EDUCATION
BS Nutrition and Dietetics, University of California at Berkeley
EXPERIENCE
Author, Diabetes Type 2 Complete Food Management Program Prima Publishing 11/01
Column Writer, diabetesincontrol.com, monthly nutrition column 1/02 - 12/02
Dietitian, UCSF Medical Center, Diabetes Clinic and Diabetes Teaching Center
Medical nutrition therapy counseling for individuals in adult and pediatric diabetes clinics, and the Diabetes and Pregnancy Program. Instructor for classes on diabetes self management for Type 1 and Type 2 diabetes. Topics including carbohydrate management, weight control, exercise, and diet strategies for co-morbidities such as hyperlipidemia and hypertension. Mentor/instructor for the dietetic internship program. Faculty in the school of medicine: diabetes management classes for 2nd year medical students.
(10/94-present)
Dietitian, UCSF Medical Center, San Francisco, CA.
Inpatient dietitian for Medicine, Cardiac, and Obstetrics floors. TPN/PPN assessments, tube feedings, therapeutic diets, and patient diet education including diet therapy for diabetes, AIDS, CF, GI, renal and liver failure. Supervised dietetic technicians and trained dietetic interns.
(7/93-10/94)
Dietitian, UCSF Obstetrics Clinic, San Francisco, CA.
Nutritional intervention and counseling for obstetric patients, Special Care Obstetrics Clinic, Diabetes and Pregnancy Clinic, and postpartum counseling. Infant feeding guidelines.
(2/93-7/93)
Dietitian, UCSF Outpatient Nutrition Clinic, San Francisco, CA.
Counseling patients on medical nutrition therapies for weight management, hyperlipidemias,
HTN, renal, AIDS, cardiac and GI disorders. Trained dietetic interns.
(10/92-2/93)
Dietitian/Kitchen Supervisor, Marin General Hospital, Greenbrae, CA.
Inpatient dietitian coverage for all hospital units. Responsible for patient care plans, screening, counseling, charting. Supervised staff in production of patient and cafeteria meals.
(6/92-10/92)
Diet Technician, UCSF Millberry Union Nutrition Center, San Francisco, CA.
Computer assisted diet analysis. Body composition measurements.
(8/90-6/93, 20% time)
PROFESSIONAL AFFILIATIONS
- American Dietetic Association
- American Diabetes Association
- American Association of Diabetes Educators
Lectures and Presentations
- 7/93 Nutritional Management of Gestational Diabetes
UCSF Dietetic Interns
- 3/94 Gestational Diabetes/Nutritional Management of GDM
UCSF Inpatient Obstetric Nursing Staff
- 4/94 Nutritional Management of the AIDS Patient
San Francisco State University
Guest lecturer for Clinical Nutrition Class, 3-hour class
- 8/94 Nutritional Management of Gestational Diabetes
UCSF Dietetic Interns
- 8/94 Nutrition Assessment
Class and case studies for UCSF Dietetic Interns
- 2/95 Medical Nutrition Therapy for Pediatric IDDM
UCSF Pediatric Endocrinology Noon Conference
- 2/95 Dietary Strategies to Minimize Your Risk of Stroke
Community Health Education Program sponsored by UCSF
- 3/95 Diabetes and Medical Nutrition Therapy
UCSF 4th year Medical Students, a two hour class
- 5/95 Advanced Dietary Update for Insulin Pump Therapy
UCSF Diabetes Teaching Center
A practical update for pump users.
- 6/95 Dietary Strategies to Minimize Your Risk of Stroke
Community Health Education Program sponsored by UCSF
- 7/95 Nutritional Management of Gestational Diabetes
UCSF Dietetic Interns
- 8/95 Treating Diabetes, Insulin and Oral Agents
UCSF Dietetic Interns, 2 hour class
- 10/95 Diabetes in the Nineties: Adult and Perinatal Management
UCSF Medicine and Surgery Inpatient Nursing Staff
- 10/95 Dietary Strategies to Minimize Your Risk of Stroke
Community Health Education Program sponsored by UCSF
- 10/95 Medical Nutrition Therapy for Diabetes
UCSF Diabetes Clinic Noon Conference
For MD’s, Endocrinologists, Residents, Nurses
- 12/95 Nutritional Assessment and Management of Diabetes Mellitus
UCSF 1st and 2nd year medicine residents, 2 hour class
- 2/96 Diet and IDDM: Counting Carbo’s for Kids
Article published in newsletter for California Dietetic Association
- 3/96 Diabetes and Medical Nutrition Therapy
UCSF 4th year Medical Students, a 2 hour class
- 4/96 Television News Interview
CBS News/7 On Your Side: regarding Sugar Alcohol
- 5/96 Home Blood Glucose Monitoring: What to do with the numbers
Dietary strategies for IDDM and NIDDM, case studies.
