Achieving A Healthy Weight In Children

Transcription

Achieving a Healthy
Weight in Children
Medical Nutrition Therapy
Protocol and Handouts
Material distribution
funded by:
Achieving a Healthy Weight in Children
Introduction
In 2004, there was no published national standard of medical nutrition therapy (MNT) care for children and
adolescents who are overweight or at risk of becoming overweight. An estimated 40% of Pitt County
children and adolescents are overweight or at risk for becoming overweight. One recommendation in the
“Moving Our Children Toward A Healthy Weight” state plan* was to “ensure medical providers,
nutritionists/dietitians, mental health care providers and physical activity specialists have the skills needed
to effectively communicate with, evaluate, and provide care for children and youth who are overweight or
at-risk for overweight”. To assist with this need at a local level, a group of Pitt County dietitians and
nutrition educators collaborated to develop a nutrition counseling protocol and patient education materials
for use throughout Pitt County medical practices.
Professionals from University Health System, the Brody School of Medicine at East Carolina University,
East Carolina University College of Human Ecology, the Growing Up FIT! Project of the North Carolina
Agromedicine Institute and the Pitt County Public Health Department participated. The group was called
together by the Pediatric Healthy Weight Research and Treatment Center at East Carolina University.
The group contributed their expertise and individual creativity to develop the comprehensive nutrition
protocol and education material packet for dietitians and other nutrition professionals, Pitt County
physicians, case managers, and others providing nutrition care to children and adolescents. Several
models were considered and the group selected the template used by the American Dietetic Association in
its Medical Nutrition Therapy Across the Continuum of Care client protocols. The protocol describes a
time frame for treatment and goals for different age groups. Seven intervention sessions are outlined. The
topics are prioritized based on both the evidence and the clinical experience of the group. The visits are
every 2-4 weeks. Patient education materials (available on CD) for each visit are included. These are
designed for the child or teen but should be reviewed with parent or guardian. Follow-up contact
(e.g. visit, phone call, email) is suggested every 12 weeks.
The group meets quarterly to evaluate the effectiveness of the protocol and make any needed revisions.
Feedback is welcomed and encouraged.
Support for production and distribution of these packets was paid for by a grant from the Pitt Medical
Society. In addition, grant monies from the Pitt Memorial Hospital Foundation supported the salary and
benefits of two contributing dietitians. In-kind and financial support have also been provided by the Kate B
Reynold’s Foundation through the Growing Up FIT! Project. Please contact Kathryn Kolasa PhD, RD,
LDN for permission to duplicate these materials. [email protected]
Please return comment and evaluation forms to:
Emilie Davis Balkman, MPH, RD, LDN
4N-70 Brody Medical Science Building
600 Moye Blvd.
Greenville, NC 27834
(252) 744-9210
[email protected]
Pitt County Pediatric Dietitians and Nutrition Educators 07.04
*North Carolina Healthy Weight Initiative. www.nchealthyweight.com
Co-editors:
Emilie Davis Balkman, MPH, RD, LDN
East Carolina University Brody School of Medicine, Department of Pediatrics and Family
Medicine
Community Dietitian for overweight youth
Kathryn Kolasa, PhD, RD, LDN
East Carolina University Brody School of Medicine, Department of Family Medicine
Professor and Section Head, Nutrition Services and Patient Education
Contributing dietitians and nutrition educators include:
Catherine Sullivan, MPH, RD, LDN
Assistant Professor
Jacqueline Duffy, RD, LDN
Food Literacy Partners Program Coordinator
Latosha Hope Redd, BS
East Carolina University Brody School of Medicine, Family Practice Center
Nutrition Educator
Amanda McKee, BSPH
East Carolina University Brody School of Medicine, Family Practice Center
Nutrition Educator
Nancy Harris, MS, RD, LDN, FADA
East Carolina University College of Human Ecology
Lecturer
Ginger Hester, MS, RD, LDN
East Carolina University Brody School of Medicine, Department of Pediatrics
Pediatric Dietitian
Joanne Moylan, MPH, RD, LDN
Pitt County Health Department
Nutrition Program Director
Karen Bellacera, MA, RD, LDN
ViQuest Center, University Health Systems
Nutrition Specialist
Kristen Borre, PhD, MPH, MA
North Carolina Agromedicine Institute
Associate Scientist
Program Director of Growing Up Fit!
East Carolina University
Achieving a Healthy Weight in Children
Contents of Medical Nutrition Therapy Packet:
Referral Information
MNT resources in Pitt County
- with fee division
- without fee division
Patient Education Materials for MDs, Case Managers, and group classes*
*F/B indicates handouts are double-sided
Weight Management Guidelines (F/B)
Clinical Tools
MNT protocol overview
MNT protocol, divided by sessions
Expected outcomes of MNT
Detailed list for initial assessment
Clinical assessment grid sheet (for initial measurement and goals)
Hunger Scale
Hypertension algorithm
NHBEP ’04 Blood pressure percentile tables for boys and girls
CDC Growth Charts (body mass index-for-age)
Patient Education Materials*
*F/B indicates handouts are double-sided.
Food Guide Pyramid for school-aged children
Stoplight Food Guide (2 pages F/B)
What Does a Serving Size Look Like?
Think Before You Drink! (F/B)
Physical Activity (F/B)
The Activity Pyramid (F/B)
My FIT! Pyramid
How to Read a Nutrition Facts Label (F/B)
Healthy Eating on the Go…(F/B)
Dining Out- How to Choose (F/B)
Snack Attack! (F/B, age-dependent worksheet on back)
Together…Let’s Try New Foods!
Ideas for Helping Your Child Try New Foods (F/B)
Fruits & Veggies (F/B)
Calcium (F/B)
Parents & Guardians as Role Models (F/B)
Food Preparation-What to Do
Lower Calorie, Lower Fat Alternatives (F/B)
Eat Smart Lunches (F/B)
Healthy Guidelines for Weight Management (F/B)
Hyperinsulinemia packet (8 pages F/B)
What is BMI?
What is High Blood Glucose?
What is High Blood Pressure?
Currently, medical nutrition therapy (MNT) is not usually reimbursed for the treatment of overweight
children and adolescents. The major exception is that Medicaid-eligible children can receive these services
through the health department. In an effort to maximize the resources and reimbursement available, a list
of MNT resources is provided below. The listing is divided into sections to assist the health care provider.
If you are unsure whether the child is eligible to receive free-, or reduced-rate nutrition consultations, you
may prompt them about which lunch service they receive at school. You may refer the child to any of these
providers.
For children eligible to receive free school lunch:
Appointment: 902-2388
Contact: Joanne Moylan, MPH, RD, LDN
Cost: Free for Medicaid children; sliding scale for others.
ECU Family Practice Center
Appointment: 744-5479 (Elaine Martin) Must specify that child has a weight concern, or is
enrolled in KIDPOWER study
Ask for appointment with Emilie Balkman, MPH, RD, LDN
Cost: Free. Supported by grant from Pitt Memorial Hospital Foundation.
For children eligible to receive reduced-price school lunch:
Ask for appointment with nutrition educator or dietitian
Cost: $38 for initial assessment (60 mins)
$17 for follow-up (30 mins)
Pediatric Outpatient Center, Brody School of Medicine
Ask for appointment with Ginger Hester, MS, RD, LDN
For children who are able to pay full price for school lunch:
East Carolina University Family Practice or Pediatrics. See above
ViQuest
Contact: Karen Bellacera, MA, RD
Cost for non-members: $50 for initial assessment (60 mins)
ViQuest members are eligible for one free initial session and one free follow-up session.
Medical Park Associates
Ask for appointment with Katrina Segrave, RD, LDN
Cost: Initial visit $85, nutrition packages are also available for $189 (3 visits)
Medical Nutrition Therapy Resources
for Overweight Youth
in Pitt County
Appointment: 744-5479 (Elaine Martin) Must specify that child has a weight concern, or
is enrolled in KIDPOWER study
Ask for appointment with: Emilie Balkman, MPH, RD, LDN
Cost: Free. Supported by grant from Pitt Memorial Hospital Foundation.
Ask for appointment with nutrition educator or dietitian.
Pediatric Outpatient Center, Brody School of Medicine
Ask for appointment with Ginger Hester, MS, RD, LDN
Contact: Joanne Moylan, MPH, RD, LDN
Cost: Free for Medicaid children; sliding scale for others
ViQuest
Contact: Karen Bellacera, MA, RD
Cost for non-members: $50 for initial assessment (60 mins)
ViQuest members are eligible for one free initial session and one free follow-up session
Medical Park Associates
Ask for appointment with Katrina Segrave, RD, LDN
Cost: Initial visit $85, nutrition packages are also available for $189 (3 visits)
Pediatric Weight Management Medical Nutrition Therapy Protocol
Setting: Ambulatory Care or adapted for other health care settings. Children 2-20 years old.
(Caregiver is encouraged to attend with all children, but adult must attend with patients 18 years and
younger)
Number of sessions: 7
Intervention
1
2,3,4,5 & 6
7
Length of contact
60 minutes
30-45 minutes
30-45 minutes
Time between interventions
2-4 weeks
2-4 weeks
3 months
Cost/charge
Ongoing follow-up contact (visit, phone call, letter or email) every 12 weeks is suggested for optimal weight management.
Target Audience: Children and adolescents (2-20 years) with a BMI that classifies the individual as
overweight, at-risk for overweight, or those with 3-4 BMI increase over 12 months.
Classifications for overweight: Using gender-specific CDC growth charts, a child is considered at-risk
for becoming overweight if BMI is 85-94th %-ile for their age. A child is considered overweight if
BMI is > 95th %-ile for their age.
Program Goals:
1. Attain and maintain optimal metabolic outcomes within three months following
initiation of dietary and behavioral modifications.
2. Modify nutrient and energy intake and lifestyle as appropriate for the prevention and
treatment of chronic complications associated with overweight and obesity.
3. Improve health through education and skill development about health promoting food
choices.
