, reducing screen time, and keeping track of our weight.

Childhood Obesity. Childhood obesity poses a huge problem for our communities. Today, more than 1 in 3 children and adolescents are overweight or obese, more than ever before. Some children, including Latino and Mexican American children, are much more likely to be overweight or obese. Problems that children can suffer from being obese include high blood pressure, high cholesterol, Type 2 diabetes and sleep apnea. It also affects how children feel about themselves and how others treat them.


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Screen Time. Screen time includes the time that you spend watching television and playing video or computer games. Too much screen time is associated with being overweight, not getting regular sleep, developing behavior problems, having problems at work and having less energy.

Modeling Healthy Behaviors. Modeling healthy behaviors is important because one never knows how one can influence those around us. Family members including young children learn from what they see! Parents and grandparents serve as the role models. This means we can inspire the people we care most about to begin their own healthy lifestyle habits You can do this by exhibiting healthy behavior yourselves. Focus on Screen Free things to do!

Non-Food Rewards. Do not reward yourself or others with food. It is important to reward children and other family members for good behavior and achievements. However, avoid offering food as a reward. Excellent forms of non-food rewards are hugs, kisses and spending extra time doing things you or your loved one likes to do, such as going to the beach or park, or dancing. Don’t forget to reward all attempts at physical activity and healthy eating with praise and encouragement.

Session 11 Review Slips Are a Part of Life. Slips are times when we do not follow our plans for healthy eating or being

active. Slips are normal. If you haven’t already had a slip, you will surely have one in the future. However, no need to worry. Slips do not always hurt our progress. What can hurt your progress is the way you react to slips.

What Causes Slips? Different things cause different people to slip. We talked about cues that make us eat or not be active. Moods or feelings cause many of us to slip from healthy eating. Some of us overeat when we are happy. Some of us overeat when we are bored. What causes us to slip is a habit, something we learned over time.

Getting Back on Track. Getting back on track after a slip is easy to do! Keep in mind that no single time of overeating or of being inactive, no matter how extreme, will ruin everything. Follow the following steps: Respond to negative thoughts with positive thoughts. Ask yourself what happened. Use this information to learn from the slip. Regain control the next time. Talk to someone supportive. Focus on all the positive changes you have made and realize that you can get back on track!

Session 12 Review

How to Stay Motivated. Motivation is very important to maintain healthy eating and physical activity

in the long term. Here are some suggestions for staying motivated: Keep in mind the goals you have already reached and those you hope to reach, Recognize your successes, Keep visible signs of your progress so you can see how far you’ve come, Keep track of your weight, eating, and activity, Add variety to your routine, Set new SMART goals for yourself and develop ways to reward yourself when you meet each goal, Create some friendly competition, and Use others to help you stay motivated.

Alumni Group Meetings. Alumni group meetings will occur once per month for 3 months. They will provide you with continued support in order to meet your long-term healthy lifestyle goals!


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• Try my action plan for staying motivated.


Did my action plan work? ______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________


• Keep track of my activity and what I eat, using my Food and Activity Tracker! • Do my best in working toward my SMART goal(s).

SESSION ONE: Welcome to Nuestra Program Vida Participant ... · Being overweight, especially having...

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Transcript of SESSION ONE: Welcome to Nuestra Program Vida Participant ... · Being overweight, especially having...