Supporting people to eat well for a healthy weight The carer s guide to supporting people with learning disabilities with their weight 1
About this booklet This booklet gives you as the carer or support worker of somebody who has a learning disability additional information to back up the Your way to eating well for a healthy weight DVD. Additional information can be found on all the topics at your local Health Promotion Unit, on the Department of Health website and in easy to read format on the Easyhealth website. Cornwall and Isles of Scilly Health Promotion Service www.healthpromcornwall.org Department of Health www.dh.gov.uk Easyhealth www.easyhealth.org.uk Contents Carer s responsibility and an individual s choice Introduction to eating well for a healthy weight Eat plenty of vegetables and fruit every day Cut down on sugary foods and drinks Cut down on fatty foods Cut down on salt Serve the right amount for each person Do something active every day 3 Easy to understand recipes Porridge with fresh fruit Country fresh soup Baked fish with vegetables Page 4 5 8 10 12 13 14 16 17 19 25 31 2 3
Carer s responsibility and an individual s choice Everyone should be seen as being able to make their own choices about what they want to eat and the exercise they do. This can be taken to mean service users choosing not to exercise and having an unhealthy diet. In these situations care staff have a responsibility to ensure that service users are truly making an informed choice. An informed choice means someone is able to understand and retain information about the effect of their diet on their health and weigh up the pro s and con s of the choices that they make. This can be difficult for many people. If weight is an issue for an individual, the development of a Health Action Plan that encompasses a multifaceted, interdisciplinary approach to weight management is essential. Carers then have a responsibility to implement the action plan providing an environment in which healthy choices are made easy and encouraged but allowing for less healthy choices to be made within a managed plan. Some of the hints and tips in this booklet are aimed at understanding why someone may be making unhealthy choices and trying to find ways to provide motivation and support to help them choose a healthier lifestyle. Service users can only make choices from what is known and accessible. Part of your responsibility is to think creatively in order to widen choice which might be acceptable to that individual person. If accessibility is a problem then this should be addressed and resolved by the wider support team. Introduction to eating well for a healthy weight The greater the variety of foods we eat the more likely we are to meet our nutritional requirements. Eating too much of any one food or drink is not a good idea as it can have serious health consequences. Our food and some drinks give us energy, protein, fat, vitamins, minerals and fluid. We need to eat the right amount for our individual needs. This is particularly important for energy. If we get more energy from our food than we burn up we store it as fat. Tips. Help someone to complete a diary that records why they ate as well as what they ate. Making a list of their favourite meals may help a person to identify some of the factors that influence what they eat. 4 5
Tips. Talking about why somebody might want to eat more healthily and perhaps lose some weight can help identify motivating factors. It might be for their health or to be able to do a specific activity or it may just be to look better or fit in to a particular piece of clothing. Writing these things down or finding pictures that they go back to when the going gets tough can be helpful. It is always worth remembering that we all eat for a number of reasons many of which are nothing to do with nutrition. Just think about when you ate over the last week and then why you ate. Were you hungry or just a bit bored, fed up, happy, lonely, angry etc. What we eat is influenced by a whole range of factors such as what we can afford, who we eat with and whether we like the taste. The advice and support we give to people has to take into account all the factors that will be affecting what they eat. If we consider these factors the advice will be more relevant. It is also important to remind ourselves and the people we work with why healthy eating and being a healthy weight is important. People who are overweight or who don t eat well are