A Recipe Box for Good Health.

Recipe Box for Good Health

Preventing Obesity and Encouraging Healthier Living (OPWDD Health Alert March 2012)

The most recent national core indicators state that 68 percent of adults with developmental disabilities are overweight or obese. Given that many people we support have limited mobility, healthy living and eating takes on an even more important role in their daily lives. Being overweight or obese greatly increases a person’s risk for many major illnesses and diseases, which can decrease one’s quality and longevity of life. It can lead to coronary heart disease, hypertension, type 2 diabetes, cancer, and hypercholesterolemia, as well as many other illnesses.

Weight Management It is important to be conscious of the need for weight management and healthy living, and to promote a healthy lifestyle, as appropriate, which includes good food choices and activities. A healthy weight range depends on many factors, such as a person’s height, weight, and age, among others. It is determined by the balance of energy intake from food and beverages with the expenditure of energy through physical activity and exercise. (OPWDD Health Alert March 2012)

What Can You Do? If you are involved in food preparation, consistently help individuals with a prescribed diet, as ordered by their medical practitioner, to make choices that work for them, and practice proper calorie consumption and appropriate food portions for meals and snacks. • Ensure that healthy choices are always an option. • Encourage the consumption of lower fat protein foods such as seafood, lean meat, poultry, and legumes for the weekly menu. • Encourage the consumption of a minimum of five servings (2 ½ cups) of nutrient rich fruits and vegetables in place of high calorie foods that have fewer nutrients like donuts, cake, cookies, and candy. • Encourage the substitution of water and sugar free or unsweetened beverages for sugared drinks like soda, fruit punch, energy drinks, and sweetened teas, to reduce calories. • Encourage the consumption of low fat or fat free dairy products such as yogurt, cheese, or milk. • Incorporate whole grains into the daily diet to increase fiber, such as whole grain breads and pasta. • When eating out, encourage the individual to choose restaurants that offer healthy and reduced calorie food choices that are within the parameters of their prescribed diet. Seek guidance from a dietitian for good choices. • Encourage healthy eating and increased physical activity by serving as a role model. Prior to starting any exercise program, it is important to ensure that there are no medical restrictions to the amount or type of activity that is acceptable. • Encourage the individual to incorporate exercise or physical activity into their daily routine, consistent with any restrictions imposed by a medical practitioner.

(OPWDD Health Alert March 2012)

Encourage healthy eating and increased physical activity by serving as a role model. Assist, teach and/or supervise the person in decision-making regarding food purchases, meal planning and food preparation. Model healthy eating habits while on site in line with the General Heart Healthy Dietary Guidelines. All staff meals brought into the home must follow Heart Healthy Dietary guidelines. This includes apartment style settings. Plan and develop menus with the input of the person and with consideration to health care provider prescribed diets as indicated on the Dietary Order form located in the Physician Notes and Order book. Plan activities that involve physical movement and don’t always include going to a restaurant.

Encourage Portion Control using MyPlate!

Encourage Water instead of Soda!

Encourage Exercise! Provide education on the benefits of regular physical activity. • It can help prevent excess weight gain /help maintain weight loss. • Combats Health Conditions/ Diseases • Improves your mood • Boosts energy • Promotes better sleep • It can be fun!

Dietary Orders The Primary Care Physician must sign off on an updated Dietary Order for the person annually. This should be at the time of their annual physical, or before in the event of a medical status change (i.e. choking risk, weight concerns, etc.) or if the order is due to expire.

Most Common Dietary Orders CSDD always provides a General Heart Healthy Diet. Physicians most commonly order General Heart Healthy, 1800 Calorie, (ADA) Diabetic Diet.

General Heart Healthy Diet A heart healthy diet can help you in the following ways:  Protect heart health

 Keep blood lipid profiles within healthy ranges  Minimize dietary risks that contribute to heart disease, heart attack, and stroke.

RECOMMENDATIONS FOR A HEART HEALTHY DIET GO FOR VARIETY!! - Eat a variety of fruits, vegetables and grains, as well as low-fat or fat-free dairy products. Choose lean meats and poultry without skin and prepare them without added saturated or trans-fats. Use fat-free, one-percent (1%) fat or low-fat dairy products. Keep an eye on portion sizes. Cut back on foods and drinks with added sugar and SALT! Cut back or eliminate trans-fat (partially hydrogenated oils) from your diet.

General Heart Healthy Diet CONTROL PORTION SIZES (Use Spoodles) EAT MORE VEGETABLES AND FRUITS Choose vegetables and fruit with little or no added fat, sugar or salt. Have vegetables and fruit more often than juice. SELECT WHOLE GRAINS Make at least half of your grain products whole grain each day.

