session one: welcome to the national diabetes prevention ... · lose weight. being more active....

Philis-Tsimikas A, Fortmann AL, Dharkar-Surber S, et al. Dulce Mothers: An Intervention to Reduce Diabetes and Cardiovascular Risk in Latinas After Gestational Diabetes. Transl Behav Med. 2014;4(1):18–25. http://dx.doi.org/10.1007/s13142-014-0253-4.

Research supported by: NIH/NLBI R56 HL081604-01A1 (Gallo); NCRR-1U54RR025204-01 (Topol); NCRR (ARRA) UL1 RR025774 (Topol); Scripps Clinic Medical Group. For more information, please contact Athena Philis-Tsimikas, ([email protected])

These materials are a part of the Compendium of Culturally and Linguistically Tailored Resources for Type 2 Diabetes Prevention, assembled by NORC at the University of Chicago under contract with the Centers for Medicare & Medicaid Services Office of Minority Health.

Dulce Mothers

SESSION ONE: Welcome to the National Diabetes Prevention Program

Participant Handout 1

Session 1 – Overview

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SESSION 1: OVERVIEW

Welcome!

You are here because you want to reduce your risk for type 2 diabetes, and we’re glad to have you. We will work together toward two goals: Lose weight. Being more active. You’ll lose weight through healthy eating and 150 minutes of brisk physical activity each week.

We Will Work Together as A Team

Throughout this program, you will rely on the group in different ways to learn and grow. I will count on you to do the items listed below:

Come to sessions and bring your Participant Notebook.

Call 24 hours ahead if you must miss a session.

Do your best to reach your eating and activity goals. This includes doing home activities to practice what you learn.

Keep track of your eating and activity 7 days a week.

Be honest.

Keep track of your weight at home.

Let me know if you have any problems by calling or e-mailing me.

Stay willing and open to change. Always hang in there. You can count on your Lifestyle Coach and the group to do the items listed below:

Notice what you are doing well and what can be improved.

Answer your questions; share solutions and ideas, while learning together.

Be honest.

Stand by you during hard times.

Believe you can reach your eating and activity goals.

Support and help you always. The group will hang in there with you.


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What is Diabetes?

What is diabetes? Diabetes is a lifelong disease. It affects how your blood sugar level is controlled in your body. If your blood sugar stays too high it can affect your health. Eat healthy foods, exercise and take your medications to help your blood sugar level stay healthy. Walking, swimming, strength training and riding a bike are examples of exercise.

Signs and Symptoms of Diabetes

Pre-Diabetes or IGT Type 1 Type 2 Gestational

Physiological Causes

Exact cause

unknown (possible

causes could be risk

factors for diabetes)

Exact cause unknown

(possible causes include:

injury to beta cells or

virus)

Insulin resistance, and

or insulin deficiency

Hormones of pregnancy

cause insulin resistance

Body Type

Abdominal obesity

Generally thin or athletic

build

Abdominal obesity 80%

are overweight

Pregnant, overweight

Onset of Symptoms

There may not be

any symptoms

Rapid onset, days to

weeks in children and

weeks to months in adults

Slower onset; weeks to

months

Usually occurs after the

26th week of pregnancy.

Related to a rise in

placental hormones

Treatment

Nutrition and

increased physical

activity

Insulin therapy, healthy

eating patterns and

physical activity

Meal planning, regular

physical activity,

diabetes pills and/or

insulin therapy

Meal planning, and

physical activity, and/or

diabetes pills or insulin

therapy


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Symptoms of High Blood Sugar (hyperglycemia) Causes: Too much food, not enough medication, illness, surgery, stress, pain, infection or steroids. Onset: Gradual. May progress to diabetic coma. Blood Sugar: Above 180 mg/dl

Symptoms

Nausea Drowsiness Blurred Vision Dry Skin

Hunger Extreme Thirst Frequent Urination

Recommended Action

Check your blood sugar. If your blood sugar is above 250 mg/dl for two days, call your doctor.


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Symptoms of Low Blood Sugar (hypoglycemia) Causes: Too little food, more than five hours from last meal, too much insulin or diabetes medicine, too much physical activity or alcohol. Onset: Sudden. May pass out if untreated. Blood sugar: Below 70 mg/dl

Symptoms

Shaking Sweating Rapid Heartbeat Headache Hunger

Weakness, Fatigue Impaired Vision Anxious Irritable Dizziness

Reccomended Action

Check your If it is below 70 drink Check your blood Eat a snack or blood sugar. one-half to one cup juice, sugar in 15 minutes. meal within skim milk or regular soda, If still below 70, 30 minutes. or chew five to six hard take more sugar. candies or four glucose If symptoms don’t tablets, or swallow stop, call your doctor. one tube of glucose gel.


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Risk Factors for Developing Obesity and Type 2 Diabetes

Risk Factors for Developing Obesity and Type 2 Diabetes.

How many risk factors apply to you? (check off the ones that apply)

Having GDM during pregnancy (this one applies to all women here)

Having a relative who has (or had, if deceased) diabetes

Being of Latino, Native American, African American or Pacific Islander descent

Being over the age of 45

Giving birth to a baby weighing over 9 lbs

Being overweight, especially at the waistline (we will go over this specifically in another class,

when we calculate BMI)

Having and inactive lifestyle

Darkened skin pigmentation under the arms, around the neck, and in other skin fold areas (i.e.,

Acanthosis nigricans)

Having irregular menstrual periods.


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Tipping the Calorie Balance

Tipping the Balance How many calories and how much physical activity is needed to tip the balance in favor of losing weight? The amount varies from person to person. This program has many tools to help you tip the balance in the healthy direction. Just remember, the best way to tip the blalance is to both reduce the amount we eat and drink and increase the time we are physically active. The Calorie Balance Calorie balance means that the calories we take in through eating and drinking should equal the calories we use through physical activity and our body’s other energy needs (for example, breathing, digesting food, sleeping).

1. Your weight can stay the same.

Calories in (food) are the same as calories out (physical activity).

2. You will gain weight.

Calories in are greater than calories out.

3. You will lose weight.

Calories in are less than calories out. 4. You can reach a new balance at a new weight.

Calories in are the same as calories out.


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Self-Monitoring Keeping Track

Start keeping track of what you eat and drink each day. Write down everything you eat and drink. It’s the most important part of changing your behavior. Spelling is not important. What is important is to –

Be honest. Write down what you really eat. Write down if you are physically active.

Be accurate. Measure portions and read labels. Describe which physical activity you do.

Be complete. Include every last scrap you eat. Include how long each physical activity lasts. Start keeping track of your activity, and what you eat and drink each day!

Date Activity Duration

Date Food or Drink Amount


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SMART GOALS

Use the SMART goal method to make gradual changes each week in order to achieve a healthy weight by eating healthy and being physically active! SMART Stands for: “S” stands for specific. Your goal is targeted. “M” stands for measurable.

This means that your goal can be measured in some way (for example, in minutes or in serving sizes).

“A” stands for achievable.

Your goals can be accomplished. “R” stands for realistic. Your goal is practical. “T” stands for time-based.

Your goal will be met within a certain timeframe (for example, within 3 days, 1 week, or 2 weeks).


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WEEKLY SMART GOAL-SETTING Week of:__________ Session:___________ Is my goal: Specific Measurable Attainable Realistic Time-based

My SMART goal for being more PHYSICALLY ACTIVE this week is:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I will achieve this by doing the following:

________________________________________________________________________________

________________________________________________________________________________

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My SMART goal for HEALTHY EATING this week is:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I will achieve this by doing the following: ________________________________________________________________________________

________________________________________________________________________________

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To-Do Next Week During the next week, I will –

Write down every little thing I eat and drink every day.

Include the time when I eat each item.

Include the amount of food, the name of the food, and a description.

Skip the other columns for now.

Use one line for each food. For example, instead of writing “sandwich,” write all the things that are in the sandwich, one on each line.

2 slices whole wheat bread 1 slice American cheese 1 slice turkey 1 tsp mayonnaise

“Toast with butter” should be on two different lines: 1 slice whole wheat toast 1 tsp butter

Circle the foods or drinks I think are high in fat and calories.

Keep track of my activity and what I eat, using my Food and Activity Tracker.

Do my best in working toward my first SMART goal this week.

Bring my Food and Activity Tracker to the next session.


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Weight and BMI Tracker

Height_____ in

Class #

Date Weight +/- BMI Comments

1

2

3

4

5

6

7

8

9

10

11

12

Dulce Mothers

SESSION TWO: Welcome to the National Diabetes Prevention Program


Session 2– Welcome to the National Diabetes Prevention Program

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Session 2: Overview

Be a Fat and Calorie Detective

Reducing the fat and calories in our meals is one of the most important steps we can take to improve our health. To reach healthy eating goals, we need to track our weight and how much we eat. Our role as a “fat and calorie detective” is to find the high-fat, high-calorie foods in our meals and figure out ways to make them healthier.

Monitor Our Food and Weight

Monitoring what we eat is a smart way of making sure we make healthy choices. Monitoring what we do is the most important part of changing our behavior. Therefore, and important part of this program is to write down everything you eat and drink in your Food and Activity Tracker.

How Am I Doing?

Use the How Am I Doing? weight chart to track your weight at home and before each session. This chat is important because it shows how your weight is changing over time.

