Nutrition: Unintended Weight Loss

Unfortunately in long-term care, sometimes residents lose weight. The most important step is to determine why and address that issue.

If you go to the doctor because you are not feeling well, you want the doctor to diagnosis and treat the disease, not the symptoms. For example, if you have headaches, you want the doctor to determine why. If he/she just treats the headache, without determining that cancer is causing it, you won’t last long.

Determining why the resident is losing weight determines the actions to take. Usually it is because the resident is not eating enough. Determine why the resident is not eating enough. If the resident is depressed, address that issue. If the resident is in pain, address the pain. If the resident needs more assistance, provide the assistance. If the resident’s dentures don’t fit anymore, get new dentures. If medications are causing a lack of appetite, address that. And so on, and so on, and so on….

Maybe the resident eats, but cannot consume enough at meals to maintain weight. Provide food between meals. Provide more caloric dense foods at meals. And consider smaller portions at meals. If the resident is not going to eat it, too much food can be overwhelming and cause the resident not to want to eat at all.

Sometimes a resident eats well but because of metabolic issues needs more than what is provided with meals. Consider large or double portions as well as caloric dense foods.

Adding cream, sauces, butter, gravies, etc. to food increases the calories. Sugar, brown sugar, honey, syrup, and other sweeteners added to food add calories as well. And an old-fashioned standby that still works is non-fat dry milk. It adds calories and protein to foods like hot cereal, cream soups, potatoes, and others. These foods work well both for residents that cannot handle a normal volume of food and those that require more calories.

Commercial supplements are also an option. Too often, though, these are provided as an easy solution without first investigating why the resident is losing weight and using the above approaches to address the why. It’s usually good to try to address the problems with “real food first.”

Nutrition: Eating Out

It is much easier to eat out and eat healthy now than it was in the past. Many more restaurants offer healthier menu items and healthier options, such as low fat dressings and condiments.

Some things that you can do to eat healthier and/or consume fewer calories include:

• Share entrees. Order one meal, an extra salad or soup, and split the entrée. The food tastes just as good, and there is less of it for both of you.
  
• Share desserts. If you have to have something sweet (and we all do sometimes!) share it.
  
• Only eat half the meal and take the other half home for a second meal.
  
• Order items that are baked or grilled rather than fried.
  
• Order items without sauces and gravies or ask for them on the side.
  
• Order fat free or reduced fat dressings and condiments or ask for the regular ones on the side. If it is on the side, you control how much goes on.
  
• Ask for plain bread and olive oil on the side for dipping rather than buttered garlic bread.
  
• Ask for half the amount of cheese on your pizza and order vegetables instead of meat.
  
• Focus more on chicken and fish and less on meat. (But still watch the preparation method.)
  
• Order a plain baked potato with salsa or fat free dressing instead of butter and sour cream.
  
• Save the high fat, but really good, appetizers for when there is a group. You can have a bite or two, but are less likely to overindulge.
  
• Avoid sugared beverages.
  
• Ask for nutrition information if you are uncertain of an item. Many restaurants have this available.
  
• If you are old enough, order from the senior menu. The portion sizes are often smaller.

As I said in an earlier post, I look at this as being able to eat anything I want; just not as much as I may want, or as often as I may want! But there is nothing that I have forbidden myself to never have again. In my opinion, that would be setting myself up for failure.

Please share any ideas you have for eating healthier when you eat out!

Nutrition: Portion Control

Portion control is important in any food service establishment. It affects costs and customer satisfaction. In healthcare, it also affects nutritional status and regulatory compliance.

Portion control is also important in our everyday lives. The only way to know if we are consuming the right amount of nutrients, not too much and not too little, is to follow the portion sizes in recipes and on ingredient labels.

Much of the overweight and obesity problems in this country are related to overeating (obviously!) but much of the overeating is related to not watching portion sizes.

The only way to learn accurate portion sizes is to measure it, weigh it, or count it. If you are not used to doing this, it will be amazing!

For example, the label on a brand name of potato chips states that a serving size contains 160 calories and 10 grams of fat. The serving size is 1 ounce, or about 12 chips. Have you ever counted out and eaten just 12 chips? It’s not much. But that is a serving for this item.

