Health Professional Manual Session: Healthy Eating COPD and healthy eating General healthy eating advice Getting the most out of every meal Adapted from the Living Well with COPD program (2nd edition), Montreal Chest Institute, Canada
SESSION SUMMARY Education Plan and Methods Session Length: 15 minutes Working Phase 1. COPD and Healthy Eating. Group Discussion. 2. General Healthy Eating Advice. Interactive lecturing. 3. Getting the most out of every meal. Interactive lecturing. 4. Summary of the session and assessment of participants understanding and self-efficacy. Group discussion. Closing of the session Human Resources 1. One healthcare professional (recommended facilitator: dietitian) Living Well with COPD for Pulmonary Rehabilitation Resources 1. Patient Information Booklet (Pages 40 to 41) 2. Key messages: Healthy Eating 3. Educational Posters: Maintain a healthy body weight 4. Cue card: Maintain a healthy body weight Additional Resources 1. Board / Flipchart Environment 1. Use a quiet and comfortable room for 10 to 15 people. Ensure proper ventilation. 2. Place the chairs in a semi-circle around the board. 2
Introduction Presentation of the Facilitator. Outline the goals of this session. Review the key messages from the last session and link them to this session. Working Phase Educational Interventions Note to the facilitator: This education session is not designed to replace individualised interventions with a dietitian. It can be used, however, to help identify at risk patients who may require one-to-one input from a dietitian. 1. COPD and Healthy Eating 1.1 PRESENTATION OF THE IMPORTANCE OF HEALTHY EATING IN COPD Present this section using Group Discussion Use the poster Maintain a healthy body weight and Attachment 1 (Cue card: Maintain a healthy body weight) to support your teaching. 1.1.1 Present the goal and benefits of healthy eating in COPD to the participants. Suggested question: Why do you think healthy eating is important when you have COPD? Suggested script for the Facilitator: Eating a healthy diet is an important part of your everyday life. When you have COPD you may find that your appetite is poor or that you feel too tired to prepare and eat meals. However, in order to breathe, your body requires a lot of energy or fuel. In fact, a person with COPD can use up to 50% more energy on breathing compared to a person who does not have a lung disease. Goal: To maintain a healthy body weight through a balanced diet Benefits: Enhances general well-being Helps you do your normal activities Helps prevents infections 3
1.1.2 Present the body mass index to the participants. Suggested question: What is a healthy body weight? Suggested script for the Facilitator: Body mass index (BMI) is a simple tool for use with the general population. It takes into account height as well as weight. BMI = weight in kg (height in m) 2 BMI >31 26-30 20-25 <19 Weight Category Obese Overweight Normal range Underweight If anyone would like their BMI calculated please speak to a member of the pulmonary rehabilitation team at the end of the session (attachment 1). Points to remember: If you are underweight, you can lack energy and you may need to eat more or increase the energy and protein content of your diet. If you are overweight, it makes it harder for your muscles to work and can worsen your shortness of breath. A healthy diet can help you achieve gradual weight loss. Note to the facilitator: The following criteria could be used to help identify patients at risk who require referral to a dietitian for one-to-one input: 1. Patients with a BMI less than 18.5kg/m 2 or greater than 30kg/m 2 2. Patients with a BMI less than 20kg/m 2 and unintentional weight loss greater than 5% within last 3-6 months 3. Patients with unintentional weight loss of greater than 10% within last 3-6 months 4. Patients who have been eating less than half of their normal amount of food within last 10 days 5. Patients who have had several courses of corticosteroids Please note the patient must have verbally consented to have their details and BMI shared with the dietitian. 4
2. General Healthy Eating Advice 2.1 PRESENTATION OF GENERAL HEALTHY EATING ADVICE Present this section in an Interactive Way Use the poster Maintain a healthy body weight to support your teaching. Present the strategies to improve general healthy eating habits to participants. Suggested question: What do you think is a balanced and healthy diet? Suggested script for the Facilitator: The Eatwell plate shows how much of what you eat should come from each food group. This includes everything you eat during the day, including snacks. Try to eat: Plenty of vegetables and fruit. Try to eat at least five portions of a variety of vegetables and fruit every day. Plenty of potatoes, bread, rice, pasta and other starchy foods. Choose wholegrain varieties whenever you can. Some milk and dairy foods Some meat, fish, eggs, beans and other non-dairy sources of protein Only a very small amount of foods and drinks high in fat and/or sugar, since they have little or no nutritional benefits Try to choose options that are lower in salt when you can. 5