Quick Fact Why does it matter if I get type 2 diabetes? People with diabetes are twice as likely as people without diabetes to die early. The good news is that by making smart choices in eating and physical activity, you can delay or prevent type 2 diabetes. But there’s more good news. Even with diabetes, people can lower their chances of blindness, kidney disease, heart attack, and stroke by eating healthy and getting regular physical activity.)


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Weight Tracking My Weight Tracker “My Weight Tracker” will help you track your weight loss. It will show you your current weight and your goal weight, according to your weight loss goal. Each week we will record your weight so you can see the changes in your weight from week to week. Starting Weight__________________lbs Goal Weight_________________lbs Weeks 1 2 3 4 5 6 7 8 9 10 11 12


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BMI Chart: Tracking Your BMI

To track your BMI, locate your height on the left hand column. Scroll across that row to locate your current weight. Then, look at the corresponding BMI number on the top row. This is approximately your Body Mass Index.


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Goal Weight Chart

Goal Weights This chart shows starting weight and goal weight with a 7% loss. Find your current weight, and then your goal weight to achieve during this program. Starting weight:_________________ Goal Weight:__________________


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Goal Weights (continued)


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Goal Weights (continued)


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MyPlate

MyPlate

Grains- Make at least half of the grains you eat whole grains.

Vegetables- Vary your veggies.

Fruits- Focus on fruits.

Dairy- Get your calcium-rich foods.

Proteins- Go lean with protein.


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Tips for Healthy Eating

Tip 1: Eat a regular pattern of meals. Try to eat 3 meals each day. This will keep you from

getting too hungry and losing control.

Tip 2: Attentive eating. Eat slowly… and attentively! This means paying attention to eating and not to other things while you eat.

Choose food you enjoy that nourishes your body.

Turn to all your senses to find pleasure in your food (smelling, chewing, tasting, swallowing, and savoring each bite).

Pause between bites, put down your utensils, and enjoy the taste of your food and the people you are with.

Be aware of your level of hunger and fullness.

Tip 3: Pay attention to portion control. Don’t worry about cleaning your plate. The greatest

waste of food is to eat more than you want or need. Practice serving yourself a little less to begin with… pay attention to portion size!


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Portion Control

Estimating Portion Sizes

Fist = 1 cup Example: three servings of pasta or two servings of oatmeal (one cup pasta = three servings)

Palm or Deck of cards = 3 oz. Example: a cooked serving of

meat

Thumb Tip = 1 teaspoon Example: a serving of mayonnaise or margarine

Handful = 1 or 2 oz. snack Example: 1 oz. nuts = 1 handful; 2 oz. pretzels = 2 handfuls

Thumb = 1 oz. Example: a piece of cheese


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Daily Recommended Food Group Portions

Following these recommendations will help you get the right amount of each food group your body needs. Food Group How many daily

portions? One portion equals:

Vegetables 2 ½ portions One cup of raw or cooked vegetables or vegetable juice, or two cups of raw leafy greens

Fruits 1 ½ to 2 portions One cup of fruit or 100% fruit juice, or ½ cup of dried fruit

Grains 6 portions (at least half of those – 3 portions – should be whole grains)

One slice of bread, one cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal

Protein 5 – 5 ½ portions One ounce of meat, poultry or fish, ¼ cup cooked beans, one egg, one tablespoon of peanut butter, or ½ ounce nuts or seeds

Dairy 3 portions (choose low-fat or fat-free options)

One cup of milk, yogurt, or soymilk, one ounce of cheese

Oil 5-6 portions (maximum) One teaspoon of cooking oil, mayonnaise, butter, lard

Avoid eating solid or saturated fats as much as possible!


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Portion Control Activity

ACTIVITY

[Participants to choose the picture food model that represents one portion of meat, grain, vegetable, and fruit. Have different sized portions for each food model, and see if participants chose actual, larger, or smaller portion sizes.]

We are going to practice this now. I’d like you to use these food models to serve yourselves a plate

based on the portion-sizes you’ve just learned about. What should your plate look like? What

proportion of it should contain vegetables and fruits? What proportion should contain meat? Grains?

ASK: How do your portions compare to what you just learned?

ASK: How can you control portions when being served by another person?

Remember, portion size is very important! A small difference in portion size can make a huge

difference in the amount of fat and calories. Nibbles count too!


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Rate My Plate Log

Rate My Plate Name: __________________________ Week #: ______________ My healthy eating goal for this week is to ___________________________________________. Check the box for every serving that you ate from the MyPlate food groups. The shaded boxes show you the number of portions recommended each day. Remember to look back at your [Title/Name of Study] notebook if you need help with a food group or portion size. Monday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets

Sugar sweetened beverages

Tuesday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets


Wednesday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets



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Thursday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets


Friday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets


Saturday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets


Sunday

Vegetables

Fruits

Whole grains

Lean protein

Dairy

Fats and sweets



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Keep track of my weight in the Food and Activity Tracker

Weigh myself at home every day, or every few days, at this time of day ___________.

Record my weight on the back of the Food and Activity Tracker.

Keep track of what I eat and drink

Write down everything I eat and drink in the Food and Activity Tracker.

Use the Fat and Calorie Counter to figure out how much fat is in each item I eat.

Write down the fat grams in the Food and Activity Tracker.

Keep a running fat gram total throughout the day.

Come as close to my fat gram goal as I can.

- Keep track of my activity and what I eat, using my Food and Activity Tracker.

- Do my best in working toward my SMART goal(s). - Practice what I learned about portions at home with my

family. - Bring my Food and Activity Tracker to the next

session.

Dulce Mothers

SESSION THREE: Three Ways to Eat Less Fat and Fewer Calories


Session 3– Three Ways to Eat Less Fat and Fewer Calories

2 12/22/13

Session 3: Overview

Weighing and Measuring Food

Weighing and measuring food are important ways of knowing what we eat. Measuring helps us make healthier choices. Eating even a slightly smaller amount can make a big difference in fat grams and calories. Many people feel they do not need to weigh or measure their food because they think they know how much they eat. But most of us are surprised when we actually do measure. Our eyes can play tricks on us!

Estimating Fat and Calorie Content It is hard to know the amount of fat and calories in our food, but with practice, we can make a good guess.

Quick Fact

Eating too much fat can cause heart disease and type 2 diabetes.

Eating a lot of fat can increase the amount of cholesterol in our blood.

The higher our cholesterol, the greater our chances of having a heart attack.

Eating a lot of fat also increases our chances of getting type 2 diabetes.


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The Food Guide THE FOOD GUIDE BOOK Your stop-light food intake guide

Green- Light foods Are foods that you should eat more of! Yellow- Light Foods Are foods you should eat in moderation. Red-Light Foods Are foods you will want to eat less of or avoid!

Terms to know Nutrients

Help you grow healthy

Give you energy for all your activities

Protect you against chronic disease Calories

Are energy you eat

A calorie is a calorie no matter where it comes from

They come from o Fat, carbohydrates, protein, and alcohol

But in different quantities Recommended: eat foods with more nutrients and less calories

Try to eat a balanced diet

Include different food groups in your plate Like:

Vegetables Whole grains Fruits Protein Dairy


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FOODS TO EAT MORE OF Colorful Vegetables Dark green vegetables Broccoli, spinach, kale, chard, beet greens, cilantro Orange and Red Vegetables Winter squash, carrots, beets, red cabbage, red peppers, sweet potatoes, pumpkin, tomatoes Beans and peas Black beans, kidney beans, pinto beans, garbanzo beans, red beans, green beans, black-eyed-beans, lentils


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Starchy Vegetables Corn, chamote, white yam, cassava/yucca, plantains

Other Vegetables Avocado, chayote, zucchini, cucumber, celery, jicama, nopales, peppers, onions, artichokes, mushrooms


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How to eat more of these

1. Serve different vegetables to your family each week

2. Eat different colored vegetables

3. Use fresh, frozen, dried/dehydrated, or canned

Don’t add fat to your vegetables by frying or dipping in high-fat dressings!