4. Ensure nutrient requirements are met. Address individual nutrition needs, taking into
consideration personal, lifestyle, and cultural preferences while respecting the
individual’s wishes and willingness to change.
RECOMMENDATIONS FOR WEIGHT GOALS FOR CHILDREN 2-7 YEARS OLD
BMI
Absence of Medical
Presence of Medical Complications*
Complications
85th -94th %-ile Weight maintenance
Weight maintenance
> 95th %-ile
Weight maintenance
Weight loss**
RECOMMENDATIONS FOR WEIGHT GOALS FOR CHILDREN > 7 YEARS OLD
BMI
Absence of Medical
Presence of Medical Complications*
Complications
85th -94th %-ile Weight maintenance
Weight loss**
th
> 95 %-ile
Weight loss**
Weight loss**
* Medical complications include: hypertension, dyslipidemias, sleep apnea, asthma, metabolic syndrome,
orthopedic problems and insulin resistance.
** Create a daily deficit of 125-250 calories for ¼-½ pound/wk weight loss (~1 lb/month).
© Pitt County Pediatric Dietitians and Nutrition Educators 07.04
Pediatric Weight Management Medical Nutrition Therapy Protocol
Expected Outcomes of Medical Nutrition Therapy
Outcome/assessment
factors
visit
1
Clinical
•
Biochemical parameters:
Serum glucose
visit
2
Lipid profile
Serum Insulin
C-Peptide (optional)
Blood Pressure (BP)
visit
3
visits
4-7
It may not be feasible to have labs done at
these intervals. In cases where labwork is
not warranted, continue MNT as protocol
describes.
•
Anthropometrics
Weight, BMI, waist circumference,
growth chart classification (%ile)
Behavioral
•
Food guide
- anytime, sometimes and rarely foods
- food models; portion sizes
Expected outcome
Glucose Ð 10% or at target goal
Cholesterol Ð 6-12% (if elevated)
Triglycerides Ð (if elevated)
LDL-C Ð (if elevated)
HDL-C Ï or no change
Serum Insulin Ð
C-Peptide Ð
Blood pressure Ð
•
Food/meal planning
- sweetened beverages
- water
- snacks
- fruits and vegetables
- trying new foods
•
Dining out/Fast food
•
Food preparation
- recipe modification
•
Physical Activity
- Television budget
Ð or maintain weight as appropriate
•
•
•
•
•
•
•
•
•
•
Additional Topics
Additional topics may include: trying new
foods, setting goals, and calcium
Female
32-99
35-114
41-138
40-128
Within reasonable body weight.
BMI <85th %ile for age and gender
or consistent percentile over time.
MNT Goal:
Adhere to appropriate meal pattern,
exercise and individualized weight
management plan (calorie or
macronutrient budget) to achieve
and maintain healthy body weight,
blood glucose, blood pressure, and
lipids within target goals.
Triglyceride (mg/dL)
Male
0-5yrs
30-86
6-11yrs
31-108
12-15yrs 36-138
10-19yrs 40-163
LDL-C <110 mg/dL
HDL-C >45 mg/dL
Insulin 0-17 uU/mL
C-Peptide 0.5-2.0 ng/ml
Blood pressure < 95th percentile for
age (see attached table)
Food label reading
Fasting Labs:
Glucose 70-99 mg/dL
Cholesterol <170 mg/dL
Under the assumption that the patient
follows the guidance of the
Nutritionist, changes in biochemical
measures are expected. Evaluation of
intervention is measured in terms of
expected outcomes. Measured
outcomes (labs) will be evaluated if
feasible.
•
•
Ideal/goal value
Understands and uses food guide
to make healthy choices and
age-appropriate portion sizes
Eats meals/snacks at appropriate
times
Chooses food and amounts per
meal plan
Selects foods and drinks to fit
pattern
Uses food labels to make
healthful food choices
Selects appropriately from
restaurant or fast food menu
Modifies recipes to Ð total
fat/saturated fat and sugar
Uses healthy cooking techniques
Increase in physical activity.
Goal is 60 mins/d.
Decrease in sedentary activity.
Limit “screen” time to 2 hrs/d.
Sessions in which behavioral topics
are covered may vary according to
client’s readiness, skills, resources,
and need for lifestyle changes.
Pediatric Weight Management
Medical Nutrition Therapy Protocol
Before Initial Session
After nutrition referral
Initial Session
60 minutes
Obtain Referral Data (if possible)
Height, weight, BMI, growth chart classification (%ile)
Labs⎯fasting blood glucose, insulin, lipid profile
Blood pressure, C-Peptide (optional)
Personal and family medical history
Medications
Exercise limitations/medical clearance
Physical activity participation (including sedentary time)
Assessment: height, weight, BMI, growth chart classification
(%ile), blood pressure, lifestyle/psychosocial/nutrition history,
readiness to change, physical activity pattern
Intervention: Self-management training; nutrition prescription,
Review appropriate food guide, portion sizes, meal planning
(including age-appropriate portion sizes and fluids), physical
activity goals (if necessary), potential food/drug interaction.
Mutually set goals. Food records to be kept.
Handout(s): *Stoplight Food guide, *Diet/physical activity log, What Does a
Portion Size Look Like?, Fruits & Veggies, Think Before You Drink
Communication: Summary to PCP.
First Follow-up Session
30-45 minutes
(%ile), blood pressure, dietary intake from records, adherence and
comprehension; physical activity pattern, lifestyle changes, change
in medication.
Intervention: (as appropriate for client’s needs/interest): Selfmanagement training: reading food labels, grocery shopping, fast
food/dining out, skills to meet goals.
Handout(s): *How to Read a Nutrition Facts Label, *Healthy Eating on the Go,
Dining Out-How to Choose
Communication: summary to PCP.
Second Follow-up Session
30-45 minutes
Assessment: height, weight, BMI, growth chart classification (%ile),
blood pressure, review labs, dietary intake from food records,
adherence and comprehension, physical activity pattern, lifestyle
changes, change in medication
Intervention: (as appropriate for client’s needs/interest) Selfmanagement training: review fast food/dining out, introduce recipe
modifications, skills to meet goals. Modify medical nutrition therapy as
needed.
Handout(s): Ideas for Helping Your Child Try New Foods, Food Preparation- What
to do, Lower Calorie, Lower Fat Alternatives
Communication: Send summary to PCP.
PCP = primary care provider
© Pitt County Pediatric Dietitians and Nutrition Educators 07. 04
Pediatric Weight Management
Medical Nutrition Therapy Protocol
Third Follow-up Session
30-45 minutes
Assessment: height, weight, waist circumference, BMI, growth
chart classification (%ile), blood pressure,
lifestyle/psychosocial/nutrition history, physical activity pattern
Intervention: (as appropriate for client’s needs/interest): Selfmanagement training; Discuss lunch at school (sack lunch ideas
& healthy school lunch options). Mutually set goals. Food
records to be kept.
Handout(s): * Eat Smart Lunches
Communication to PCP: Request labs (if feasible) and send summary to PCP.
Fourth Follow-up Session
30-45 minutes
(%ile), blood pressure, lifestyle/psychosocial/nutrition history,
physical activity pattern
Intervention: (as appropriate for client’s needs/interest): Selfmanagement training; Discuss snacks (vending choices and
snacks at home). Mutually set goals. Food records to be kept.
Handout(s): *Snack Attack (age-appropriate version)
Communication: Summary to PCP.
Fifth Follow-up Session
30-45 minutes
(%ile), blood pressure, dietary intake from records, adherence
and comprehension; physical activity pattern, lifestyle changes,
change in medication.
Intervention: (as appropriate for client’s needs/interest) Selfmanagement training; Discuss physical activity (reducing
sedentary time.). Mutually set specific skills to meet activity
goals.
Handout(s): * Physical Activity, Physical activity pyramid/log
Communication to PCP: Request labs (if feasible) and send summary to PCP.
Sixth Follow-up Session
30-45 minutes
Ongoing Follow-up Sessions
Minimum contact of once
every 12 weeks
Assessment: height, weight, waist circumference, BMI, growth
chart classification (%ile), blood pressure, review labs, discuss
nutrient analysis of food records, adherence and comprehension,
physical activity, lifestyle changes, change in medication
Intervention: (as appropriate for client’s needs/interest): Selfmanagement training; Discuss setting goals and healthy
incentives (vs. food as reward). Modify medical nutrition therapy
as needed.
Handout(s): *Parents and Guardians as Role Models
Communication: Summary to PCP (including longterm goals and plans for ongoing care).
PCP = primary care provider
Pediatric Medical Nutrition Therapy Protocol for Weight Management
Prior to the first nutrition consultation, provider will review available existing medical information.
1. Determine any existing medical conditions
2. Review medical record
- Weight
- Height
- BMI
- Growth chart classification (%-ile)
- Fasting Lipids:
- Total cholesterol
- HDL cholesterol
- LDL cholesterol
- Triglycerides
- C-Peptide (optional)
- Fasting glucose
- Fasting insulin
- Document presence of acanthosis nigricans
- Family history (obesity, diabetes, hypertension, heart disease)
- Personal health history (including physical limitations)
- Physical activity (PE, sports, recreational/leisure)
- Amount of sedentary time (TV, Computer, video games, reading)
- Review medications for drug-nutrient interactions
First Session (1 hour)
ASSESSMENT
- Gather anthropometric data (height, weight, waist circumference)
- Determine BMI
- Plot BMI on CDC growth chart
- Determine growth chart percentiles for height, weight, and BMI
- Introduction (build rapport)
- Present growth chart to patient
- Identify perceived risk (re: growth chart, weight gain, lab results)
- Discuss individual’s nutrition-related goals
- What is their motivating factor? Readiness to change?
- Discuss previous weight management efforts. What were the barriers?
- Conduct 24-hr recall (Is it reflective of usual intake?)
- Discuss strengths and weaknesses of usual diet
- Determine Energy needs.
