Outline for today (1/20) 12:30pm-3:15pm

1. Outline for today (1/20)12:30pm-3:15pm • Sign-In/Handouts • Questions about Interviewing/Counseling? • Turn in Dairy Council Counseling Skills Module Test Score • Nutrition Assessment PowerPoint, Handouts • For Tuesday (Older Adults, 51+): Read over the California Food Guide Chapter 14 (Go to: http://www.cafoodguide.ca.gov and click on CFG Table of Contents and it will bring you to all the chapters: click on Chapter 14) • Read Nutrition & You Pages 469-487

2. NutritionAssessment (Gaining further nutrition information after an initial Nutrition Screening) Source: Student manual P.4-7

3. Components of Nutrition Assessment • Anthropometric data • Biochemical • Clinical • Dietary • Note: Sometimes data can fit into more than one category.

4. Components of Nutrition Assessment • Anthropometric data: • Physical Measurements: height or length, weight, BMI, head or arm circumference, or skinfold measurement. (This data is most valuable if it is measured over time) • Example: Jenna is 5’4.”

5. Components of Nutrition Assessment • Biochemical data: • Lab work: analysis of blood, urine, and other body tissues. • Example: Jim’s recent blood test shows that his cholesterol is 200 mg/dL.

6. Components of Nutrition Assessment • Clinical data: • Includes a complete physical examination and a medical and psychosocial history. • Example: Jay smoked for 10 years and quit 1 month ago.

7. Components of Nutrition Assessment • Dietary data: • Includes foods and quantities eaten, eating habits, accessibility of food, and cultural and socioeconomic factors that affect selection of food. • Example: Bob drinks 3 cans of Coke a day.

8. Case Study #1 Selena is a 19 year old pregnant woman This is her first pregnancy. She is 15 weeks pregnant. Before she became pregnant her BMI was 27.0 Her Hct is 31.6% She is currently living in a homeless shelter. Her 24 hour recall listed the following foods:………… Source: California WIC Training Manual

9. Case Study #2 Sarah Jones is 28 y.o. She is breastfeeding her 2 month-old son. She is 5 feet, 6 inches tall She weighs 130 pounds. She smokes 10 cigarettes/day. Her hemoglobin is 10.8 gm/dl. Her 24 diet recall listed the following foods……. Source: California WIC Training Manual

10. Case Study #3 John is 6 feet tall, weighs 200 pounds. His recent blood test shows his cholesterol is 240, LDL is 103, TG is 220, FBG is 102. He smoked for 20 years and finally has stopped 3 months ago. He walks in the park 30 minutes every morning. Currently, he is sharing a apartment with his cousin. His food frequency show that his consumption of certain foods…….

11. ABCD Practice!

12. 3 Types of Dietary Assessments • 24 hour recall/diet history • Food record/diary • Food frequency questionnaire

13. Dietary Assessment Source: WIC Training Manual

14. Dietary Assessment Source: WIC Training Manual

15. Dietary Assessment Source: WIC Training Manual

16. 3 Types of Dietary Assessments • 24 hour recall/diet history • Food record/diary • Food frequency questionnaire

17. Dietary Assessment Source: WIC Training Manual

18. 24 hour recall • Welcome and explain purpose • Use food models • Try to use open-ended questions and avoid leading questions at the beginning of the session • Start with yesterday in the am, or start backwards • Avoid giving comments/approval or disapproval with facial expressions

19. 24 hour recall • Ask what foods/drinks/condiments are consumed • Can ask daily activities to help patient remember what foods were related with activities • Mixed foods-break them apart • Rephrase questions if needed • Allow silence • Ask if patient understands the question

20. 24 hour recall Information should include: • Specifics of food (e.g. low fat/1%/whole milk, fresh/frozen/canned etc) • How food is prepared (home/restaurant) • Portion size (estimate #, size, volume)

21. 24 hour recall • Review recall • Ask if typical • Check if there are any contradictions • Thank patient/client • Make plans for education/counseling topics