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Whole Grains Whole wheat tortillas, bread, and pasta

Brown or wild rice Popcorn (low on butter and salt), oatmeal, whole cornmeal Other foods, such as corn tortillas may be made from whole or refined grains, so check the label! Whole grains are different from refined grains Whole grains

Have nutrients and dietary fiber that help you feel full Refined grains

Have had many of the nutrients removed

Avoid


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Colorful Fruits Oranges, apples, mangos Guavas, bananas, papaya Pineapple, watermelon, melon

All types of berries and grapes How to add to your diet

1. Eat them as snacks

2. Try fresh, home-squeezed or frozen juices, smoothies

3. Fruit salsas

4. On your yogurt


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Lean Protein Beans, lentils, soy Nuts

White meat poultry Fish

Low fat/non-fat dairy products (milk, yogurt) Egg Whites

Dairy Choose low fat or non-fat dairy options

Cheeses- fresco, Oaxaca

Yogurt

Milk

- These low fat/non-fat products allow you to get your dairy nutrients without having all the grams of fat


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FOODS TO EAT LESS OF DIETARY FAT

We need fat to give the body energy, support growth and protect our organs, BUT in moderation

If we eat more fat than what we need, the body stores what is left over as body tissue

Fat has the highest amount of calories

Each gram of fat has 9 calories How to reduce fat

1. Be a fat detective by watching out for

Red meats and pork

Full fat dairy products o Whole milk, sour cream, regular cheese, cream cheese, butter/margarine, and ice

cream

Snacks: potato chips, tortilla chips, pork rinds, Cheetos

Gravy, mayonnaise, salad dressing, cream sauces

Baked goods

Fat added through cooking (especially deep-frying): oil, lard, shortening

2. And plan to cut back on

High fat and high calorie foods o Eat your favorite high fat, high calorie food only once per week instead of every day

Eat smaller amounts of high fat and high calorie foods o Share with someone o Save some for later

Substitute with low calorie, low fat foods instead o Fruit, tomato salsa, or lime/lemon juice instead of salad dressing


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SALT (SODIUM)

Choose foods low in salt

Eat less than 1 teaspoon of salt per day

Salty food examples o Soups, salad dressings, sauces o Tortilla, potato chips o Flour tortillas o Chorizo o Cheesy dishes

How to reduce your salt intake

Take the salt-shaker off the table where you eat

When adding salt to food, pour it into your hand first, instead of directly into your food

Use herbs and other spices to add flavor instead of salt

Buy low or reduced sodium foods

Use fresh instead of canned meats o If using canned meats, rinse before using

SUGAR

Has absolutely no nutrients, but lots of calories

Your body doesn’t even need sugars to work well

Too much sugar makes you gain weight, and leads to insulin resistance How to cut down on the sugars we eat

Eat fruits and low-salt nuts instead of candy

Serve fruit instead of cookies or ice cream

Eat sugar free desserts

Try whole grain breakfast cereal (watch for the amount of sugar)

Instead of flavored yogurt, buy plain and just add honey or jam

Avoid sodas, slurpees, blended coffee drinks – drink water or unsweetened tea or iced tea instead

Add lemon, lime to water (or soda water)

Mix 50/50 water and fruit juice

Drink diet instead of regular sodas

Flavor your coffee or tea with artificial sweeteners instead of sugar Other foods to watch out for

Flour tortillas

Couscous

White rice

White bread


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Most pasta noodles

Reading the Nutrition Label Eating Packaged Foods This is a sample of a nutrition label that you see on many packaged foods. This label shows information about the fat, calories, and other nutrients in the food.

Find the serving size, and decide is that is the amount you ate. Maybe you ate more

or less.

Find the calories per serving Find the total fat grams per serving

Keep this in mind: If you eat a larger serving than the size on the label, you will be eating more calories and more fat grams than are given on the label.


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Reading The Food Label In order to lose weight and have a healthy weight, it’s important to know what’s in our food. Here are

general nutrition facts that you can find on a food label and some guidelines to follow when choosing

foods.

Serving size: The amount of food that makes one serving. The nutrition facts listed on the label are

“per serving” – meaning that all of the numbers listed on the label are the amounts in one serving.

Total Fat/Cholesterol: This tells you how many grams of fat are in each serving. To follow a low-fat

diet, choose foods that are 3 grams or less per serving. Meats and cheeses should be 5 grams or

less fat per serving. Choose foods with less than 1/3 of the fat as saturated fat and zero trans fat.

Sodium: Tells you how many grams of salt in the food. To follow a low sodium diet, choose foods

that have 5% or less of the Daily Value of Sodium; 20% or more is considered a high sodium food.

Total Carbohydrate: This is the number of grams you should look at to determine how many

carbohydrate servings this food equals. Remember, one carbohydrate = 15 grams of total

carbohydrate.

Dietary Fiber: Aim for 25 grams of dietary fiber daily.

Sugars: The number of grams of sugar is already included in the “Total Carbohydrate”. Do not use

this number for calculating carbohydrate servings.

Vitamins and Minerals: Your goal is 100% of each for the day. Eating a variety of foods daily will

help you reach this goal.


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Make sure to check whether a product is really a whole grain. Look for corn tortillas that list ‘whole

corn’ as the first ingredient. Be sure there is no hidden sugar – avoid foods with “sucrose” or

“fructose.”



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15 12/22/13

________________________________________________________________________________

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To-Do Next Week Next week, I will –

Keep track of my weight and what I eat.

Keep track of all the fat grams I eat each day.

Come as close as I can to my fat gram goal.

Make a plan to eat less fat and follow it.

In the table below, write down five foods you eat that are high in fat. Circle one.

Pick one of the three ways to eat less fat from the food you circled. Write down in the space below how you will cut fat next week. Be sure you write something you can do.

My top 5 High fat

foods

The 3 ways to Eat Less Fat

I will eat it less often:

I will eat a smaller

amount:

I will eat a lower-fat

food instead:


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What I will need to do to carry out this plan:

________________________________________________________________________________

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To-Do Next Week (continued)

Problems I might have cutting down on these foods, and what I will do to solve them: ________________________________________________________________________________

________________________________________________________________________________

Before the next session answer these questions:

1. Did you follow your plan? Yes____ No____ Almost_____

2. What did you do well? ________________________________________________________________________________

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3. What problems did you have following your plan?

________________________________________________________________________________

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4. What could you do differently next week?


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________________________________________________________________________________

________________________________________________________________________________

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Keep track of my activity and what I eat, using my Food and Activity Tracker.

Do my best in working toward my SMART goal(s).

Practice what I learned about portions at home with my family.


Dulce Mothers

SESSION FOUR: Overview


Session 4– Overview

2 12/23/13

Session 4: Overview Healthy Eating Healthy eating is determined both by what we eat and the way we eat. To eat healthier, try to eat at regular times. Eat slowly to digest food better. Eating slowly also makes us more aware of what we are eating. And, don’t worry about cleaning your plate. These are just a few of the many tricks for changing how we eat. Find out more! MyPlate MyPlate is a general guide to healthy eating. It is based on the latest research about nutrition and health. It was developed by the U.S. Department of Agriculture and has suggestions for how much people should eat, depending on their sex, age, and level of physical activity. The plate image on page 3 shows us the amount we need of each food group. Go to choosemyplate.gov to learn more about this useful tool. The suggestions offered in MyPlate can help us make better food choices. They give us ideas for changing the way we eat. During the week, use the MyPlate information found in these handouts and on the website to practice changing how you eat.

Quick Fact To prevent type 2 diabetes, should you avoid eating starchy foods such as bread, potatoes, and pasta? No. Starchy foods are part of a healthy meal plan for people with or without diabetes. What is important is the amount we eat. Whole grain breads, cereals, pasta, rice, and starchy vegetables like potatoes, yams, peas, and corn can be part of your meals and snacks. The key is the amount. For most people with diabetes having 3 or 4 servings of bread, fruit, or starchy foods is about right. Whole grain starchy foods are also a good source of fiber. They help keep your gut healthy.


3 12/23/13

Stretching Your Fruit and Vegetable Budget Here are some recommendations for eating healthy on a budget:

- Cook enough for several meals and freeze

the leftovers.

- You can also create a meal plan for the week

that uses similar fruits and vegetables,

prepared in different ways. This will help you

make the most out of the produce you buy.

- Look for sales and deals on fruits and

vegetables at the grocery store or through

coupons. Buy fruits and vegetables that are in

season at the grocery store or your local

farmers’ markets.

- Frozen fruit and vegetables store well in the

freezer until you’re ready to add them to a meal.

- Canned fruits and vegetables will last a long

time (choose canned vegetables that have no

added salt and fruit that is canned in 100% fruit

juice).

- Grow your own vegetables.


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How to Find Community Resources For Healthy Eating [In this section, include information on local/state resources related to healthy eating. This may include details (e.g., websites, addresses, contact information, etc.) for organizations like: local food cooperatives, food stamp programs, food banks, farmers markets, and community gardens]


5 12/23/13

Cooking Wisely Recommendations for healthy cooking

- Steam, microwave, or boil vegetables in a small amount of water – be careful not to overcook

because they might lose their nutrients!).

- Poach, boil, or scramble eggs or egg whites with vegetable cooking spray.

- Bake, roast, broil, barbeque, or grill meats.

- Remove skin from chicken and turkey (before or after cooking).

- Trim all the fat you can see.

- Drain off fat after cooking (blot using paper towel; drain and rinse ground beef).

- Spoon off the fat before using broth or sauces.

- Do not use salt in cooking, or use half the amount you normally would. Remember what we

learned about reducing sodium last week!

Recipe Modification Changing or modifying your recipes to make healthier meals is a great option for healthy cooking. Try these recommendations:

Leave out a high-fat or high calorie ingredient (example: don’t add cheese!)

Use less of a high-fat or high calorie ingredient. Use half the amount of cheese.

Use a lower fat/calorie ingredient instead. Use low-fat or fat-free cheese.

Add liquid (i.e., water, fruit juice, skim milk, or broth) when you remove fat.

Make healthy seasoning choices. Use hot peppers, fresh herbs/spices, garlic, onions, lemon juice, and wine.


6 12/23/13

Add Flavor Without Fat To avoid adding fat to foods, make healthy seasoning choices! Use hot peppers, fresh herbs and

spices, garlic, onions, lemon juice, and wine! Here are some suggestions for healthy seasoning

options for a variety of foods.

Food to Flavor

Low-Fat Flavoring Options

Potatoes and Vegetables

Use a small amount of low-fat margarine, nonfat sour

cream, broth with the fat removed, low-fat or fat-free

plain yogurt, salsa, herbs, mustard, and lemon juices!