“Taking Control of Your Diabetes” An educational and motivational conference and health fair. Moscone Center, San Francisco, Ca.
- 8/96 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 8/96 Carbohydrate Counting/Nutrition, and Managing Exercise with IDDM
3 Lectures at Bearskin Meadows Pediatric Diabetes Family Camp
for staff and families
- 10/96 Olestra: A Review of the New Low Calorie Food Additive
UCSF Diabetes Symposium, 250 attendees
- 11/96 1994 ADA Guidelines for Diabetes
Diabetes…Approaching the 21st Century. A continuing education seminar for the
nursing staff at St. Mary’s Hospital, San Francisco, CA
- 12/96 Nutritional management for children with diabetes
Family diabetes workshop, sponsored by Diabetic Youth Foundation
Mount Diablo Medical Center, CA.
- 3/97 IDDM: Nutritional Management in the school setting
Diabetes Inservice for Marin County Public School Nurses
- 4/97 Carbohydrate Counting
Taking Control of your Diabetes ’97
Moscone Center, San Francisco, CA.
- 5/97 A Multidisciplinary Approach to the Care of Patients with Type 2 Diabetes the
Pharmacist’s Role on the Team
Seminar for 250 pharmacists, lecturer for nutritional management principles
- 8/97 Carbohydrate Counting/Nutrition, and Managing Exercise with IDDM
3 Lectures at Bearskin Meadows Pediatric Diabetes Family Camp for staff and families
- 9/97 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 9/97 Treating Diabetes; Insulin and Oral Agents
2 hour Pharmacology class for UCSF Dietetic Interns
- 11/97 Diabetes and the Cardiovascular Patient Nutritional management for diabetic patients with cardiovascular risk factors.
Seminar lecture for 100 Nurses, and dietitians at St. Mary’s Hospital, SF, CA
- 1/98 Diet Therapy for Diabetes
Management for Complications of Diabetes
UCSF Diabetes Symposium, 300 attendees
- 6/98 Carbohydrate Counting, Safe Exercise with IDDM, Preventing Ketones and Delayed
Low Blood Sugar after Exercise, and Precautions of ETOH
Staff training for Bearskin Meadows Pediatric Diabetes Camp, 60 attendees
- 8/98 Carbohydrate Counting/Nutrition, and Managing Exercise with IDDM
Precautions about Alcohol, Treating Hypoglycemia
6 Lectures at Bearskin Meadows Pediatric Diabetes Family Camp for staff and 30 families
- 9/98 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 9/98 Emerging Perspectives in the Primary Care Management of Type 2 Diabetes
Round table meeting with Scientific Exchange Inc. to develop educational activities for family practitioners who care for patients with Type 2 diabetes.
- 10/98 Television News Interview
ABC Dr Dean Edell regarding Olestra synthetic fat
- 11/98 Treating Diabetes; Insulin and Oral Agents
2 hour Pharmacology class for UCSF Dietetic Interns
- 11/98 Exercise and Type 2 Diabetes
Consultant for developing booklet for national distribution by Krames Staywell Co.
- 12/98 Understanding Diabetes; pathophysiology, pharmacology, medical nutrition therapy
1 hour class for UCSF Stanford Diet Technicians
- 1/99 Nutritional Management for Type 1 and Type 2 Diabetes/the role of the RD, CDE
Lecture for UCSF Endocrine Fellows
- 8/99 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 8/99 Carbohydrate Counting/Nutrition, and Managing Exercise with IDDM
2 Lectures at Bearskin Meadows Pediatric Diabetes Family Camp for staff and families
- 9/99 Treating Diabetes; Insulin and Oral Agents
2 hour Pharmacology class for UCSF Dietetic Interns
- 10/99 Nutrition Management of the Pediatric Patient with Diabetes
What the Nurse Needs to Know
1 hour Lecture for UCSF Inpatient Pediatric Nursing Staff
- 11/99 Medical Nutrition Therapy for Type 1 and Type 2 Diabetes Mellitus and
Nutritional Treatment for Associated Co-Morbidities
1 hour lecture for UCSF pharmacy, nursing and medical students
- 11/99 Diabetes and Children
Host for 1 hour live chat for web-site Mediconsult.com
Answering questions pertaining to childhood diabetes.