Choose grain products that are lower in fat, sugar or salt. LIMIT UNHEALTHY FATS AND CHOLESTEROL REDUCE THE SODIUM IN YOUR FOOD CHOOSE LOW-FAT PROTEIN SOURCES PLAN AHEAD: CREATE DAILY MENUS ALLOW YOURSELF AN OCCASIONAL TREAT

This is what a healthy plate should look like…

Diabetes It is very important to find out what to eat and not to eat for diabetes. A diet high in fiber, but low in fat is most often recommended for diabetics. You especially want to stay away from saturated fat and limit the amount of sugar you eat. Saturated fat is animal fat such as butter, and lard. Dairy products high in saturated fat include cream, cheese, meat, and chocolate. *Use the “Prevent, Understand & Live with Diabetes: A Guide for Individuals with Developmental Disabilities on Homeplate!

Diabetic Diet Bread is a major source of carbohydrates in our diets. Carbohydrate is an valuable source of energy, vitamins, and minerals. It also provides fiber that helps maintain blood sugar levels. Beans, peas, oats, and barley contain this fiber. Whole grain products are the wisest choice because it takes longer for your digestive system to break down. This keeps the body from releasing sudden bursts of sugar. Potatoes, corn, and pasta are also carbohydrates.

Diabetic Diet Vegetables should be included on your list of what to eat for diabetes. Tasty samples to include are spinach, carrots, broccoli, tomatoes, lettuce, cabbage and cucumbers. You should have three to five servings a day, mixing it up, serving both raw and cooked vegetables.

Diabetic Diet Milk and other dairy products should be limited due to being high in carbs. Switching to low-fat milk, and unsweetened yogurt will help keep your diabetes in check, and an added bonus of saving calories. Two to three serving of dairy products are your daily requirement.

Diabetic Diet Protein can be meat or meat substitutes such as peanut butter, tofu, cheese, and eggs. You only require about six ounces of protein a day, broken up over two to three meals. One tablespoon of peanut butter or an egg weighs an ounce. Fish, poultry, beans, and nuts, are sources of protein.

Diabetic Diet Fats and Sweets are necessary for our bodies but only in moderation. Avocados make a delicious topping in the place of mayonnaise.

Sweets are allowed for many diabetics if the portion size is strictly under control. Sugar free desserts are an option, but remember to take the extra carbs into consideration.

Carbohydrate Counting Carbohydrate counting, or "carb counting” is a meal planning technique for managing your blood glucose. While counting carbohydrates, it is also important to space carbohydrate intake throughout the day. Evenly distributing carbohydrate consumption throughout the day helps keep blood sugar levels steady. The American Diabetes Association recommends that people with diabetes consume between 45 and 60 g of carbohydrates at each meal, though the exact number may vary depending on how many carbohydrates you eat per day. It is also important to note that simple carbohydrates, such as sugary foods, white bread and white rice, can cause a more rapid spike in blood glucose levels. You and your health care team can figure out the right amount for you. Once you know how much carb to eat at a meal, choose your food and the portion size to match. Free Carb Counters are available online. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understandingcarbohydrates/carbohydrate-counting.html & http://www.livestrong.com/article/306652-a-carbohydrate-counter-fordiabetes/

Foods that Contain Carbs Grains like rice, oatmeal, and barley Grain-based foods like bread, cereal, pasta, and crackers starchy vegetables like potatoes, peas and corn Fruit and juice Milk and yogurt

Dried beans like pinto beans and soy products like veggie burgers Sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips Non-starchy vegetables like lettuce, cucumbers, broccoli, and cauliflower have a little bit of carbohydrate but in general are very low.

Reading food labels is a great way to know how much carbohydrate is in a food. For foods that do not have a label, you have to estimate how much carbohydrate is in it. Keeping general serving sizes in mind will help you estimate how much carbohydrate you are eating. For example there is about 15 grams of carbohydrate in: 1 small piece of fresh fruit (4 oz) 1/2 cup of canned or frozen fruit 1 slice of bread (1 oz) or 1 (6 inch) tortilla 1/2 cup of oatmeal 1/3 cup of pasta or rice 4-6 crackers 1/2 English muffin or hamburger bun 1/2 cup of black beans or starchy vegetable 1/4 of a large baked potato (3 oz) 2/3 cup of plain fat-free yogurt or sweetened with a sugar substitute. 2 small cookies 2 inch square brownie or cake without frosting 1/2 cup ice cream or sherbet 1 Tbsp syrup, jam, jelly, sugar or honey 2 Tbsp light syrup 6 chicken nuggets 1/2 cup of casserole 1 cup of soup 1/4 serving of a medium french fry http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understandingcarbohydrates/carbohydrate-counting.html

GERD Considerations Gastroesophageal Reflux disease, or GERD, is a fairly common digestive disorder that occurs when stomach acid, and sometimes bile, refluxes or flows back into the esophagus and mouth.

