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A Workshop on Obesity and Pregnancy A Dietary History in TWO Minutes! (Can it be done?). Susan van Maanen Dietitian, Diabetes in Pregnancy Nutrition Services Auckland City Hospital August 2011. What do Pregnant Women Eat in NZ?. Eat more than recommended:

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a workshop on obesity and pregnancy a dietary history in two minutes can it be done

A Workshop on Obesity and PregnancyA Dietary History inTWO Minutes!(Can it be done?)

Susan van Maanen

Dietitian, Diabetes in Pregnancy

Nutrition Services

Auckland City Hospital

August 2011

what do pregnant women eat in nz
What do Pregnant Women Eat in NZ?

Eat more than recommended:

  • Fat, especially saturated fat and sugar

Eat less than recommended:

  • Vegetables & fruit leading to less fibre and folate eaten than recommended
  • Calcium, Iron, Zinc and Selenium

504 pregnant women, 1x24hr diet recall, 3x1 day food records, 2 day activity record, Ht, Wt, skinfolds, blood sample at mth 5, demographic, medical and lifestyle details

Nutrition in Pregnancy- Report to MoH.Watson P. 1999

what do pregnant women eat in australia
What do Pregnant Women Eat in Australia?
  • Women (52%) are piling on extra weight & keeping on the weight gained, post-natally
  • Choosing fatty food over vegetables & fruit
  • Iron, calcium & folate requirements not met

50 overweight and obese pregnant women, diet history at 12, 28, 36 wks, food frequency questionnaire, Ht, Wt – prepregnancy, 12, 28, 36 wks and 6 weeks P/N

Nutrition and Dietetics. De Jersey et al. Vol. 68, No 1,P 53-59

March 2011

my clinical observations
My Clinical Observations:
  • Women are shocked at how little weight gain is recommended in pregnancy & that no-one had told them sooner what was appropriate
  • Women want to do well for their baby & family but don’t know how to eat well
  • They feel they will never achieve weight loss post-natally
  • Embarrassment & feelings of hopelessness
observations
Observations:
  • Eating too much!
  • Poor food choices (finances)
  • No exercise
  • Skipping meals, hunger, then over eating
the challenge how to give personally relevant advice
Diet history

Food record

Food frequency questionnaire

24 hour dietary recall

The Challenge: How to give personally relevant advice?
taking a diet history
Taking a Diet History:

Compared to giving out a generic pamphlet, personally relevant advice has been shown to:

  • Be remembered
  • Effect change more readily
  • Build confidence and rapport so that disclosure is more likely
a diet history will identify
A Diet History will Identify:
  • The adequacy of the woman’s usual

food/ nutrient intake

  • Frequency of eating: regular meals and snacks?
  • Takeaways?
  • Excess energy from added sugars/drinks, cooking & spreading fat
  • Portion sizes?
  • Who cooks?
dietary history
Dietary History-

Advantages:

  • Identify where changes can be made
  • Negotiate ‘actual’ change
  • See through their ‘outside’ layer

Disadvantages:

  • Relies on honesty
  • Underestimates intake
  • Not precise
what is the goal
What is the goal?

To gain enough information to advise the woman on achieving:

Nutritionally adequate diet

Appropriate weight gain in pregnancy

Encourage weight loss post-natally & future disease prevention - Diabetes, Cardiovascular Disease

Healthy baby

Positive attitude to health - now & for the future.

slide13

A Dietitian’s Request to Midwives:Please weigh women every visit if you can (including out of pregnancy if appropriate), so they know how they are progressingFailing to receive any weight gain advice during pregnancy favours excessive weight gain! Remember PREVENTION is easier than CURE

slide14

Food for a Healthy Mother and Baby:Lean Meat, Chicken, Fish etc- 2 servings/dayBread & Cereals - 6 servings/dayVegetables & Fruit - 6 servings/dayMilk & Milk Products - 3 servings/dayDrink plenty of fluids every day - 9 cupsChoose & prepare foods low in Fat, Salt & SugarKeep ActiveFood SafetyEating for Healthy Pregnant Women. MoH. August 2010.

slide15

So - do you think

you can do a

Dietary History in TWO minutes

self completed questionnaires
Self completed questionnaires:

Advantages:

  • Save health professionals time
  • Bring to clinic completed or complete while waiting in clinic

Disadvantages:

  • Needs to be short and simple or women will lose interest
  • Literacy barriers
slide20

A Nutrition Guide for Health Professionals,

Resources Tool Kit, ADHB. 2011.

slide21

A Nutrition Guide for Health Professionals,

Resources Tool Kit, ADHB. 2011.

slide22

Time Well Spent:Whatever method you use,I recommend spending as much time as you can, getting information on the woman’s usual eating habits and giving sensible nutrition advice.Your time will never be wasted!

slide23

Websites/ Resources Available:www.dietitians.org.nzwww.moh.govt.nzwww.healthpoint.co.nzEating for Healthy Pregnant WomenHealthy Eating for South Asian People