Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘Food Diary’

Photo Food Diaries – Do You See Any Difference In Food Intake?

In Food Diaries on May 2, 2011 at 1:18 PM

The photos below were taken by the same people , once in the first few weeks of the FHCHC DPP and once in the last few weeks.
Do you see any differences?

January 2011 Participant #1

March 2011 Participant #1

January 2011 Participant #1

March 2011 Participant #1

January 2011 Participant #2

March 2011 Participant #2

January 2011 Participant #2

March 2011 Participant #2

January 2011 Participant #3

March 2011 Participant #3

January 2011 Participant #3

March 2011 Participant #3


Photo Food Diaries

In Food Diaries, Nutrition Class on March 29, 2011 at 10:22 AM

The FHCHC Diabetes Prevention Program is testing the effectiveness of photo food diaries, and comparing the results with written food diaries. According to the NIH:

“All participants are asked to record their intake daily…because of the extensive evidence that self-monitoring is highly correlated with success in reaching dietary change goals. Numerous studies have shown a dose-response relationship between frequency of self-monitoring and level of success in losing weight and/or improving cardiovascular risk factors. Many experts consider self-monitoring the single most effective approach to changing dietary intake.” NIH DPP

For many FHCHC DPP participants, writing their daily food intake and the amounts of those foods they consume, occurs as very challenging. Indeed, it is rare that 100% of participants present their food diaries in any given week. Knowing the importance of self-monitoring, and the challenging nature of food diaries for our participants, we handed out disposable cameras with explicit directions on how to document their food consumption. Use the flash! Take a picture of everything you eat, even if it’s a snack or beverage. Bring it back next week.
Below are some examples of the photos women took in the first couple weeks of their participation in the FHCHC DPP program. In a week, participants will return their second set of disposable cameras, and the Lead Provider and nutritionist will analyze the results to see whether photo food diaries are a more effective self-monitoring strategy than written food diaries. They will look at rate of return, as well as glean any changes in food consumption that may have taken place since the first couple weeks of the program.






Providing Individual Feedback on Food Diaries – A Delicate Task

In Nutrition Class on July 1, 2010 at 5:11 PM

Recently, a discussion flared up when one woman from Mexico flatly declared that a cooking suggestion could not apply to both her and the Guatemalan woman sitting to her right.

How does a medical provider advise patients on dietary practices while at the same time being sensitive to the cultural, historic, economic, and social implications of food habits?

This is the question that our Nutrition Class teachers ask themselves before, during, and after each session. How can I say this in a way that acknowledges the difficulty of obtaining fresh leafy greens where they live, and at the same time be uncompromising in my commitment to their health? How do I respond to a woman for whom eating tortillas is as natural as breathing, and yet is not reaching her weight loss goal?

Our teachers have discovered that asking this question repeatedly is in fact the answer to the question itself. As in, there is no straight answer. The key is to be aware that food has implications that stretch much further than waist circumference, and having what innovative businesses call a double bottom line is essential: plant a few pots with spinach seeds on your back stoop. Have one tortilla instead of two. Be committed to your wellbeing AND your cultural heritage, financial stability, and social obligations! You can consider all those factors with every choice you make.

Maintaining Use of Food Diaries Over Time

In Nutrition Class on July 1, 2010 at 4:16 PM

Because the practice of recording one’s food and exercise habits can be a significant challenge for program participants in the beginning, the Nutrition Class teacher generally requests that for the first few weeks they simply record what they have eaten/done to exercise each day.

Weight loss results in the beginning of the program are often dramatic, which happens when participants are getting comfortable using the food diaries. A plateau, where participants will stop experiencing change, however, often overshadows this accomplishment somewhere after the program’s first quarter. At this point, the Nutrition Class teacher adds components to the food diary, making it a tool that meets their expanded needs.

Around class #3, participants are instructed to become more specific about their dietary and exercise activities. What percentage fat did your milk contain this morning? How much did you use in your cereal? Did you walk at a slow, medium, or fast pace around the block?

