activitynutrition&
TOOL KIT
M CANMissouri Council forActivity & Nutrition
Health Care Provider
AdultAdult
CO
NT
EN
TS
• How to Use This Tool Kit
• Introduction
• Physician ResourcesPocket Guide — Assessement and Treatment of Adult Overweight and ObesityBody Mass Index (BMI) ChartMissouri Consensus Diabetes Management Guideline for Adults (15 page guide is available byclicking on title)State of Missouri Consensus Screening Guidelines for Pre-diabetes and Diabetes in a MedicalSettingCommunication Guidelines to Promote Health Behavior ChangeApplying the Stages of Change Model to Assess ReadinessPatient Readiness ChecklistTips for Nutrition Counseling
• Patient HandoutsA. Are You Ready and Motivated to Lose Weight?B. Food Weight-Loss TipsC. Nutrition Facts Label—An OverviewD. Tips for Dining OutE. Grocery Shopping GuideF. MyPlateG. Making Physical Activity Part of Your Life: Tips for Being More ActiveH. Overcoming Barriers to Physical ActivityI. Tips to Make Small Changes—That Add Up to Big SuccessJ. Developing Your Success Plan!K. Goal WorksheetL. Personal Pledge to Better HealthM. Daily Food and Activity Diary
• Resources and References
• Evaluation Form
How to Use This Tool Kit
The Health Care Work Group from the Missouri Council for Activity and Nutrition (MoCAN)developed this tool kit to provide you with all of the information you need to effectively assess and treatyour overweight and obese adult patients. In addition, this kit offers pertinent information for providersto consider when discussing healthy lifestyles, including physical activity and healthy eating behaviors,with all patients.
The Health Care Work Group consists of leaders from Missouri health plans, academic medical centers,physician practices as well as other health care professionals, including advance practice nurses anddietitians. These professionals shared their daily experiences of working to address the growing obesityepidemic in their practices and communities to determine the materials presented within this tool kit.
The physician resources and patient handouts address assessing readiness to change, goal setting anddiet and physical activity information. These handouts have been designed for you to copy and explainto your patients.
An evaluation form is also included in the tool kit. Your feedback is important for continuing our workto provide health care providers with effective tools for encouraging patients to adopt healthy behaviors.Instructions for completing and returning the evaluation can be found on the evaluation form.
Thank you for joining MoCAN’s efforts to reverse obesity trends by utilizing these resources developedby health care providers for health care providers.
Additional materials can be downloaded on the Missouri Department of Health and Senior Services(DHSS) web site at: http://www.dhss.mo.gov/Obesity/Publications.html.
M CANMissouri Council forActivity & Nutrition
The United States is in the midst of an escalatingepidemic of obesity. Over one-third of the adultpopulation in the United States is currently obeseand the prevalence of obesity is growing rapidly.Physicians can play a critical role in stemming thisgrowing epidemic through their frequent patientcontact and have unique opportunities to encouragephysical activity, dietary and behavior changes. Thistool kit proposes a model for the assessment andtreatment of obesity in clinical practice, including assessment of risk factors for obesity,recommending lifestyle and behavior modifications, and instituting pharmacologic therapy orsurgery when appropriate. Resources to help guide your patient in making these changes are alsoprovided as handouts. By utilizing this tool kit, physicians can unite with other health careprofessionals in the fight to effectively help prevent and treat the chronic disease of obesity.
Missouri Statistics• 62% of Missouri adults are overweight or obese. (Centers for Disease Control and
Prevention [CDC] Behavioral Risk Factor Surveillance System, 2004)• 24% of non-Hispanic white adults and 39% of non-Hispanic black adults in Missouri are
obese. (CDC BRFSS, 2004)• Only 20.2% of adults eat 5 servings of fruits and vegetables daily.• Only 45.1% of adults meet the CDC’s physical activity recommendations.
Causes of Overweight and Obesity• Overweight and obesity result from an imbalance involving excessive calorie
consumption and/or inadequate physical activity.• Body weight is the result of a combination of behavioral, genetic, metabolic,
environmental, cultural, and socioeconomic influences and is different for eachindividual.
• Behavioral and environmental factors are large contributors to overweight and obesityand provide the greatest opportunity for actions and interventions designed for preventionand treatment. (Department of Health and Human Services [DHHS]).
Health Consequences of ObesityAccording to the 2001 U.S. Surgeon General’s Call to Action to Prevent and DecreaseOverweight and Obesity, those who are overweight or obese are at a greater risk for thefollowing health conditions:
Premature Death:• Individuals who are obese have a 50 to 100% increased risk of premature death from all
causes, compared to individuals with a healthy weight.• An estimated 300,000 deaths per year may be attributable to obesity.• The risk of death rises with increasing weight.
INT
RO
DU
CT
ION
Assessment and Treatment of Adult Overweight and Obesity
• Even moderate weight excess (10 to 20 pounds for a person of average height) increases the riskof death, particularly among adults aged 30 to 64 years.
Heart Disease:• The incidence of heart disease is increased in persons who are overweight or obese.• High blood pressure is twice as common in adults who are obese than in those who are at a
healthy weight.• Obesity is associated with elevated triglycerides and decreased HDL cholesterol.
Diabetes:• A weight gain of 11 to 18 pounds increases a person’s risk of developing type 2 diabetes to twice
that of individuals who have not gained weight.• More than 80% of people with diabetes are overweight or obese.
Cancer:• Overweight and obesity are associated with an increased risk for some types of cancer including
endometrial (cancer of the lining of the uterus), colon, gallbladder, prostate, kidney andpostmenopausal breast cancer.
• Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausalbreast cancer, compared to women whose weight remains stable.
Breathing Problems:• Obesity is associated with a higher prevalence of asthma.
Arthritis:• For every two-pound increase in weight, the risk of developing arthritis is increased by 9 to 13%.
Reproductive Complications:• In addition to many other complications, women who are obese during pregnancy are more
likely to have gestational diabetes and problems with labor and delivery.
Benefits of Weight Loss• Weight loss, as modest as 5 to 10% of total body weight in a person who is overweight or obese,
reduces the risk factors for some diseases, particularly heart disease.• A person with a Body Mass Index (BMI) above the healthy weight range may benefit from
weight loss, especially if he or she has other health risk factors, such as high blood pressure, highcholesterol, smoking, diabetes, a sedentary lifestyle, and a personal and/or family history of heartdisease.
• Weight loss can result in lower blood pressure, lower blood sugar, and improved cholesterollevels.
Obesity-Related Medical Conditions (American Obesity Association)The prevalence of various medical conditions increases with overweight and obesity for men andwomen as shown below.
Table 1. Prevalence of Medical Conditions by Body Mass Index (BMI) for Men
Medical Condition Body Mass Index
18.5 to 24.9 25 to 29.9 30 to 34.9 > 40
Prevalence Ratio (%)Type 2 Diabetes 2.03 4.93 10.10 10.65Coronary Heart Disease 8.84 9.60 16.01 13.97High Blood Pressure 23.47 34.16 48.95 64.53Osteoarthritis 2.59 4.55 4.66 10.04
Source: National Health and Nutrition Examination Survey (NHANES) III, 1988 - 1994.
This publication was supported by Cooperative Agreement Number U58/CCU722795-02 from the Centers for Disease Control and Prevention.Its contents are solely the responsibility of the authors and do not represent the official views of CDC.
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.
Metabolic SyndromeAccording to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, andTreatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), metabolic syndrome isdefined as having three or more of the traits shown below. Identification of metabolic syndrome requireseven greater urgency for the treatment of overweight or obesity.
Table 2. Prevalence of Medical Conditions by Body Mass Index (BMI) for Women
Medical Condition Body Mass Index
18.5 to 24.9 25 to 29.9 30 to 34.9 >40
Prevalence Ratio (%)Type 2 Diabetes 2.38 7.12 7.24 19.89Coronary Heart Disease 6.87 11.13 12.56 19.22High Blood Pressure 23.26 38.77 47.95 63.16Osteoarthritis 5.22 8.51 9.94 17.19
Abdominal obesity Waist circumference Men >40 in (>102 cm) Women >35 in (>88 cm)
Triglycerides >150 mg/dL
High-density lipoprotein(HDL) cholesterol Men <40 mg/dL Women <50 mg/dL
Blood pressure >130/>85 mmHg
Fasting glucose 110-125 mg/dL (ATP III defines as >110)
Risk factor Defining level
Source: NHANES III, 1988 - 1994.
Framework for Implementing an Adult Weight Loss ProgramIndicated for BMI levels of 25.0 and over
Initial Visit:Determine BMI.Measure waist circumference.Determine risk status (blood pressure, triglyceride and cholesterol levels, blood sugar level).Assess nutrition and physical activity habits and readiness to change health behaviors.Determine if patient should be treated. If yes:
o Identify patient’s contributing factors (for example: depression, environmental influences on foodchoices and physical activity, such as access to healthy foods and a safe place to engage in physicalactivity, family dynamics and support systems).
o Assist patient in setting goals for making health behavior changes related to eating and/or physicalactivity utilizing patient-centered counseling techniques.
o Prescribe weight loss medication, if indicated. A referral to a licensed psychologist and/or licensedregistered dietitian may also be helpful to assist with behavior changes before medication is considered.
First Four Months:Weekly communication for the following purposes:
o Weight monitoring.o Problem resolution, if indicated (medicine, diet or physical activity).o Group meetings on exercise, nutrition and behavior change.
Second Four Months:Biweekly meetings for the following purposes:
o Weight monitoring.o Group meetings on exercise, nutrition and behavior change.o Problem resolution, if indicated (medicine, diet or physical activity).o If after six months, patient has not made or been able to maintain any behavior changes related to eating,
consider pharmacotherapy. A referral to a licensed psychologist and/or licensed registered dietitian mayalso be helpful to assist with behavior changes before medication is considered.
Follow-up Visits:Six months after initial visit:
o Weight monitoring.o Problem-resolution, if indicated (medicine, dietary or physical activity).o Monthly group meetings for next six months on exercise, nutrition and behavior change topics.