For Children 10 years and younger, determine BEE using pediatric
formula: 22.1 + 31.1 (wt in kg) + 1.16 (ht in cm)
For children/adolescents older than 10 years, use adult formula:
Males: 88.362 + (4.799 x ht in cm) + (13.397 x wt in kg) - (5.677 x age)
Females: 447.593 + (3.098 x ht in cm) + (9.247 x wt in kg) - (4.330 x age)
Activity Factors: 1.3 sedentary; 1.5 light activity
*** For overweight or at risk children (¼ - ½ pound/wk weight loss), subtract 125- 250 kcals/day.
See table defining age-appropriate goals for weight loss. There currently is no published protocol to
determine energy needs for this population. Protocol will be updated when national formula is
implemented.
©
Pediatric Medical Nutrition Therapy Protocol for Weight Management
EDUCATION
- Provide patient with meal plan and handout(s)
- Review meal plan with client and emphasize measuring servings
- Discuss sample meal and snack ideas (using foods the patient typically
consumes)
- Provide a food diary to use at home (2 week days, 1 weekend day).
Mention incentive to be provided upon return of completed diary.
- Refer patient to appropriate source to schedule follow-up
- Complete documentation in medical chart (paper or electronic).
- Send chart note to referring physician (if applicable)
ADDITIONAL EDUCATIONAL TOPICS AND EDUCATIONAL HANDOUTS
Spanish Food Diary
Spanish Food Guide
Stoplight Food Guide
Lower Calorie, Lower Fat Alternatives
Dining Out-How to Choose
Food Preparation-What to Do
Hyperinsulinemia-What is it and what can we do about it?
My FIT! Pyramid
Food Group Servings for Children
Hunger Scale
Calcium
Together…Let’s Try New Foods
Ideas for Helping Your Child Try New Foods
Modified Food Guide Pyramid (developed by ECU Family Medicine for use with 40/30/30 diet)
ADDITIONAL RESOURCES
Patient Counseling Guidelines for Families with Overweight Children and Adolescents, a Reference Tool
for Health Care Practitioners.
www.wellpoint.com/press_room/special_reports/health_parenting/PhysHandbook_final.pdf
Helping Your Overweight Child, Weight-Control Information Network, NIH Publication No. 97-4096,
updated February 1998.
If My Child is Overweight, What Should I Do About It?, University of California, Division of Agriculture
and Natural Resources, Publication 21455, Copyright 1998.
Nutrition and Your Health: Dietary Guidelines for Americans, Fifth Edition, USDA, Home and Garden
Bulletin No. 232, 2000.
How to Get Your Child to Eat…But Not Too Much (1987), By: Ellyn Satter. $16.95 ASIN# 0915950839
www.bmc.tmc.edu/cnrc is a link to the Children’s Nutrition Research Center at Baylor College of
Medicine. This site includes helpful tools to assess BMI and energy needs. There is also a link to the
brochure, Help Your Child with Successful Weight Management.
www.brightfutures.org
www.nchealthyweight.com
©
Handouts and
Worksheets
The Stoplight Food Guide
The Stoplight Food Guide lists ANYTIME, SOMETIMES and RARELY foods from
each of the food groups.
ANYTIME FOODS are part of a healthy diet. Most are low in fat, sugar and
calories. They are the best choices within a food group. Try to eat as many of the
recommended daily servings from this group as you can.
SOMETIMES FOODS are high in many nutrients that are needed for good health,
but many are also higher in fat, sugar or calories than ANYTIME FOODS. Try to
limit these foods to no more that one serving a day from each group.
RARELY FOODS have more fat, sugar and calories than foods on the
SOMETIMES or ANYTIME lists. Eat these foods no more than 1-2 times per week.
Oils
Fats
Sweets
Fats, Oils, & Sweets are mostly
RARELY foods
Use Sparingly
Milk, Yogurt, & Cheese Group
Choose 2-3 servings
Meat, Poultry, Fish, Dry Beans,
Eggs, Tofu, & Nuts Group
Choose 2-3 servings
Vegetable Group
Fruit Group
Choose 3-5
Choose 3-5
servings
servings
Bread, Cereal, Rice, &
Pasta Group
Choose 6-11 servings
Daily Servings
Grains: 6-11 Servings
1 serving =
1 slice bread,
1 ounce ready-to-eat cereal,
½ cup cooked cereal, rice, pasta,
½ of a bun, English muffin, sub roll, or bagel.
Anytime
Bagel
Breadsticks
English muffin
Fat-free crackers
Fat-free muffin
Grits
Hamburger bun
Hotdog bun
Low-sugar cereal
Loaf bread
Oatmeal
Pita bread
plain pasta
Rice
Sub roll
Spaghetti
Tortilla
Sometimes
Low fat: Cereal bars
Granola
Muffins
Crackers
Granola bars
Corn bread
Pancakes
Stuffing
Sweetened cereal
Waffles
Rarely
Biscuits
Buttered popcorn
Captain Wafers
Doughnuts
Granola
Granola bars
Hard taco shell
Hush puppies
Muffins
Nabs
Ritz crackers
Townhouse crackers
Triscuits
Fruits: 2-4 Servings
1 serving =
½ cup juice*,
1 piece fresh,
½ cup canned or fresh,
¼ cup dried
* Limit juice intake to 1-2 servings/day
Anytime
Sometimes
Rarely
Fresh, frozen or canned fruit or
juice, no added sugar
Apples
Oranges
Bananas
Peaches
Blueberries
Pears
Cantaloupe
Plums
Grapes
Strawberries
Kiwi
Watermelon
Canned fruit packed in light syrup
Cranberry juice
Dried fruit
Frozen juice bar
Sweetened applesauce
Canned fruit in heavy syrup
Coconut
Fruit cobbler
Daily Servings
Vegetables: 3-5 Servings
1 serving =
½ cup chopped, raw or cooked,
1 cup raw leafy,
½ cup juice
Anytime
Fresh, frozen or canned vegetables,
no added fat or sugar
Broccoli
Mushrooms
Butter beans
Mustard greens
Carrots
Okra
Cabbage
Onions
Cauliflower
Peas
Celery
Peppers
Collards
Potato/ Sweet potato
Corn
Spinach
Cucumbers
Squash
Fat-free coleslaw Swiss chard
Green beans
Tomato
Lettuce
Tossed salad
Sometimes
Coleslaw with low fat mayonnaise
Oven-baked fries
Potato salad with low fat mayonnaise
Tossed salad with low fat dressing
Rarely
Vegetables with added fat (fat
back, margarine, etc.)
Vegetables with cheese
Fried vegetables:
Onion rings, French fries
Tater tots, hash browns
Vegetable Salads: Tossed Salad
with regular dressing, potato salad,
coleslaw
Creamed Vegetables:
Corn, peas, spinach
Dairy: 2-4 Servings
1 serving =
1 cup milk or yogurt,
1 cup calcium fortified soy milk,
1 ½ ounces cheese,
1 cup cottage cheese,
½ cup frozen yogurt
Anytime
Sometimes
Rarely
Fat-free and artificially sweetened:
pudding, ice cream, and frozen
yogurt.
Buttermilk
Soy milk
Fat-free yogurt
Skim milk
Fat-free cheese
½ - 1% lowfat milk
Lowfat cottage cheese
Mozzarella cheese
1% chocolate milk
Low fat pudding
2% milk
Low fat yogurt
Low fat frozen yogurt Reduced fat cheese
Lowfat ice cream
Ice Cream
Whole milk
Cheese spreads: Pimiento cheese,
Cheez Wiz
Regular cheese: Cheddar, American,
Monterey Jack, Colby, Muenster
Daily Servings
Protein: 2-3 Servings
1 serving =
2 ½ to 3 ounces of cooked meat, poultry, or fish,
2 eggs,
½ cup seeds/nuts,
2 tablespoons peanut butter,
1 cup cooked dried beans,
4 oz. tofu
Anytime
All meats and poultry should be:
baked, broiled, boiled, steamed,
roasted or grilled.
Dried beans and peas Tofu
Fish
Tuna
Fat-free hot dogs
Turkey
Ham
Veggie (soy) burgers
Lean beef
Vegetarian baked beans
Lean pork
Venison
Skinless chicken (in water)
Pinto beans
Egg whites
Sometimes
Tuna or chicken salad with Low fat
mayonnaise
Chicken with skin
Low fat hot dogs
Eggs
Peanut butter
Hamburger
Baked beans
Rarely
Tuna or chicken salad with regular
mayonnaise
Bacon
Pepperoni
Bologna
Pork BBQ
Fried Chicken
Ribs
Fried fish
Salami
Hot dogs
Sausage
Tuna packed in oil
Other Foods are not needed for healthy diet, but add enjoyment to eating. There are no recommended
serving sizes or number of servings a day.
Anytime
Sometimes
Rarely
Fat-free: margarine, mayonnaise,
salad dressing, sour cream, cream
cheese, whipped topping.
BBQ sauce
Fruit spread
Butter flavored granules Mustard
Ketchup
Salsa
Cooking spray
Lemon juice
Vinegar
Low fat: margarine, mayonnaise, salad
dressing, sour cream, cream cheese, and
whipped topping
Bacon bits
Jelly
Olives
Croutons
Honey
Syrup
Jam
Low fat gravy
Butter
Cream Cheese
Dips Margarine
Fat back
Gravy
Mayonnaise
Guacamole
Meat grease
Salad dressing
Sour cream
Vegetable oil
Whipped cream
Drinks and Snacks can be eaten with or between meals. Remember that all anytime foods make great
snacks.
Anytime
Sometimes
Rarely
Sugar-free: Jell-O, Kool-Aid, diet
soda, or plain tea with Equal or
Splenda.