What To Avoid Although specific foods to avoid may vary from person to person, there are a few general guidelines that may help reduce symptoms of GERD. Spicy Food. Certain hot spices are known to irritate the esophagus and cause heartburn. Avoiding these may help prevent painful symptoms and reduce the risk of ulcerations. Trans Fats and High Fat Foods. High fat foods, particularly those that contain trans fats, can cause reflux because of the large amounts of acid required to digest them. Foods with a high fat content have been linked to a decrease in LES pressure and a delay in stomach emptying which can also lead to acid reflux. As well, dangerous trans fats have been connected to esophageal disease, and since GERD can also contribute to complications with the esophagus, it is best to eliminate them from your GERD diet.

Very Hot Food and Liquid. It is best to let food and beverages cool a little before consuming since very hot substances have been linked to stomach and intestinal ulcers, which can intensify the symptoms of acid reflux. Mint and Chocolate. Both peppermint and chocolate contain chemicals that can stimulate the release of stomach acids while also relaxing the smooth muscle sphincter between the stomach and esophagus, often resulting in acid reflux and heartburn. Alcohol. Alcohol irritates the lining of the stomach and is actually one of the most reported causes of heartburn.

Your Own Trigger Foods. Everyone has certain foods that irritate their condition and cause severe symptoms. Make a list of these foods and avoid them in the future.

Least Commonly Ordered Diets Texture Modified Diets, 1200-1600 Calorie Diets.

Texture Modified Diets Texture Modified Dietary Orders must always be followed to minimize the persons risk of choking. Training Materials: http://www.opw dd.ny.gov/node/ 1953.

Meal Planning Planning for meals is to occur at least weekly prior to grocery shopping. Staff are to use the menus on Homeplate & document the planned meals on the “Monthly Menu Plan Calendar”. Portions are to be documented on the “Daily Menu”.

Grocery Shopping Check off the items needed on the agency approved “Grocery Shopping List”. If the item is not on the “Grocery Shopping List”, you will need to seek approval as this might not be a food item that meets “Heart Healthy Guidelines” (i.e. In the even that a person would like to buy soda, they would need to do so with their personal funds).

General Grocery Shopping Tips • Start with using the Grocery List. Include items you need as well as amounts. • Use the weekly store ads to purchase items on sale and stock up. • Divide your grocery list into the different grocery store sections (Example: Place all your fruits and vegetables under the heading Produce) • Choose fresh foods instead of frozen or canned whenever possible. • Always look for items with 100% whole grain. • Look for low salt options. You can always add more salt yourself. • Don’t shop when you’re hungry!

Produce Department Spend the most time here! Use the rainbow method to choose your fruits and vegetables.

Pick up as many colors as possible; blueberries/raspberries for breakfast, salad greens for lunch, yellow squash and carrots for dinner. Always have a bowl of fresh fruit available on the counter for easy snacking

Meat, Fish & Poultry Choose lean cuts of meat Try Round, Top Sirloin and Tenderloin,

90% lean ground beef or ground turkey breast. Some ground turkey is higher in fat than ground beef! Read the label! Opt for skinless poultry Limit deli meats selection and look for low sodium or healthier choice deli meats (Wegman’s 98% fat free turkey or Just Roast Beef for example or Healthy Choice) Try to include at least two servings of fresh fish per week; broiled Tilapia or Grilled Shrimp Tacos for example

Breads, Cereals & Pasta Look for labels that say whole grain and/or 100% whole wheat. There are varieties of white whole grain pasta that look and taste just like what you are used to but with much higher nutrient content. Choose less processed food (Example: Regular Oatmeal instead of Instant Oatmeal) When choosing cereals, select ones that are low in sugar and high in fiber) Choose brown rice instead of white rice, try mixing half and half until you are used to all brown

Dairy Choose low fat and non-fat. Skim milk or 1% milk only. Choose part skim mozzarella and ricotta cheeses. Try 2% shredded cheddar instead of the full fat version. Purchase light or whipped cream cheese. Cottage cheese can be purchased fat free or 1%. Margarine is OK, the preferred brands are Smart Balance or Olivio. These have less saturated fat per serving. Choose light ice cream or frozen yogurt.

Frozen Foods Look for frozen fruits and vegetables without added sugar and sauces Look for whole grain options such as whole grain frozen waffles Frozen processed foods such as lasagna, chicken fingers and fish sticks are not on the approved Grocery List. These can be made from scratch!

