Eating Pattern Assessment (Move Yourself-Cooper Clinic)

Transcription

1 WHAM Handouts 1

2 Comfort Contract What is said in this room stays in this room. No pagers or cell phones during class time. Speak from your own experience. Nothing about me without me! Go easy on aftershave and perfume (some of your classmates may be allergic to these). No personal attacks. No side conversations 2

3 Eating Pattern Assessment (Move Yourself-Cooper Clinic) For each of the food groups in the chart below, circle the foods that you usually eat from that particular category Food Group One Two Three Breads, cereals, and other starchy food Whole grain breads, cereals, crackers and pasta; wild and brown rice; corn tortillas; beans prepared with healthy or limited fats. White bread; presweetened cereal; granola; white rice; regular pasta; cornbread; muffins; regular crackers; flour tortillas; beans prepared with fat Doughnuts; biscuits; croissants; pastries; egg noodles; high-fat crackers; refined beans; potato skins; French fries; pasta, potatoes, and rice prepared with butter, cream or cheese Fruits and vegetables 4 or more servings of vegetables per day; 2 or more servings of fruit per day 2-4 servings per day of combined vegetables and fruit; canned fruit in heavy syrup Less than 2 servings of fruits and vegetables a day, coconut; vegetables cooked with cream, butter or cheese Dairy products Skim or 1% milk; 1% yogurt; low-fat soy milk; nonfat cheese; cheese with less than 3 grams of fat per ounce Reduced fat (2%) milk; 2% yogurt; reduced-fat cheese; light cream cheese; light sour cream Whole milk; whole milk yogurt; custard-style yogurt; Regular sour cream; cream cheese; regular cheeses like ricotta, Swiss, American, cheddar Meats, poultry, fish, eggs Small to moderate portions of lean beef and pork tenderloin; extra lean hamburger; skinless poultry; seafood; fish; egg whites or only a few eggs a week Larger portions of lean beef and pork cuts; lean hamburger; ground turkey; poultry with skin Marbled beef and pork; regular hamburger; bacon; sausage; bologna; hot dogs; fried chicken; fried fish; canned fish packed in oil; more than 6 egg yolks a week Fats and oils Use vegetable oils in moderation when preparing foods; consume moderate amounts of nuts, avocado, and olives; no trans fats Often add fats and oils when preparing foods at home; use soft margarine Always add fats and oils when preparing foods at home. Do not measure the amount of oil used. Frequently eat fried foods and fat foods. Use butter or stick margarine Desserts and snacks Pretzels; angel food cake; fig bars; graham crackers; lowfat crackers and cookies; low-fat popcorn; non-fat plain frozen yogurt without added sugar or fructose; sorbet Low-fat chips; cakes; brownies; regular popcorn; sherbet Regular potato, corn, and cheese chips; ice cream; candy; rich cakes; cookies; pies Beverages Water; less than 1 or 2 cups of coffee a day; 100% fruit juice; 100% vegetable juice; a variety of tea; little or no alcohol. Few alcoholic beverages; sports drinks; fruit punch. More than 2 cups of coffee a day; more than 2 drinks of regular latte drinks, regular soft drinks, and hot chocolate. 3

4 Interpreting the Results Into which column (one, two, or three) do most of your circled foods fall? If your answers are in Column one: Congratulations. You are enjoying a healthful diet that may help you reduce many of your risk factors for heart disease and stroke. Keep up the good work. Columns one and two: You are doing a good job of eating a healthful diet. Make a few changes so more of your food choices are in column one. Column two: Your diet is moderately healthy. You may have made some steps in the right direction. Keep making changes slowly until most of your food choices are in column one. Columns two and three: Your diet is not as heart healthy as it could be. Try to move away from some foods in column three and eat them only occasionally. Make changes slowly so that more of your choices are in column two, then mostly in column one. Column three: Your diet has room for improvement. Choose one or two food groups and start to slowly make changes toward two, then column one. Save the column three foods for eating on special occasions. 4

5 The YOU Diet Crib Sheet (YOU on a Diet by Roizen and OZ) Meal Strategy Waist Foods (eat em) Waste Foods (Trash em) In a Hunger Emergency Substitute Foods Meal Journal Supplements The Team The YOU-Turn Three main meals plus snacks, so you are never hungry. No eating within three hours of bedtime. Consider dessert an every other day treat. Whole-grain carbohydrates; fiber; nuts, which include healthy monounsaturated and polyunsaturated fats; protein, such as lean meats (two-legged preferred) and fish. Added sugars, simple carbohydrates, fructose as in high fructose corn syrup, trans fat, saturated fat, nonwhole- grain flour, and enriched and/or bleached flour. Apples, almonds, walnuts, edamame (soybeans), sugarless gum, water, cut-up vegetables, low-fat yogurt and cottage cheese. In any recipe or meal plan, you can replace any fruit or vegetable with another to make recipes to your taste. You can keep track of what you eat at Once a day, take a multivitamin as an insurance policy against less-than-perfect food choices. Other supplements need to be discussed with your doctor. Don t be afraid to enlist advice from qualified nutritionists and trainers. But one of your most important team members will be your support partner someone who can encourage you and be a deterrent to failure, too. It s OK to make mistakes. The important thing is to catch them, recognize them, control them, and allow yourself the opportunity to get back on the right (waist management) road. 5