Baked chips
Graham crackers
Dill pickles
Rice cakes
Gum
Plain popcorn
Fat-free dips
Pretzels
Flavored water
Angelfood cake Ginger snaps
Low fat cookies Fruit chews
Hard candy
Low fat desserts
Fruit roll-ups Jell-O
Fruit Newtons Low fat toaster-pastries
Kool-Aid
Fruit punch / drinks
Cakes
Danish
Regular soda Candy bars
Doughnuts
Sweet tea
Chocolate
Honey buns
Toaster pastries Cookies
Pies
Tortilla chips
Corn chips
Potato chips
Turnovers
I need to be physically active because it will help me:
☺ do better on my school work
☺ not gain too much weight
☺ stay healthy and less likely to get heart
disease, diabetes and cancer
☺ have enough energy to do all the things I
want to do throughout the day
Tips to help me be physically active:
☼ Choose my favorite things to do on The Activity Pyramid and do them
regularly.
☼ Use a pedometer to help me count the
number of steps I take and keep track of how
close I am to the goal of 10,000 steps each
day.
☼ Spend recess time being active – I can play, walk or skip rope rather
than sit and talk.
☼ Limit the amount of time that I watch TV, play video games, and use
the computer at home to less than 2 hours each day.
☼ When I do watch TV, I can march in place during the commercial
breaks.
☼ Play games with my family like charades or Twister.
☼ Ask my parents to park the car farther away from school or the store
so that I can get some extra steps in my day.
☼ Go for a walk with my parents and spend time
telling them about my day.
for the week of _____________________
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
Physical Activity Recommendations
North Carolina Healthy Weight Initiative,
NC Department of Health and Human Services
The following tips are ideas to help families
“ensure that all children and youth participate in at least 60
minutes of physical activity every day.”
☺ Establish physical activity as a routine part of everyday life for all family
members.
☺ Avoid using or restricting physical activity as a punishment
☺ Plan special weekend activities that include enjoyable physical activity for all
members.
☺ Learn about public facilities for physical activity and use them.
☺ Become involved in promoting policies that support safe non-motorized
transportation for children and youth (walkable, bikable neighborhoods) and
increase opportunities for physical education and recess in schools.
WHAT DOES A SERVING
SIZE LOOK LIKE????
• 1 oz. bread = CD case
• 1 medium fruit= tennis
ball
• 1 oz. cheese = 2 dice
• 3 oz. meat, fish or
poultry = cassette tape
• 2 Tbsp. peanut butter =
ping-pong ball
• 1/2 cup cooked pasta =
computer mouse
Think Before You Drink!!!
Q. Can some drinks cause me to gain too much weight?
A.
YES!! Drinks sweetened with sugar give your body
energy but no nutrition from protein, vitamins
and minerals.
WHAT YOU SHOULD DRINK:
LOW-FAT MILK
100% FRUIT JUICE
2-3 cups (3-9 yrs)
3-4 cups (>10 yrs)
½- ¾ cup (1-6 yrs)
1- 1 ½ cups (7-18 yrs)
WATER
Drink plenty!!!
Consume at least:
5-6 Cups (1-3 yrs)
7-8 Cups (4-8 yrs)
10-11 Cups (9-18 yrs)
These are healthy drinks you need every day.
Many drinks give your body sugar and “empty
calories”. Taking in too many calories (even from
drinks) can quickly cause weight gain.
DRINK LESS OF THESE
SWEETENED DRINKS:
Strawberry Milk
Chocolate Milk
Fruit Punch
Sweet Tea
Slushie, Slurpee
Milkshake
Lemonade
Regular Soft Drinks
Sports Drinks
Coffee Drinks
Hot Chocolate
Powdered Drink Mix
Think Before You Drink!!!
Use this table to help you choose a smart drink.
1 cup (8 oz)
Energy
(cal)
Water (plain or 0
flavored)*
Milk, Skim*
Milk, 2%*
Crystal Light
85
130
5
Protein Fat
(g)
(g)
0
0
Carbohydrate Calcium
(g)
(mg)
0
0
8
8
0
12
12
1
0
5
0
300
300
0
(some types
are fortified)
100% Orange
Juice*
105
2
0
24
30
Regular Soft
Drink
Lemonade
Fruit Drinks or
Punch
Cranberry
Cocktail
Sports Drink
Sunny Delight
Sweetened
coffee drinks
108
0
0
27
0
108
116
0
0
0
0
27
29
0
0
144
0
0
36
7
76
0
130
0
210-310 5
0
0
5
19
30
36-49
0
0
0-100
with whipped
cream: 310410
with
whipped
cream: 1216
Sweet Tea
90
(some types
are fortified)
0
0
depends on the
amount of
added milk
23
0
Shaded portion indicates healthier choices. * Refer to serving sizes and daily needs on other side of handout.
Even 100% fruit juice is high in calories and sugars and low in fiber.
Choose the whole fruit instead of juice as often as possible.
Instead of reaching for a sweet drink, make an effort to drink more
water. It is the most satisfying and best for your body!
Having one extra cup of a sweetened drink every day for one month can
cause your body weight to go up by one pound. That is equal to 12 pounds in
one year!!
Pitt County Dietitians and Nutrition Educators 07.04
Reading Food Labels
It is important for you to know about the foods and beverages you eat and drink.
The Nutrition Facts on the food label of most foods and beverages can help you
figure out which foods are the healthier choices. The Nutrition Facts panel has a
lot of important information, but for this activity, we are going to focus on four
parts of the label: serving size, calories, carbohydrates and grams of fat.
1. Go to a grocery store or convenience store and choose two similar foods,
one of which says fat-free or low-fat, the other one regular. For example:
low-fat salad dressing and regular salad dressing, low-fat cookies and
regular cookies, baked corn chips and regular corn chips. Pick foods that
you usually eat, and then complete the chart below:
Low-fat Version
Regular Version
What is the serving size?
Is this the amount that
you usually eat or drink?
How many calories are in
a serving?
How many grams of fat
are in a serving?
How many grams of
carbohydrate are in a
serving?
2. Which of the two foods is lower in fat?
3. Which of the two foods is lower in carbohydrates?
4. Did you notice any other differences between the two labels?
Eating Healthy on the Go…
Eating out in fast food restaurants is fun and convenient.
Unfortunately, eating out is also related to weight gain. To
avoid this problem, try to eat meals at home as much as possible.
When you do eat out, it is possible to eat a healthy meal if you know how to make
the right choices.
To help you make healthier choices, keep these 3 rules in mind:
1. Beware of large portions
Many of the meals that are served in fast food restaurants have enough calories
for two people! When you make your order, always choose the small or regular
sized portions. Don’t give into pressure from the salesclerk, they may try to get
you to buy a bigger meal…just tell them “no thank you”. Children and teens don’t
need to “supersize”.
2. Choose lower-fat options
Stick to the same rules of healthy eating as you would at home. Instead of fried
foods, choose baked or grilled items.
Look for the hidden “extras”. Some choices seem like they would be healthier,
but they may have a lot of added fat and calories. Those “special sauces” can
easily make a healthy grilled chicken or fish sandwich into a not-so-healthy
choice. Look at the nutrition information sheets provided at the restaurants or
on the internet.
3. Don’t drink your dinner
Many restaurants offer “deals” that include a drink. When you are deciding what
you want to drink, keep in mind that a large regular soda or sweet tea could have
almost as many calories as your whole meal (and that’s not including refills)!
If you want to take advantage of the meal deal, you can order a diet soda or a
plain tea. To sweeten your tea, add a sugar substitute like Splenda or Equal. If
the restaurant offers milk, choose 2% or skim. The most healthy, least
expensive, and always available choice is water.
Explore Your Options…
Most restaurants offer a variety of menu items. Look
for ways you can make your usual meal healthier.
Here is an example:
Instead of:
2 Cheeseburgers
Large Fries
Large Milkshake
Try:
1 Grilled Chicken
Sandwich
Small or Medium
Fries
Diet Soda
What is your favorite fast food meal?
How can you make that meal healthier?
__________________________________________________
Dining Out--- How to Choose
You Are the Customer
•
Ask questions. Don’t be intimidated by the menu, your server will be
able to tell you how foods are prepared or suggest substitutions on the
menu. Ordering healthier meals does not have to be difficult. Try
asking these questions when you call ahead or before you order. Ask
the restaurant, whether they would, on request, do the following:
- serve nonfat (skim) milk rather than whole milk or cream
- reveal the type of cooking oil used
- serve butter, gravy, dressing, or sauces on the side
- wrap half of the entrée to be taken home
- avoid bringing abundant bread of chip baskets to the table
- substitute vegetable or salad for chips or fries
- accommodate special requests if made in advance (by telephone or in
person)
Reading the Menu
•
Choose lower calorie, low fat cooking methods. Look for terms such as “steamed in
its own juis” (au jus), “garden fresh”, “broiled”, “baked”, “roasted”, “poached”, or
“lightly sauteed”.
•
Be aware of foods high in calories, fat, and saturated fat. Watch out for terms such
as “butter sauce”, “fried”, “crispy”, “creamed”, “in cheese or cream sauce”, “au
gratin”, “parmesan”, “prime”, “pastry”, “flaky crust”, “pot pie”, or “casserole”.
Sample Healthy Choices
Breakfast
Fresh or canned fruit, whole grain bread, bagel, English muffin, whole
grain cereal with low fat milk, oatmeal topped with fruit, omelet made with
egg whites or egg substitute, whole grain pancakes with reduced-sugar
syrup, low fat or “light” yogurt
Entree
Lean meat or poultry, pasta with marinara (red) sauce, vegetable-based
dishes, salads (with low fat dressing on the side)
Dessert
Fruit, frozen yogurt, sherbet, fruit sorbet
Appetizers Steamed seafood, shrimp cocktail, salad, broth-based soup
Beverages
Water, flavored sparkling water, club soda, diet soda, tomato juice,
unsweetened tea (sweetened with artificial sweetener at the table)
SNACK ATTACK!
Snacks are important for people of all ages,
especially children and teens. Healthy
snacks between meals help us get the vitamins
and minerals needed everyday.
Snacks we choose should include 2 or 3 food
groups. Prepare ready-to-eat snacks in
advance and pack your snack for those times
when you need energy.
Choose healthy alternatives to high-fat, sugary,
low-fiber snacks. Before you get you started,
here are some ideas you should keep in mind:
● For calcium, choose low-fat dairy products
such as yogurt, milk, cheese, and pudding.