One year after initial visit:o Weight monitoring.o Problem resolution, if indicated (medicine, dietary or physical activity).o Corrective actions, as needed (medication, re-education, etc.).o If no or limited weight loss has occurred by the end of one year, consider surgery.o Referral to local support groups for continued weight maintenance.
Continued follow-up at annual visits:o The amount of follow-up provided will depend on your patient’s needs (recommendation should be based
on what the patient has done previously - were they not ready for change, but now they are? Did theyparticipate in a program, but regained weight? Did they agree to make behavior changes but did notfollow through?).
o Weight monitoring.o Problem resolution, if indicated (medicine, dietary and/or physical activity).
Physician Resources
do it for yourself . . .
Step
7b.
Rec
omm
end
Phys
ical
Act
ivity
Gui
delin
es:
Han
dout
s F,
G
BM
I C
ateg
ory
Tre
atm
ent
2
5-2
6.9
2
7-2
9.9
30
-34
.93
5-3
9.9
>4
0
Die
t, p
hys
ical
acti
vity
&
beh
avio
r
chan
ge
+ +
+
+
+
Pha
rmac
o
ther
apy
W
ith
com
or-
bid
itie
s
+
+
Sur
gery
+
-
Wit
h
com
or-
bid
itie
s
Step
7.
Rec
omm
end
Trea
tmen
t Opt
ions
• Ta
ilor t
reat
men
t to
indi
vidu
al n
eeds
of p
atie
nt.
Step
7a.
Pre
scrib
e D
ieta
ry T
hera
py:
Han
dout
s B
, C, D
, E•
Red
uce
calo
ries b
y 50
0 to
1,0
00 c
alor
ies/
day
from
the
curr
ent l
evel
and
hav
e pa
tient
kee
p fo
od d
iary
.•
Rec
omm
end
eatin
g a
varie
ty o
f nut
rient
-den
sefo
ods f
rom
the
basi
c fo
od g
roup
s and
lim
it in
take
of
satu
rate
d an
d tra
ns fa
ts, a
dded
suga
rs, s
alt,
and
alco
hol.
• Pr
evio
usly
sede
ntar
y pe
ople
shou
ld st
art w
ith sh
ort
sess
ions
(5-1
0 m
inut
es) o
f phy
sica
l act
ivity
and
grad
ually
bui
ld u
p to
the
desi
red
leve
l of a
ctiv
ity.
• T
o re
du
ce c
hro
nic
dis
ease
ris
k:
Be
phys
ical
lyac
tive
for a
t lea
st 3
0 m
inut
es o
n m
ost o
r all
days
of
the
wee
k.•
To
lose
wei
ght:
Be
phys
ical
ly a
ctiv
e fo
r 60
to 9
0m
inut
es a
day
.
Step
7c.
Sug
gest
Beh
avio
r The
rapy
:H
ando
uts
H, I
, J, K
, L
• A
ddre
ss th
e pa
tient
’s b
arrie
rs a
bout
abi
lity
to m
ake
and
mai
ntai
n ne
eded
cha
nges
.•
Rec
omm
end
spec
ific
lifes
tyle
cha
nges
.•
Cre
ate
a pl
an to
pro
mot
e w
eigh
t los
s or p
reve
ntfu
rther
wei
ght g
ain.
Step
7d.
Con
side
r Add
ition
al T
reat
men
t Opt
ions
(if n
eede
d)P
har
mac
oth
erap
y•
Med
icat
ions
shou
ld o
nly
be c
onsi
dere
d if
lifes
tyle
chan
ges d
o no
t ind
uce
wei
ght l
oss a
fter 6
mon
ths.
• W
eigh
t los
s dru
gs (F
DA
app
rove
d) m
ay b
e us
ed a
spa
rt of
a w
eigh
t los
s pro
gram
for p
atie
nts:
• W
ith a
BM
I >=3
0 w
ith n
o ac
com
pany
ing
obes
ity-r
elat
ed ri
sk fa
ctor
s or d
isea
ses O
R•
With
a B
MI >
=27
with
acc
ompa
nyin
g ob
esity
-re
late
d ris
k fa
ctor
s or d
isea
ses.
Step
4.
Ass
ess R
eadi
ness
to C
hang
e: H
ando
ut A
• A
sk y
our p
atie
nt to
fill
out H
ando
ut A
tode
term
ine
read
ines
s to
mak
e he
alth
y ch
ange
s.•
A p
atie
nt th
at is
not
read
y to
mak
e ch
ange
s may
still
ben
efit
from
a d
iscu
ssio
n ab
out t
he im
por-
tanc
e of
wei
ght l
oss a
nd th
e he
alth
risk
s ass
oci-
ated
with
ove
rwei
ght a
nd o
besi
ty.
Step
5.
Det
erm
ine
Trea
tmen
t
Step
6.
Set G
oals
• Se
t rea
sona
ble
wei
ght g
oals
that
are
a h
igh
prio
rity
for t
he p
atie
nt a
nd in
volv
e sm
all c
hang
es.
• In
volv
e a
varie
ty o
f hea
lth c
are
prof
essi
onal
sw
hen
poss
ible
(e.g
., R
egis
tere
d D
ietit
ian
orB
ehav
ioris
t).
Redu
cing
wei
ght b
y 5%
- 10
% c
an d
ecre
ase
chro
nic
dise
ase
risk
fact
ors.
Wei
ght l
oss s
houl
dno
t exc
eed
1-2
lbs/w
eek
and
shou
ld b
e ba
sed
ona
calo
rie d
efic
it of
500
- 1,
000
kcal
/day
.
Ass
essm
ent
and
Tre
atm
ent
of A
du
ltO
verw
eigh
t an
d O
bes
ity
Step
1.
Mea
sure
Hei
ght,
Wei
ght &
Wai
st C
ircum
fere
nce
How
to
mea
sure
wai
st c
ircu
mfe
ren
ce:
Loca
te th
e up
per h
ip b
one
and
the
top
of th
erig
ht il
iac
cres
t. P
lace
a m
easu
ring
tape
in a
horiz
onta
l lan
e ar
ound
the
abdo
men
at t
hele
vel o
f the
ilia
c cr
est.
Bef
ore
read
ing
the
tape
mea
sure
, ens
ure
that
the
tape
is sn
ug,
but d
oes n
ot c
ompr
ess t
he sk
in, a
nd is
para
llel t
o th
e flo
or.
The
mea
sure
men
t is
mad
e at
the
end
of a
nor
mal
exp
iratio
n.*H
igh-
Ris
k W
aist
Circ
umfe
renc
e:M
en: >
40 in
(>10
2 cm
)W
omen
: >35
in (>
88 c
m)
Step
2.
Det
erm
ine
Bod
y M
ass I
ndex
(BM
I)
Use
BM
I C
har
t or
on
e of
th
e fo
rmu
las
bel
ow:
BM
I = w
eigh
t (kg
)/hei
ght s
quar
ed (m
eter
s)If
pou
nds a
nd in
ches
are
use
d:B
MI =
[wei
ght (
lbs)
x 7
03]/h
eigh
t squ
ared
(inc
hes)
Cla
ssB
MI
Und
erw
eigh
t<1
8.5
Nor
mal
Wei
ght
18.5
-24.
9O
verw
eigh
t25
-29.
9O
besi
ty (C
lass
I)30
-34.
9O
besi
ty (C
lass
II)
35-3
9.9
Extre
me
Obe
sity
(Cla
ss II
I)>4
0
Step
3.
Ass
ess r
isk
or e
xist
ence
of c
omor
bid
cond
ition
sPa
tient
s can
be
clas
sifie
d as
bei
ng a
t hig
h ab
solu
te ri
skfo
r obe
sity
-rel
ated
dis
orde
rs if
they
hav
e th
ree
or m
ore
of th
e m
ultip
le ri
sk fa
ctor
s lis
ted
belo
w:
• C
igar
ette
Sm
okin
g•
Hyp
erte
nsio
n•
Fam
ily h
isto
ry o
f pre
mat
ure
CH
D•
Hig
h LD
L ch
oles
tero
l (>
160
mg/
dL)
• Lo
w H
DL
chol
este
rol (
< 35
mg/
dL)
• Im
paire
d fa
stin
g gl
ucos
e (1
10-1
25 m
g/dL
)
Step
7b.
Rec
omm
end
Phys
ical
Act
ivity
Gui
delin
es:
Han
dout
s F,
G
Su
rger
y•
Wei
ght l
oss s
urge
ry is
a p
ossi
ble
optio
n in
pat
ient
sw
ho e
ncom
pass
the
follo
win
g:•
Clin
ical
ly se
vere
obe
sity
(i.e
., pe
rson
s with
a B
MI
>=40
or w
ith a
BM
I >=3
5 w
ith c
omor
bid
cond
i-tio
ns).
• Le
ss in
vasi
ve m
etho
ds h
ave
faile
d.•
At h
igh
risk
for o
besi
ty-r
elat
ed m
orbi
dity
and
mor
talit
y (N
HLB
I).
Step
8.
Con
tinue
Mon
itorin
g an
d Fo
llow
-up
• C
ondu
ct p
erio
dic
wei
ght,
BM
I, an
d w
aist
circ
umfe
renc
e ch
ecks
.
Alg
orith
m o
f Ass
essm
ent a
nd T
reat
men
t
BM
I >25
or w
aist
circ
umfe
renc
e >3
5 in
. [fe
mal
e]; w
aist
circ
umfe
renc
e >4
0 in
. [m
ale]
Ass
ess r
isk
fact
ors
His
tory
of B
MI >
25?
BM
I > 3
0 or
BM
I 25
to 2
9.9
or w
aist
circ
umfe
renc
e >
35in
ches
[fem
ale]
> 4
0 in
ches
[mal
e] a
nd >
2 ri
sk fa
ctor
sYes
No
Ye
s
Doe
s pat
ient
wan
t to
lose
wei
ght?