6 ROLE PLAYING SHARED DECISION MAKING GETTING READY FOR YOUR DOCTOR APPOINTMENT AND HEALTH TESTS An important emerging concept in whole health self-management is shared decision making. In the WHAM training, shared decision making is defined as the collaboration of a medical professional and recipient of whole health services to determine the treatment and self-management actions for maximizing whole health. In this collaboration, both the medical professional and recipient of whole health services should be valued as experts. The doctor may be an expert on medications, tests, and treatment, but equally important is the recipient of whole health services who uses skills like person-centered planning and the eliciting of the Relaxation Response as an expert on self-management. Following are 2 suggested scenarios for role playing: 1. A peer seeks support from a peer leader after learning that his blood pressure was high when taken at a health fair. He did not understand what terms like systolic and diastolic meant and due to his anxiety he is having problems sleeping. The peer leader demonstrates respectful listening and validating the peer s concerns. Then, if appropriate, the peer leader suggests some brainstorming of ideas to provide more information, like support to search on the internet to learn more about high blood pressure and ways to selfmanage it. The peer leader shares the concept of shared decision making and becoming an expert on self-management of whole health issues like high blood pressure. The peer leader introduces the handout called Questions to ask about medical tests and offers support on how to fill it out. (Take 10 minutes to role play this scenario using volunteers from the group and/or trainers) 2. In conversation with a peer leader, a peer expresses concern about weight gain and whether medication could be causing the gain. The peer shares how meetings with the doctor are frustrating because the doctor always focuses on mental illness symptoms and how the medications are helping those symptoms, and never seems interested in discussing the weight gain or how gaining weight could negatively be impacting getting a meaningful life. The peer leader demonstrates respectful listening and validation of the peer s concerns. The peer leader shares information on the concept of shared decision making and how that process should be a collaboration with two experts the doctor and the recipient of whole health services. The peer leader introduces the handout called Getting ready for your Doctor appointment and offers support on how to fill it out. (Take 10 minutes to role play this scenario using volunteers from the group and/or trainers) 6

7 Questions to ask about medical tests: Why is the test being done? What does the test involve? How should I get ready? Are there any dangers or side effects? How will I find out the results? How long will it take to get the results? What will we know after the test? 7

8 Getting ready for your Doctor appointment Reason for visit: What am I doing to address? What do I need help with? Life or health changes since last visit: Questions: 1) 2) 3) Challenges with current treatment: Current medications: Medication Questions: Medication refills: Link to an online question generator: 8

9 IMPACT Handout Improve - Does it improve the quality of my health and resiliency? Measurable - Is it measurable in terms of my supporter knowing if I have accomplished it? Positively stated - Is it positively stated as something new I want in my life? Achievable - Is it achievable for me in my present situation and with my current abilities? Call forth actions - Does it call forth actions that I can take on a regular basis to begin to create healthy habits? Time limited - Is it time limited in terms of when I will begin and when I plan to accomplish it? There are three of the six IMPACT criteria that are often the most difficult to meet Measurable A goal statement that is hard to measure I want to feel better. How would a peer supporter know how to measure that? Positively stated A goal statement that is not positively stated I want to quit smoking. Focusing on what you do not want is often less motivating than focusing on what you do want. Calls forth actions A goal statement that does not call forth actions that you could work up to over a period of time I want to exercise once a week. Exercising once a week could be accomplished in the first week, not requiring actions that build new habits resulting in new health behavior over eight weeks. When the goal is not measurable, or not stated positively, you ask the following questions until you get a feel for what it is the person wants to do. - Why do you want this? - What will be the benefits? - How will your life be different if you accomplish this goal? - If you achieve this goal, what will you be able to do that you can t or aren t doing now? When these questions are asked, the new goal statement gets related to the benefits, it is more motivating, and leads to actions that the person can do to accomplish the goal. Remember your job as the support person is to ask the questions, not provide the answers. Continuing to ask questions that tie the goal to personal benefits will help others clarify in their own mind what their goal is and build excitement around creating something new in their lives. When people find the answers within themselves, they have ownership of their goal. Ownership + Benefit = Motivation. 9