3. Getting the most out of every meal 3.1 IMPACT OF COPD ON THE PARTICIPANTS EATING HABITS Present this section in an Interactive Way Explore the effect COPD has had on the participants eating habits. Suggested question: What stops you from eating properly? Suggested script for the Facilitator: You may find that COPD makes eating more difficult, because you may: Feel breathless or fatigued while eating Feel breathless or fatigued when preparing meals Feel bloated and/or get wind Feel very full quickly Feel constipated 3.2 STRATEGIES TO IMPROVE EATING HABITS Present this section in an Interactive Way 3.2.1 Discuss with participants the strategies that could be used to prevent shortness of breath and fatigue during meals Suggested question: What strategies could you use to prevent shortness of breath or fatigue while eating? Answers expected from the participants: Take your time. Try putting your knife and fork down between bites to slow down your eating. Cut food into small bite-size pieces Buy tender meats and foods which don t require much chewing 6
Relax before and after meals Sit upright Use your short acting bronchodilator (reliever) and your airway clearance techniques before meals. 3.2.2 Discuss with participants the strategies that could be used to prevent shortness of breath and fatigue when preparing meals Suggested question: What strategies could you use to prevent shortness of breath or fatigue when preparing meals? Answers expected from the participants: Use fast and easy recipes. Cook more than one meal at a time. Freeze what you do not eat and save it for later. Eat early in the day when you feel you have the most energy. Sit down when peeling and cutting Keep utensils and saucepans in easy reach Rest before and after meals to conserve your energy Get a family member or friend to help you prepare the meals Use convenient ready made meals, but try to avoid those high in salt and fat. Take advantage of services such as meals on wheels 3.2.3 Discuss with participants the strategies that could be used to prevent feeling bloated Suggested script for the Facilitator: Eating too much of some foods can leave you feeling bloated. This makes it harder to breathe. Suggested question: What strategies could you use to avoid feeling bloated? Answers expected from the participants: Eat slowly and chew food well. Avoid fizzy drinks and food which encourages bloating, e.g. beans, cabbage, onions, grapes, peas, corn and dried fruit. 7
3.2.4 Discuss with participants the strategies that could be used to prevent feeling full too quickly. Suggested Question: What strategies could you use to avoid feeling full too quickly? Answers expected from the participants: Drink fewer liquids during meals. Instead, sip on fluids an hour before meals. Eating six smaller meals rather than three larger meals means your stomach is never overly full. A full stomach will prevent your lungs from expanding fully. Eat cold foods, which provide less of a sense of feeling full than hot foods. 3.2.5 Discuss with participants the strategies that could be used to prevent constipation. Suggested Question: What strategies could you use to help prevent constipation? Answers expected from the participants: Eat foods that are high in fibre, e.g. brown rice, bran or oat cereals, wholemeal bread. Drink at least 8 glasses of water a day (if you have no restrictions). Exercise regularly according to your ability. Note to the facilitator: The following criteria could be used to help identify patients at risk who require referral to a dietitian for one-to-one input: 1. Patients with a BMI less than 18.5kg/m 2 or greater than 30kg/m 2 2. Patients with a BMI less than 20kg/m 2 and unintentional weight loss greater than 5% within last 3-6 months 3. Patients with unintentional weight loss of greater than 10% within last 3-6 months 4. Patients who have been eating less than half of their normal amount of food within last 10 days 5. Patients who have had several courses of corticosteroids Please note the patient must have verbally consented to have their details and BMI shared with the dietitian. 8