more likely to: Seven key things to remember about eating well and being healthy 1. Eat a variety of foods everyday 2. Eat plenty of vegetables and fruit everyday - at least 5 portions a day 3. Cut down on sugary foods and drinks 4. Cut down on fat 5. Eat the right amount for you this often means eating smaller portions 6. Do something active everyday 7. Cut down on salt - this is not linked to weight but is important for your health Tips. The 3 food - group plate model When talking to someone with a learning disability about what should be on their plate at each meal it is sometimes better to use just 3 food groups on a plate. Meat, Fish, Eggs, Beans, Milk, Cheese Bread, Potatoes, Breakfast cereal, Pasta, Rice Fruit and Vegetables Suffer from heart disease Have a stroke Get certain forms of cancer Dairy foods are also important, particularly as a source of calcium. Have diabetes Suffer from problems with digestion and constipation Have weaker bones Have poor teeth Suffer from breathlessness Experience fatigue and sleeping problems. The Eatwell plate (produced by the FSA) shows the 5 different food groups and the proportions of each that we should be eating over the whole day. The next chapter deals with each of these groups in more detail. 6 7
Facts A portion is: 2-3 tablespoons of fresh, frozen or tinned vegetables (about 80g) 1 medium size fruit (apple/ banana) or 2 small fruits (satsumas/plums) 2 tomatoes 2-3 tablespoons of chopped or grated carrots or peppers 1 glass of pure fruit juice 2 tablespoons of tinned fruit in juice not syrup 1 tablespoon of dried fruit. These are not good for teeth so are better eaten with a meal rather than as a snack. Eat plenty of vegetables and fruit every day - at least 5 portions a day Eating fruit and vegetables every day helps us prevent getting diseases in adult life, like heart disease or stroke and some forms of cancer. This is because of the vitamins, minerals and fibre in fruit and vegetables. These nutrients help neutralise the harmful chemicals that naturally circulate in our systems and can damage the cells of our body. Fruit, vegetables and salads also help to fill us up and helps us to eat less of the foods that are high in calories - a unit of energy. The greater the variety of colours of fruit and vegetables you have in the day the better, as this will increase your chances of getting the vitamins and minerals you need. However, remember that most fruits contain about 50kcal per portion and fruit juice contains 100kcal in a 200ml glass, and they all add up. What doesn t count? Ways to include more vegetables and fruit Vegetables can be used in soups, casseroles and stews. Some people like raw vegetables more than cooked (carrots, shredded cabbage) or try suggesting at least one dish a week that is mainly vegetables (vegetable curry, stir fry or pasta and vegetable sauce). Salad can be served alongside a main meal instead of vegetables. Fruit is a good snack and can be chopped up and added to cereal or yogurt, but few of us need more than one portion of fruit at a time spread your 2 or 3 portions of fruit out over the day. Tips. Keeping a fruit and vegetable chart to tick off each time they eat a portion can help someone to see if they re getting their 5 a day. Number of portions 1 2 3 4 5 Mon ü ü ü ü ü Tues Wed Thur Fri Sat Other ideas to include more vegetables and fruit: Add raisins to rice pudding Add some fruit to cereal Add salad with sandwich fillings Add peas and sweetcorn to boiled rice Have raw vegetable sticks as a snack. E.g. carrot, broccoli, cucumber, radishes and cherry tomatoes. Sun Potatoes count as sources of starchy carbohydrate rather than vegetables. Fruit in jam or yogurts doesn t count, nor does wine. 8 9
Facts Food is High in sugar if it has more than 10g sugar per 100g. Cut down on sugary foods and drinks It is better not to add sugar to any food or drinks. Some foods naturally contain sugar like fruit, milk and some vegetables. This type of sugar is not harmful to our teeth. Other foods get broken down to sugar when digested in our bodies. E.g. bread, cereals, potatoes and rice in fact all starchy foods finally become glucose (the simplest sugar) in our bodies and thus provide all the energy we need. Some foods have a lot of sugar added to them as part of manufacturing. E.g. cakes, biscuits, sweet pastries, cereal bars, flapjacks, some milk shakes and juice drinks, sweetened breakfast cereals, sweetened yogurts, ice cream and other desserts. Why