No
Clin
icia
n an
d pa
tient
dev
ise
goal
s and
trea
tmen
t stra
tegy
for w
eigh
t los
s and
risk
fact
or c
ontro
l
Yes
Ass
ess r
easo
ns fo
rfa
ilure
to lo
se w
eigh
t
Prog
ress
bei
ng m
ade?
Goa
l ach
ieve
d?
No
Yes
Mai
nten
ance
cou
nsel
ing:
• D
ieta
ry T
hera
py•
Beh
avio
r The
rapy
• Ph
ysic
al A
ctiv
ity
Yes
No
Perio
dic
wei
ght,
BM
I, an
d w
aist
circ
umfe
renc
e ch
eck
Sour
ce:
Ada
pted
from
Kus
hner
, RF,
Roa
dmap
s for
Clin
ical
Pra
ctic
e: C
ase
Stud
ies i
n D
isea
se P
reve
ntio
n an
d H
ealth
Prom
otio
n-A
sses
smen
t and
Man
agem
ent o
f Adu
lt O
besi
ty:
A P
rimer
for P
hysi
cian
s. C
hica
go, I
ll: A
mer
ican
Med
ical
Ass
ocia
tion;
200
3.
This
pub
licat
ion
was
supp
orte
d by
Coo
pera
tive
Agr
eem
ent
Num
ber U
58/C
CU
7227
95-0
2 fr
om th
e C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n. I
ts c
onte
nts a
re so
lely
the
resp
onsi
bilit
y of
the
auth
ors a
nd d
o no
t rep
rese
ntth
e of
ficia
l vie
ws o
f CD
C.
AN
EQ
UA
L O
PPO
RTU
NIT
Y/A
FFIR
MAT
IVE
AC
TIO
N E
MPL
OY
ER S
ervi
ces p
rovi
ded
on a
nond
iscr
imin
ator
y ba
sis.
Adv
ise
to m
aint
ain
wei
ght/a
ddre
ssot
her r
isk
fact
ors
No
Yes
Brie
f rei
nfor
cem
ent/
educ
ate
on w
eigh
t man
age-
men
t
No
Yes
BM
I19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
Heig
ht
(in
ch
es)
Bo
dy W
eig
ht
(po
un
ds)
5891
9610
010
511
011
511
912
412
913
413
814
314
815
315
816
216
717
217
718
118
619
119
620
120
521
021
522
022
422
923
423
924
424
825
325
8
5994
9910
410
911
411
912
412
813
313
814
314
815
315
816
316
817
317
818
318
819
319
820
320
821
221
722
222
723
223
724
224
725
225
726
226
7
6097
102
107
112
118
123
128
133
138
143
148
153
158
163
168
174
179
184
189
194
199
204
209
215
220
225
230
235
240
245
250
255
261
266
271
276
6110
010
611
111
612
212
713
213
714
314
815
315
816
416
917
418
018
519
019
520
120
621
121
722
222
723
223
824
324
825
425
926
426
927
528
028
5
6210
410
911
512
012
613
113
614
214
715
315
816
416
917
518
018
619
119
620
220
721
321
822
422
923
524
024
625
125
626
226
727
327
828
428
929
5
6310
711
311
812
413
013
514
114
615
215
816
316
917
518
018
619
119
720
320
821
422
022
523
123
724
224
825
425
926
527
027
828
228
729
329
930
4
6411
011
612
212
813
414
014
515
115
716
316
917
418
018
619
219
720
420
921
522
122
723
223
824
425
025
626
226
727
327
928
529
129
630
230
831
4
6511
412
012
613
213
814
415
015
616
216
817
418
018
619
219
820
421
021
622
222
823
424
024
625
225
826
427
027
628
228
829
430
030
631
231
832
4
6611
812
413
013
614
214
815
516
116
717
317
918
619
219
820
421
021
622
322
923
524
124
725
326
026
627
227
828
429
129
730
330
931
532
232
833
4
6712
112
713
414
014
615
315
916
617
217
818
519
119
820
421
121
722
323
023
624
224
925
526
126
827
428
028
729
329
930
631
231
932
533
133
834
4
6812
513
113
814
415
115
816
417
117
718
419
019
720
321
021
622
323
023
624
324
925
626
226
927
628
228
929
530
230
831
532
232
833
534
134
835
4
6912
813
514
214
915
516
216
917
618
218
919
620
320
921
622
323
023
624
325
025
726
327
027
728
429
129
730
431
131
832
433
133
834
535
135
836
5
7013
213
914
615
316
016
717
418
118
819
520
220
921
622
222
923
624
325
025
726
427
127
828
529
229
930
631
332
032
733
434
134
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536
236
937
6
7113
614
315
015
716
517
217
918
619
320
020
821
522
222
923
624
325
025
726
527
227
928
629
330
130
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532
232
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834
335
135
836
537
237
938
6
7214
014
715
416
216
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718
419
119
920
621
322
122
823
524
225
025
826
527
227
928
729
430
230
931
632
433
133
834
635
336
136
837
538
339
039
7
7314
415
115
916
617
418
218
919
720
421
221
922
723
524
225
025
726
527
228
028
829
530
231
031
832
533
334
034
835
536
337
137
838
639
340
140
8
7414
815
516
317
117
918
619
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221
021
822
523
324
124
925
626
427
228
028
729
530
331
131
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235
035
836
537
338
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939
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242
0
7515
216
016
817
618
419
220
020
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224
024
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626
427
227
928
729
530
331
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335
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737
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741
542
343
1
7615
616
417
218
018
919
720
521
322
123
023
824
625
426
327
127
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431
232
032
833
634
435
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738
539
440
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041
842
643
544
3
Sou
rce:
Ada
pted
from
Clin
ical
Gui
delin
es o
n th
e Id
entif
icat
ion,
Eva
luat
ion,
and
Tre
atm
ent o
f Ove
rwei
ght a
nd O
besi
ty in
Adu
lts:T
he E
vide
nce
Rep
ort.
Body
Mas
s In
dex
Tabl
e
No
rmal
Overw
eig
ht
Ob
ese
Extr
em
e O
besit
y
BM
I Cal
cula
tor:
ww
w.c
dc.g
ov/n
ccdp
hp/d
pna/
bmi
Sta
te o
f M
isso
uri
Co
nse
nsu
s S
cree
nin
g G
uid
elin
es f
or
Pre
-dia
bet
es a
nd
Dia
bet
es in
a M
edic
al S
etti
ng
Dev
elop
ed b
y th
e D
iabe
tes
Scr
eeni
ng G
uide
lines
Wor
k G
roup
and
sup
port
ed b
y th
e M
isso
uri A
ssoc
iatio
n of
Hea
lth P
lans
Edu
catio
n an
d R
esea
rch
Fou
ndat
ion
and
the
Mis
sour
i Dep
artm
ent o
f Hea
lth a
nd S
enio
r S
ervi
ces
Con
sens
us P
anel
Rec
omm
enda
tions
:A
lthou
gh th
e en
tire
Mis
sour
i pop
ulat
ion
is a
t ris
k fo
r di
abet
es, c
urre
nt e
vide
nce
is in
suffi
cien
t to
reco
mm
end
for
or a
gain
st r
outin
ely
scre
enin
g as
ympt
omat
ic
indi
vidu
als
for
type
2 d
iabe
tes,
impa
ired
gluc
ose
tole
ranc
e, o
r im
paire
d fa
stin
g gl
ucos
e. T
he p
urpo
se o
f scr
eeni
ng is
to id
entif
y pe
rson
s pr
evio
usly
not
dia
gnos
ed w
ith p
re-d
iabe
tes
or d
iabe
tes.
To
effe
ctiv
ely
utili
ze r
esou
rces
, scr
eeni
ng e
ffort
s sh
ould
be
dire
cted
to in
divi
dual
s ex
hibi
ting
risks
for
diab
etes
as
outli
ned
belo
w.
Add
ition
al r
esea
rch
is n
eede
d to
det
erm
ine
effe
ctiv
e ap
proa
ches
for
scre
enin
g in
ven
ues
outs
ide
the
med
ical
set
ting.
1. A
ge
2. O
verw
eig
ht
3. O
ther
Ris
k F
acto
rs
6. R
esu
lts/
Act
ion
Ch
ildre
n <
10
Ch
ildre
n/A
do
lesc
ents
10-1
7 ye
ars
AN
DA
du
lts
18-4
5 ye
ars
Ad
ult
s >
45
Ro
uti
ne
scre
enin
g N
OT
reco
mm
end
ed
un
less
on
set
of
pu
ber
ty
has
occ
urr
ed. I
F S
O,
BM
I is
:
>85
th p
erce
nti
le f
or
age
&
gen
der
or
>85
thp
erce
nti
le
wei
gh
t fo
r h
eig
ht
or
Wei
gh
t is
>12
0% o
f
idea
l fo
r h
eig
ht
AN
D T
wo
(2)
Ris
k F
acto
rs
BM
I >25
kg
/m2
AN
D1
risk
fac
tor
bel
ow
Eve
ry 3
Yea
rsA
nn
ual
lyE
very
2 Y
ears
(in
clu
des
ch
ildre
n if
in p
ub
erty
)
4. S
cree
nin
g T
ests
TW
O (
2) O
F T
HE
FO
LL
OW
ING
:
•F
amily
his
tory
of t
ype
2 di
abet
es (
1st/2
ndde
gree
);
•R
ace
ethn
icity
(N
ativ
e A
mer
ican
, Afr
ican
Am
eric
an,
His
pani
c A
mer
ican
, Asi
an/S
outh
Pac
ific
Isla
nder
•S
igns
of i
nsul
in r
esis
tanc
e (a
cant
hosi
s ni
gric
ans,
hyp
erte
nsio
n,
dysl
ipid
emia
, pol
ycys
tic o
vary
syn
drom
e)
OT
HE
R R
ISK
FA
CT
OR
S
•P
hysi
cal i
nact
ivity
(<
30 m
in. o
f mod
erat
e ac
tivity
5+
day
s/w
eek
or <
20 m
in.
vigo
rous
act
ivity
3+
day
s/w
eek)
•F
amily
his
tory
of d
iabe
tes
(esp
ecia
lly 1
stde
gree
rel
ativ
es)
•H
igh
risk
ethn
ic p
opul
atio
n (s
ee li
st u
nder
chi
ldre
n)
•D
eliv
ered
a b
aby
wei
ghin
g >
9 lb
s. o
r ha
s be
en d
iagn
osed
with
Ges
tatio
nal D
iabe
tes
•H
yper
tens
ion
(14
0/90
mm
Hg)
•H
isto
ry o
f vas
cula
r di
seas
e
•D
yslip
idem
ia–
HD
L ch
oles
tero
l <35
mg/
dl (
0.90
mm
ol/l)
and
/or
trig
lyce
ride
leve
l
>25
0 m
g/dl
(2.