Canned and Dry Foods Choose canned vegetables without added salt. A bit of salt can be added later Choose canned fruits that are packed with water or 100% fruit juice. Do not purchase canned fruits in heavy or lite syrup Applesauce is to be purchased without added sugar

Choose tuna packed in water only Choose low fat, low sodium soups such as Healthy Choice

Choose baked instead of fried options when looking at chips, cookies, and other packaged foods Choose whole grain or whole wheat crackers such as Triscuit or Wheat Thins

Food Label Facts

Serving Size Pay attention to how many servings are in one package One package does not always mean it contains one serving Even individual snack packs often have more than one serving A Serving Size tells how much of the product should be eaten at one time

Calories Calories are the amount of energy you are consuming from one serving of food Calories from fat is the amount of calories in one serving that is directly from fat Use this information when comparing similar food items

Nutrients Limit total fat, saturated fats, trans fat, cholesterol, sodium, and sugar Pick items with high fiber, vitamins, and minerals (ex vitamin A, calcium, and iron) Pay attention carbohydrate content especially for diabetic residents

Meal Preparation

Involve those we support in every aspect of meal preparation.

We should be encouraging independence whenever possible, and teaching new skills! Teach them to prepare their favorite meal. Involve them in stirring the sauce, tossing the salad, setting the table, filling water pitchers for the table, etc. Family Style dining is not just about passing a bowl around the table; it’s about the whole experience!

For All Meals… Always wash your hands and provide reminders to everyone else to do so prior to the meal. Always place meals in bowls, on platters, etc. on the table so everyone can serve themselves. Always use utensils such as tongs, etc. to distribute food (not your hands). Staff may need to assist (hand over hand if needed). Encourage variety and choice! Having options for salad dressings and condiments on the table is a meal time must! By placing the “spoodles” in the bowls, appropriated serving sizes can easily be portioned out. (Use hand over hand if needed to assist).

Continued… Salad and vegetables may be used as fillers to the meal and are considered healthier choices for “seconds”.

They are: Lower in calorie High in nutrition High in fiber Drink options should include: A pitcher of water on the table (quart sized, gallon size are hard to handle). low-calorie beverages Staff should be sitting at the table, eating the meal provided, interacting with and showing interest in those we support!

Healthy Cooking Methods Baking– place food in pan/dish and place in oven Broiling– Place food on broiling rack, directly below direct heat source. Grilling– Place food on grill, above direct heat source Saute– Heat pan over a high heat, add food and cook thoroughly Braising– Brown ingredients in pan, add liquid, cover, cook slowly

Poaching– Simmer ingredients in liquid (just below boiling point) until cooked Steaming– Place foods in steam, above simmering liquid until cooked

Washing Techniques Wash your hands anytime they come in contact with possible contaminants, prior to cooking and after handling raw meat. Follow proper hand washing guidelines.

Clean all kitchen surfaces regularly with hot, soapy water. Wash dish rags frequently. Wash all produce with cool water before serving, even if the product will be peeled.

Snacks All diets may include up to 2 snack options per day. See “Snack Guidelines” specific to diet ordered. Plan snacks for the afternoon & evening. Whenever possible, try to plan for snacks at around the same time everyday.

Meal Outings/Ordering In

Meal Outings/Ordering In Supervised outings that include food are to occur at restaurants that offer heart healthy, diabetic, low calorie options to ensure education regarding healthy choices can occur (i.e. Subway, Applebee’s, etc.).

In order to determine if a restaurant would carry heart healthy/other dietary options, complete an internet search by including the restaurant’s name, followed by “Nutrition Information” (i.e. Chipotle Nutrition Information).

General Guidelines Staff are to provide education and coaching prior to an individual’s unsupervised access to the community to make healthy meal choices in line with their dietary order.

Staff are to provide education and coaching prior to an individual ordering food to be delivered to the home to make healthy meal choices in line with their dietary order. It is reasonable to schedule one dining out and one ordering in meal per month on each individual’s recreational calendar. All planned recreational activities scheduled should not always include a restaurant outing. Encourage the person to eat before or after the outing or pack a bagged lunch to reserve funds for desired items/other outings.

Food Pantry Guidelines

Food Pantry Guidelines We are responsible for providing 3 heart healthy meals per day and 2 healthy snacks to have between meals. You should have a reasonable amount of food accessible at all times. This means, if you have to make a trip to the pantry every time something is requested, chances are, you do not have a “reasonable” amount of food available. There should be choices available in the kitchen at all times (i.e. salad dressings, cereal, etc.). Please be aware that not permitting access to food is a Rights Restriction and cannot occur without clinical justification/Care Review Approval.

Documentation Requirements for Meals

Rights Restrictions In the event that the person demonstrates a pattern (repeated or regular) of non-compliance with dietary orders which may impact the individuals health and/or safety, a Treatment Team meeting with clinical staff must occur to identify necessary measures to safeguard the person which may include a rights restriction for limited access to food.

Click the link below to complete this training.

https://docs.google.com/forms/d/1i2RYgaW8fX P4KMtEJv3aF2iS0zOedndGWGWLxl99qng/view form