Bread

Try Nonfat cream cheese, a small amount of low-fat

margarine, or all fruit jams!

Pancakes

Top with fruit, low-calorie syrup, unsweetened

applesauce, crushed berries.

Salads

Make a nonfat or low-fat salad dressing, lemon juice, or

vinegar.


7 12/23/13

Activity – Cooking Demonstration Today we will be cooking ___________________________________________________________ Write in the ingredients and steps as we go along! Remember we’ll be focusing on following the recommendations you learned about cooking wise and modifying your recipe to make a healthier meal! Ingredients:

Usual Ingredients

Healthy Modifications (if they apply)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Instructions: Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

Step 6:


8 12/23/13

Healthy Recipes


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10 12/23/13


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1. Keep track of my activity and what I eat, using my Food and Activity Tracker!

2. Do my best in working toward my SMART goal(s).

3. Answer these questions before the next session:

a. Did you make any changes during the week to what you ate? If yes, what were they?

b. What problems did you have? How did you solve them?

4. Begin next session by sharing my progress/experience with my SMART goal.


Dulce Mothers

SESSION FIVE: Overview



2 12/23/13

Session 5: Overview Move Those Muscles The physical activity goal for this program is 150 minutes, or 2 ½ hours, each week. You can do the activity in several ways (for example, 30 minutes for five days) or however else you want to do it! The important thing to remember is that you will work up to 150 minutes a week. It’s a goal. We will start with where you are and we will increase your activity level slowly, steadily, and safely. The Importance of Being Active Being physically active has many benefits. It helps improve our general well-being by keeping weight off, improving our mood, increasing our energy and ability to get around, and reducing stress. It also improves muscle tone and helps us sleep better. Physical activity makes our heart, lungs, and bones stronger, and it may reduce back pain and injuries. Being physically active also helps lower our risk for heart disease and some kinds of cancer. It can lower our risk for heart disease and some kinds of cancer. It can lower blood pressure and may help prevent type 2 diabetes.

Quick Fact How important is physical activity? Physical activity helps us in many ways. It helps control our blood glucose, weight, and blood pressure. It raises our “good” cholesterol and lowers our “bad” cholesterol. It helps prevent problems with our heart and blood flow. And, most importantly, for people with diabetes, it lowers the risk for heart disease and nerve damage.


3 12/23/13

Benefits of Physical Activity

Being active has many benefits: Physical activity can improve your general well-being by –

Helping you lose weight and keep it off

Perking up your mood and self-esteem

Helping with depression and anxiety

Giving you more energy

Making it easier for you to do things such as climb stair and carry groceries

Helping reduce stress

Helping you sleep better Physical activity can improve your physical fitness by –

Improving muscle tone and body shape

Strengthening you heart, lungs, bones, and muscles

Making your joints more flexible

Lowering your risk for back pain and injuries Physical activity can improve your health by –

Lowering your risk for heart disease and some kinds of cancer

Raising your HDL cholesterol (the “good” kind)

Lowering your triglycerides (the amount of fat in the blood)

Lowering your blood pressure Physical activity may lower your risk for type 2 diabetes by –

Making your body better able to use insulin and therefore lower the level of sugar in your blood


4 12/23/13

The Many Benefits of Physical Activity! Being physically active will help you:

1. Lose weight and keep it off by having healthy diet AND being more active!

2. Feel and look better. Many people say that they simply feel good when they’re more active!

Improves your mood

Helps reduce stress

Helps you sleep better

Improves your self-esteem

Counters depression and anxiety

Give you more energy

Improves your muscle tone and body measurements

Is a way to meet new friends

3. Be more physically fit.

Strengthens your heart, lungs, bones and muscles

Makes it easier for you to [physical activity example]

Reduces back pain and injuries

Makes your joints more flexible

Makes it easier for you to do your daily work, like climbing stairs and carrying groceries

4. Lower your risk for heart disease and diabetes.

Raises good cholesterol (HDL), lowers triglycerides and blood pressure- helps reduce the risk of heart disease.

Reduces the risk for type 2 diabetes by lowering blood sugar. Your body will be more sensitive to insulin, which means that your body will use insulin more efficiently.

5. [Benefit or Motivation]

[More detailed description of motivation]

[Description of how motivation is beneficial]


5 12/23/13

YOU CAN DO IT! Meet the Goal. Reaching your physical activity goal is

doable when you:

1. Pick activities you LIKE. Develop a

lifelong habit of being active by

choosing activities that you enjoy

and that are convenient for your life.

2. Choose moderate kinds of activity,

like brisk walking.

3. Work up to this goal slowly. Work up

to a weekly total of 150 minutes or 2

½ hours. Start slowly and spread it

out over the week so you don’t get

hurt and so you enjoy yourself!

4. Reach 150 minutes in many

different ways. For example, you

might do 30 minutes for five days.

Or you can even break down the 30

minutes into three 10-minute or two

15-minute periods.


6 12/23/13

Types of Physical Activity and Levels of Intensity There are many different types of physical activity that differ by how hard you work to complete the activity (“level of intensity”). Try the “talk test” to find out how intense an activity is:

Level of Intensity What you will be able to do

Low talk and sing

Moderate talk, but not sing

High can’t say more than a few words without pausing

Examples of activities of different intensities Low (easy) Intensity

Walking casually

[low intensity cardio activity]

Washing/waxing a car

Gardening

Housework

Moderate Intensity

Walking briskly (~3 miles per hour)

Stair walking, climbing

Dancing

Bicycling slower than 10 miles per hour

Vigorous Intensity

Race walking, jogging, or running

Swimming laps

Playing soccer

Jumping ropes


7 12/23/13

Safety and Physical Activity Be sure to follow these safety tips during physical activity in order to enjoy yourself and not get hurt.

1. Wear proper athletic shoes that fit well and provide good support to the feet. Wearing proper

shoes that will also help prevent you from hurting yourself. Avoid wearing plastic, canvas, or

“flip-flop” footwear.

2. Wear appropriate clothes that keep you cool (are light in weight and color and absorb sweat)

and let you move comfortably.

3. Avoid wearing rubber or plastic suits or belts – these will make you too hot and can lead to

overheating and dehydration (not enough fluids in your body).

4. Pace yourself! Trying to do too much, too soon can lead to feeling down and/or getting injured.

5. Warm up and stretch your muscles and joints at the beginning of each physical activity session

to keep muscles and joints flexible and prevent injury.

6. Cool down at the end of your activity. Try walking for 5 minutes to bring your heart rate back

down slowly.

7. Drink water to replace the fluids that your body used during your activity.

8. Avoid physical activity when you are not feeling well, or during extreme weather.

9. Stop physical activity right away if you have chest pain or shortness of breath, and call your

doctor.

10. For questions about whether you should do a certain type of activity please contact your

doctor.


8 12/23/13

Wearing the Right Shoes The type of shoes you wear is important. Here are some tips for making sure you have the best shoes for your needs.

Buy new shoes only if you need them

You do not need to buy special shoes, if you have shoes now that fit well and support your

feet. If you plan to buy shoes, here are some helpful hints:

o Visit one or more stores you trust.

o Try on different styles and brands.

o Ask the salesperson to help you find a good fit.

o Ask the salesperson to help you choose the shoe best suited for the kind of activity

you want to do.

Look for a good fit

Wear the kind of socks you will wear when you are active. Cotton is best.

If possible, go to the store right after you have been active for a while. That way, your feet

will be the size they are when you are warmed up.

The shoes should feel good right away. Try them on and walk around. They should NOT

need to stretch out later.

One thumb should fit in the space between your longest toe and the end of the shoe.

The heel should NOT pinch or slip around when you walk.

The shoes should bend easily at the ball of your feet (just behind your toes).

Get the kind of support you need

Shoes should match the shape of your foot and the way your feet strike the ground.

Take your old shoes with you to the store. Ask the salesperson to look at the pattern of

wear. This pattern can show the kind of support you need. For example, if the back of the

shoe is worn down uneven on the bottom, you may need extra support for arches or flat

feet.


9 12/23/13

Keep it Safe Being active is usually safe, but sometimes problems can come up. The best way to avoid problems is to prevent them. Here are some ways to prevent common minor injuries,

Prevent sore muscles or cramps

Increase only a little at a time how often, how intensely, and how long you are active.

Drink plenty of fluids (especially water) before, during, and after being active.

Warm-up before every activity, and cool-down afterwards.

If you do get a muscle cramp, treat it this way:

Stretch the muscle, and then massage it. Repeat until the cramp goes away.

If you still have pain, put ice on the pain for a few minutes. Then repeat the stretching and massaging.

Stretch those muscles!

Stretching is one of the best ways to keep muscles from becoming sore, cramped, or injured.

Stretching also helps you be more flexible and feel relaxed.

Warming up and cooling down should take only 5 to 10 minutes. Do your planned activity, but more slowly or at a lower intensity for 5 to 10 minutes. Do a few minutes of gentle stretching.


10 12/23/13

Important!

Never stretch if you have pain before you begin. If a stretch causes pain, stop doing it. Listen to your body!