The Nutrition Class teacher also requests that they begin to report items that are generally overlooked. How about alcohol? Were there any chips at that party?

The increased level of specificity allows the teacher to move away from power point and use the food diaries as a direct teaching tool. A class on fat content at this point in the 12-week program, for instance, could explore the impact of the Lays chips a participant ate as a snack the day before.

The One Main Use of Food Diaries in Diabetes Prevention Nutrition Education

In Nutrition Class on July 1, 2010 at 1:10 PM

For clinicians, food diaries have one essential role: to guide curriculum development. Every single aspect of the food diary, from dissemination to evaluation, can be utilized as a teaching opportunity.

When Elizabeth asks who likes to read or write before handing out the food diaries, she gains insight into her patients’ literacy rate. Knowing participants’ literacy rate then informs how she might teach the segment on Nutrition Facts, for example.

When people fail to fill out or bring in their food diaries, Elizabeth can see that as an indication of a barrier that, if overlooked, could prevent them from accomplishing their healthy living goals. Non-participation, in other words, is an opening for providing extra support where needed.

Elizabeth uses the food diary content to influence the flavor of subsequent classes as well. For instance, imagine a participant writes, ‘1.5 cups rice with beans’ for lunch 5 days in a row. Elizabeth will talk about diversifying ones diet, especially in the direction of fresh fruits and vegetables.

If a participant is not loosing weight and their food diary indicates a responsible diet, Elizabeth then has a platform on which to inquire into their other habits that may be preventing them from accomplishing their weight loss goals.

At the close of programs, Elizabeth will use the food diary to track trends. “I have never seen a grapefruit in someone’s diary” she declares in an interview. People generally do not report snacks, nor does their fresh fruit and vegetable intake general rise above 33% per week. Understanding these constraints enables the Diabetes Prevention Program’s Nutrition Class to continually evolve to meet the needs of its participants.

Food Diaries: How to Cultivate Usage and Ownership among Diabetes Prevention Program Participants

In Nutrition Class on July 1, 2010 at 12:09 PM

During the first few DPP batches, food diary usage was poor. Around 60% failed to bring them in on a weekly basis, and when they did, entries were often incomplete.

Elizabeth assumed the difficulty was complex: illiteracy, fear of confronting reality, or a simple lack of context or understanding of the food diaries’ use and benefits.

One day, she decided to go public with the process. When the first woman walked into class, Elizabeth included in her greeting the question, ‘Did you bring your food diary?’ Their answer went on the board next to a number that represented that person’s identity to maintain a basic level of anonymity. This simple change that made food diaries a public rather than private, individual affair, brought participation up to 80% weekly.

How to Introduce Food Diaries to Diabetes Prevention Program Participants

In Nutrition Class on June 23, 2010 at 5:25 PM

Elizabeth begins cultivating Diabetes Prevention Program participants’ investment in using Food Diaries from Session I.

“Not knowing exactly what you eat or how much you exercise every day is like trying to buy a bicycle without knowing how much money you have in the bank; you wouldn’t know how much to spend, save, or borrow! Being aware of what you ate yesterday, however, makes it possible for you to know what would be wise for you to eat today. Knowing how much you exercised yesterday makes it easy for you to decide how to exercise today.”

People’s interest is peaked at this point, but owning the Diary as their personal tool for healthy living is not yet present.

“What did you eat for breakfast yesterday, Lucy?”

“A piece of toast.”

Elizabeth nods solemnly. ” Thank you! A piece of toast. Anything else?”

“Um, a cup of coffee also.”

“Thank you!” Elizabeth smiles. ” Anything else?”

Elizabeth teaches Diabetes Prevention Program participants how to use Food Diaries

“No. I don’t think so.” Lucy responds quickly.

The whole group is now listening intently, suspicious of Elizabeth’s grin and apparent enthusiasm.