- 2/00 Nutrition Management of the Pediatric Patient with Diabetes
What the Nurse Needs to Know
1 hour Lecture for UCSF Inpatient Pediatric Nursing Staff
- 8/01 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 9/01 Treating Diabetes; Insulin and Oral Agents
2 hour Pharmacology class for UCSF Dietetic Interns
- 3/02 Nutritional Management of Type 2 Diabetes for Seniors
San Francisco Jewish Center
- 4/02 Medical Nutrition Therapy for Diabetes
1 hour lecture for 2nd year medical students at UCSF Medical School
- 4/02 Self Blood Glucose Monitoring Inservice
1 hour presentation/workshop for Senior Dietitians at UCSF
- 6/02 Kids get Type 2, too
1 hour lecture for 65 Kaiser diabetes educators at Clairmont Hotel, Berkeley
- 8/02 Nutritional Management of Diabetes including Gestational Diabetes
2 hour class for UCSF Dietetic Interns
- 9/02 Treating Diabetes; Insulin and Oral Agents
2 hour Pharmacology class for UCSF Dietetic Interns
- 11/02 Type 1 Diabetes: Insulin kinetics and Nutritional Management
2 hour lecture for 100 second year medical students at UCSF School of Medicine.
- 12/02 Type 2 Diabetes: Nutritional Management for diabetes and its co-morbidities.
2 hour lecture for 100 second year medical students at UCSF School of Medicine.
- 3/03 Nutritional Management for Gestational Diabetes
2 hour lecture for the San Francisco WIC program dietitians.
- 03/03 ADA Symposium: Nutritional Management of Diabetes and its complications.
Keynote speaker for the annual diabetes symposium in Marin County. 2 hour lecture. 100 attendees in the general audience.
Numerous health care providers and diabetes-related venders also attended.
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Diabetes and Pregnancy: Twice as Important |
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Pregnancy is a wondrous and exciting time. It’s a time of change, both physically and emotionally. With the proper attention and prenatal medical care, most women with diabetes can enjoy their pregnancies and welcome a healthy baby into their lives.
Why Tight Blood Sugar Control Is Critically Important
Blood sugar control is important from the first week of pregnancy all the way until delivery. Organogenesis takes place in the first trimester. Uncontrolled blood sugar during the early weeks of pregnancy increases the risk of miscarriage, and birth defects. (Women don’t develop gestational diabetes until later in pregnancy, which means they don’t share these early pregnancy risks.)
Later in the pregnancy, uncontrolled blood sugar levels can cause fetal macrosomia, which may lead to shoulder dystocia, fractures, and the need for Cesarean section deliveries. Very high blood sugar levels can increase the risk of stillbirth.
Maternal hyperglycemia can stimulate fetal hyperinsulinemia, and lead to neonatal hypoglycemia when the glucose supply (umbilical cord) is cut.
Because of all these increased risks, home deliveries are not typically recommended for women with any form of diabetes.
As many as two thirds of all women with diabetes have unplanned pregnancies and most women don’t realize that they’re pregnant until six or more weeks into the pregnancy. That’s why it’s critically important for women who have diabetes to use contraception and achieve tight blood sugar control prior to conception. Many health-care providers suggest at least three to six months of stable blood sugar control prior to attempting to conceive. Hemoglobin A1c should be within 1 percentage point above the lab normal, which means striving for a HbA1c of less than 7 percent.
Women using oral agents should be switched to insulin prior to becoming pregnant. Oral agents are contraindicated in pregnancy. It's also important to make sure that any other prescription drugs or over-the-counter medications that are being used are safe for pregnancy.
Typical Blood Sugar Targets During Pregnancy
Fasting blood sugar:
• 95 mg/dl if meter reads whole blood.