● Fruits and vegetables are great sources
of vitamins, minerals, and fiber. Many
fruits and vegetables come in their own
packaging!
● Whole grain breads, crackers, and cereals
are high in fiber and easy to pack.
● Nuts, peanut butter, and low-fat bean dip
are examples of higher fiber, protein-rich
foods that can be eaten with fruit, vegetables,
and healthy grains.
Which foods are part of a
healthy snack???
Mindful Munchies
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
Mini-pretzels
“Light” yogurt
Small banana
Apple
Orange
Grapes
Canned fruit (in juice)
Low-fat cottage cheese
Baby carrots
Cherry tomatoes
Bell pepper sticks
Whole grain crackers
String cheese
Nuts
Low-fat bean dip
Salsa
Peanut butter
Low-fat cheese
Low-fat milk
Low-sugar cereal
Low-fat granola bar
Low-fat popcorn
Combination Creation
This is your chance to be the chef.
To create your own snack combos,
you can use the Mindful Munchies
list to combine 2 of the items for a
small snack that packs a big
nutrition punch!
You’re the chef…what’s on the menu?
¾ __________ + __________
¾ __________ + __________
¾ __________ + __________
Sample Snack Ideas:
¾ 10 baby Carrots + ¼ Cup
Salsa
¾ 7 mini pretzels + 6 oz.
“light” yogurt
¾ ½ cup low-sugar cereal +
½ cup low-fat milk
Snack Goals:
¾ Instead of eating ___________________, I will
combine ___________ + ____________ to create a
healthy snack.
¾ I will enjoy a healthy snack every afternoon. I will keep
track of the days I eat healthy snacks.
¾ If I eat a healthy snack for _____________ days, I will
reward myself with ____________________.
Non-food reward
___________________________
Signature
__/__/___
Date
Let’s Try New Foods!
Enjoy all kinds of foods! That’s good advice for kids- and for you. Why? When kids learn
to enjoy many foods, they have more choices for smart eating throughout life. That’s good
because different foods promote growth and health in different ways.
Food variety makes eating more interesting and fun, too. Remember: seeing, trying,
comparing, and talking about different foods is part of learning.
Good feelings about trying new foods help lead to a lifetime of healthful eating. Try new
fruits and vegetables as fun experiences with your child.
- Offer a new food first, before foods your child eats already.
Kids usually are more
willing to try new foods when they’re hungry.
- Have your child choose a new food as you shop.
Trying new foods is more fun
for kids when they pick them.
- Do a taste test.
Talk about a new food. Have your child describe the color, shape,
feel, sound, and taste- not whether they like it or dislike it. No “yucks” allowed.
- Go for at least “one bite”.
Avoid forcing your child to taste anything. Keep food
sampling positive.
- Prepare new foods in different ways.
- Try and try again.
Many kids need to try a new food many times before they like it.
It’s normal for kids to be cautious at first.
- Relax.
Your child doesn’t need to like every food. Everyone has different food
favorites.
Adapted from Nibble For Health Nutrition Newsletter 15, USDA, FNS
Ideas for Helping Your Child Try
New Foods
Bread, Cereal, Rice,
Pasta
• Brown rice. Use instead
of white rice to add fiber
and a nutty flavor to your
recipes.
• Couscous. Add canned
tomatoes, mixed veggies,
and Parmesan cheese.
• Whole wheat pasta. For
more fiber, use these
noodles in place of the
usual white pasta.
Vegetables
• Vegetable stir-fry. Use
fresh or frozen mixed
vegetables to create
a colorful meal. Heat
a small amount of oil
or cooking spray to a nonstick skillet. Add veggies
and your own special
seasonings. Cook mixture
until veggies are soft.
Enjoy!
• Yellow squash or
broccoli. Cook and top
with low-fat cheese.
• Sweet potatoes. Lightly
coat raw slices with cooking
spray and bake (25-35 minutes
at 375 degrees) until softened.
Fruits
• Kiwi. Peel, slice, and eat!
You can also chop
the top off and eat
it out of the skin
with a spoon (like a bowl).
• Clementine. Similar to a
tangerine. Usually
seedless. Very yummy!
• Papaya and Mango.
Fresh, frozen or canned
(tropical fruit mixture)
• Berries. Check the freezer
section for frozen mixed
berries (blueberries,
blackberries, raspberries
and strawberries), or pick
them fresh at the patch!
Ideas for Helping Your Child Try
New Foods
Milk, Yogurt, and
Cheese
• Yogurt smoothie. Put
ice cubes, light yogurt,
and fruit in a blender for
a healthy snack.
• Soymilk. Try calciumfortified, low-fat soymilk
with oatmeal or cereal.
Some sugar-free
varieties are flavored
too!
• Reduced-fat cheese is
a tasty way to get
calcium! String cheese
is an example of a
lower-fat cheese.
• Low-fat cottage
cheese is good served
alone, or with fresh or
canned fruit.
• Salmon. Bake or
grill salmon with a
mixture of orange
juice, low sodium soy
sauce, and garlic.
Or, make salmon
patties from canned
salmon.
• Black beans. Cook
with chopped onions
and serve
over
brown rice.
Add salsa and fatfree sour cream if
desired.
Trying new foods doesn’t mean that you must try something unusual. If
your child has never eaten a carrot or tomato, then those would be
examples of new foods to try.
If your child doesn’t like it the first few times, don’t give up.
Many kids need to try a new food 5-10 times before they like it.
What are some new foods that you would like to introduce?
1.
2. Poultry, Fish, Dry
Meat,
3.
Beans, Eggs, and Nuts
Fruits & Veggies
Fruit and Vegetables provide nutrients such as Vitamins A and C,
fiber, and folic acid.
Try to eat fruits and vegetables that are different colors.
Red
Blue/Purple
Green
White
Yellow/Orange
Healthy Tips
Fresh, canned or frozen fruit are all healthy choices. Remember to buy
canned fruit that only contains fruit juice not syrup.
Fruit drink or fruit juice? Many fruit drinks contain added sugar
and very few nutrients. These drinks are ok on occasion, but the
best everyday choice is 100% fruit juice.
Even 100% juice should be limited to 6 oz per day. Instead of
drinking juice, eat the whole fruit.
Replace sugar-sweetened beverages with sugar-free drinks or water
(plain or flavored).
Young children (less than 4 years) may choke on raw fruits and
vegetables such as carrots or grapes. Do not leave your young child
unattended while they are eating.
How Much is a Serving?
A serving of fruit equals:
1 medium piece of fruit
¾ cup of juice
¼ cup of dried fruit
½ cup of canned fruit*
A serving of vegetables equals:
½ cup of chopped raw or
cooked vegetables
1 cup of raw leafy vegetables
*Fruit should be canned in own juices
Snack Ideas
Chilly Banana
Peel a banana and cut in half. Insert a popsicle stick in the center. Wrap
banana in foil and freeze. Enjoy frozen banana plain or with 1 teaspoon
peanut butter.
Caterpillar Crawl
Fill a celery stalk with 1 teaspoon peanut butter and add several raisins for
the body. Add cut up carrot sticks for the antennae.
Goals:
1.____________________________________________________________
2.____________________________________________________________
Calcium
Why do I need calcium?
Calcium helps keep your bones and teeth strong. It also helps your heart
work better and your muscles contract. Calcium also might help control
your weight.
How much calcium do I need?
Age
1-3 years
4-8 years
9-18 years
Calcium
500 mg
800 mg
1300 mg
Food Servings
2
3
4
Where is calcium?
Food
Milk
Yogurt
Collards
Yellow Cheese
Oatmeal
Ice Cream
Serving Size
8 ounces
1 cup
½ cup
1 ounce
½ cup
½ cup
Calcium (mg)
300 mg
150-450 mg
179 mg
174 mg
163 mg
88 mg
Calcium Fortified Foods
There are a number of foods that have calcium added to them including
orange juice, bread, cereal. You can use the label to help you figure out how
much calcium is in a food.
Supplements
Of course we want you to get your calcium from food, but if you can’t, there
are many calcium supplements that can be used. Your dietitian and doctor
will help you decide which is the best option for you.
When reading the label
for calcium it is easy to
find out how much is in
the food. All you have
to do is drop the % sign
and add a zero. Then
you have the milligrams
of the food.
For example, this label
says there is 20%
calcium per serving.
That means that there is
200mg in one cup of
macaroni.
Calcium Goals
My body needs __________ mg of calcium each day.
By my next visit I will:
1. _______________________________________
2. _______________________________________
3. _______________________________________
Signature:___________________ Date:__________
Parents & Guardians as Role Models
What can you do?
• Eat smart and move more. Your children will learn by
watching you make healthy choices.