4. Summary of the session and assessment of participants understanding and self-efficacy 4.1 SUMMARY OF THE SESSION AND ASSESSMENT OF PARTICIPANTS UNDERSTANDING AND SELF-EFFICACY Present this section using Group Discussion Evaluate participants understanding and self-efficacy to eat a healthy and balanced diet. Use this opportunity to cover the key messages from the session. Use Attachment 2 (Key messages: Healthy Eating) to support your teaching. Suggested questions: How well do you understand the importance of healthy eating for people with COPD? How confident are you that you can eat a healthy and balanced diet? Suggested script for the Facilitator: Eating healthy is important for COPD. It provides your body with energy to do your normal daily activities and helps prevent infections. It also improves your general well-being. Vary your diet and eat food from each of the basic food groups. Try to eat: Plenty of vegetables and fruit. Try to eat at least five portions every day. Plenty of potatoes, bread, rice, pasta and other starchy foods. Choose wholegrain varieties. Some milk and dairy foods Some meat, fish, eggs, beans and other non-dairy sources of protein Only a very small amount of foods and drinks high in fat and/or sugar. Try to choose options that are lower in salt when you can. There are strategies you can use to get the most of every meal: Eat six smaller meals rather than three large meals. Eat slowly and chew food well. Sit down when preparing and eating meals Get help preparing meals. Please speak to a member of the pulmonary rehabilitation team if you: are worried about your weight have had sudden weight loss have difficulty preparing or eating meals are taking long-term steroids 9
Note to the facilitator: Inform participants that the key messages from this session are summarised on their key messages sheet and additional information can be found in their information booklets (Pages 40 to 41). If participants feel capable to eat a healthy diet, ask them to continue applying the techniques taught in this session. If some participants do not feel capable to eat a healthy diet, make sure to refer these participants to their resource person to see them in an individual basis to investigate the reasons and reinforce the use of the techniques taught in this session. Closing the session Answer the questions of the participants. Learning contract: Ask the participants to complete Attachment 3 to review what they eat over a 24 hour period and then use the Eatwell plate to see if they are eating a healthy and balanced diet. CONTRACT Evaluate the satisfaction of the participants with regards to the present session. 10
ATTACHMENTS Attachment 1: Maintain a healthy body weight Would you like your weight or Body Mass Index (BMI) checked today? Ask a member of the pulmonary rehabilitation team. Body mass index (BMI) = BMI >31 26-30 20-25 <19 Weight Category Obese Overweight Normal range Underweight www.livingwellwithcopd.com 11
ATTACHMENTS Attachment 2: Healthy Eating Key Messages Eating healthy is important for COPD. It provides your body with energy to do your normal daily activities and helps prevent infections. It also improves your general well-being. Vary your diet and eat food from each of the basic food groups. Try to eat: Plenty of vegetables and fruit. Try to eat at least five portions every day. Plenty of potatoes, bread, rice, pasta and other starchy foods. Choose wholegrain varieties. Some milk and dairy foods Some meat, fish, eggs, beans and other non-dairy sources of protein Only a very small amount of foods and drinks high in fat and/or sugar. Try to choose options that are lower in salt when you can. There are strategies you can use to get the most of every meal: Eat six smaller meals rather than three large meals. Eat slowly and chew food well. Sit down when preparing and eating meals Get help preparing meals. Please speak to a member of the pulmonary rehabilitation team if you: are worried about your weight have had sudden weight loss have difficulty preparing or eating meals are taking long-term steroids www.livingwellwithcopd.com 12
ATTACHMENTS Attachment 3: A healthy diet is a matter of balance and variety What are you currently eating? Breakfast Snack Lunch Snack Dinner Snack http://www.food.gov.uk 13
ACKNOWLEDGEMENTS Living Well with COPD was developed in coordination with health professional educators on COPD and patients with COPD. Adaptation from the Living Well with COPD program (2nd edition), Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland December 2011 Authors: Northern Ireland: B. O Neill, PhD, BSc, MCSP D. Cosgrove, PhD, BSc, MCSP J. MacMahon, FRCP J. M. Bradley, PhD, BSc, MCSP Canada: M. Lebel, RN, BSc M. Sedeno, BEng, MM D. Nault, RN, MSc J. Bourbeau, MD, MSc, FRCPC Participating Institutions University of Ulster, Northern Ireland Belfast Health and Social Care Trust, Northern Ireland Montreal Chest Institute, McGill University Health Center, Canada Public Health Agency The Living Well with COPD programme for pulmonary rehabilitation has been endorsed by: The Association of Chartered Physiotherapists in Respiratory Care The Northern Ireland Regional Respiratory Forum Belfast Health and Social Care Trust www.livingwellwithcopd.com