22. Timefood/drinks/condiments (portion size) 8:30am 1 apple 1 piece toast with 1 tsp butter 2 cups of orange juice 11:00am 1 sandwich: 2 pieces bread 1 tsp mayo ½ cup lettuce & tomatoes 2oz ham 12 oz diet coke

23. TimeFood/drinks/condiments/portion 3pm 1 cup milk (2%) 2 small apples ½ cup cereal (Frosted flakes) 4-6 crackers (saltine) 7pm casserole: 1 cup pasta 2 oz chicken ½ cup carrots ½ cup pinto beans 1-2 Tbsp creamy sauce

24. Miscommunications! Operator: Hello, may I help you? Student: Yes, I would like more information on Theatre Art. Operator: Sorry, there is no one by the name of Therdore Art. Student: No, I want more information on Theatre Art. Operator: I told you, there is no Theodore Art here.

25. Student: No, I mean Theatre “t-h-e-a-t-r-e” Operator: No, that’s not how you spell Theodore.

26. 24-Hour Recall Look Over Melanie’s PowerPoint (if you need more information on conducting a good 24-hour recall)

27. 3 Types of Dietary Assessments • 24 hour recall/diet history • Food record/diary • Food frequency questionnaire

28. Dietary Assessment Source: WIC Training Manual

29. Food Record/Diary • Patient/client writes down everything they eat/drink for as many days as needed (one to seven days) • The more days, usually the more accurate • Used for individuals • Used more in an outpatient setting

30. 3 Types of Dietary Assessments • 24 hour recall/diet history • Food record/diary • Food frequency questionnaire

31. Dietary Assessment Source: WIC Training Manual

32. Food Frequency Questionnaire • Used more often in out-patient settings • Used in large studies (e.g. school studies)

33. Food Frequency Questionnaire Practice!

34. Elijah!!

35. Nutrition Screening • Process of recognizing the presence of factors known to be associated with nutrition problems for the purpose of identifying individuals who are at nutritional risk • Easy and quick to complete • Determines need for Nutrition Assessment • Examples Student Manual Pg. 7

36. Factors which affect food choices • Taste • Texture • Appetite • Ethnicity/culture • Cost • Availability • Medical Factors • Advertising • Convenience • Emotion • Nutrition/health value Source: WIC Training Manual

37. Stages of Change • Pre-contemplation • Contemplation • Preparation • Action • Maintainance

38. Pre-contemplation: • Patient is in denial or not aware of the problem • “Why eat healthy? We will all die anyway.”

39. Contemplation: • Patient is thinking about it, started to see the problem, think of pros and cons • “Should I start eating healthy? My doctor said if I eat better, my diabetes will be better.”

40. Preparation: • Patient is ready for action • “I think I am ready to try to eat healthier and take control of my diabetes. Let me schedule a time to see the dietitian.”

41. Action • Patient is actually doing it for 3-6 months Yeah! • “ I have skipped drinking regular soda everyday.”

42. Maintenance: • Patient has made change for at least 6 months and trying to maintain the action. • “I have been skipping my regular soda for 6 months.

43. Relapse: • Patient has gone back to the old behavior. • “Oops, I had a can of soda in the past 3 days while having fun in Disneyland.”

44. Goal setting/Contract Name: During the next _____________, I plan to do the following: 1._______________________________ 2._______________________________ If successful, I will reward myself _______ with the following:_______________ Signed:______________ Date:________ Signed:______________ Date:________

45. Stages of Change??? • Joan has been moderately exercising 5 times a week for the past 7 months.

46. Stages of Change??? • David has been checking his blood sugars 4 times a day for the past 5 months.

47. Stages of Change??? • Greg stopped drinking soda for 1 year, but the past week went to 3 parties and drank 8 cups of soda.

48. Stages of Change??? • Darlene was not sure if she wanted to participate in the WIC program, but today she attended her first nutrition class at WIC.

49. Stages of Change??? • Sabrina knows she needs to lose weight, but she isn’t sure if she wants to start a new meal plan now since her birthday is in 2 months.

50. Stages of Change??? • Shelly does not think she has a problem with alcohol.