82m
mol
/l)
•P
revi
ous
impa
ired
gluc
ose
tole
ranc
e (I
GT
) or
impa
ired
fast
ing
gluc
ose
(IF
G)
•C
linic
al c
ondi
tions
ass
ocia
ted
with
insu
lin r
esis
tanc
e (e
.g.,
acan
thos
is n
igric
ans)
•P
olyc
ystic
Ova
ry S
yndr
ome
(PC
OS
)
SC
RE
EN
ING
TE
ST
SR
EQ
UIR
ES
AD
DIT
ION
AL
TE
ST
ING
IF:
•F
astin
g P
lasm
a G
luco
se (
FP
G)…
……
……
..100
-125
mg/
dL (
may
indi
cate
pre
-dia
bete
s)
•F
astin
g P
lasm
a G
luco
se (
FP
G)…
……
……
..12
6 m
g/dL
(m
ay in
dica
te d
iabe
tes)
•Im
paire
d G
luco
se T
oler
ance
(IG
T)…
……
….2
hrs
. afte
r 75
g gl
ucos
e, v
alue
is
140-
199
(pre
-dia
bete
s);
200
(dia
bete
s)
Ref
eren
ce: A
mer
ican
Dia
bete
s A
ssoc
iatio
n S
tand
ards
of M
edic
al C
are
in D
iabe
tes,
Dia
bete
s C
are
28:S
5-S
7, 2
005.
Re
su
lts
No
rm
al
Scr
een
as in
1 th
roug
h 3
Res
ult
s A
bn
orm
al
1. R
epea
t tes
ts o
n su
bseq
uent
day
to d
iagn
ose
2. Im
plem
ent t
reat
men
t pla
n in
clud
ing
lifes
tyle
mod
ifica
tion
3. S
cree
n fo
r ot
her
Car
diov
ascu
lar
Dis
ease
Ris
k F
acto
rs:
•H
DL
40 m
g/dL
•F
astin
g T
rigly
cerid
es
150
mg/
dL
•B
lood
Pre
ssur
e
13
0/85
mm
Hg
5. F
req
uen
cy
No
rmal
wei
gh
t
AN
DN
o r
isk
fact
ors
(ski
p to
ste
p 4)
Orig
inal
Effe
ctiv
e D
ate:
1/1
8/20
06
Ad
ult
s >
45
BM
I >25
kg
/m2
OR
1 ri
sk f
acto
r b
elo
w
An
nu
ally
Communication Guidelines to Promote Health Behavior Change
Ask permissionWould you be willing to spend a few minutes discussing your weight?Would you like to talk about different ways to exercise and eat?
Share BMIYour BMI falls within the _________category.The target BMI for someone your height is _______.Ask for the patient’s interpretation: “What does this mean to you?”Add your own interpretation or advice as needed after eliciting the patient’s response.
Offer optionsThere are a number of ways to achieve a healthy weight.
Exercise and be physically active.Cut back on TV and computer time.Eat at least 5 servings of fruits and vegetables each day.Cut down on soda, juice, other sugary drinks and alcoholic beverages.
Is there any one of these you’d like to discuss further today? Or perhaps you have another idea that I didn’t mention?
Assess readinessOn a scale of 0 to 10, how ready are you to consider _____________ [option chosen above]
Not Ready Ready0 1 2 3 4 5 6 7 8 9 10
Straight question: Why a 5?Backward question: Why a 5 and not a 3?Forward question: What would it take to move you from a 5 to a 7?
Explore ambivalenceStep 1: Ask a pair of questions to help the patient explore the pros and cons of the issue.
What are the things you think are important or that you like about __________?What are the problems, or things, you don’t like about __________?
Step 2: Summarize ambivalenceAsk: Did I get it right?
Tailor the interventionState of Readiness Key QuestionsNOT READY 0-3 Would you be interested in knowing more about reaching a healthy weight?
Raise Awareness How can I help?Elicit Change Talk What needs to be different for you to consider making a change in the future?Advise and Encourage
UNSURE 4-6 Where does that leave you now?Evaluate Awareness What do you see as the next steps?Elicit Change Talk What are you thinking/feeling at this point?Advise and Encourage Where does ________ fit into your future?
READY 7-10 Why is this important to you now?Strengthen Commitment What are your ideas for making this work?Elicit Change Talk What might get in the way? How can you deal with that?Facilitate Action Planning How might you reward yourself along the way?
CloseSummarize.Show appreciation. Acknowledge willingness to discuss change.Offer advice, emphasize choice, establish realistic goals, and express confidence.Confirm next steps and arrange for follow-up.Source: Adapted from the Adolescent Provider Tool Kit, Adolescent Health Working Group, 2004.
Applying the Stages of Change Model to Assess Readiness
Stage Characteristic Patient verbal cue Appropriate intervention Sample dialogue
Precontemplation Unaware of problem “I’m not interested Provide information “Would you like to readno intesest in change in weight loss. It’s not about health risks and information about the
a problem.” benefits of weight loss health aspects of aging.”
Contemplation Aware of problem “I know I need to lose Help resolve “Let’s look at the benefitsbeginning to think weight, but with all ambivalence and of weight loss, as well asof changing that’s going on in my discuss barriers what you may need to
life right now, I’m not change.”sure I can.”
Preparation Realizes benefits of “I have to lose weight Teach behavior “Let’s take a closer lookmaking changes and and I’m planning to modification; provide at how you can reducethinking about how do that.” education some of the calories youto change eat and how to increase
your activity during the day.”
Action Actively taking steps “I’m doing my best. Provide support and “It’s terrific that you’retoward change This is harder than guidance, with a focus working so hard. What
I thought.” on the long term problems have you had so far? How have you solved them?”
Maintenance Initial treatment goals “I’ve learned a lot Relapse control “What situations continuethrough this process.” to tempt you to overeat?
What can be helpful for the next time you face such a situation?”
Adapted from Prochaaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, ed. TreatingAddictive Behaviors. New York, NY: Plenum; 1986:3-27
Source: Kushner, R.F.
This checklist includes a list of more detailed questions that correspond with the National Heart, Lung,and Blood Institute and North American Association for the Study of Obesity Practical Guidelines forevaluating readiness. They can be used to more thoroughly assess patients’ readiness and to evaluate forother medical conditions.
Motivation/support• How important is it that you lose weight at this time?• Have you tried to lose weight before?
• What factors have led to your success and what has made weight loss difficult? (Forexample, cost, peer pressure, family, etc.)
• Who of your family and friends is supportive of your decision to begin a weight lossprogram?
• What do you consider the benefits of weight loss?• What would you have to give up in order to lose weight?
Stressful life events• Are there events in your life right now that might make losing weight especially difficult?
(For example, work responsibilities, family commitments?)
Psychiatric issues• What is your mood like most of the time? Do you feel you have the needed energy to lose
weight? Do you feel that you eat what most people would consider a large amount of food ina short period of time? Do you feel out of control during this time?
• Do you ever forcibly vomit, use laxatives, or engage in excessive physical activity as ameans of controlling weight?
Time availability/constraints• How much time are you able to devote to physical activity on a weekly basis?• Do you believe that you can make time to record your caloric intake?
Weight-loss goals/expectations• How much weight do you expect to lose?• How fast do you expect to lose weight?
Source: Kushner, R.F.
Patient Readiness Checklist
Tips for Nutrition Counseling
Educational efforts should pay particular attention to the following topics:
• Energy value of different foods.• Food composition: fats, carbohydrates (including dietary fiber), and proteins.• Evaluation of nutrition labels to determine caloric content and food composition.• New habits of purchasing—give preference to low-calorie foods.• Food preparation: avoid adding high-calorie ingredients during cooking (e.g., fats and oils).• Avoiding over consumption of high-calorie foods (both high-fat and high-carbohydrate foods).• Adequate water intake (at least eight, 8 oz. glasses per day).• Reduction of portion sizes.• Limiting alcohol consumption.
What diet should I recommend?Aim for a slow, steady weight loss in your patients by decreasing calorie consumption, maintainingadequate nutrient intake, and increasing physical activity. Consider the following options to determinecalorie needs to support weight loss.
• To lose weight, in general, diets containing 1,000 to 1,200 kcal/day should be selected for mostwomen; diets between 1,200 kcal/day and 1,600 kcal/day should be chosen for men and may beappropriate for women who weigh 165 pounds or more, or who exercise regularly. If the patientcan stick with the 1,600 kcal/day diet but does not lose weight you may want to try the 1,200kcal/day diet. If a patient on either diet is hungry, you may want to increase the kcals/day by 100to 200.
• Go to www.mypyramid.gov and enter patient’s information (age, sex, weight, height andphysical activity level) to receive a customized food guide and recommended calorie level forweight maintenance. These amounts can then be modified by a reduction of approximately 500calories a day for weight loss. The MyPyramid food plans are based on average calorie needs forgroups of people and may not exactly match your patient’s calorie needs. Monitor weight andrecommend adjustments in the calorie level as needed.
• If patient is not losing weight through calorie reduction, consider resting metabolic rate (RMR)testing to more specifically determine patient’s calorie needs.
• If possible, refer patient to a Licensed Registered Dietitian for an in-depth dietary assessment.