• 105 mg/dl if meter is plasma calibrated.
Blood sugar level measured 1 hour after the meal:
• 140 mg/dl if meter reads whole blood.
• 155 mg/dl if meter is plasma calibrated.
(Your doctor may have different blood sugar targets for you. Follow your doctor’s advice.)
Dietary Management
Calorie requirements increase by 300 calories per day during months 4-9. Most women end up needing a total of about 2,000-2,200 calories per day. Weight should be monitored and calories adjusted to ensure appropriate weight gain.
A minimum of 1,700-1,800 calories per day is recommended during pregnancy. Eating too few calories or too few carbohydrates can cause the production of ketones. Ketones can pass through the placenta and may have a negative impact on the fetus.
Diabetes during pregnancy is one situation when a slightly lower carbohydrate intake may be prudent. I usually recommend that 40-50 percent of the calories come from carbohydrate. I have women start with the lower end and move up as tolerated. (Women using insulin often tolerate 45-50 percent, as insulin can be adjusted to cover.) Excessive carbohydrate intake may make it difficult to maintain the strict blood sugar control required during pregnancy. It’s equally important to ensure adequate carbohydrate intake. If too little carbohydrate is eaten, then important nutrients from the carbohydrate food groups may be lacking. Grains, milk, and fruits are each important components of a healthful diet.
Calorie Level Grams of carbohydrate needed to provide 40-50 % of total calories
1,700 170-213
1,800 180-225
1,900 190-238
2,000 200-250
2,100 210-263
2,200 220-275
2,300 230-288
2,400 240-300
2,500 250-313
2,600 260-325
Once carbohydrate goals are determined, it’s important to distribute the carbohydrate intake throughout the day. Eating too much at one time can cause the blood glucose to go dangerously high. It works best to split the carbohydrate budget between three meals and two to four snacks--for example, 45-60 grams of carbohydrate for each main meal and 15-30 grams of carbohydrate for each snack. (Note: some women do best to limit breakfast to 30 grams of carbohydrate secondary to hormonally mediated glucose intolerance that commonly occurs in the morning.)
Dietary Strategies for Controlling the Blood Sugar
*Distribute carbohydrate between three meals and two to four snacks. Distributing the carbohydrate throughout the day allows the body to process it one batch at a time.
*Milk and fruit are both healthful choices. However, they tend to digest rather quickly, which means that the glucose derived from those foods enters the bloodstream rapidly. To prevent spiking post-meal blood sugar levels, it’s recommended to eat those foods one portion at a time.
*Avoid fruit juices, regular soft drinks and sugary beverages.
*Avoid added sugars. That includes natural sugars, honey, and syrups. Every bite should count toward good nutrition.
*Breakfast matters: Because of hormones, blood sugar levels can be especially difficult to control at breakfast time. For women with elevated post-breakfast blood glucose values, it helps to avoid milk, fruit, and refined breakfast cereals at the breakfast meal (since those foods digest so quickly). Milk and fruit should still be included, but at meals or snacks other than breakfast. A breakfast that consists of starch plus protein may be better tolerated. Another option is to limit breakfast to 30 grams of carbohydrate and distribute the remaining carbohydrate between the other meals and snacks. But don’t skip breakfast.
Blood glucose monitoring is crucial. If the above dietary guidelines are being followed, and blood glucose cannot be maintained within target levels, then insulin should be added or adjusted until control is achieved.
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High-Fat Diets and Sedentary Lifestyles Contribute to Childhood Obesity
Type 2 diabetes was once considered an adult-only disease. Not anymore. Every year the number of cases of type 2 diabetes in children and adolescents increases.
Why?
Because kids are getting heavier and are exercising less.
Obesity is becoming an epidemic. As the incidence of obesity rises, the incidence of obesity-related diseases rises. Type 2 diabetes, high blood pressure, and high cholesterol are all associated with obesity and threaten potential long-term complications. The duration of diabetes is a strong predictor of risk for developing complications. How much more likely is someone to develop complications if that person is diagnosed with type 2 diabetes at age 15 instead of age 45? No one knows for sure, but giving type 2 diabetes a 30-year head start can’t help. Fortunately, we have good studies showing that complications are preventable. We know that controlling the blood sugar, the blood pressure, and the blood cholesterol is critical in preventing complications. Appropriate education, treatment, and control must start immediately.