How to stretch

1. Do a short warm-up before stretching.

2. Move slowly until you feel the muscle stretch. A safe stretch is gentle and relaxing.

3. Hold the stretch steady for 15 to 30 seconds. Do not bounce.

4. Relax. Then repeat 3 to 5 times.

5. Stretch within your own limits. Do not push yourself.

6. Breathe slowly and naturally. Do not hold your breath.


11 12/23/13

Safe and Easy Stretches Here are some safe and easy stretches. Arm Reaches

1. Stand up straight with your feet shoulder-width apart. 2. Counting to 5, stretch your right arm to the ceiling while keeping your feet flat on the floor. 3. Repeat with your left arm. 4. Do this 10 times. Then shake out your arms.

Arm Circles

1. Stand with feet shoulder-width apart, knees slightly bent. 2. Extend your arms straight out from the shoulders with

your fingers spread and palms down. Keep your buttocks and stomach tight.

3. Rotate your arms in circles 10 times forward and then 10 times backward. Then shake out your arms.

4. Over time, work up to 20 circles in each direction. Waist Bends

1. Stand up tall with your feed shoulder-width apart. 2. Bend to the right, bringing your right arm down the side of your

body and left arm over your head. Look straight ahead and count to ten. Slowly return to the straight-up position.

3. Repeat the exercise, bending to the left side. 4. Over time, work up to 5 of these.


12 12/23/13

Safe and Easy Stretches (continued)

Sitting Toe Touch

1. Sit on the floor with your feet placed flat against a wall, knees slightly bent. Reach out your hands and slowly stretch them toward your toes. Keep breathing.

2. Repeat 2 to 3 times to start. 3. Over time, work your way up to 10 of these.

Back Press

1. Lie on your back with your knees bent and your hands clasped behind your neck. Keep your feet flat on the floor. Take a deep breath and relax.

2. Press the small of your back against the floor and tighten your stomach and buttock muscles. This should cause the lower end of the pelvis to rotate forward and flatten your back against the floor.

3. Hold for 5 seconds. Relax. Back Stretch

1. Lie on your back with your knees bent and your arms flat on the floor at your sides. Keep your feet flat on the floor. Take a deep breath and relax.

2. Grasp the back of one knee (not the top of the knee) with both hands and pull as close to your chest as possible. Return to the starting position.

3. Repeat with the other leg.


13 12/23/13

Safe and Easy Stretches (continued)

Heel Cord (Achilles) Stretch

1. Stand facing a wall an arm’s distance away, with your knees straight and your heels flat on the floor.

2. With your hands resting on the wall, allow your body to lean forward by bending your elbows slowly. Keep your legs and body straight and your heels on the floor.

Calf Stretch

1. Stand straight with feet shoulder-width apart. 2. Step forward with your right foot, slightly bending your right

knee. The front of your knee should be lined up with the front of your toes. Your left leg should stay fairly straight and your left heel should remain on the floor. Hold for 10-20 seconds.

3. Slightly bend your left knee. Hold for 10-20 seconds. 4. Repeat for the other side.


14 12/23/13

When to Stop Exercising Being active is usually safe, but you should be aware of some signs and symptoms that mean you should stop exercising.

Chest pain or discomfort What is it?

Tight feeling of pressure, pain, squeezing, or heaviness in the chest

Where in the chest? The pain could be –

- In the center of the chest - Spread throughout the front of the chest - Radiating to the shoulders, arms, neck, or

back

What should I do? Stop exercising, Sit or lie down.

- If the pain does not go away after 2 to 4

minutes, go to a hospital emergency room. - If the pain goes away but returns each time

you exercise, see your doctor.

Severe nausea, shortness of breath, sweating, or feeling faint

What should I do?

Call your doctor!

These symptoms may indicate something serious. However, sweating alone is not usually a concern. Severe sweating plus other symptoms should not be ignored.


15 12/23/13



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To-Do Next Week During the next week I will –

Be active for __________________________________ minutes.

I will set aside one 20 to 30-minute block of time every day. Or I will find two or more periods of 10 to 15 minutes each.

I will plan other activities I like to do.

I will warm up, cool down, and stretch.

Plan my activities for the week.

Day What I will do When Minutes

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total minutes for the week:

In my Food and Activity Tracker, I will record only the time that I am actually doing an activity. I will not record activities that last less than 10 minutes.

Keep track of my activity and what I eat, using my Food and Activity Tracker!


Wear clothes and shoes that are appropriate to participate in our group walk session

next week.


Dulce Mothers

SESSION SIX: Overview



2 12/26/13

Session 6: Overview Be Active – It’s Your Choice! This session focuses on how to become more physically active as a lifestyle choice. We have lots of choices in life, and each of us can choose a healthy lifestyle if we want to. However, we have busy lives, and changing is not simple. Finding the Time Time is something we never seem to have enough of. This session will help you find time to be more physically active. If you struggle with finding the time, you may be surprised at all the simple ways that you can include physical activity in your day. Choosing an Active Lifestyle Having an active lifestyle means making choices to move instead of to sit. For example, an active choice is to take the stairs instead of the elevator. An example of a not-so-active choice is to park your car as close to the entrance as you can. An active choice would be to park far away and walk to the entrance. These choices take an extra minute or two, but they all make a difference and add up to a more active you.

Quick Fact Why should I work to control my blood pressure? By controlling our blood pressure, we can lower our risk for heart disease and stroke by one-third to one-half. We can also lower our risk for eye, kidney, and nerve diseases by almost one-third.


3 12/26/13

Establishing a Safe Walk Route [In this section, develop a walking map/route of the local area to share with participants]


4 12/26/13

Being Active: A Way of Life. You can find the time to be active.

Set aside one block of time every day to be active.

When can you set aside 20 to 30 minutes to do an activity you like?

________________________________________________________

Look for free time (10 to 15 minutes) during the day. Use the time to be active.

When during the day might you have some free time (10 to 15 minutes)?

________________________________________________________ Lifestyle Activity Make active choices throughout the day. Every minute adds up to a “more active you.”

Inactive Choice (Limit)

Active Choice

When you shop, park your car as close as you can to the entrance of the store.

Park your car further away and walk.

Turn inactive into active time: Try cutting your TV time in half. Walk instead. Or be active while you watch TV (e.g., ride an exercise bike, lift weights).


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Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday






next week.


Dulce Mothers

SESSION SEVEN: Take Charge of What’s Around You


Session 7– Take Charge of What’s Around You

2 12/26/13

Session 7: Take Charge of What’s Around You

Session 7: Overview Understanding Cues We often eat or drink because something triggers our desire for food. These triggers are called cues. Food cues affect how much we eat, and activity cutes affect how much we move. Some cues are positive and lead to a healthy behavior. Other cues are a problem and lead us to overeat or be less active. What Make Us Eat? Hunger is the most obvious one. But there are other triggers. Seeing other people eat makes some of us want to eat too. Maybe it’s the sight or smell of food or the way we feel. Or maybe it’s certain activities such as watching TV or movie. Taking Charge When we respond to a food cue in the same way over and over again, we build a habit. When faced with the food cue, we respond without thinking. Once a habit forms, it becomes hard to break. Changing behavior requires us to take control and stay in control.

Quick Fact What is prediabetes? We have prediabetes when the glucose in our blood is higher than normal but not high enough for type 2 diabetes. In the United States, 79 million adults have prediabetes, and 26 million have diabetes.


3 12/26/13

Finding The Time To Be Active The Challenge: We have many demands on us every day so finding the time to be active can be challenging. The Goal: Find ways to make time. Here’s how:

1. Plan to be active

Schedule physical activity into your day.

Set aside a block of time for an activity and make being active a regular part of your daily routine.

When can you set aside 20 to 30 minutes to do an activity you like?

2. Be on the lookout during the day for 10 to 15 minutes of free time

Some people can’t find one big block of time to be active because they’re so busy.

If this is true for you take a 10-minute break between chores, other home activities, or between

meetings at work, and go for a brisk walk. Then later, take another 10-minute walk after lunch. In

the evening, [example of how to use spare time or change certain actions to be more active]. By

the end of the day you’ve done 30 minutes of activity!

3. Take advantage of the opportunity!

Think ahead about when to be looking out for free moments and take advantage! [Example of

activity to be done while waiting] If you take the bus, get off a “stop” or two early to get some extra

walking in.

When you have 10 or 15 free minutes? How can you add activity during these times?


4 12/26/13

What “Cues” You To Be More Or Less Physically Active? Many things around us lead us to not being active. For example, after dinner, you may always sit

down in front of the TV. This could be because the end of dinner and TV has been paired together

many times in the past.

Remember – you DO have a choice! Choose to take a walk after dinner instead!

Add “cues!” – To be active more often, it is important to add signals (or “cues”) for physical activity

to your life.

Make a new habit – Over time, the signals (like the end of dinner) will become paired with being

active (like taking a walk), and you will make new activity habits that will happen more and more

often.

Add Activity “Cues” To Your Life! What are some activity cues that you can add to your living room, kitchen, bedroom, bathroom (etc.)?

1. Keep exercise clothes and shoes out where you can see them, and not in the closet.

2. Hang a photo or poster of people being active in a place you see a lot.

3. Put a note on the TV saying that a half hour of TV time could be used for a walk instead.

4. One suggestion is to post photos that motivate you, pictures of the outdoors, or reminders to be active on the refrigerator.

5. One example of how to add signals to be physically active is to post a reminder on the mirror

to take a walk before breakfast.


5 12/26/13

Add Social “Cues” To Your Life! What are social cues? They are what other people say or do that affect your activity. Problem social cues:

1. Seeing other people around you not being active. For example, you come home and see

someone you live with sitting on the couch, relaxed, watching TV.