• Recommend your patient keep a Daily Food and Activity Diary (Patient Handout M) and weigh/measure food portions for increased accuracy of calorie intake. Awareness is an important partof making lasting changes for healthy living. Keeping a diary will increase awareness of whatthey eat, why they eat (such as hunger levels or eating triggers) and physical activity patterns.
do it for yourself . . .
Patient Handouts
do it for yourself . . .
Are You Ready and Motivated to Lose Weight?
Answer these quick questions to assess how ready you are to achieve a healthier weight.
1. Is there a reason you are seeking treatment at this time?____________________________________________________________________________________
2. What are your goals about weight control and management?____________________________________________________________________________________
3. Your level of interest in losing weight is: (circle the number that indicates your level of interest)
Not Interested 1 2 3 4 5 Very Interested
4. Are you ready for lifestyle changes to be a part of your weight control program?
Not Ready 1 2 3 4 5 Very Ready
5. How much support can your family provide?
No Support 1 2 3 4 5 Much Support
6. How much support can your friends provide?
No Support 1 2 3 4 5 Much Support
7. What is the hardest part about managing your weight?____________________________________________________________________________________
____________________________________________________________________________________
8. What do you believe will be of most help to assist you in losing weight?_____________________________________________________________________________________________
____________________________________________________________________________________
9. How confident are you that you can lose weight at this time?
Not Confident 1 2 3 4 5 Very Confident
Source: Adapted from Kushner, R.F.
Patient Handout A
do it for yourself. . .do it for yourself . . .
1. Establish regular meal times.Skipping meals leads to overeating later in the day.If you don’t have time for a full meal, try to eat ahealthy snack or meal replacement bar instead.
2. Read food labels when buying food items.Pay attention to the portion size, the number ofcalories in each portion, and the amount ofsaturated fat in each portion. This can help youmake the healthiest food choices.
3. Make small substitutions in your diet tocut calories.For example, drink water, diet soda, orunsweetened iced tea instead of high-caloriedrinks. Choose low-calorie and low-fat versions ofsalad dressing, cheese, sour cream, andmayonnaise. Go easy on fried foods — bake, broil,poach, or grill your food instead. To find out theaverage amount of calories you should beconsuming every day, go to www.mypyramid.gov.
4. Identify “guilty pleasures” such as ice cream,cookies, or potato chips.Continue to enjoy them by trying the low-calorieversions or eating less of the regular versions.
5. Pre-portion your servings to control theamount.For example, scoop your ice cream in a bowlinstead of eating it out of the carton. Bag potatochips or cookies to single-serving sized containersor zip-lock bags. Eat the serving size only whenyou have a craving. Remember to pass on seconds.
6. Control calories when dining out.At fast-food restaurants, “down-size” food anddrinks instead of “super-sizing” them. Checkfavorite fast- food restaurant web sites for nutritioninformation to select the healthiest options.
7. Share an entrée with a friend at sit-downrestaurants.However, order a personal salad or side ofvegetables. Ask restaurants to: “Please hold thecheese,” “Leave the sauce on the side,” “Use low-fat salad dressing,” and “Please substitutevegetables for French fries.” As always, try toavoid fried dishes.
8. Pre-plan meals and snacks, and make certainto have the food on hand.This makes it easier to resist trips to the vendingmachine and unhealthy, unplanned snacking.
9. Avoid places and situations that triggereating.For example, if walking past the donut shop causesdonut cravings, try changing your route. Replacethe candy on your desk with fruit or avoid walkingnear the office candy bowl. Avoid eating whilewatching television, reading, or driving. Manypeople do not recall what they’ve eaten whiledoing other things.
10. Try substituting other activities for eating.For example, take a walk, talk to a friend, or listento music. These activities avoid the extra caloriesand can be more satisfying than eating.
Food Weight-Loss Tips
Patient Handout B
Source: Adapted from the American Medical Association: Roadmaps for Clinical Practice Series.
do it for yourself . . .
The Nutrition Facts Label - An Overview
When you’re at the grocery store it’s hard to take the extra minute to look at the food labels of the itemsyou’re buying. But reading the label is really the only way to know for sure what you’re eating. Thischeat sheet will make the process a little easier.
In the following Nutrition Facts label, certain sections have been colored to help you focus on the areasthat will be explained in detail. You will not see these colors on the food labels on products youpurchase.
This list gives percentages that arebased on recommended dailyallowances based on a 2,000 calorieper day diet. However manypeople’s calorie needs may besignificantly less than 2,000.
For example, a label may show that aserving of food provides 30% of thedaily recommended amount of fiber.This means you may need another70% to meet the recommended goal.Remember this is just an estimate,but it serves as a good guide.
Nutrition FactsServing Size 1 cup (228g)Servings Per Container 2
Amount Per Serving
Calories 250 Calories from Fat 110
% Daily Value*
Total Fat 12 g 18% Saturated Fat 3 g 15% Trans Fat 3 gCholesterol 30 mg 10%Sodium 470 mg 20%
Total Carbohydrate 31 g 10% Dietary Fiber 0g 0% Sugars 5 gProtein 5 g
Vitamin A 4%Vitamin C 2%Calcium 20%Iron 4%
*Percent Daily Values are based on a 2,000 caloriediet. Your Daily Values may be higher or lowerdepending on your calorie needs.
Calories: 2,000 2,500Total Fat Less than 65g 80g Sat Fat Less than 20g 25gCholesterol Less than 300mg 300mgSodium Less than 2,400mg 2,400mgTotal Carbohydrate 300g 375g Dietary Fiber 25g 30g
Source: Adapted from healthiergenerations.org and http://www.cfsan.fda.gov/~dms/foodlab.html
Try to keep sugars low. More sugarmeans more calories.
The less cholesterol and sodiumyou eat, the better. The latestrecommendation for sodium is lessthan 2,300 mg per day for adults.
Check the serving size, particularlyhow many servings there are in thecontainer. If there are 2 and you eatthe whole container, you’re eatingdouble the calories that are on thelabel!
Try to minimize saturated and transfat. These are both bad fats thatclog arteries.
Get enough fiber, vitamins A andC, calcium and iron.
Patient Handout C
do it for yourself . . .
Tips for Dining Out
The new National Heart, Lung, and Blood Institute Obesity Guidelines say that whether or not you’retrying to lose weight, you can eat healthy when dining out, if you know how.
So, if you’re treating yourself to a meal out, here are some tips to help make it a dining experience thatis both tasty and good for you.
ASK!Will the restaurant:
• Serve fat free (skim) milk rather than whole milk or cream?
• Trim visible fat from poultry or meat?
• Leave all butter, gravy or sauces off a dish?
• Serve salad dressing on the side?
• Accommodate special requests?
• Use less cooking oil when cooking?
• Provide a take-out box when your meal arrives? Put half the dinneraway immediately, even before your fork hits the plate.
ACT!Select foods which are:
• Steamed
• Garden fresh
• Broiled
• Baked
• Roasted
• Poached
• Lightly sautéed or stir-fried
DO YOUR HOMEWORK!• If possible, obtain nutritional information of menu items at the restaurant you will be dining at
before you leave for your meal. Try www.calorieking.com or the restaurant’s web site.
Patient Handout D
Source: Adapted from The National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetesand Digestive and Kidney Diseases, National Institutes of Health.
do it for yourself. . .
Grocery Shopping Guide
The new National Heart, Lung, and Blood Institute Obesity Guidelines say that you can reduce the timeyou spend cooking healthy by using a shopping list and keeping a well-stocked kitchen. Read the labelsas you shop and pay attention to serving size and servings per container. Compare the total calories insimilar products and choose the lowest calorie ones. So, shop for quick low fat food items and fill yourkitchen cupboards with a supply of lower calorie basics like the following:
Patient Handout E
Source: Adapted from The National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetesand Digestive and Kidney Diseases, National Institutes of Health.
Low Fat Dairy• Fat free or low fat milk, yogurt, cheese, and
cottage cheese
Whole Grain Carbohydrates• Whole grain sandwich breads, bagels, pita
bread, English muffins• Soft corn tortillas, low fat flour tortillas• Low fat, low sodium crackers• Whole grain cereal, dry or cooked• Brown rice or whole wheat pasta
Meat/Poultry/Seafood• White meat chicken or turkey (remove skin)• Fish and shellfish (not battered)• Beef: round, sirloin, chuck arm, loin and extra
lean ground beef• Pork: leg, shoulder, tenderloin• Dry beans and peas• Eggs/egg substitutes
Fruits and Vegetables• Fresh, frozen, canned fruits in water, juice or
light syrup• Fresh, frozen, or no salt added canned
vegetables (rinse regular canned vegetables toreduce sodium)
Fats and Oils• Monounsaturated fats
− Olive Oil− Canola Oil
• Light or diet margarine• Low fat or nonfat salad dressings
Condiments• Mustard and catsup• Low sugar jam or jelly• Herbs and spices• Salsa
Beverages• Water or sugar-free flavored water• Milk - fat free or low fat• 100% juice• Diet soda• Tea and coffee
do it for yourself . . .
What’son your plate?
Make half your plate fruits and
vegetables.
Switch to skim or 1% milk.
Vary your protein food choices.
Make at least half your grains
whole.
Before you eat, think about what and how much food goes on your plate or in your cup or bowl. Over the day, include foods from all food groups: vegetables, fruits, whole grains, low-fat dairy products, and lean protein foods.
ChooseMyPlate.gov
Grains
DairyFruits
VegetablesProtein
August 2011
USDA is an equal opportunity provider and employer.
Cut back on sodium and empty calories from solid fats and added sugars
Look out for salt (sodium) in foods you buy. Compare sodium in foods and choose those with a lower number.
Drink water instead of sugary drinks. Eat sugary desserts less often.
Make foods that are high in solid fats—such as cakes, cookies, ice cream, pizza, cheese, sausages, and hot dogs—occasional choices, not every day foods.
Limit empty calories to less than 260 per day, based on a 2,000 calorie diet.
Be physically active your wayPick activities you like and do each for at least 10 minutes at a time. Every bit adds up, and health benefits increase as you spend more time being active.
Children and adolescents: get 60 minutes or more a day.