Children who develop type 2 diabetes usually do so after age 10 or when puberty kicks in. The changing hormone levels associated with puberty cause increased insulin resistance.
Who’s at Risk, and Should Be Screened?
All children who are overweight or over 10 years old
should be screened every 2 years if they have any 2 of the following risk factors:
- Has a family history of type 2 diabetes
- Is a member of a high-risk ethnic group
- Has high blood pressure
- Has high cholesterol or high triglycerides
- Has polycystic ovary syndrome (PCOS)
- Has acanthosis nigricans
Fasting blood sugar of 126 mg/dl or higher, indicates diabetes.
Nonfasting blood sugar of 200 mg/dl or higher, indicates diabetes.
Coping With the Diagnosis
Dealing with type 2 diabetes can be especially challenging for an adolescent. Adolescents need support, and at the same time they struggle for independence. They want to fit in but must accept and cope with a chronic disease. Diabetes requires planning and many self-care strategies to prevent complications. Yet children live in the moment, tend to experiment, and generally feel invincible.
Overweight children are often teased, which can damage self-esteem. Children who have a hard time fitting in with their peers may not want to disclose that they have diabetes. Children who get chronic diseases may harbor feelings that they caused the diabetes because they did something wrong or because they were bad. Children with diabetes often experience a myriad of emotions, including anger, frustration, denial, fear, depression, and anxiety. Children need support. Seek the help of a counselor or mental health specialist who can meet with the child, as well as with other members of the family.
Parents can be supportive by talking with and listening to their children. Keep the lines of communication open. Provide options to children whenever possible. For example, children have to check their blood sugar. Monitoring is not an option. But you can allow the child to choose which finger to use. Remind older children that it’s time to check the blood sugar but don’t nag. Older children may not want their parents looking over their shoulder while the blood sugar check is being performed. But parents should have access to knowing what the numbers are. Blood sugar monitors retain a record of past readings.
Parenting Pointers
Parenting a child with diabetes takes knowledge, skill, patience, trust, finesse, courage, hope, support, discipline, and a great deal of responsibility. No one will tell you it’s easy. At first, the brunt of the responsibility for diabetes care falls on the parents. As children get older, they can begin to take on age-appropriate diabetes self-management tasks. The transfer of responsibility from parent to child is a tricky dance. Despite the fact that some children are quite capable of performing diabetes-related tasks themselves, parents should not relinquish their support and supervision. It’s crucial that the child isn’t overly burdened too soon. Kids can get burned out. They don’t get a vacation from diabetes. Responsibility for diabetes care should be shared between the child and caretakers. Instead of considering it “the child’s diabetes,” consider it “the family’s diabetes.”
Adolescence is a tricky time, when parents must supervise and support yet give up some of the control. Teens tend to be risk-takers and feel as if they’re indestructible. They want to fit in. They don’t want to be different and may not want their friends to know they have diabetes. Caregivers must convey the importance of diabetes self-management without using scare tactics. Don’t threaten a child with diabetes complications. Fear isn’t a good motivator and can actually leave the child feeling, “Why bother?” Children need praise and reinforcement. Use positive motivators such as allowing the child to earn a privilege for performing diabetes tasks. Let kids know that blood sugar control improves the ability to concentrate and do well in school. Well-controlled blood sugar also reduces fatigue and allows peak athletic performance. One thing has become evident to me; the kids who receive the most support and supervision tend to have the best blood sugar control.
Meal Planning
The nutritional management of diabetes involves establishing healthful eating behaviors that should last a lifetime. It’s important for parents to demonstrate healthful eating behaviors. Kids learn many eating habits from their parents. Children with diabetes should not be singled out to eat entirely different foods from the rest of the family.
Here are a few suggestions to improve childhood nutrition:
- Don’t skip meals. Eat three meals per day (plus snacks if desired).
- Choose healthful, lowfat snacks. Limit junk food.
- Strive for five! Choose at least five servings per day from a combination of fruits and vegetables.
- Choose lean meats and lowfat dairy products.
- Limit added fats and fried foods.
- Try to use higher fiber and higher water content foods.
- Eat fewer fast food meals. Consider fast food fat food.
- Discourage eating out of boredom or for emotional reasons.