2. Being invited to do something that is not active. For example, you friend asks you to come over

to watch a movie.

3. Being nagged. Some people may think nagging is helpful, but actually it tends to make people

more inactive.

4. Hearing complaints. For example, your spouse says, “You’re always outside walking. You

never have time for the family anymore.”

Good social cues:

1. Seeing other people being active. For example, you go to a neighborhood park and see people

walking or running.

Being invited to do something active. For example, [example of someone asking, e.g.- mother,

child/grandchild, etc.]

2. Being praised. When someone gives you praise for being active it’s encouraging!

3. Hearing compliments. For example, your spouse says, “You’ve really committed to walking

every day. I’m proud of you.”

Add more positive cues:

1. Stay away from the problem cue, if you can.

2. If you can’t avoid the cue, change it!

a. Talk about the problem.

b. Be willing to make changes to find a solution that will work for everyone.

c. Tell people about the [Title of Program], your efforts to lose weight and be more active,

and why this is important to you. Many people will be willing to help if they understand

that you are trying to change your eating and activity and why.

d. Ask others to praise your efforts and ignore your slip-ups.


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Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday






next week.



8 12/26/13

Dulce Mothers

SESSION EIGHT: Overview



2 12/29/13

Session 8: Overview What is stress? Stress is a part of life and occurs when we tense up in response to pressure. Stress is what happens to us when we allow events or situations to overwhelm our ability to cope with them. Any change, good or bad, big or small, can cause stress. What causes stress? Stress can be caused by many events and situations. Getting married, a serious illness, or changing jobs can cause stress. Losing keys, having a birthday, having a flat tire, or [example of a relevant stressor (ex, children, grandchildren, caregiving, etc.] can also cause stress. An ounce of prevention… The old saying “An ounce of prevention is worth a pound of cure” is certainly true when it comes to stress. It’s best to avoid stress whenever we can. However, if we cannot avoid stress, there are ways to cope.

Quick Fact What does it feel like to have diabetes? People with type 2 diabetes usually have no clear symptoms. In fact, millions of people have type 2 diabetes and do not know it. Symptoms develop so slowly that people often are unaware of them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, frequent urination, blurred vision, and a feeling of being tired most of the time for no apparent reason.


3 12/29/13

How do you feel stress?

What situations make you feel stressed?

How do you feel, physically and mentally, when you are stressed?

What do you do differently when you get stressed?

What Causes Stress? Stress can be caused by many events and situations. Getting married, a serious illness, or changing jobs can cause stress. Losing keys, having a birthday, having a flat tire, or [example of a relevant stressor (ex, children, grandchildren, caregiving, etc.)] can also cause stress.


4 12/29/13

Stress and Your Health

Why are we talking about stress in this program? Many people react to stress by changing their

eating and activity habits. Some people eat and drink too much as a way to deal with stress, and

others may stop eating. Some people become very inactive and withdrawn.

We understand that it is stressful even to attend this program and to think about all the lifestyle

changes we suggest. Changing behavior and asking your family to make changes to help you can

create stress.


5 12/29/13

How Can We Prevent (Avoidable) Stress?

An ounce of Prevention…

The old saying “An ounce of prevention is worth a pound of cure” is certainly true when it comes to stress. It’s best to avoid stress whenever we can. However, if we cannot avoid stress, there are ways to cope.

Ways to Prevent Stress

Practice these tips to prevent stress:

Say “No” when asked to do something you do not want to do.

Try to say “Yes” only to important matters.

Share some of your workload with others.

Set goals you can reach in a realistic time.

Take charge of your time.

Make realistic schedules.

Get organized.

Use problem-solving techniques.

Describe the problem in detail.

Think of all your options.

Pick one option to try.

Make an action plan.

Try the plan. See how it goes.

Plan ahead.

Think of all the good things in your life.

Remember why you joined this program.

Keep things in perspective. Remember your purpose.

Think of all the good things in your life.

Remember why you joined this program.

Reach out to people for support.

Be physically active. Physical activity is a great stress reducer.


6 12/29/13

How We Can Prevent Stress That is Out of Our Control When you cannot avoid stress Despite your best attempts, you cannot always avoid stress. However, several actions can help you cope with the stress. When you cannot avoid stress:

Learn to be aware of the signs that show you are getting stressed.

My signs of stress:

1. _________________________________________________

2. _________________________________________________ 3. _________________________________________________

Stop yourself as soon as you realize you are stressed.

Move those muscles. Go for a walk, a bike ride, or do another activity you enjoy.

Pamper yourself. Do something you enjoy doing just for yourself.

Breathe. Take a full, deep breath. Count to five. Then let go of your breath slowly. Let the muscles in your face, arms, legs, and body go completely loose.

Catch the stress early

Take a 10-minute time-out


7 12/29/13

Relaxation Exercise

Try this Relaxation activity. It will take you about 20 minutes! Sit on a chair or on whatever you can sit upright with both feet flat on the ground. Do the following exercises in a quick order to learn the order and how to do it. Before you start, close your eyes and enjoy the rest for a minute or so. Clear your mind.

1. Right hand and forearm: Make a fist; Release

2. Right upper arm: Bend the arm and “show off your muscles”; Release

3. Left hand and forearm: Make a fist; Release

4. Left upper arm: Bend the arm and tighten the muscles; Release

5. Forehead: Raise your eyebrows; Relax your face

6. Eyes and Cheeks: Squeeze your eyes; Relax

7. Mouth and Jaw: Clench your teeth and pull the corners of the mouth back; Relax

8. Shoulder and Neck a little pre-training first: Lock your hands behind the neck and push back

that head against this resistance (the head does not alter its position) – got the idea? That’s

how this should feel: pull up your shoulders and press your head back against their resistance

(horizontally – not like when you look up) let your shoulders hang; Relax

9. Chest and Back: Breathe in deeply and hold your breath pressing the shoulders together at the

back at the same time; Let your shoulders hang; Breathe normally

10. Belly: Tighten the abdominal muscles )or draw in the belly); Release

11. Right thigh: Shovel the right foot forward against resistance (while it keeps its position);

Release

12. Right calf: Lift up the right heel (be careful not to cramp); Release

13. Right foot: Crook the toes; Release

14. Left thigh: Shovel the left foot forward against resistance (while it keeps its position); Release

15. Left calf: Lift up the left heel (be careful not to cramp); Release

16. Left foot: Crook the toes; Release

Repeat this exercise once in a quick succession then repeat by memory. Tighten each group of

muscles and hold the tension for about 5 seconds then relax for about 30 seconds. Repeat each

exercise.

At the end, keep your eyes closed for a short time and enjoy the relaxation a little longer.

Breathe in deeply and move your fingers and toes playfully. Breathe in deeply again and stretch

yourself. Breathe in deeply and open your eyes. Do this at the end of each session. This breathing

and stretching will make sure that your circulation is reactivated. Usually you will feel quite

refreshed afterwards.


8 12/29/13

Sources of Community Help

Emotions and Diabetes Having fears about diabetes is normal. You can’t change the fact that you have been diagnosed with diabetes, but you can choose to make your emotional healthy a priority. Living well with diabetes takes time and effort. Diabetes can be tough to handle. Do you feel any of the following about the daily hassles of managing your health?

Overwhelmed Angry

Unmotivated

Sad

Frustrated

Scared

Burned out

Addressing these emotional aspects of your diabetes is important for long-term success. Think about ways you can take care of your whole self (mind, body and spirit). Some suggestions include talking to your doctor about your feelings, taking your medications every day and attending a support group (see resource page or contact Scripps Whittier Diabetes Institute (1-858-626-5672) or Behavioral Diabetes Institute (1-858-336-8693) for additional information). In addition, avoid alcohol and drugs. Take time to relax by:

Walking Dancing

Yoga Deep breathing

Daily sunlight Spend time with family and friends

I like to: _____________________________________________________________

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________


9 12/29/13

You Are Not Alone Many patients newly diagnosed with diabetes feel alone and unable to connect with those around them. Social media – websites you can interact with and that allow you to interact with other visitors – can help. A two-way street, social media gives you the ability to connect with others who have diabetes to share stories and ask questions. Learn how to control your diabetes with others. Social Media for Patients with Diabetes

Diabetes Mine This site was created by and for patients as a “diabetes newspaper with a personal twist” Diabetesmine.com/category/essential-diabetes/emotions

Diabetes Advocates A collective of individuals and organizations that offers expertise, resources and support to those touched by diabetes. We believe that connecting with others living with and caring for diabetes, and providing emotional and anecdotal support, goes hand-in-hand with the support of a health care provider. Diabetesadvocates.org

Tu diabetes A community of people touched by diabetes, run by the Diabetes Hands Foundation. Tudiabetes.org

EsTu Diabetes.org Una comunidad de personas afectadas por la diabetes, un programa de la Diabetes Hands Foundation. Estudiabetes.org

You can do this project Collects personal powerful videos of patients affected by diabetes. Share your diabetes story. Be a light in someone else’s darkness. Youcandothisproject.com

dLife Make diabetes applications that you can use to log glucose levels, find recipes and nutrition information. Watch dLife videos and connect with the dLife community and experts to get answers to diabetes related questions. You can graph weekly or monthly levels and track trends, which you can email to yourself or health care provider. Dlife.com

Scripps Health does not control, endorse or guarantee the accuracy of information contained on the above websites. Please consult your health care provider with any questions or concerns regarding your health.