Adults: get 2 hours and 30 minutes or more a week of activity that requires moderate effort, such as brisk walking.risk
minuteds up, and health
e as you spend morve.
d adolesces or more a
s: get 2 hours and 30 minutesmore a week of activity that
equires moderate effort, such as brisk walking
ena
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Vegetables Fruits Grains Dairy Protein Foods
Eat more red, orange, and dark-green veg-gies like tomatoes, sweet potatoes, and broccoli in main dishes.
Add beans or peas to salads (kidney or chickpeas), soups (split peas or lentils), and side dishes (pinto or baked beans), or serve as a main dish.
Fresh, frozen, and canned vegetables all count. Choose “reduced sodium” or “no-salt-added” canned veggies.
Use fruits as snacks, salads, and desserts. At breakfast, top your cereal with bananas or strawberries; add blueberries to pancakes.
Buy fruits that are dried, frozen, and canned (in water or 100% juice), as well as fresh fruits.
Select 100% fruit juice when choosing juices.
Substitute whole-grain choices for refined-grain breads, bagels, rolls, break-fast cereals, crackers, rice, and pasta.
Check the ingredients list on product labels for the words “whole” or “whole grain” before the grain ingredient name.
Choose products that name a whole grain first on the ingredi-ents list.
Choose skim (fat-free) or 1% (low-fat) milk. They have the same amount of calcium and other essential nutrients as whole milk, but less fat and calories.
Top fruit salads and baked potatoes with low-fat yogurt.
If you are lactose intolerant, try lactose-free milk or fortified soymilk (soy beverage).
Eat a variety of foods from the protein food group each week, such as seafood, beans and peas, and nuts as well as lean meats, poultry, and eggs.
Twice a week, make seafood the protein on your plate.
Choose lean meats and ground beef that are at least 90% lean.
Trim or drain fat from meat and remove skin from poultry to cut fat and calories.
For a 2,000-calorie daily food plan, you need the amounts below from each food group. To find amounts personalized for you, go to ChooseMyPlate.gov.
Eat 2½ cups every day
What counts as a cup? 1 cup of raw or cooked vegetables or vegetable juice; 2 cups of leafy salad greens
Eat 2 cups every day
What counts as a cup? 1 cup of raw or cooked fruit or 100% fruit juice; ½ cup dried fruit
Eat 6 ounces every day
What counts as an ounce?1 slice of bread; ½ cup of cooked rice, cereal, or pasta; 1 ounce of ready-to-eat cereal
Get 3 cups every day
What counts as a cup? 1 cup of milk, yogurt, or fortified soymilk; 1½ ounces natural or 2 ounces processed cheese
Eat 5½ ounces every day
What counts as an ounce?1 ounce of lean meat, poultry, or fish; 1 egg; 1 Tbsp peanut butter; ½ ounce nuts or seeds; ¼ cup beans or peas
Patient Handout G
There are 1,440 minutes in every day...schedule 30 of them for physical activity.
Making Physical Activity Part of Your Life: Tips for Being More Active
do it for yourself. . .
Adults need recess too! With a little creativity and planning, even the person with the busiest schedule canmake room for physical activity. For many folks, before or after work or meals is often an available timeto cycle, walk, or play. Think about your weekly or daily schedule and look for or make opportunities to bemore active. Every little bit helps. Consider the following suggestions:
• Walk, cycle, jog, skate, etc., to work, school, the store, or place of worship.• Park the car farther away from your destination.• Get on or off the bus several blocks away.• Take the stairs instead of the elevator or escalator.• Play with children or pets. Everybody wins. If you find it too difficult to be active after work,
try before work.• Take fitness breaks-walking or doing desk exercises-instead of taking cigarette or coffee breaks.• Perform gardening or home repair activities.• Avoid labor-saving devices-turn off the self-propel option on your lawn mower or vacuum
cleaner.• Use leg power-take small trips on foot to get your body moving.• Exercise while watching TV (for example, use hand weights, stationary bicycle/treadmill/
stairclimber, or stretch).• Dance to music.• Keep a pair of comfortable walking or running shoes in your car and office. You’ll be ready for
activity wherever you go!• Make a Saturday morning walk a group habit.• Walk while doing errands.
Tips for People Who Have Been Inactive for a WhileUse a sensible approach by starting out slowly.
• Begin by choosing moderate-intensity activities you enjoy the most. Bychoosing activities you enjoy, you’ll be more likely to stick with them.
• Gradually build up the time spent doing the activity by adding a fewminutes every few days or so until you can comfortably perform aminimum recommended amount of activity (30 minutes per day).As the minimum amount becomes easier, gradually increaseeither the length of time performing an activity or increasethe intensityof the activity, or both.
• Vary your activities, both for interest and to broadenthe range of benefits.
• Explore new physical activities.• Reward and acknowledge your efforts.
Given the health benefits of regular physical activity, we might have to ask why two out of three (60%)Americans are not active at recommended levels. There are barriers that keep Americans from being, orbecoming, regularly physically active. Understanding common barriers to physical activity and creatingstrategies to overcome them may help you make physical activity part of your daily life.
Identify available time slots. Monitor your daily activities for one week. Identify at least three30-minute time slots you could use for physical activity.
Add physical activity to your daily routine. For example, walk or ride your bike to work orshopping, organize school activities around physical activity, walk the dog, exercise while youwatch TV, park farther away from your destination, etc.
Make time for physical activity. For example, walk, jog, or swim during your lunch hour, ortake fitness breaks instead of coffee breaks.
Select activities requiring minimal time, such as walking, jogging, or stairclimbing.
Explain your interest in physical activity to friends and family. Ask them to support yourefforts.
Invite friends and family members to exercise with you. Plan social activities involvingexercise.
Develop new friendships with physically active people. Join a group, such as the YMCA or ahiking club.
Schedule physical activity for times in the day or week when you feel energetic.
Convince yourself that if you give it a chance, physical activity will increase your energy level;then, try it.
Plan ahead. Make physical activity a regular part of your daily or weekly schedule and write iton your calendar.
Invite a friend to exercise with you on a regular basis and write it on both your calendars.
Join an exercise group or class.
Learn how to warm up and cool down to prevent injury.
Learn how to exercise appropriately considering your age, fitness level, skill level, and healthstatus.
Choose activities involving minimum risk. Select activities requiring no new skills, such aswalking, climbing stairs, or jogging.
Exercise with friends who are at the same skill level as you are.
Find a friend who is willing to teach you some new skills.
Take a class to develop new skills.
Fear of Injury
Patient Handout H
Suggestions for Overcoming Physical Activity Barriers
“If you can find a path with no obstacles, it probably doesn’t lead anywhere.” —Anonymous
Overcoming Barriers to Physical Activity
Lack of Time
Social Influence
Lack of Energy
Lack of Motivation
Lack of Skill
Lack of Resources Select activities that require minimal facilities or equipment, such as walking,jogging, jumping rope, or calisthenics.
Identify inexpensive, convenient resources available in your community(community education programs, park and recreation programs, worksite programs,etc.).
Develop a set of regular activities that are always available regardless of weather(indoor cycling, aerobic dance, indoor swimming, calisthenics, stair climbing, ropeskipping, mall walking, dancing, gymnasium games, etc.)
Look on outdoor activities that depend on weather conditions (cross-country skiing,outdoor swimming, outdoor tennis, etc.) as “bonuses”-extra activities possible whenweather and circumstances permit.
Put a jump rope in your suitcase and jump rope.
Walk the halls and climb the stairs in hotels.
Stay in places with swimming pools or exercise facilities.
Join the YMCA or YWCA (ask about reciprocal membership agreement).
Visit the local shopping mall and walk for half an hour or more.
Bring a small tape recorder and your favorite aerobic exercise tape.
Trade babysitting time with a friend, neighbor, or family member who also hassmall children.
Exercise with the kids-go for a walk together, play tag or other running games, getan aerobic dance or exercise tape for kids (there are several on the market) andexercise together. You can spend time together and still get your exercise.
Hire a babysitter and look at the cost as a worthwhile investment in your physicaland mental health.
Jump rope, do calisthenics, ride a stationary bicycle, or use other home gymnasiumequipment while the kids are busy playing or sleeping.
Try to exercise when the kids are not around (e.g., during school hours or their naptime).
Encourage exercise facilities to provide child care services.
Look upon your retirement as an opportunity to become more active instead of less.Spend more time gardening, walking the dog, and playing with your grandchildren.Children with short legs and grandparents with slower gaits are often great walkingpartners.
Learn a new skill you’ve always been interested in, such as ballroom dancing,square dancing, or swimming.
Now that you have the time, make regular physical activity a part of every day. Gofor a walk every morning or every evening before dinner. Treat yourself to anexercycle and ride every day while reading a favorite book or magazine.
Source: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and HealthPromotion.
Suggestions for Overcoming Physical Activity Barriers (continued)
Weather Conditions
Travel
Family Obligations
Retirement Years
1. Walk to work.2. Use fat free milk instead of whole milk.3. Do sit-ups in front of the TV.4. Walk during lunch hour.5. Drink water before a meal.6. Eat leaner red meat and poultry.7. Eat half your dessert.8. Walk instead of driving whenever you can.9. Take family walk after dinner.10. Skate to work instead of driving.11. Avoid food portions larger than your fist.12. Mow lawn with push mower.13. Increase the fiber in your diet.14. Walk to your place of worship instead of driving.15. Walk kids to school.16. Get a dog and walk it.17. Join an exercise group.18. Drink diet soda.19. Replace Sunday drive with Sunday walk.20. Do yard work.21. Eat off smaller plates.22. Get off a stop early and walk.23. Don’t eat late at night.24. Skip seconds.25. Work around the house.26. Skip buffets.27. Grill, steam or bake instead of frying.28. Bicycle to the store instead of driving.29. Take dog to the park.30. Ask your doctor about taking a multi-vitamin.31. Go for a half-hour walk instead of watching TV.32. Use vegetable oils over solid fats.33. More carrots, less cake.34. Fetch the newspaper yourself.35. Sit up straight at work.36. Wash the car by hand.37. Don’t skip meals.38. Eat more celery sticks.39. Run when running errands.40. Pace the sidelines at kids’ athletic games.41. Take wheels off luggage.42. Choose an activity that fits into your daily life.