If instead of one serving, you ate the entire 10 ounce bag (10 servings), it would be 1600 calories and 100 grams of fat! An average calorie level is considered 2000 calories (many people need to consume less than that to maintain weight and some more). So this bag of potato chips contains over 3/4 of the average caloric needs for one day.

For a 2000 calorie diet, recommended total fat (for a healthy person) is less than 65 grams. This one bag of chips provides all the fat for that day and a good portion for the next.

One of the best things you can do for your health and your weight is follow portions sizes.

Nutrition: Therapeutic Diets for Long-Term Care

In the early 1980’s when I finished my dietetic internship and started working as a food service director and dietitian, it was still common to see strict therapeutic diets in long-term care. There were some residents who probably benefited from this, but for many weight loss was a bigger issue.

As the residents in long-term care became older with more issues related to being able to consume adequate nutrition and maintain weight, it made sense to go with more liberalized diets. Often the goal was just to get the person to eat, so why make it more difficult by eliminating many foods she would eat.

Liberalized diets still make sense for most of the elderly-elderly from nutrition as well as quality of life and resident choice stands. However, many facilities now also have younger residents (50s and 60s) for rehab or other reasons.

Many of these residents follow a therapeutic diet with good results, often related to health conditions. It is usually in their best health interests to continue to follow their diets. Or, if they are not following a therapeutic diet, they are young enough to benefit from one.

Because of this, facilities need to reevaluate the diets they offer. Options include:

• Offering strict therapeutic diets again in addition to the liberalized diets.
  
• Using food preferences to meet individual needs, such as having fat free or reduced fat options available and seasonings other than salt.
  
• Modify the existing menu so it is more “heart healthy” and address individually those that may need more concentrated calories. Be sure to follow the diet manual for heart healthy, and do not just “make it up.”

A tool that will assist with the decision is an accurate nutritional analysis of the menu. This allows you to determine what changes you would need to make in the menu and in the recipes to achieve a heart healthy diet.

Happy Saint Patrick’s Day!

We are all familiar with traditional Irish foods—Irish stew, potatoes, cabbage, soda bread, potatoes and cabbage, corned beef, cabbage and potatoes, and green beer. (Well, green beer is really more of an Irish-American tradition. Or maybe it is more just an American tradition. There are probably many more people drinking green beer that are not of Irish descent than are.)

Other traditional staples in Ireland included grains (especially oats) and dairy products. The Irish have been accomplished cheese makers for centuries. Soups, seafood, and meats such as beef, lamb, and pork are also traditional staples.

It has only been in the last few decades that the Irish diet has changed much. This change related heavily to more Irish having the economic means to travel to mainland Europe and other parts of the world. There they ate new foods and wanted to continue to eat them when they returned home. Today the typical Irish diet is similar to that of Western cultures.

There is also a large slow food movement in Ireland. There is greater emphasis on using the freshest foods available and taking time with preparation.

If you were to travel to Ireland today, you would find many of the same foods there as you would here.

Nutrition: Cutting the Fat

Three years ago my husband almost had a heart attack. Luckily it was determined what was wrong and he had a stent put in prior to actually having a heart attack. We have both watched our diet and fat intake much better since then!

What is a little scary is that his cholesterol levels were not that bad. They are good now! Mine have always been pretty good, and now they are great! So diet does help and is worth it. A side benefit to cutting the fat was that we both lost weight. Dropping two clothing sizes was fun (and expensive). I got to buy two wardrobes in less than a year!

The following are just some things that have worked for us.

• Fat free salad dressings, condiments, mayonnaise, “butter” etc. we use wherever possible. The quality has improved greatly over the past several years!
  
• Naturally fat free condiments such as catsup, mustard, barbecue sauce, etc. are always an option. My husband really loves salsa on his baked potatoes now instead of butter and sour cream. Fat free ranch dressing is another option and many restaurants carry it.
  
• Fat free cheeses (hard, cottage, cream) work well in casseroles, pizza, etc. I prefer the low or reduced fat for sandwiches or bagels.
  