10 If a goal is hard to measure The following is an example of how to use these questions with a goal that may be hard to measure. - Can you share with me the goal you came up with using the formula? In order to: Have less stress, My whole health and resiliency goal is: to feel better, By: 8 weeks - Let's see if we can check off the IMPACT questions. Are you ok with trying that? Sure. - Does it IMPROVE the quality of your health and resiliency? Yes - Is it MEASURABLE in terms of how I, as your supporter would know if you have accomplished it? I m not sure. I guess it doesn't sound very measurable. - Let s see if we can better clarify this. I have some other questions that might help. Why do you want to feel better? If I felt better, I think I would get out more often. - What would be the benefits of getting out more often? I wouldn t isolate so much. I wouldn t sit around feeling sorry for myself. - How would your life be different if you didn t isolate so much? I wouldn t be so lonely. - What would you like to do that you aren t doing now? I would like to do things with my friends. - Like what? Like go out to dinner or go to the movies. - Then maybe going out with your friends might be your goal. What do you think? Yes, I would like that goal. - In eight weeks, how often would you like to be going out with your friends? I don t know, maybe twice a week. - What if we made your goal about doing things with your friends? Well that is really what I want to do. - Would you like me to try to rephrase the goal for you? That would be great. - Let s see if this works. In order to - feel better about myself, My whole health and resiliency goal is - to be going out with my friends at least twice a week, By - 8 weeks from now. - Does that sound like something that would improve your whole health? Yes because when I sit home by myself I just get depressed. Doing things with my friends would make me feel better in all areas of my life. 10

11 If a goal is not positively stated The following is an example of how to use these questions with a goal statement that does not meet the positively stated criteria. Remember you want to focus on what you want to create, not what you want to change. - Can you share with me the goal you came up with using the formula? In order to: Be more healthy, My whole health and resiliency goal is: To quit smoking, By: 8 weeks - Let's see if we can check off the IMPACT questions. Are you ok with trying that? Sure - Does it IMPROVE the quality of your health and resiliency? Yes. - Is it MEASURABLE in terms of how I, as your supporter would know if you have accomplished it. Yes. I will have quit smoking. - Is it POSITIVELY stated as something new you want in your life? I guess quitting doesn t sound very positive. Maybe I could say that my goal is to be a non-smoker. - Why do you want to quit smoking? I think it would improve my health. - What would be some of the benefits of improving your health? I would feel better. I might have more energy. - How would your life be better if you felt better or had more energy? I would be able to do more things. - What would you be able to do that you can t or aren t doing now? My friends have a walking group and I would be able to take walks with them. - It sounds like being able to take long walks with your friends is really what you want to create in your life. Would you like to try writing your goal statement around that? Ok - In eight weeks, what would you like to be doing? I would like to be walking at least three times a week with my friends. - Would you like me to try to help you rephrase the goal for you? Sure. In order to - have more energy and walk with my friends three times a week, My whole health and resiliency goal is - to be a non-smoker, By - 8 weeks from now. - Does that sound like a whole health goal that would be exciting to you? Yes, if I could go for walks at least three times a week I would feel better, breathe better and be more active. 11

12 If a goal does not call forth actions It is a little different if the goal statement does not call forth actions. Here you need to help the person move his or her focus to what they want eight weeks from now. - Can you share with me the goal you came up with using the formula? In order to: Feel healthier and more physically fit, My whole health and resiliency goal is: To exercise once a week. By: 8 weeks - Let's see if we can check off the IMPACT questions. Are you ok with trying that? Sure - Does it IMPROVE the quality of your health and resiliency? Yes. - Is it MEASURABLE in terms of how I, as your supporter will know if you have accomplished it. Yes, I will be exercising. - Is it POSITIVELY stated as something new you want in your life? Yes, I will be healthy and fit. - Is it ACHIEVABLE for you in your present situation and with your current abilities? Yes. - Does it CALL FORTH ACTIONS that you can take on a regular basis to begin to create healthy habits? Sure, just start exercising once a week. - It sounds like that is something you feel you could accomplish by next week and not something you will need to develop new habits to achieve. Sure. - What if you stated your goal as something you want to be able to do regularly at the end of eight weeks? Well, in eight weeks I want to be exercising three days a week. - If we made your goal exercising three days a week at the end of eight weeks, we can focus on things you can start doing to work toward that goal. Now I see that there are a lot of things I can do to work up to exercising three days a week, like starting in the first week to exercise once a week. - How about if we try restating your goal in terms of an eight week goal? Ok In order to - feel healthier and more physically fit My whole health and resiliency goal is - to be exercising three days a week, By - 8 weeks from now. - Does that sound like a whole health goal that you could work on over the next eight weeks? That is exactly what I want to be doing. 12