43. Try your burger with just lettuce, tomato, andonion.
44. Ask a friend to exercise with you.45. Make time in your day for physical activity.46. Exercise with a video if the weather is bad.47. Bike to the barbershop or beauty salon instead
of driving.48. Keep to a regular eating schedule.49. If you find it difficult to be active after work,
try it before work.50. Take a walk or do desk exercises instead of a
cigarette or coffee break.51. Perform gardening or home repair activities.52. Avoid laborsaving devices.53. Take small trips on foot to get your body
moving.54. Play with your kids 30 minutes a day.55. Dance to music.56. Keep a pair of comfortable walking or running
shoes in your car and office.57. Make a Saturday morning walk a group habit.58. Walk briskly in the mall.59. Choose activities you enjoy and you’ll be more
likely to stick with them.60. Stretch before bed to give you more energy
when you wake.61. Take the long way to the water cooler.62. Explore new physical activities.63. Vary your activities, for interest and to broaden
the range of benefits.64. Reward and acknowledge your efforts.65. Choose fruit for dessert.66. Consume alcoholic beverages in moderation, if
at all.67. Take stairs instead of the escalator.68. Conduct an inventory of your meal/snack and
physical activity patterns.69. Share an entree with a friend.70. Grill fruits or vegetables.71. Eat before grocery shopping.72. Choose a checkout line without a candydisplay.73. Make a grocery list before you shop.
Tips to Make Small Changes - That Add Up to Big Success
Patient Handout I
74. Buy 100% fruit juices over soda and sugarydrinks.
75. Stay active in winter. Play with your kids.76. Flavor foods with herbs, spices, and other low
fat seasonings.77. Remove skin from poultry before cooking to
lower fat content.78. Eat before you get too hungry.79. Eat breakfast every day.80. Stop eating when you are full.81. Snack on fruits and vegetables.82. Top your favorite cereal with apples or
bananas.83. Try brown rice or whole-wheat pasta.84. Include several servings of whole grain food
daily.85. When eating out, choose a small or medium
portion.86. If main dishes are too big, choose an appetizer
or a side dish instead.87. Ask for salad dressing “on the side”.88. Park farther from destination and walk.89. Try a green salad instead of fries.90. Bake or broil fish.91. Walk instead of sitting around.92. Eat sweet foods in small amounts.93. Take your dog on longer walks.94. Drink lots of water.95. Cut back on added fats or oils in cooking or
spreads.96. Buy a set of hand weights and play a round of
Simon Says with your kids - you do it with theweights, they do without.
97. Walk to a co-worker’s desk instead of emailingor calling them.
98. Carry your groceries instead of pushing a cart.99. Use a snow shovel instead of a snow blower.100. Cut high-calorie foods like cheese and
chocolate into smaller pieces and only eata few pieces.
101. Use nonfat or low-fat sour cream, mayo,sauces, dressings, and other condiments.
102. Replace sugar sweetened beverages with water and add a twist of lemon or lime.
103. Replace high-saturated fat/high calorieseasonings with herbs grown in a small herbgarden in your kitchen window.
104. Refrigerate prepared soups before you eatthem. As the soup cools, the fat will rise tothe top. Skim it off the surface for reducedfat content.
105. When eating out, ask your server to put halfyour entrée in a to-go bag.
106. Substitute vegetables for other ingredients inyour sandwich.
107. Every time you eat a meal, sit down, chewslowly, and pay attention to flavors andtextures.
108. Try a new fruit or vegetable (ever had jicama,plantain, bok choy, starfruit or papaya?)
109. Make up a batch of brownies with applesauceinstead of oil or shortening.
110. Instead of eating out, bring a healthy, lowcalorie lunch to work.
111. Ask your sweetie to bring you fruit or flowersinstead of chocolate.
112. Speak up for the salad bar when yourco-workers are picking a restaurant for lunch,and remember calories count, so payattention to how much and what you eat.
113. When walking, go up the hills instead ofaround them.
114. Walk briskly through the mall and shop ‘tilyou drop ... pounds.
115. Clean your closet and donate clothes that aretoo big.
116. Take your body measurements to gaugeprogress.
For more information, visithttp://www.smallstep.gov
Tips to Make Small Changes -That Add Up to Big Success (continued)
do it for yourself . . .
Developing Your Success Plan!
There are several steps in developing a workable plan for weight management- 1st set realistic goals- 2nd develop a plan to meet goals- 3rd record behavior to see if goals are met- 4th reward yourself for meeting goals
Realistic goals- Can be achieved without making drastic changes- Can be described as lifestyle behavior changes for healthy living- Can make you feel good when you meet them
Characteristics of realistic goalsRealistic goals are . . . . . easily understood
measurable behavior-related achievable
It is important to have time frames set for achieving goals
- Long-term goalsSet your sights on what you can achieve in 1-3 years
Example: Your long-term goal may be to lose 5% - 10% of your body weight.
- Short-term goalsBehaviors and weight don’t change overnight, so setting goals for three months is a goodidea.
Example: Your short-term goal may be to eat 5 servings of fruits and vegetableseach day or to increase physical activity to at least 30 minutes on most days perweek.
- Weekly goalsWeekly goals are your small steps taken toward your short-term goal.
Example: Your weekly goals may be to take the stairs at work 3 days this weekor to eat a piece of fruit with breakfast and lunch every day.
Patient Handout J
do it for yourself . . .
Healthy Eating Goal
Physical Activity Goal
Environment Goal
Goal Worksheet
What do you want to achieve in the next 7 days?
Healthy Eating:
What do you need to do to achieve it? __________________________________________________________________
What roadblocks do you need to address?
_______________________________________________________________
How can you overcome the roadblocks?_________________________________________________________________
Physical Activity:
What do you need to do to achieve
it?___________________________________________________________________
What roadblocks do you need to address?_______________________________________________________________
How can you overcome the roadblocks? ________________________________________________________________
Changing Environment:
What do you need to do to achieve it? __________________________________________________________________
What roadblocks do you need to address?_______________________________________________________________
How can you overcome the roadblocks?______________________________________________________
Recording Behavior
do it for yourself. . .
Patient Handout K
Behavior Record for 7 Days – Place a in the boxes for the days you meet a goal.
Sun Mon Tues Wed Thurs Fri Sat
How Will You Reward Yourself?
Name 3 things that you value and could use and rewards for meeting your goal at the end of the week:
1. _________________________________________________________________________________
2. _________________________________________________________________________________
3. _________________________________________________________________________________
√√√√√
I, __________________________, pledge to [write goal(s)]1)2)
for the next 3 weeks. I will reward myself with
when I have made this a habit.
_____________________________ __________
personal pledgeInstructions: Before completing the personal pledge to betterhealth, think about the 1-2 goal(s) you wish to achieve tobecome healthier and the reward(s) you will give yourself whenyou are successful.
Signature Date
Record your goals in the Goal Log for each week on the reverseside of this personal pledge to better health.
Patient Handout L
do it for yourself . . .
goal logIn the calendar, off each day that you meet your goal(s). Good luck!
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
week 1
week 2
week 3
week 1
week 2
week 3
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
activitynutrition&
. . .time for reward!
GOAL 1
GOAL 2
SundaySundaySundaySundaySunday MondayMondayMondayMondayMonday TuesdayTuesdayTuesdayTuesdayTuesday WednesdayWednesdayWednesdayWednesdayWednesday ThursdayThursdayThursdayThursdayThursday FridayFridayFridayFridayFriday SaturdaySaturdaySaturdaySaturdaySaturday
SundaySundaySundaySundaySunday MondayMondayMondayMondayMonday TuesdayTuesdayTuesdayTuesdayTuesday WednesdayWednesdayWednesdayWednesdayWednesday ThursdayThursdayThursdayThursdayThursday FridayFridayFridayFridayFriday SaturdaySaturdaySaturdaySaturdaySaturday
Daily Food and Activity Diary
Research has shown that keeping a food and activity diary is an important tool for losing weight andkeeping it off. Diaries can help target areas for improvement. To find out the food and activity behav-iors to focus on, keep a diary before making any changes in your meals and activities. Discuss yourdiary and make a nutrition and activity plan with your health care professional.
INSTRINSTRINSTRINSTRINSTRUCTIONSUCTIONSUCTIONSUCTIONSUCTIONS
1. Fill out the following sections of your diary.
Time:Write the time of day you ate the food.
Food/Drink:Describe the type of food or drink you consumed. Be as specific as you can. Include sauces andgravies. Don’t forget to write down “extras,” such as soda pop, salad dressing, mayonnaise, butter,sour cream, sugar and ketchup.
Amount:In this space note the amount of the item you ate or drank (not how much was served). Use measur-ing cups and spoons to describe most foods (examples: 1 cup Cheerios, ½ cup 2% milk) or use sizeor shape to describe foods that don’t fit into a cup or spoon (examples: 8 inch corn tortilla, 3 x 3 x 1inch chocolate cake with frosting, 1 medium chicken breast).
Where:Write what room or part of the house you were in when you ate. If you ate in a restaurant, fast-foodchain or your car, write that location down.
Mood:How were you feeling while you were eating (for example, sad, happy, depressed)?
Hunger Scale:Rate how hungry you were before you began eating using the hunger scale.
Empty Starving Hunger Pains Hunger Slight Hunger Neutral Contented Slightly Full Full Overfed Nausea
0 1 2 3 4 5 6 7 8 9 10
Activity:Write down all your activities in the day, including day-to-day activities such as a 15-minute walk towork, or 30 minutes spent vacuuming, as well as more formal exercise (e.g, 50-minute aerobics class)._______________________________________________________________________________________
______________________________________________________________________________________
____________________________________________________________________________________
Patient Handout M
HUNGER SCALE
2. Advice for keeping a Food Diary.
Write down everything you eat and drink. A piece of candy, a handful of pretzels or a can of sodapop may not seem like much at the time, but over a week these calories add up!