• Try new foods with your child
• Eat meals as a family
• Eat lunch with your child at school
• Get active with your child (walk, bike, play)
• Provide meals with foods from each food group
• Reward your child with non food items
o Give them praise!!!
o Take them to the movies
o Buy them a book or tape of their choice
• Talk to your child about healthy eating
• Keep healthy snacks in your house
• Limit fast food and restaurant meals
• Limit time in front of the T.V.
o 2 hours per day maximum
• Eat at the kitchen table and turn the TV off when
eating
• Avoid criticizing or name calling
• Try to turn negatives into positives
o Example: If your child wants to eat a candy bar
and soda for a snack
Negative response: “You shouldn’t eat that
because you are going to get fat”
Positive response: “How about a granola bar
that has chocolate chips and a flavored water
or milk”
My Goals as a Parent or Guardian:
1.____________________________________
____________________________________
2.____________________________________
____________________________________
3.____________________________________
____________________________________
Signature:_________________________________
Date:______________
Sometimes Foods:
____ Servings Eaten
Milk & Milk
Products:
______
Servings
Eaten
Meat & Meat Alternatives:
_____ Servings Eaten
Fruits:
_____
Servings
Eaten
Vegetables:______
Servings Eaten
Breads,
Cereals, &
Grains:
____ Servings
Eaten
My Name:__________________
Food Group
Servings Eaten
Today
Servings
Goal
Date:
Today’s Date:_____________
Eat More
Servings
Bread
Vegetables
Fruit
Milk & Milk
Products
Meat & Meat
Alternatives
Sometimes
Foods
Scores
Eat Fewer
Servings
Food Preparation—What to Do
Low fat cooking methods
• Bake, broil, microwave, roast, or steam
• Lightly stir-fry or sauté in cooking spray, small amounts of oil, or reduced sodium broth
• Grill seafood, chicken or vegetables
Low fat flavorings
• Mustard, salsa, ginger, lemon or lime juice, parmesan cheese, salt substitute, low fat salad
dressings, flavored vinegars
• Spices- cinnamon, nutmeg, pepper, or paprika
• Herbs- oregano, basil, cilantro, thyme, parsley, sage, or rosemary
Instead of………
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Evaporated whole milk
Whole milk
Ice cream
Whipping cream
Sour cream
Cream cheese
Cheese (cheddar, Jack, Swiss,
American, Mozzarella)
Regular (4%) cottage cheese
Whole milk ricotta cheese
Half and half or creamer
Alfredo (white) sauce
Granola
Bologna & high-fat lunch meat
Bacon or sausage
High fat ground beef
Poultry with skin or dark meat
Oil-packed tuna
Fried fish
Whole eggs
Croissants
Donuts, muffins, pastries
Pound cake or sheet cake
Canned cream soups
Frozen dinners
Replace with ………
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Evaporated fat free (skim) or reduced fat milk
Reduced fat (2%), low fat (1%) or skim milk
Sorbet, sherbet, low fat frozen yogurt or ice milk
Light or fat free cool whip
Light or fat free sour cream
1/3 less fat cream cheese
Reduced fat cheeses or fat free singles
String cheese
Reduced fat (2%) or low fat (1%) cottage cheese
Part skim ricotta cheese
Low fat milk (2%) or nonfat dry milk powder
Marinara (red) sauce
Oatmeal or lower-sugar cereal
Light bologna & lean deli meats (turkey, ham, chicken)
Turkey bacon and Canadian bacon
Ground sirloin
Skinless breast (white) meat
Water-packed tuna
Grilled, baked or broiled fish
Egg whites or egg substitute
Hard French rolls or “brown & serve” rolls
English muffins, small bagels, low-fat muffins
Angel food cake
Canned broth-based soups
Lean or lower-fat frozen dinners
Join the Winner’s Circle
Look for the purple star and fork
in your school cafeteria and
vending machines. Choose foods
and drinks that are marked with
the Winner’s Circle logo.
Ask your teacher and parents to
help you choose healthy Winner’s
Circle items from the school
lunch menu. Healthy foods and
drinks are marked with a “*” on
the school lunch menu that you
take home every month.
Baked,
Not Fried
Did you know that the tasty
French fries and yummy chicken
nuggets that you get in your
school cafeteria are not fried?
They taste just as good baked,
and are healthier for you!
Lunch Packing Tips:
☺ Use a variety of breads in
sandwiches – bagels, rolls,
pita pockets, English
muffins, raisin or multigrain
breads.
☺ Take a pasta salad made
with fun-shaped and
colored pasta – small
shells, wagon wheels or
corkscrews.
☺ Use lean meats in
sandwiches and salads –
turkey breast, chicken
breast, ham or roast beef.
☺ Choose milk that is 2%, 1%
or fat-free.
☺ Don’t forget the fruit –
take fresh fruit or fruit cups
packed in light syrup or
juice.
☺ Find ways to add veggies to
meals – put them in
sandwiches, pasta salads or
soups.
for the week of _____________________
1. Choose Winner’s Circle lunches at school at least
times each week.
2._________________________________________________
3._________________________________________________
Only Turkeys Get Stuffed
Overeating can make you feel sleepy and slow at school.
Take only one helping and don’t fill up on sodas, Kool-Aid and
other sugar-sweetened drinks, candies, and desserts. Be sure to eat
breakfast every morning. Eating a healthy breakfast will keep your
body and brain fueled throughout the school day.
What’s Good for Lunch?
Circle the healthy food and drink items that you can choose at your school.
Bananas
Soda
Water
Ice Cream
Cookies
Pretzel
Potato Chips
100% Juice
Milk
Kool-Aid
Candy
Winner’s
Circle Items
Carrots
Hunger Scale
Most of us eat when we aren’t hungry some of the time. Instead of listening to our
body’s sign of hunger, we eat for other reasons. Sometimes we start eating because it’s
time to eat, or it’s our favorite food. Sometimes our feelings trigger us to eat when we
aren’t hungry.
For some of us, once we start eating, it is hard to stop. Overeating may be a habit, but
overeating can also be triggered by our feelings, the great taste of a favorite food or
watching TV while eating.
Try listening to your body’s signs of hunger and fullness. Use the HUNGER SCALE to
make a note of your hunger before you start and right after you stop eating. Write down
how hungry you feel before you start eating – very hungry, hungry, not hungry, and then
how you feel when you stop eating – satisfied, full, or stuffed.
The goal is to learn to eat only when you are hungry and to stop when you are satisfied.
This takes practice. Try to be honest with yourself and in touch with your feelings of
hunger and fullness.
Healthy Guidelines for Weight Management
Your child has been identified as being overweight or at risk for becoming
overweight. Weighing too much increases the risk that children will suffer
complications from diseases such as high blood pressure, heart disease,
diabetes, cancer, and sleep apnea.
It is important to work together as a family to help your child achieve a healthy
weight. As the parent or guardian, you must model healthy eating and physical
activity habits.
These are just a few tips to get your family on the right track. The whole family
will need to practice eating healthier and being more active. Think of these
changes as “being healthy”, instead of “dieting”:
•
Eat regular meals (breakfast, lunch, dinner).
•
Eat smaller portions, especially of high fat foods.
•
Eat more fruits and vegetables (fresh, frozen, canned in natural juice).
•
Drink more water or sugar-free beverages.
o Avoid regular soda and other sugarsweetened beverages (Kool-Aid, Gatorade,
juice, punch, and sweet tea).
o Limit juice intake to 4-6 ounces per day.
•
Read the food label. It is important to be aware of the amount of calories
each food provides per serving. Your child’s
energy needs depend on his/her body size, age,
and activity level. For a “ball park” figure, use this
table to estimate your child’s energy needs. Keep
in mind that these recommendations are for
children who are active. If your child spends a lot
of time sitting instead of playing, they will need
fewer calories per day.
Age (years)
Calories
Carbohydrate
(grams)
Protein
(grams)
Fat
(grams)
1-3
4-8
9-13
14-18 girls
14-18 boys
1200-1300
1800-1900
2200-2500
2000-2200
2700-3000
200-210
290-300
330-350
280-330
375-425
15-20
25-30
75-100
55-90
100-140
40-45
60-65
75-85
70-75
90-100
Healthy Guidelines for Weight Management
•
Choose lean meats, poultry, and fish such as:
o Chicken or turkey without the skin
o Lean cuts of beef (ground round, flank steak, sirloin, tenderloin)
o Lean pork trimmed of visible fat
(tenderloin, center loin)
o Any fish that is not breaded or fried
(broiled, baked, and grilled are healthy choices)
o Low-fat deli meat (less than 3 grams of fat per serving)
•
Choose low-fat dairy products.
o Switch from whole milk to 2% and eventually 1% or skim milk.
o Eat lower-fat cheeses: cottage cheese, string cheese, fat-free
cheese slices, ricotta, and feta.
o Eat low-fat or fat-free (“light”) yogurt.
•
Avoid high-fat and high-sugar snack foods.
o Beware of foods that are fat-free or sugar-free. They may still
have a lot of calories, and it’s tough to control portions.
o Be creative with your snacks! A healthy snack includes smaller
portions from 2 different food groups.
•
Instead of frying foods, try baking, grilling, boiling, or broiling.
o Use non-stick pans or cooking spray (ex: Pam) instead of oil.
•
Move more and sit less!
o Do not watch more than 2 hours of TV
each day.
o Make an effort to be active as a family.
o Encourage your child to play at least 30
minutes every day.
For an individual nutrition evaluation, make an appointment with a registered
dietitian. The dietitian will work with your child to develop personal goals to
achieve a healthy weight. It is important for parents or guardians to attend
these meetings for support and understanding of the issue. Your pediatrician
will be able to provide you with the referral information you will need to
schedule an appointment.
Name:______________________ Physician: ______________ DOB: ___/___/___
Food Diary Instructions (example diary is shown below):
1. Choose three consecutive, typical days to record. Include two weekdays and 1 weekend
day. For example: Thursday, Friday, and Saturday.
2. Record all foods and beverages (including water) that are consumed.
3. List portion sizes of all foods and beverages. Be as specific as possible. For example: 2
ounces of chicken breast, ¼ cup mashed potatoes, 8 ounces orange juice. Estimate
meat portions after cooking.
4. List brand names of foods if known.
5. Describe how each food is prepared. (For example, fried chicken, scrambled eggs, and
roasted pork.)
6. Record any “extras”/condiments used and amount. (For example, 1 tablespoon
mayonnaise, 1 teaspoon butter, 2 tablespoons Italian salad dressing).
7. List any snacks (foods and beverages) consumed in between meals.
8. If you eat away from home, list the name of the restaurant.
9. If a combination food was consumed (such as a casserole, salad, or stew), please list all
ingredients and the total amount consumed.
Time
Amount
7:00 AM 2 cups
Food
How Prepared
Where Consumed
Honey-nut Cheerios
n/a
kitchen
1 1/2 cups
2% milk
n/a
kitchen
8 oz.
apple juice
n/a
kitchen
1/2 piece
Wonder White bread
toasted
kitchen
1/2 tsp.
Promise margarine, regular
n/a
kitchen
Smucker's grape jelly
n/a
kitchen
10:00 AM 1
1 tsp.
medium apple
n/a
break room
12:30 PM 1
Chicken-Supreme Burrito
n/a
Taco Bell
1
Beef Soft Taco
n/a
Taco Bell
16 oz.