• Fat free sour cream works great in dip. We serve it routinely and no one knows the difference.
  
• Fat free yogurt is great to eat alone (there are so many flavors) or in fruit dips.
  
• There is an absolutely fabulous fat free brownie mix—No Pudge! Fudge Brownie Mix. It is mixed with fat free yogurt.
  
• Many dessert recipes and mixes can be altered to use fat free yogurt or applesauce.
  
• Eating less meat helps cut the fat. Both watching the portion size and eating it less frequently helps.
  
• There are healthier oils to use for cooking than butter or margarine. Dipping bread in olive oil is really very good! But you still need to watch the amounts.

The way I look at it, I can eat anything I want. I just can’t eat it whenever I want and as much as I want! But we do allow ourselves “diet holidays” for special occasions. And it has been worth it!

Nutrition: Using a Registered Dietitian

Since today is National Registered Dietitian Day, I wanted to talk a little about how beneficial working with a registered dietitian can be in meeting your health and weight goals.

To become a registered dietitian, a person must first complete a bachelor’s degree in nutrition or dietetics. The next step is to complete an internship (generally a year) or obtain a master’s degree. This enables the person to take the national registration exam through the American Dietetic Association. Once the exam is passed, it is necessary to obtain 75 continuing education credits every five years to maintain registration. In addition, many states also have licensure and certification requirements that must be met to operate in that state.

Be aware that “nutritionist” is a very vague term. Anyone can call themselves a nutritionist. Some dietitians do use that term because the public seems to respond well to it. But before you work with a nutritionist, ask for his or her credentials.

Registered dietitians (RD) that specialize in nutrition keep up on the latest scientific research. There are so many fads and trends out there, that it is hard to know what is true and what isn’t. RDs filter through all this and can help you understand it. They also educate you on healthy eating for your situation. Maybe you want to lose weight, maybe you have diabetes, maybe you have a heart condition, maybe you have several concerns—they can help you develop an eating plan that meets your needs.

Some RDs are also coaches. They go beyond just educating you; they also help you determine what you can do to make healthy changes. In many ways, they ask the questions, but you provide the answers on what you are willing to do!

To contact an RD you can ask your physician for a recommendation. You can also go to the American Dietetic Association’s website, www.eatright.org. In the upper right hand corner, click on “Find a Registered Dietitian.” From there, you can search by specialties and location.

Nutrition: Diet Manual

The diet manual is a critical component of nutrition care in any health care setting. The diet manual provides information for normal and therapeutic nutrition. The diet manual needs to be based on the latest scientific evidence.

The diet manual is the basis for writing the menus. It is the diet manual that states how many servings of the different food groups are necessary for optimal nutrition for different groups of people. It also states what changes are necessary in nutrients and textures to meet the needs of people with special dietetic needs such as diabetes, heart conditions, and dysphasia.

Menus cannot be written based on what the writer “thinks” a diet should contain. Menus need to be written based on the latest scientific research. The diet manual provides this.

If you are purchasing menus, ask for a copy of the diet manual upon which the menu was based. This is your foundation for ensuring good nutritional status of your residents! This is the first step in meeting the nutritional needs of the residents. It is also your first line of defense if surveyors question why you are providing residents with certain food items or withholding certain food items.

The diet manual is critical!

Nutrition: National Nutrition Month

March is National Nutrition Month! In honor of National Nutrition Month, this month’s blog will contain various nutrition information segments. Some of it will be aimed to help you help your residents, and some will be just to help you.

National Nutrition Month is an annual nutrition and education campaign by the American Dietetic Association. The focus is to help the public make informed food choices and develop good eating and physical activity habits.

This year’s theme is “Nutrition from the Ground Up.”

March 10 is also Registered Dietitian Day. This day is to increase the awareness of the important role registered dietitians play in providing nutrition information.

For more nutrition information, go to www.eatright.org (American Dietetic Association). Another good source for nutrition information, including an interactive site, is www.mypyramid.gov (USDA). Some of your Internet-savvy residents may enjoy this one. It is also a great place for nutrition information for you and your family.