cut down on sugar Some people are sensitive to sugar and it can adversely affect how they feel and their behaviour another good reason not to have too much. How to cut down on sugar Try to limit sweets, biscuits, squash and fizzy drinks to occassional treats rather than everyday foods. It can be more difficult to cut down on sugar when it is hidden in foods, but checking the label can help. You can get more information on food labelling from the Health Promotion Service. Artificial sweeteners There are a number of artificial sweeteners used in a lot of food products. These sweeteners are well tested for safety and are OK to use in normal quantities. However, artificial sweeteners are often included in foods with little nutritional value and having lots of foods with artificial sweetners does not help people get used to foods that are less sweet. It is best to try to gradually cut down the overall taste for sweetness over a period of time. Tips. Reduce added sugar by: Have a glass of water instead of a sweetened fizzy drink. This could save 7 teaspoons of sugar - 135 calories Have a plain yogurt with fruit, instead of a chocolate dessert. This could save 4 teaspoons of added sugar - 75 calories Use less sugar if you re baking or making puddings. This could save 4 teaspoons per portion - 75 calories. Sugar doesn t contain any vitamins or minerals, it gives us only energy. Unless we re Sorbitol is a specific sweetener that is often very active and burning a lot of energy, any used in foods designed for people with excess calories get turned into body fat. diabetes. It does provide some calories and can act as a laxative or give people wind, so Sugar is bad for our teeth and increases the care should be taken that people do not have risk of tooth decay. Cutting down on sugar, large amounts of foods that contain sorbitol. both the total amount we have and how Foods labelled as being suitable or specifically often we eat it, can help decrease the risk of for those with diabetes are not encouraged. developing tooth decay and gum disease. 10 11
Tips. Grill or bake rather than frying food Trim the fat off meat and remove the skin from chicken Use low fat dairy foods and limit the amount of cheese you have to not more than 100g (4oz) per week Have vegetables or fruit instead of crisps Try leaving off the butter or margarine from your sandwich Have plenty of vegetables with your meals, this will help reduce your intake of high fat foods. Cut down on fatty foods We only need a little fat in our diet and many foods are high in fat. There are the obvious sources of fat such as butter and other spreads, cooking oils and fat on meat. Some dairy foods are high in fat such as cream and cheese and many snack foods like crisps and biscuits are high in fat. Why should we cut down on fat? Fat is high in calories so too much fat will contribute to making us overweight, and saturated (mainly animal) fats also increase our risk of heart disease. Cut down on salt The usual form of salt is sodium chloride. We need small amounts of salt but if we have too much we are more likely to have high blood pressure. This increases our risks of having a stroke or coronary heart disease. The problems with salt are that: Large amounts are often included in processed food so it can be difficult to know how much you re already eating Salt is measured as salt or sometimes as sodium chloride. Thinking about food that tastes salty is a good place to start e.g. crisps, ready made meals, take away foods, soups, sauces, meat products. Cut down on these foods, use fresh foods instead., preparing your own meals and you will then know exactly how much salt you re adding. If you have pre-packed food, check the label. See the Tips box for other ideas to try instead of salt. If you are cooking and preparing your own meals you quickly get used to less salt and the food itself tastes better! Facts Food that is High in salt has: 1.5g salt or 0.6g sodium per 100g Food that is Low in salt has: 0.3g of salt or less or 0.1g sodium or less per 100g. Tips. Choose low salt options Avoid adding salt at the table or during cooking Try adding other flavourings: Use garlic, ginger and chilli in stir fries Squeeze lemon juice onto fish, meat and casseroles Use black pepper instead of salt on eggs, tomatoes and other foods Add fruit to meat to give natural flavouring e.g. pork and apricots Use tomato puree or balsamic vinegar 12 Add herbs and spices to 13 stews and casseroles.