Dr. Pepper
n/a
Taco Bell
Lance peanut butter/cheese crackers
prepackaged
home
4:00 PM 1 pkg. (6 crackers)
12 oz.
7:15 PM 4 oz.
water
n/a
home
chicken breast (no marinade)
grilled
home
home
1/2 cup
Ragu alfredo sauce
heated-stove top
1 1/2 cups
spaghetti noodles
boiled in water
home
1/2 cups
2 tbsp.
tossed salad (iceburg lettuce, tomatoes)
Kraft fat-free Italian dressing
n/a
n/a
home
home
8 oz.
9:00 PM 1/2 cup
lemonade
prepackaged
home
Del Monte fruit cocktail (lite syrup)
prepackaged
home
FOOD DIARY
Name:______________________________
Date:_______________________________
Time
Food
Amount
Brand
Name
How Prepared
Where
Consumed
NUTRITION FOLLOW-UP
Date(dd/mm/yyyy): ________________________
Age: ____________ BMI: ________ BMI %: ________
Wt: _______lbs, Ht:_______in, Previous Wt: ________lbs, Wt ∆ ↑ ↓ −_______lbs; Ht: ________in, Ht ∆↑ ↓ −_______in
Current Story:________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
NUTRITION HISTORY
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
DIETARY RECALL
Breakfast
AM
Lunch
PM
Dinner
HS
-----------------------------
TV/Computer/Activity: _________________________________________________________________________________
Medication/Herbs/Vitamins/Minerals:______________________________________________________________________
Clinical Findings:_____________________________________________________________________________________
ASSESSMENT
WT Gaining Losing Maintaining
FOLLOWING RECOMMENDATIONS Yes No
MOVING TOWARDS GOAL: Yes No
___________________________________________________________________________________________________
___________________________________________________________________________________________________
GOALS: ___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
HANDOUTS: ________________________________________________________________________________________
FOLLOW-UP: __________________TOPIC TO DISCUSS:__________________________ VISIT #__________________
Lab Measures, Goals,
and Handouts
Pediatric Weight Management MNT Protocol Clinical Assessment
Measurement
Date
My
Value
Healthy Numbers
Blood Glucose or Blood
Sugar (fasting)
Normal
70-99 mg/dL
Lipids (fasting)
Acceptable
(mg/dL)
<170
<110
>35
¾
¾
¾
¾
Total Cholesterol
LDL-C (Lousy)
HDL-C (Healthy)
Triglycerides
pre-diabetes
100-126 mg/dL
Borderline
(mg/dL)
170-199
110-129
High
(mg/dL)
>200
>130
Triglyceride (mg/dL) normal levels
Male
Female
0-5yrs
30-86
32-99
6-11yrs
31-108
35-114
12-15yrs 36-138
41-138
10-19yrs 40-163
40-128
Insulin (fasting)
Normal = 0-17 uU/mL
C-Peptide
Normal = 0.5-2.0 ng/mL
Blood Pressure
Hypertension: <95th percentile (based
from gender, age, and height)
- Gender, height, and weight
are all considered and
plotted before determining
whether the child has high
blood pressure.
Prehypertension:
• 90-94th percentile (based from
gender, age, and height)
• adolescents: >120/80
<85th percentile (using gender and ageappropriate CDC growth charts)
Body Mass Index (BMI)
- measures body fatness
Waist Circumference
No reference value for children and
adolescents.
Blood must be drawn for glucose, lipid, insulin, and C-Peptide measurements. Urine is not used to evaluate any of the above
measurements. Fasting means that no food or drink is consumed for 12 hours before the blood is drawn.
Nutrition and physical activity directly impact each of the above measurements. If
you make an effort to eat smart and move more, your body will thank you.
What is BMI?
Body Mass Index (BMI) is a number that is calculated for children and adults using height and
weight measurements. For children (ages 2-20), this number is plotted on the CDC growth
charts to compare BMI with other children of the same age and gender.
If you want to determine BMI, use the calculation below:
Weight (lb) / Height (in) / Height (in) x 703
What is Body Mass Index?
Body Mass Index (BMI) is a number that is calculated for children and adults using height and
weight measurements. For children (ages 2-20), this number is plotted on the U.S. Centers for
Disease Control (CDC) growth charts to compare with other children of the same age and sex.
How should I interpret my child’s BMI?
The curved lines on the CDC growth chart show how your child’s BMI ranks compared to other
children his or her age and sex. For example, if a child is plotted on the 75th percentile line for
BMI-for-age, it means that 75 of 100 children (75%) of the same age and sex have a lower BMIfor-age. It also means that 25 of 100 children (25%) of the same age and sex have a higher
BMI-for-age.
According to the CDC, children with a BMI:
• Between the 85th and 95th percentile are at risk for overweight
• Greater than the 95th percentile are overweight.
How is BMI decreased?
Body Mass Index will decrease if:
- Height is gained and weight remains the same
- Height is gained and weight is lost
- Height remains the same and weight is lost
It is not necessary to focus on weight. As children grow, if they are able to maintain their
weight, their BMI will eventually decrease. This will reduce the risk of future health implications
that are related to being overweight as a child. If your child is considerably overweight, they will
work with their dietitian or health care provider to lose weight at a healthy rate. Eating smart
and moving more are two important goals to build on as your child moves toward achieving a
healthier weight.
It is important to keep track of your child’s measurements at each doctor’s office visit. This helps
you see if there are any big changes in your child’s growth. If your child’s BMI changes a lot in
one year, you should talk with your doctor about it.
What is high blood glucose?
Blood glucose is a measure of the sugar level in your blood. If the level is high, it
means that there is too much sugar. If your blood glucose level remains high for a
long period of time it can lead to damage of your blood vessels and organs and
may lead to developing diabetes.
If your glucose lab value was elevated, there are several changes you can
make in your diet before you have an appointment with a nutritionist.
1. Begin to cut back on the number of sweetened beverages you drink
including sodas, sweet tea, Kool-Aid, Jungle Juice and fruit punch. For
children ages 1-6 years old, limit sweetened beverages to 4-6 oz per day
and for children 7-18 years old, limit sweetened beverages to 8-12 oz per
day.
Better choices include: plain or flavored water, diet sodas, Crystal Light,
sugar-free Kool-Aid, or unsweetened tea with a sweetener such as Splenda
or Equal.
If you drink juice, choose 100% juice and count this toward the sweetened
beverages limit for the day.
2. Choose cereals wisely. Try to limit cereal to 1-cup servings. Limit intake
of sugar-sweetened cereals such as Frosted Flakes, Fruit Loops, Fruity
Pebbles or Coco Puffs. Instead, choose a cereal with less than 10 grams of
sugar and at least 3 grams of fiber per serving.
3. Choose snacks wisely. Avoid eating snacks that have a lot of sugar.
Healthier snack choices include graham crackers, string cheese, low-fat
popcorn, carrot sticks, or fruit.
If you have any questions about your lab values and/or what you can do to
improve them, be sure to consult your nutritionist or health care provider. They
will educate you and your child about making healthier choices to help lower
blood glucose levels.
What is high blood pressure?
Blood pressure is the force in the arteries when the heart beats (systolic pressure) and
when the heart is at rest (diastolic pressure). It's measured in millimeters of mercury (mm
Hg). In children and adolescents, high blood pressure (hypertension) is based on age,
weight and height. If the child’s blood pressure is greater than 95% of other children of
the same age, height, and weight, they are considered to have high blood pressure.
Children and adolescents are considered to have prehypertension if their blood pressure
percentile is between 90 and 94. For adolescents, a blood pressure greater than 120/80 is
also an indicator of prehypertension.
Uncontrolled high blood pressure can cause damage to organs such as your kidneys and
heart. In order to prevent potential health problems, it is important to reduce blood
pressure levels as soon as possible.
Recommendations for lowering Blood Pressure
•
Eat more fruit and vegetables. Strive for recommended servings each day.
•
Meet your daily calcium needs from dairy foods or calcium supplement.
Ages: 1-3
500mg
4-8
800mg
9-13
1300mg
14-18
1300mg
•
Increase intake of unsalted nuts, seeds and legumes.
o Try to consume 1/3 cup unsalted almonds, pecans, peanuts or
2 tablespoons of peanut butter 3-4 times per week.
•
Increase physical activity. Try to accumulate 30-60 minutes of physical activity
each day. Do something you enjoy. Examples of physical activity include:
bicycle riding, walking, swimming, skipping, jumping on a trampoline or playing
basketball.
What is C-Peptide?
C-peptide is a protein that is measured in the blood to help assess
your risk for developing hyperinsulinemia (high insulin in the blood).
C-Peptide=Protein that links to insulin in the pancreas (the organ
behind the stomach)
Insulin=Hormone released from the pancreas to help move glucose
(sugar) into the muscle to be used for energy. This is important
so that you can play, be active and have brain power.
Your doctor looks at the c-peptide level in your blood to see if
you might develop high insulin in your blood. Many scientists
believe that a high c-peptide leads to a high insulin level in the
blood, which increases the risk for diabetes in the future.
Normal C-peptide= 0.4-2.2 ng/mL
Your C-peptide level=__________ng/Ml
Hyperinsulinemia
Packet
Hyperinsulinemia:
What is it, and what can we do
about it?
A teaching tool for children and teens
who have elevated
levels of insulin in their blood.
Hyperinsulinemia...
When the body's cells are resistant to
the action of the insulin, it is called
insulin resistance. Eating too many
carbohydrates (soda, candy, juice, bread)
may contribute to insulin resistance. When this occurs,
the pancreas produces too much insulin. The extra
insulin found in the blood is referred to as
Hyperinsulinemia. This condition is related to
increased weight and may be a step toward developing
Type 2 Diabetes.
Department of Family Medicine
Brody School of Medicine at ECU
7/04
Hyperinsulinemia and being
overweight go hand in hand.
Eating too much and exercising
too little can cause weight gain.