- Limit eating in front of the television.
- Choose diet soft drinks instead of regular sodas and sugary beverages.
- Don’t force kids to clean their plates! Provide healthful menu selections and let kids choose from those selections and choose how much they want to eat. Children need to learn to quit eating when they’re full, by following their appetite cues.
Kids with diabetes are still kids!
It’s important to incorporate favorite foods in reasonable amounts, even if those foods aren’t the most healthful choices. It’s all about moderation. If a child has a well-balanced, healthful diet most of the time, that’s what counts. There’s room to fit a candy bar or a couple of cookies into the meal plan. Besides, if you don’t negotiate the inclusion of some favored items, those items tend to get eaten anyway. The kids just don’t tell you. It’s better to fit the item in at a designated snack time or mealtime. Treats can be traded for the usual carbohydrate snacks. Forbidding treats can lead to feelings of anger and isolation. Imagine being the only child at the birthday party who is not allowed to eat cake. The psychological impact of being singled out is probably more damaging than fitting a piece of cake into the meal plan for a child with diabetes.
In addition to the general dietary guidelines listed here, carbohydrate counting or the exchange system can be used to manage carbohydrate intake and distribution. A registered dietitian who is familiar with both pediatrics and diabetes can help to develop an individualized meal plan.
Children must learn that having diabetes doesn’t have to be a roadblock in life. Children with diabetes can do anything, and be anything. They should be encouraged to believe that they are capable of attaining their goals. The sky is the limit.
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At least half of all Americans are overweight or obese. Excess weight poses many health risks. Obesity increases the chance of developing numerous diseases, including:
- Type 2 diabetes
- Hypertension
- Lipid Abnormalities
- Coronary heart disease
- Peripheral vascular disease
- Stroke
- Gallbladder disease
- Osteoarthritis
- Sleep apnea and respiratory problems
- Certain cancers, including endometrial, breast, prostate, and colon
Input versus Output
If the calories you eat are roughly equal to the calories you burn, then theoretically, you will stay about the same weight. When caloric intake exceeds the body's requirements, excess calories are stored as fat.
One pound of body fat stores roughly 3,500 calories! Ouch! To get rid of one pound of body fat requires using 3,500 calories out of storage. That won’t happen in a day. Weight takes time to put on and takes time to take off. A caloric deficit of 500 calories per day can mean losing one pound per week. To achieve this, it's best to combine caloric restriction with an increase in energy expenditure through regular exercise.
Small dietary changes can make a difference over time. Giving up 150 calories per day saves you 54,750 calories per year! (150 calories is the amount of calories in either 1-ounce of regular potato chips, or 12 ounces of regular soda.) When cutting back on calories, be sure to eat a varied and well-balanced diet. You still need the recommended amount of vitamins and minerals. The food pyramid is one tool to assist you in following a balanced diet.
A suggested rate of weight loss is 1-2 pounds per week. Health benefits can be realized with even modest amounts of weight loss. Health experts recommend an initial weight loss goal of 5-10 percent of current weight. I usually advise women who are working on weight loss to eat at least 1,200 calories per day, and men who are limiting their diets to eat at least 1,400 calories per day.
Eating for non-hunger reasons
Sometimes people eat in response to situations or events other than hunger. Situational eating and emotional eating at times is normal, but if not kept in check can contribute to weight and health problems. Individual counseling, classes, workshops, and support groups may be valuable in breaking patterns that lead to overeating.
Behavior Change Tips
- Identify what triggers “non-hunger” eating.
- Create a strategy for making a change.
- Predict challenges and devise a plan to overcome them.
- Act on your plan.
- Get support, if needed.
- Evaluate your progress.
- Don’t get discouraged, and don’t give up!
- Refine your plan, or make changes to your plan as needed.
100 Tips for Successful Weight Management
- Set realistic goals.
- Take it one day at a time.
- Keep a food record.
- Don’t use food as a reward.
- Don’t eat on the run.
- Take small bites and savor each bite before swallowing.
- Don’t eat in the middle of the night (unless, of course, you’re experiencing hypoglycemia).
- Make an appointment with a registered dietitian.
- See a counselor about behavior change.
- Make crafts instead of baked goods.
- Ask your family and friends to be supportive of your weight loss efforts.
- Use smaller plates, cups, bowls, and glasses.