10 12/29/13

Your Stress Plan Your Plan for Stress

1. What are your major sources of stress?

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2. Choose one source of stress. Make a positive action plan:

I will:___________________________________________________________________________________________________________

When?________________________________________________________________________________________________________

I will do this first:_____________________________________________________________________________________________ Roadblocks that might come up: I will handle them by:

____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________

I will do this to make my success more likely:

_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________


11 12/29/13

What are the symptoms of stress? Stress can affect all aspects of your life, including your emotions, behaviors, thinking ability, and physical health. No part of the body is immune to stress, but because people handle stress differently, symptoms of stress can vary. Some symptoms can be the same as those caused by medical conditions. So it is important to discuss them with your doctor. You may experience any of the following symptoms of stress. Emotional symptoms of stress include:

Becoming easily agitated, frustrated, and moody

Feeling overwhelmed, like you are losing control or need to take control

Having difficulty relaxing and quieting your mind

Feeling bad about yourself (low self-esteem), lonely, worthless, and depressed

Avoiding others

Physical symptoms of stress include:

Low energy

Headaches

Upset stomach, including diarrhea, constipation, and nausea

Aches, pains, and tense muscles

Chest pain and rapid heartbeat

Insomnia

Frequent colds and infections

Loss of sexual desire and/or ability

Nervousness and shaking, ringing in the ear, cold or sweaty hands and feet

Dry mouth and difficulty swallowing

Clenched jaw and grinding teeth

Cognitive symptoms of stress include:

Constant worrying

Racing thoughts

Forgetfulness and disorganization

Inability to focus

Poor judgement

Being pessimistic or seeing only the negative side

Behavioral symptoms of stress include:

Changes in appetite – either not eating or eating too much

Procrastinating and avoiding responsibilities

Increased use of alcohol, drugs, or cigarettes


12 12/29/13

Exhibiting more nervous behaviors such as nail biting, fidgeting and pacing WEEKLY SMART GOAL-SETTING Week of:__________ Session:___________ Is my goal: Specific Measurable Attainable Realistic Time-based


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13 12/29/13


Keep track of my weight, eating, and physical activity.

Try my action plan for managing stress.

Answer these questions:

Did my action plan work?

_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ If not, what went wrong?

_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ What could I do differently next time?

_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________




Dulce Mothers

SESSION NINE: OVERVIEW



2 01/03/14

Session 9: Overview Overcoming Negative Thoughts Positive thoughts are thoughts that make us feel good about our progress. Negative thoughts cause us to lose hope or stand in the way of our progress. A negative thought is usually a criticism of ourselves. We become angry with ourselves for something as simple as eating a piece of cake or not going for a walk. We are all human, so we all have negative thoughts from time to time. However, we must try to overcome them because they often lead us into doing even more eating and less activity rather than the reverse. The Negative Spiral Suppose you come home after a hard day at work. You think to yourself, “I am tired of working so hard. I am sick of this program. I can never eat what I want.” This negative thought might lead you to eat some potato chips. And then you think, “I did it again. I will never lose weight.” So you go on to eat more chips. Does this sound familiar? We’ve all done this, so please don’t give up because you ate one or two unhealthy items. If you begin to lose hope because of this chain of thoughts and unhealthy actions, take a deep breath and start again. You are worth it!

Quick Fact Is it true that diabetes is linked to Alzheimer’s disease? Recent studies show that the risk for Alzheimer’s disease is much higher for people with diabetes than for people without diabetes, especially for people with type 2 diabetes. The link between diabetes and Alzheimer’s disease may contribute to the loss of memory that people with chronic diabetes often suffer from.


3 01/03/14

Myths and Attitudes about Diabetes Some common myths about how diabetes develops and whether or not it can be prevented are:

1. If I get diabetes:

It is a punishment from God

No matter what doctors or nurses tell me, I am meant to get diabetes

No matter what I eat or if I exercise, I am meant to get diabetes

2. A traumatic experience can cause diabetes, for example:

Being shocked or frightened by something

Pent up anger

A traumatic impression

3. Diabetes medication:

Insulin causes blindness, addiction, amputation or cancer

Herbs can be used to cure diabetes

Eating nopales and aloe vera is a good treatment for diabetes

Drinking urine is a cure for diabetes

Have you heard any of these statements before? Do you believe that any of these are true? Know The Facts Be sure to know the facts and correct information. It will make a difference! Believing the wrong information can be unhelpful and potentially harmful.


4 01/03/14

The Habit of Negative Thoughts Negative thinking can become a habit. For many of us, negative thoughts occur automatically. We tend to believe and act on our negative thoughts without being aware that we are doing so. One goal of this program is to help you recognize negative thoughts as they occur and to teach you to talk back to them. Negative Thoughts Everyone has negative thoughts. This table helps explain the different types of negative thoughts.

Type of Negative Thought Example

Good or Bad Divides the world into

good or bad foods

Sees self as a success or

failure

Is on or off the program

“Look at what I did. I ate that cake. I will never be able to do well in the program.”

Excuses Blames others for

problems

Claims to not be able to

help or control situations

“I have to buy these cookies just in case friends drop in.”

Should Expects to always make

the right choice

Gets set-up for failure

Leads to anger

“I should have eaten less dessert.”

Not As Good As Compares self to

someone else

Blames self for not doing

as well as someone else

“Martin lost two pounds this week, and I only lost one.”

Give Up Beats self up

Often follows the other

kinds of negative

thoughts

“This program is too hard. I might as well forget it.”


5 01/03/14

Talking Back to Negative Thoughts We can talk back to negative thoughts. Here are some examples of how it works for the

different types of negative thoughts. General way to stop negative thoughts:

1. Catch yourself. Think, “I am being negative about myself.”

2. Say “Stop!” to yourself. Say it loud. Picture a huge, red stop sign.

Negative Thought

Talk back with a positive thought

Foods are either “good” or “bad” “I can never eat dessert again.” “Look at what I did. I ate that cake. I will never do well.”

Work toward balance “I can eat dessert and cut back on something else.” “One slip-up is not the end of the world. I can get back on track.”

Excuses “It’s too cold to take a walk.” “I do not have the willpower.”

It’s worth a try “I can go for a walk and stop if it gets too cold.” “It is hard to change old habits, but I will give it a try and see how it works.”

Should “I should have eaten less dessert.” “I haven’t written down everything I eat.”

It is my choice “It was my choice. Next time I can decide not to eat so much.” “I’m writing down everything I eat because it helps me eat better.”

Not as good as “Martin lost two pounds this week, and I only lost one.”

Everyone is different “It is not a race. Martin and I can lose weight at different rates and both do well.

Give up “This program is too hard. I might as well forget it.” “I will never get it right.”

One step at a time “I’ve learned something about what is hard for me.” “I will try something different next time.”


6 01/03/14

Practice Talking Back Follow these steps to practice replacing a negative thought with a positive one:

1. Write below the negative thoughts you’ve had.

2. Say each thought out loud. Then say, “Stop!”

3. Talk back, again out loud, with a positive thought. Write down the positive thought.

Negative Thought

STOP!

Positive Thought


7 01/03/14



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8 01/03/14



Catch myself when I have negative thoughts.

I’ll practice stopping the negative thoughts and talking

back with positive thoughts.

I’ll write down the positive thoughts in my Food and

Activity Tracker.




Dulce Mothers

SESSION TEN: OVERVIEW



2 01/05/14

Session 10: Overview One of the biggest health problems that the country and our communities face is childhood obesity. Today, more than 1 in 3 children and adolescents are overweight or obese. Latino and Mexican American children are even more likely to be overweight or obese. Childhood obesity can affect children in many ways. Too much time spend in front of the television is one of dozens of factors that can increase the chances children will be overweight or obese. So, how can we change this? We can begin healthy lifestyle habits of our own, so we can inspire our children to begin their own healthy lifestyle habits!

Quick Fact Is it true that people with diabetes cannot eat sweets? People with diabetes can eat sweets and dessert if those foods are part of a healthy meal plan that is combined with plenty of physical activity. Sugar is not off limits to people with diabetes. But people with diabetes must be careful about how much sugar they eat.


3 01/05/14

Facts about Breastfeeding

BREASTFEEDING Benefits

Breastfeeding mothers reduce their risks for:

- Ovarian cancer - Breast cancer - Type 2 diabetes

Breastfed infants have a reduced risk of:

- SIDS - Lower respiratory

infections - Type 2 diabetes - Asthma - Obesity

Workforce & environmental:

- Infants have less illness so mothers miss less work

- Less trash and plastic waste compared to formula and bottle supplies

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and UNICEF recommend:

Initiation of breastfeeding within the first hour of life

Exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water

Breastfeeding on demand – that is as often as the child wants, day and night

No use of bottles, teats or pacifiers


4 01/05/14

Childhood Obesity: How Can I Help?

Encourage Healthy Eating Habits

Serve reasonably-sized portions

Encourage them to drink lots of water

Limit sugar-sweetened beverages

Limit consumption of sugar and saturated fat What changes can I make to encourage healthy eating habits in my family? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Look for ways to make their favorite dish healthier

Provide plenty of fruits, vegetables and whole-grain products

Include low-fat or no-fat milk and dairy products

Choose lean meats, poultry, fish, lentils and beans for protein Which dishes can I make changes to make it healthier? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Remember that small changes every day can lead to a recipe for success!