“Was there anything else you had for breakfast yesterday?” She asks.

Lucy, somewhat surprised, takes a moment to think. “Ah yes, I had a glass of orange juice. I think I also tasted my mom’s torta.”

Elizabeth turns to the rest of the group, and declares with compassion and intensity, “It is difficult to remember what we eat, isn’t it? For that reason, it is sometimes easy to fool ourselves when it comes to our own health. But you ladies are committed to living long and vital lives, no?” Everyone concurs. “I am going to therefore provide you with a tool to use for the next 12-weeks of the program and on an ongoing basis as well. It’s called the Food Diary.”

Elizabeth then gages one of the more important factors influencing the efficacy of the Food Diary tool: participant literacy rate. Although their ability to use the Food Diaries will become abundantly clear within the next few weeks, she likes to get a general sense of people’s comfort levels from the start. “Who here likes to read or write?” A few people raise their hands. Elizabeth, in true form, thanks them for their candor.

At this point everyone is given a Food Diary, and Elizabeth proceeds to describe how to fill it out. Because the assignment is so unfamiliar and often jarring for people in the beginning, Elizabeth requests that they simply document the contents of their meals and physical activities from day to day. She coaches them to ignore portions and nutrition facts for the time being.

Elizabeth closes that component of the class with a reminder that using the Food Diary is central to avoiding diabetes, and their participation is correlated closely with their success in the program.

Food Diaries – What are They and Why are They Important in Diabetes Prevention?

In Nutrition Class on June 18, 2010 at 6:37 PM

A food diary is a simple notebook that participants use to declare their short-term physical fitness and dietary goals, daily exercise regimen, and food and beverage intake. Distinct from the recall method, where subjects chronicle their activities on a weekly or even monthly basis, studies have shown that lifestyle interventions are more effective when subjects account for their performance on a daily basis.

It is important to note here that the Food Diary does not single handedly change dietary and physical fitness behavior; nor is it presented as such by the program administrators. Indeed it is one of a series of interventions, the combination of which make the Diabetes Prevention Program as successful as it is.

The following english version of a food diary comes directly from the NIH:

Elizabeth explains how to use a Food Diary to DPP participants

Accountability – A Key to Changing Behavior

In Nutrition Class on June 10, 2010 at 9:54 PM

Elizabeth starts at the left end of the row, and asks the woman sitting attentively,” Did you bring your food diary?” The program participant opens a notebook, whose pages are clearly empty, and with a sheepish smile says yes. Without hesitation Elizabeth understands that something about the process got lost in translation. She moves swiftly from the front of the classroom and takes a seat casually next to the participant.

” Que comiste hoy? What did you eat today?”

” Nada.” The woman replies, simply.

” Nada?!”

” Only some snacks. And water.”

” Perfect! You write the specific snacks, quantity, and time eaten here, in this space. The drinks go over here.”

When Elizabeth is confident that the communication has been received, she takes her place at the blackboard again.

” Did you bring your food diary?” She asks the next woman in the row.

The woman replies affirmatively, and Elizabeth adds a check under the informal ‘food diary’ column she’s drawn on the elementary school music room’s blackboard. This is one of the providers’ ways of holding the program participants to account, as well as a way to track their progress. Elizabeth never fails to use it as a teaching moment either.

The next question is how many times they exercised that week. One woman has a question about whether the walking she did could be considered exercise. Instead of attempting to describe what distinguishes recreational from aerobic walking, Elizabeth demonstrates her answer. A fast walk around the classroom, arms moving deliberately back and forth with each stride, for up to 30 minutes consecutively, counts. A stroll from your bedroom to your car, however, does not.

The questions and answers continue, from pounds lost this week to overall weight loss goals. Elizabeth celebrates each reported minute exercising, and uses every instance when a participant failed to meet their goal as an opportunity to discuss common barriers and possible solutions. She thanks them for their participation and candor.

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