- Serve food from the stove and not from serving bowls at the table.
- Set your fork down in-between bites.
- Eat slowly.
- If hungry, have a small, lowfat snack an hour before the meal to curb your appetite.
Drink a glass of water before each meal.
- Drink a glass of water before each snack.
- Limit sweets and desserts.
- Don’t skip meals; it sets you up for overeating later.
- Choose calorie-free beverages.
- Don’t eat for emotional reasons such as anger, depression, or stress
- Don’t shop for food when you’re hungry.
- Don’t shop for food when you’re tired.
- Don’t overeat at holidays or celebrations.
- Be patient with yourself.
- Choose smaller portions of high-calorie foods and larger portions of low-calorie foods.
- Keep meat portions the size of the palm of your hand, up to twice a day.
- Keep fat portions the size of your thumb for each meal.
- Packaged snack foods should have less than 3 grams of fat per serving.
- Use a measuring cup to measure reasonable portions.
- Think positive thoughts.
- Take a field trip to the grocery store to look for lower-fat, more healthful options.
- Use lowfat cooking methods.
- Choose lean meats.
- Choose nonfat and lowfat dairy products.
- Read food labels to compare calorie content and fat grams.
- Limit fast food restaurant dining.
- Eat vegetables at every meal.
- Choose higher fiber foods.
- Don’t buy tempting foods.
- Limit alcohol intake.
- Let your friends and family know what your food needs are.
- Include regular exercise in your life.
- Take the skin off the chicken and turkey.
- Don’t eat fried foods.
- Start your meal with a broth-based vegetable soup (choose low sodium, if appropriate).
- Bring a healthful snack along when traveling or away from home.
- When at work, don’t eat at your desk.
- Skip the butter, margarine, and mayo (or use nonfat/lowfat varieties).
- Use diet soft drinks.
- Share dessert when dining out.
- Join a support group.
- When served large portions, put half of your restaurant meal in a to-go bag before you eat.
- Don’t eat standing in front of the refrigerator.
- Don’t eat in front of the television.
- Don’t eat standing up.
- Chew a piece of gum while preparing meals.
- Brush and floss your teeth right after dinner.
- Love and accept yourself.
- Strive for five: eat at least five portions per day from the fruits and vegetable groups.
- Reward yourself for making progress (but don’t use food as the reward).
- Visualize yourself losing weight.
- Don’t eat a larger portion just because it’s a reduced-fat version.
- Bring a healthful dish to parties so that you know there will be an appropriate choice available.
- Drink at least 8-10 cups of fluid each day.
- Weigh yourself first thing in the morning, but no more than once a week.
- Snack on raw vegetables and fat-free dip.
- Make a plan in advance for how you’ll handle a tempting situation.
- Make a list of reasons why you want to lose weight and review it often.
- Avoid fad diets.
- Look for the words lowfat, nonfat, or fat-free on the package.
- Divide your food evenly throughout the day; don’t eat heavy evening meals.
- Don’t go to sleep right after a meal.
- Finish your meal with a walk instead of dessert.
- Call a buddy when things get tough.
- If you do eat a food that isn’t a good choice, limit the portion size.
- If you feel like you’ve fallen off the wagon, get back on.
- Don’t give up.
- Pick up new hobbies.
- Keep healthful snacks handy.
- Plan your menus in advance.
- Buy a lowfat cookbook.
- Shop from a list; don’t impulse buy.
- Package and freeze leftovers for future use.
- Don’t strive to be a member of the clean plate club.
- Wait at least 15 minutes after you finish your meal to decide if you’ll have seconds.
- Start your meal with a salad; use lowfat dressing.
- Fill at least half of your dinner plate with vegetables.
- Have fresh fruit for dessert.
- Don’t skip breakfast.
- Eat only when you’re truly hungry.
- Stop eating when you’re satisfied.
- Don’t arrive at a restaurant or party too hungry; have a small snack first.
- Schedule main meals 4-6 hours apart.
- Schedule snacks at least 2 hours after a main meal.
- Use a small teaspoon to sample while you cook.
- Politely refuse, rather than feel obligated to eat something you shouldn’t.
- Ask the waiter which menu selections are low in fat.
- If it’s a high-fat but favorite item, include it in small portions and infrequently.
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