5 01/05/14

Help Your Children Stay Active Children and teens should participate in at least 60 minutes of moderate intensity physical activity most days of the week. Here are some examples:

Brisk walking

Playing tag

Jumping rope

Playing soccer

Swimming

Dancing Reduce Screen Time Studies have shown that decreasing the amount of TV kids watched led to less weight gain and lower body mass index (BMI).

Healthy TV Habits

Keep TV’s and internet connections out of bedrooms

Stock the room you have the TV in with plenty of other non-screen entertainment (toys, books, kids magazines, puzzles, board games, etc.)

Turn the TV off during meals

Don’t allow kids to watch TV while doing homework

Treat TV as a privilege to be earned – not a right. Establish and enforce family TV viewing rules, such as TV is allowed only after chores and homework are completed.

Try a weekday ban – you’ll have more family togetherness time to spend on meals, games, physical activity and reading during the week.

Set a good example by limiting the amount of TV you watch


6 01/05/14

Healthy Food Rewards Simply recognizing kids for good work or behavior is a great motivator and is always appreciated – say “You did a great job!” or “I appreciate your help”. Here are some other non-food rewards:

Allow your child to have a few friends over after school to play sports

Invite a few of their friends to a sleepover

Let your child help plan a special outing

Read a bedtime story of your child’s choice

Have a family game night, and let your child choose the game

Allow your child pick a movie that the family will watch together

or an outdoor sport that the family will play together

Keep a box of special toys, games or art supplies that can only be used on special

occasions

Create a system so your child can earn movie tickets, coupons, gift certificates, or

discounts to skating rinks, bowling alleys, and other entertainment outlets


7 01/05/14



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8 01/05/14



Follow my action plan for making social cues work for me.


Did my action plan work? ______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________

What could I do differently next time? ______________________________________________________________________________ ______________________________________________________________________________




Dulce Mothers

SESSION ELEVEN: The Slippery Slope of Lifestyle Change


Session 11 – The Slippery Slope of Lifestyle Change

2 01/10/14

Session 11: The Slippery Slope of Lifestyle Change

Session 11: Overview Slips We know that sometimes change is hard. It is not easy to be the best we can be. What are slips? Slips are times when we do not follow our plans for healthy eating or being active. Slips are normal. If you haven’t already had a slip, you will surely have one in the future. However, no need to worry. Slips do not always hurt our progress. What hurts our progress is the way we react to slips. Why do we slip? Because we’re human. However, different things cause different people to slip. We talked about cues that make us eat or not be active. Moods or feelings cause many of us to slip from healthy eating. Some of us overeat when we are happy. Some of us overeat when we are bored. What causes us to slip is a habit, something we learned over time.

Quick Fact What does diabetes cost us?

Having diabetes is expensive, mainly because of the many complications associated with the disease.

The medical costs for a person with diabetes average nearly $12,000 a year. That amount is more than double the medical expenses of people without diabetes.

Each year in the United States, the costs associated with diabetes total more than $200 billion.


3 01/10/14

The Slippery Slope of Lifestyle Changes Slips are times when we don’t follow our plans for healthy eating or being active. They are –

A normal part of lifestyle change.

To be expected.

What causes slips? Ask yourself, how can I react to slips when they happen? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Slips do not hurt our progress. What hurts our progress is the way we react to slips. What causes us to slip is a habit, something that we learned over time. The way we react to slips is also a habit. We can learn a new way to react to slips to get back on our feet again.


4 01/10/14

After a Slip As you go forward with this program, remember two things: slips are normal and are to

be expected. Just about everyone who tries to lose weight and be more active has slips. A slip is not a problem. Just get back on your feet, and continue to work toward your goals.

So after you slip:

1. Talk back to negative thoughts with positive thoughts.

Negative thoughts are your worst enemy. Talk back. “I am not a failure because I slipped. I am back on my feet again.”

2. Ask yourself how the slip happened.

Learn from the slip. Can you avoid the cue in the future? Will you be able to handle this situation better?

3. Regain control immediately. Make your very next meal a healthy one. Get back on schedule with your activity plan right away.

4. Talk to someone supportive. Call your “Peer-Educator” or another friend and discuss your new plan for handling slips. Commit yourself to a new effort.

5. Focus on all the positive changes you made. You are making lifelong changes, and slips are just part of the process.

Overeating once, no matter how extreme, will NOT ruin everything.


5 01/10/14

Slips from Healthy Eating and Physical Activity: Action Plan

To avoid slips from your healthy eating, spend a moment thinking about how you slipped in the past, and how you might handle similar situations better in the future.

1. Describe one thing that caused you to slip from healthy eating or physical activity.

___________________________________________________________________________

2. How can you avoid it in the future? If so, how? ___________________________________________________________________________

3. Make a plan for how to get back on your feet the next time you slip:

I will:__________________________________________________________________________ When?________________________________________________________________________ I will do this first:_________________________________________________________________

Barriers that might come up: I will handle them by: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

In order to meet my goal, I will: _____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How can my classmates, family, and my Promotora help me reach my goals: ________________ ______________________________________________________________________________ ______________________________________________________________________________


6 01/10/14



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7 01/10/14



Use my two action plans for handling slips.


Did my action plans work? ______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________





Dulce Mothers

SESSION TWELVE: Ways to Stay Motivated


Session 12 – Ways to Stay Motivated

2 01/29/14

Session 12: Ways to Stay Motivated

Session 12: Overview Congratulations! This session is the last week of this 12-week program. From now on, you will have the tools and information to continue your work toward a healthier lifestyle. You will continue to meet as a group with a Lifestyle Coach, but the group will meet only once a month. Reviewing You Progress As we close this part of the program, think about all the great progress you made. Think back to the first session, and be proud of your success. If you have met your goals – GREAT! If you are still working on them – GREAT! Just don’t give up! You have what you need to succeed. Remember, you just finished the most successful program known to science for helping people prevent type 2 diabetes.

Quick Fact: How does my doctor test for diabetes? To find out whether someone has prediabetes or diabetes, doctors will probably do a test called the Glycated Hemogolobin (HbA1c) test. This test measures the average percentage of glucose in your blood during the 6 to 8 weeks before the test. You do not have to fast to have the test done.

If the result is 6.5% or higher, you have diabetes.

If the result is somewhere from 5.7% to 6.4%, you have prediabetes.

Doctors may also do a fasting glucose test to diagnose diabetes.

If the result is 126 mg/dL or higher, you have diabetes.

If the result is somewhere from 100 to 125 mg/dL, you have prediabetes.


3 01/29/14

Staying Motivated A key part of keeping on track with healthy habits is staying motivated. This week, we will review ideas for staying motivated that worked for others. It is important to find out which ideas work best for you.

Ways to Stay Motivated

What did you hope to achieve when you first joined this program?

Have you reached these goals?

Were there any benefits to being in the program you did not expect?

What would you like to achieve during the next 6 months of the program?

What changes in your eating and activity do you feel proudest of?

What was easier than you thought it would be? What was harder?

1. Stay aware of the goals you’ve already reached and the goals you plan to reach.

2. Recognize you successes.


4 01/29/14

Post weight and activity graphs on your refrigerator door.

Mark on a chart your activity milestones toward a specific goal.

Measure waist or belt size once a month.

Record your activity daily.

Record everything you eat every day.

Record your weight once a week on:_____________________

How have you varied your activity?

How do you vary meals and snacks to avoid becoming bored?

Can you think of some new ways to vary your food choices?

3. Keep visible signs of your progress.

4. Keep track of your weight, eating, and activity.

5. Add variety to your routine.


5 01/29/14

Develop ways to reward yourself when you meet new challenges. Challenges: should be specific, short-term, and realistic. Rewards: something you will do or buy if, and only if, you succeed in your challenge.

What are some non-food ways you can reward yourself for meeting a challenge?

Set up a friendly contest that everyone wins. That is, everyone will lose weight, although one person my lose more than others.

What ideas do you have for a contest?

If you do slip, focus on how to get back in the game. Stay motivated.

Call your lifestyle coach, fellow group member, or friend for encouragement and support.

6. Identify new ways to challenge and reward yourself.

7. Create some friendly competition.

8. Remember slips are normal.

9. Look to others for help in staying motivated.


6 01/29/14

Progress Review

Changes you made to be more active: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Changes you made to eat less fat and fewer calories: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Have you reached your weight goal? ☐ Yes ☐ No

Have you reached your activity goal? ☐ Yes ☐ No If you have not met one or both of these goal, what will you do to move closer to them? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________


7 01/29/14

A Plan for Staying Motivated

1. Choose one way to stay motivated that would help you now.

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1. Make a positive action plan:

I will:______________________________________________________________________ When?____________________________________________________________________ I will do this first:_____________________________________________________________ Roadblocks that might come up: I will handle them by: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

I will do this to make my success more likely: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ How can other program participants or the Lifestyle Coach help you? _____________________________________________________________________________

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8 01/29/14



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9 01/29/14



Try my action plan for staying motivated.

Answer these questions: Did my action plan work?

______________________________________________________________________________ ______________________________________________________________________________ If not, what went wrong? ______________________________________________________________________________ ______________________________________________________________________________




session one: welcome to the national diabetes prevention ... · lose weight. being more active....

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