Causes
Do you...
•
Eat while you are watching TV?
•
Spend more than 2 hours per day
in front of the TV, computer, or
playing video games?
•
Use food or desserts as a reward?
•
Eat when you are not hungry or
just bored?
•
Eat a lot of sugary snacks?
•
Eat out often?
•
Drink soda or more than 6 oz. of
juice everyday?
7/04
Prevention &
Intervention
1. Work together as a family
to prevent becoming overweight
by eating smart and moving more.
2. Monitor your diet with a dietitian . A meal plan
with fewer carbohydrates may
reduce insulin resistance and
weight.
3. Increase physical activity.
Instead of watching TV, do
something active to reduce
insulin resistance and weight.
7/04
Carbohydrate
Counting
Our bodies need carbohydrates for energy. It is important
to eat enough to be healthy, but it is not healthy to eat more
than our bodies need. Your dietitian will work with you to
determine your diet needs. You will be given a daily
carbohydrate allowance. You will need to add up the
carbohydrates in everything you eat or drink and subtract
that number from your total allowance. Think wisely about
how you want to “spend” your allowance.
Your carbohydrate allowance is
_____ grams.
Examples of Foods with
carbohydrates:
• Bread, Cereal, Rice, Pasta
• Starchy vegetables (corn, potato, beans, peas)
• Fruit, Fruit juice
• Milk and yogurt
• Sugar and other sweets
7/04
Each serving of
Carbohydrate counting
continued...
Carbohydrates has about
15 grams.
Examples of 1 serving size:
• 1 small piece of fruit
• 1/2 bagel, English muffin, or
biscuit
• 1 slice of bread
• 1/2 cup of cereal
• 1 cup of milk, or “light” yogurt
• 8 animal crackers
• 1/2 cup corn, grits, peas, rice,
pasta, or mashed potato
• 17 small grapes
• 3 cups of popcorn
7/04
Physical
Activity
Diary
ACTIVITY
HOW MANY
MINUTES?
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
My Food Diary
What
(food/
drink)
When
(time)
Where
(home/work
church/school)
How
(fried/baked)
Hungry
(Y/N)
Carbohydrates
(subtract)
Start= ___g
7/04
Simple Activity Ideas
*Be more active during recess
*Help with the house work or yard work
(vacuuming, taking out trash, mowing the lawn)
*Take the dog for a walk
*Play with brother or sister
*Jump rope, play tag, ride a bike, play outside
*Play in the pool or at the beach
*Push the cart at grocery store
*Help make dinner
*Stand up (instead of sitting down) more often
*Walk around the house during tv commercials, or
while talking on the phone
7/04
Responsibilities
Parent:
•
Attend nutrition appointments.
•
Help child keep food diaries & count carbohydrates.
•
Encourage physical activity.
•
Be a good role model by eating smarter and moving
more
•
Be an active participant—keep healthy foods in the
house.
Child/Teen:
•
Attend nutrition appointments.
•
Keep food diaries & count carbohydrates.
•
Be active!
7/04
ModifiedFoodGuidePyramid
Fats, Oil, andSweets
2–3servings
Milk, Yogurt, andCheese Group
2–3servings
Meat, Poultry, Fish,
andEggs
3+servings
Fruit Group
2–4servings
Vegetable Group
3–5servings
©Department of FamilyMedicine, TheBrodySchool of MedicineatECU
For use inHyperinsulinemiaResearchStudyOnly
Bread, Pasta,
Starchy
Vegetables, Cereal
&Bean Group
5–8servings
Always look at the
serving size first →
Place your mess age here. For maximum i mpact, use t wo or three sent ences.
Add up the total
amount of
carbohydrate
→
*Don’t forget write it in your
food diary
Try to get 100% of your
Calcium
→
* You may need to take a calcium
supplement to help you meet your
needs
Brody School of Medicine at ECU 7/04
WHAT DOES A SERVING
SIZE LOOK LIKE????
• 1 oz. bread = CD case
• 1 medium fruit= tennis ball
• 1 oz. cheese = 2 dice
• 3 oz. meat, fish or
poultry = cassette tape
• 2 Tbsp. peanut butter =
ping-pong ball
• 1/2 cup cooked pasta =
computer mouse
High carbohydrate foods add
up fast & everything counts!
• 12 oz Coca Cola = 39g
• 12 oz. Mountain Dew = 46g
• 12 oz. fruit punch = 45g
• 1/8 cake with icing = 35g
• 25 Peanut M&M’s = 30g
• 1 glazed donut = 22g
• 1 choc. covered donut= 33g
• 32 Cheese Nips = 32g
• 59 (2.3 oz) Skittles = 59g
7/04
SNACK ATTACK!
Remember to keep track of the carbohydrates in your
snacks. Read the labels and measure your portions so
that you can fit your favorite snacks into your meal plan.
5-7 grams
1/4 cup non-sweet cereal
1/2 cup mixed vegetables
1/2 cup low-fat milk
6 grapes
1 graham cracker square
1 stalk celery with 1 teaspoon
peanut butter
15-20 grams
1/2 turkey sandwich
1/2 cup chocolate milk
1 orange
1 cup “light” yogurt
1 low-fat granola bar
3 cups low-fat popcorn
8-10 grams
5 baked potato chips
1/4 cup 100% fruit juice
10 baby carrots
3 wheat crackers
1 popcorn cake
1/4 cup sweet cereal
1 plum
FREE (0-5 grams)
Sugar-free drinks (Crystal Light,
Wyler’s Light, Sugar-free Kool-Aid, diet sodas,
water)
Sugar-free Jell-o
1 string cheese stick
1/2 cup low-fat cottage cheese
2 stalks celery with 2 tablespoons
salsa
A healthy snack combines foods from two groups.
Carbohydrates are
important, but we also
need to pay attention to
fat...
There are different types of fat in our foods. Some
fats are less-healthy than others. Saturated fat
is usually solid at room temperature. Examples
include: meats, cream, whole milk, butter, cheese,
ice cream, poultry skin, and bacon. Eating too
much of this type of fat can clog your arteries and
make it harder for blood to flow to the heart and
brain. This type of fat is not healthy, and should
be avoided.
A healthier type of fat is called unsaturated fat.
This type is most often found in plants. It is liquid
at room temperature. There are different types of
unsaturated fats. Polyunsaturated fats are
found in reduced fat mayo, salad dressings, and
margarine. Monounsaturated fats are better for
you. They are found in nuts, seeds, and olive oil.
7/04
Hyperinsulinemia is a serious condition,
but the good news is that it can usually be
controlled by eating smarter and moving
more.
Your dietitian will work with you to
determine a healthy meal plan with fewer
carbohydrates. This book will help you
understand your personal goals and how
different foods fit into your plan.
If you have any questions, call your doctor
or dietitian.
Growth Charts and
Blood Pressure
Percentile Charts
2 to 20 years: Boys
Stature-for-age and Weight-for-age percentiles
Mother’s Stature
Date
Father’s Stature
Age
Weight
Stature
BMI*
NAME
RECORD #
12 13 14 15 16 17 18 19 20
cm
AGE (YEARS)
97
190
90
185
75
50
25
180
175
170
10
in
62
S
T
A
T
U
R
E
60
58
56
54
52
50
48
46
44
42
40
38
36
cm
3
4
5
6
7
8
9
10 11
3
165
160
160
155
155
150
150
74
72
70
68
66
64
62
60
140
105 230
135
97
100 220
130
125
90
95 210
90 200
120
85
115
80
75
75
110
105
50
100
25
95
10
90
3
190
180
170
160
70
150 W
65 140 E
I
60 130 G
55 120
34
85
50 110
32
80
45 100
40 90
35
35
30
30
25
25
20
20
15
15
10
kg
10
kg
80
70
60
50
40
30
lb
S
T
A
T
U
R
E
145
30
W
E
I
G
H
T
in
76
AGE (YEARS)
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
80
70
60
50
40
30
lb
H
T
2 to 20 years: Girls
Stature-for-age and Weight-for-age percentiles
Mother’s Stature
Date
Father’s Stature
Age
Weight
Stature
BMI*
NAME
RECORD #
12 13 14 15 16 17 18 19 20
cm
AGE (YEARS)
190
185
180
95
90
175
170
75
in
62
60
58
56
S
T
A
T
U
R
E
54
52
50
48
46
44
42
40
38
cm
4
5
6
7
8
9
10 11
160
50
25
155
10
5
150
165
160
155
150
50
40
30
lb
66
S
T
A
T
U
R
E
64
62
60
100 220
130
125
95 210
90 200
120
85
95
115
80
110
90
75
190
180
170
160
70
105
75
100
95
85
60
68
135
34
70
70
105 230
50
150 W
65 140 E
I
60 130 G
55 120
25
10
5
80
30
W
E
I
G
H
T
72
140
90
80
74
145
36
32
3
in
76
50 110
45 100
40 90
35
35
30
30
25
25
20
20
15
15
10
kg
10
kg
AGE (YEARS)
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
80
70
60
50
40
30
lb
H
T
2 to 20 years: Girls
Body mass index-for-age percentiles
Date
Age
Weight
Stature
NAME
RECORD #
Comments
BMI*
BMI
35
34
33
32
31
95
30
29
BMI
28
90
27
27
26
26
85
25
25
24
24
75
23
23
22
22
50
21
21
20
20
25
19
19
10
18
18
5
17
17
16
16
15
15
14
14
13
13
12
12
kg/m
2
kg/m2
AGE (YEARS)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
2 to 20 years: Boys
Body mass index-for-age percentiles
Date
Age
Weight
Stature
NAME
RECORD #
Comments
BMI*
BMI
35
34
33
32
31
30
95
29
28
BMI
90
27
27
85
26
26
25
25
75
24
24
23
23
50
22
22
21
21
25
20
20
10
19
19
5
18
18
17
17
16
16
15
15
14
14
13
13
12
12
kg/m
2
kg/m2
AGE (YEARS)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Achieving A Healthy Weight In Children

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