Facts Guideline portion sizes for weight loss Starchy foods 30 40g cereal, or 2 slices bread, or 100g (4oz) potato - 2 egg sized if new or boiled, or 1 fisted sized if baked, or 50g (2oz) dry weight pasta - 1 cup or rice - ½ cup Protein foods 75g (2-3oz) meat - the size of a deck of cards, or 125g (4-5oz) chicken - the size of a deck of cards, or 150g (5-6oz) fish - the size of a cheque book, or 25g (1oz) cheese - the size of a matchbox, or Serve the right amount for each person We all need slightly different amounts of foods, but lots of us eat more food than we need. We often eat too much out of habit and habits are difficult to change. Having smaller amounts at meal times and between meals gets our eyes and our stomachs used to having less. You can have plenty of vegetables and up to 3 pieces of fruit during the day but remember that very large amounts of any food will stop you getting used to smaller and healthier portions. See the Facts box for a very rough guide to the amounts of food a person might need at each meal if they are trying to lose weight. Tips. Only cook the right amount Weigh a healthy portion and then find a measure in the kitchen that holds this quantity (e.g. a teacup) so you can ensure the same amount is served each time without having to weigh it every time Use a smaller plate Eating more slowly, enjoying every mouthful and checking out how full you are all helps Have a drink of water with your meal Don t skip meals especially breakfast, you just end up eating more at the next meal Don t panic if you feel hungry if you are eating healthily you will feel hungry now and again. This is OK. Have a glass of water as you may be thirsty. Most hunger pangs pass and will just mean you are ready for your next meal. 2 eggs Remember to add as little fat e.g. oil, butter and spreads as possible to your meals. 14 15
Tips. Set small targets when increasing activity that is suitable for the individual. Use a pedometer to measure the number of steps you do each day. Keep a chart of what activity or exercise you do each day. Limit the amount of time you spend sitting down, like when watching TV or playing computer games. Do something active every day Our bodies need to be active. It helps keep our heart healthy, our muscles and bones strong, and makes us feel better. It s great if we enjoy the activity that we do, e.g. swimming, dancing, using a Wii, but sometimes we need to decide to do something just for our health going for a walk most days, going to the gym or following a fitness DVD. Any exercise has health benefits but actually uses relatively few calories unless we are doing more than 1 hour of vigorous exercise everyday. Very few people can lose weight just by exercising most need to change what they eat as well. 3 Easy to understand recipes These 3 easy to understand recipes are accompanied by video explanations on the Your way to eating well for a healthy weight DVD. There are lots of recipe books with ideas that can be adapted to be easier to understand. The internet is also a place to source videos that show different recipes and cooking 16 techniques. 17
Porridge with fresh fruit Ingredients 1 sachet or 1 cup of oats 1 banana ½ cup of semi-skimmed milk ½ cup of water 18 19
What to do Put the oats into a microwaveable bowl. Add half a cup of milk and half a cup of water. Microwave on full for 2 minutes. 20 21
Add the banana to the oats. Peel and chop the banana. Take the hot oats out of the microwave. Stir the oats. 22 23
Country fresh soup Ingredients 2 large tomatoes 1 stick of celery 2 carrots 1 onion 1 large potato 1 cup of red lentils 1 tablespoon of oats 2 pints of vegetable stock or 2 stock cubes Mixed chopped herbs 24 25
What to do Peel and chop all your vegetables and put them in a pot. Add the lentils, oats and mixed herbs to the pot. 26 27
Turn the hob down to a low heat. Simmer for 20 minutes. Make your 2 pints of vegetable stock and add it to the pot. Put the pot on the hob and turn it to a high heat. This means the soup will have very small bubbles on the surface and only move a little. Serve the soup into bowls. Bring to the boil. This means you will see the soup bubbling and moving a lot. 28 29
Baked fish with vegetables Ingredients 4 portions of fish 1 onion 1 red pepper 2 tomatoes A small bunch of fresh parsley Black pepper 30 31
Peel and slice the onion. Cut out the stalk and middle of the pepper. Slice the rest of the pepper. Slice the tomatoes and chop the parsley. What to do Turn on the oven to 190 C or Gas Mark 5. Place the fish fillets on a large piece of foil. 32 33
Wrap the fish in the foil so air cannot get out. Bake on a tray until fish is completely cooked - about 20 minutes. Put the onion, pepper and tomato on the fish. Take the fish out of the foil. Serve with salad and potatoes or rice. Sprinkle on the parsley. Add black pepper. 34 35
If you would like this information in another format or language please contact: Cornwall and Isles of Scilly Health Promotion Service ( 01209 313218 2nd Edition Printed March 2015