Tell the truth. There’s nothing to be gained by trying to look good on these forms. Your health careprovider can help you only if you record what you really eat.
Do it now. Don’t depend on your memory at the end of the day. Record your eating as you go.
Remember the little things like butter, margarine, jelly, sugar, sauces, gravies, salad dressings, etc.
Remember to include snacks and beverages while cooking, between meals and before bed.
Note what is in a mixed food. (Example: stew [1/4 cup meat, 1/4 cup potatoes, 1/4 cup carrots, 1/4cup gravy])
Describe how a food was prepared. (Example: 1 chicken breast fried with PAM spray)
do it for yourself . . .
Dai
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ood
and
Act
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iary
Nam
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Dat
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Tim
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rink
Am
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Whe
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Hun
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Rat
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SWeb SitesAmerican Academy of Family Physicians (AAFP)Practical Advice for Family Physicians to Help Overweight Patients (2003)http://www.aafp.org/PreBuilt/afpmonograph_obesity.pdf
American College of Preventive Medicine (ACPM)Weight Management Counseling of Overweight Adults (2001)www.acpm.org/polstmt_weight.pdf
American Medical AssociationAssessment and Management of Adult Obesity: A Primer for Physicians.www.ama-assn.org/ama/pub/category/10931.html
National Heart, Lung, and Blood Institute (NHLBI)Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (1998)www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm
NHLBI’s Obesity Education Initiative provides the Clinical Guidelines on Overweight and Obesity in Adults to physicians ina free interactive program for use on handheld electronic devices. This electronic resource allows physicians to generateindividualized assessment and treatment recommendations at the point of care.http://hin.nhlbi.nih.gov/obgdpalm.htm
Health Information CenterThis center presents a wealth of information on the prevention and treatment of heart, lung, and blood diseases. Patienteducational materials and publications intended for health professionals are available on many topics including cholesterol,high blood pressure, heart disease, exercise, and obesity. Clinical practice guidelines on high blood cholesterol, high bloodpressure, and obesity are also made available.www.nhlbi.nih.gov/health/infoctr/index.htm
Aim for a Healthy WeightThis Web site offers information for both health professionals and the general public. The educational materials for healthcare professionals include clinical guidelines for obesity, a BMI calculator and table, and access to continuing medicaleducation courses.www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.html
North American Association for the Study of Obesity (NAASO) and the National Heart, Lung, and Blood Institute (NHLBI)The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (2000)www.nhlbi.nih.gov/guidelines/obesity/practgde.htm
America on the Move (AOTM)Partnership to Promote Healthy Eating and Active LivingThe AOTM program is accessible to all Americans through an interactive Web site, which offers several tools forparticipants to track their steps and progress.www.AmericaOnTheMove.org
Fruits & Veggies - More MattersNational Cancer Institute (NCI), Produce for Better Health FoundationThe national program is designed to encourage Americans to eat more servings of fruits and vegetables every day. Theprogram provides consumers with practical and easy ways to incorporate more fruits and vegetables into their daily eatingpatterns. For health care professionals, it offers promotional and educational materials as well as information and access toadditional resources.http://www.fruitsandveggiesmorematters.org
Steps to a HealthierUSU.S. Department of Health and Human Services (DHHS)Steps to a HealthierUS is an initiative from DHHS that encourages physical activity, a nutritious diet, healthy choices, andpreventive screenings.www.healthierUS.gov
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Center for Nutrition Policy and PromotionU.S. Department of Agriculture (USDA)This Web site translates nutrition research into publications and reports for use by physicians, and also into brochures and informationfor the general public. The new personalized food guide pyramid, dietary guidelines, and recipes are among the resources available.www.usda.gov/cnpp
Division of Nutrition, Physical Activity, and ObesityCenters for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)The CDC developed this site to address the role of nutrition and physical activity in living a healthy lifestyle and reducing chronicillnesses. It serves as a resource for guidelines, fact sheets, and other types of publications on topics related to nutrition and physicalactivity. In addition, a section designed specifically for health professionals offers access to data and statistics, programs, andrecommendations.www.cdc.gov/nccdphp/dnpa
Food and Nutrition Information CenterUSDA Agricultural Research Service (ARS)The ARS collects and disseminates information on food and human nutrition. It contains dietary guidelines, the food guide pyramid,links to various databases, additional resources, and much more.www.nal.usda.gov/fnic
Mayo ClinicThe Mayo Clinic Web site contains up-to-date information, programs, and interactive tools that include health management programs,health decision guides, a personal health scorecard, and various health centers that address food and nutrition, fitness and sportsmedicine, women’s health, men’s health, and more.www.mayoclinic.com
Weight Control Information NetworkNational Institute of Diabetes and Digestive and Kidney DiseasesThe network disseminates science-based information on obesity, weight control, and nutrition to health care professionals and thegeneral consumer. It also offers various types of statistics, publications, and videotapes on clinical weight loss and control.http://win.niddk.nih.gov/index.htm
Nutrition.govThis national resource provides access to all on-line federal government information about nutrition, healthy eating, physical activity,and food safety.www.nutrition.gov
American Heart AssociationThe American Heart Association is committed to reducing disability and death from cardiovascular diseases and stroke. Itscomprehensive Web site presents detailed information on topics regarding heart disease and health, as well as numerous health toolssuch as the cardiovascular disease risk assessment tool, exercise diary, and the body mass index Web calculator for use by the generalconsumer. Health care professionals can retrieve scientific publications, statistics, patient information sheets, treatment decision tools,guidelines, and performance measures.www.americanheart.org
Calorieking.comThis site provides information and tools to control weight and lead a healthy lifestyle. An on-line food and exercise diary, and mealplans are available, as is a food and diet diary for computers and handheld devices.www.calorieking.com/handheld/
American Dietetic AssociationThis is the nation’s largest organization of food and nutrition professionals and it serves the public by promoting optimal nutrition,health, and well-being. The Web site provides resources and information on food and nutrition, as well as a referral service that linksconsumers with registered dietetic professionals. Additionally, its professional reference publications section offers patient educationalmaterials and books for physicians.www.eatright.org
This publication was supported by Cooperative Agreement Number U58/CCU722795-02 from the Centers for Disease Control and Prevention.Its contents are solely the responsibility of the authors and do not represent the official views of CDC.
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.
References
The American Obesity Association, http://www.obesity.org.
Kushner, R.F. Roadmaps for Clinical Practice: Case Studies in Disease Prevention and Health Promotion-Assessment and Management of Adult Obesity: A Primer for Physicians. Chicago, Ill: American MedicalAssociation; 2003.
National Heart, Lung, and Blood Institute (NHLBI) and National Institute for Diabetes and Digestive and KidneyDiseases (NIDDKD). Clinical guidelines on the identification, evaluation, and treatment of overweight andobesity in adults: evidence report. Obesity Research. 1998; 6(suppl 2): 51S–210S. Available at http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm.
Healthy Missourians Initiative. Preventing Obesity and Other Chronic Diseases: Missouri’s Nutrition andPhysical Activity Plan. Missouri Department of Health and Senior Services, 2005.
J. Shalwitz, D. Bushman, K. Davis, S. Williams (2005).San Francisco, CA: Adolescent Health Working Group,San Francisco. Body Basics: An Adolescent Provider Toolkit.
Screening for obesity in adults: recommendations and rationale. United States Preventive Services Task Force -Independent Expert Panel. 1996 (revised 2003 Dec 2). 13 pages. NGC:003163, Available at:http://www.guideline.gov.
P.A. Estabrooks. R.E. Glasgow, D.A. Dzewaltowski. Physical Activity Promotion through Primary Care, JAMA,June 11, 2003 – Vol 289, No. 22.
The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity 2001. Forward from theSurgeon General, U.S. Department of Health and Human Services. http://www.surgeongeneral.gov/topics/obesity/calltoaction/toc.htm.
Weight Management Counseling of Overweight Adults. United States Preventive Services Task Force –Independent Expert Panel. National Guideline Clearinghouse. Available at http://www.guideline.gov.
The Center for Nutrition Policy and Promotion, an organization of the U.S. Department of Agriculture.http://www.mypyramid.gov.
Department of Health and Human Services, Centers for Disease Control and Prevention. National Center forChronic Disease Prevention and Health Promotion. Division of Nutrition, Physical Activity, and Obesity.
Alliance for a Healthier Generation. William J. Clinton Foundation/American Heart Association.http://www.healthiergeneration.org.
Food and Drug Administration/Center for Food Safety & Applied Nutrition. http://www.cfsan.fda.gov/~dms/foodlab.html.
U.S. Department of Health & Human Services. http://www.smallstep.gov.
The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of HighBlood Cholesterol in Adults (Adult Treatment Panel III). The National Heart, Lung, and Blood Institute (NHLBI)launched the National Cholesterol Education Program (NCEP).
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Did the “How to Use this Tool Kit” page engage you enough to review the contents of the packet?
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If your answer is “strongly agree” or “agree,” please check which items you will continue to use in your day-to-day practice: Physician Resources __ Pocket Guide—Assessment and Treatment of Overweight and Obesity __ BMI Chart __ Diabetes Management Guidelines __ Missouri Consensus Screening Guidelines __ Communication Guideline to Promote Health Behavior Change __ Applying the Stages of Change Model to Assess Readiness __ Patient Readiness Checklist __ Tips for Nutrition Counseling Patient Handouts __ Are You Ready and Motivated to Lose
Weight? __ Food Weight-Loss Tips __ Nutrition Facts Label __ Tips for Dining Out __ Grocery Shopping Guide __ MyPyramid __ Making Physical Activity Part of Your Life __ Overcoming Barriers to Physical Activity __ Tips to Make Small Changes __ Developing Your Success Plan! __ Goal Worksheet __ Personal Pledge to Better Health __ Daily Food and Activity Diary
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This publication was supported by Cooperative Agreement Number U58/CCU722795-02 from the Centers for Disease Control and Prevention.Its contents are solely the responsibility of the authors and do not represent the official views of CDC.
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.