Nutrition Resources
Defining and Promoting
the “Healthy Diet”
By Polly Malby, CNM, MSN
As medical and nursing professionals, we dispense a great deal of advice daily. We tell our patients, family members and anyone who will listen: get regular exercise and adequate sleep, drink plenty of water, practice personal hygiene, avoid harmful substances, reduce stress, and maintain a “healthy diet.”
One of the keys to good health is good nutrition, but there has been controversy over what constitutes a “healthy or balanced” diet. The focus of this section is to provide a compilation of resources to help providers explore definitions of and recommendations for nutrition. We know that a healthy meal is not a fast-food “Happy Meal.” So, what exactly do we mean by the term “healthy diet?” And, even more importantly, how can we help our patients translate our well-intended educational moments in the office setting into practical knowledge they can use in the rush of daily life, the supermarket and the home?
Our patients present in varying degrees of health and illness. More than ever before, they are likely to be overweight, obese, and malnourished. Also, they come to us from diverse backgrounds with equally diverse personal experiences, beliefs, family demands, likes and dislikes around the issue of food. Demands and restrictions on their time and finances certainly play a role in how they feed themselves and their families. In addition, packaged foods, fast food restaurants, poor quality school cafeteria meals and advertising of empty, non-nutritive food items have a considerable negative impact on their health.
The medical, emotional,
and economic impact of malnutrition, eating disorders and obesity could
(and does) fill conference agendas, journal pages and textbooks, and are
well beyond the scope of this web site. Let’s keep it simple.
This web site will provide the following:
1. Guidelines and
tips for the provider who is long on good intensions but short on time;
2. References and resources for providers and consumers on general nutrition,
ethnic food pyramids, specific dietary practices and fad diets;
3. Web sites on children’s nutrition;
4. Sites to explore for a variety of healthful recipes.
References for finding nutritional solutions for common pregnancy complaints such as morning sickness, heartburn and anemia are beyond the scope of this site. There are many good primers on these topics. I would suggest Sheila Kitzinger’s book, The Complete Book of Pregnancy and Childbirth and Penny Simkin’s book, Pregnancy, Childbirth, and the Newborn as good places to start.
One of our primary roles as healthcare providers is to use the precious time we have with patients to make a positive impact on health and nutrition. The months of frequent visits during pregnancy give us an unprecedented opportunity to intervene and have a long-lasting impact on the health of our patients and their families.
Here are a few quick tips:
First, assess the client’s current nutritional status, knowledge, preferences and individual constraints. This is simple: Look, Ask, and Listen. Visually assess her appearance, BMI, affect, skin, color and complexion. Get a “24 hour diet recall” by asking her what she had for breakfast this morning, dinner last night and lunch yesterday. Jot these down and compare what she’s been eating to the recommendations on your favorite food pyramid.
In addition to water, proteins, carbohydrates, fats, and grains, note if she is getting a variety of fruits and vegetables. An easy way to do this is to “count the colors.” Praise your client for every food choice you find in the red, green, blue-purple and yellow-orange ranges, especially when they are intensely colored (as long as the color is natural!). And remember that while supermarkets and other produce marketers are still trumpeting the five-a-day recommendation, the Recommended Guidelines for Americans 2005 now call for nine to13 servings per day, depending on calorie intake. The research on the powerful health and antioxidant properties of deeply pigmented fruits and vegetables is well established. Though the studies have not yet focused on human pregnancy and newborn outcomes, these new concepts are worth attending to.
Second, we can advise, encourage, educate, support, and motivate our clients to make positive changes in their shopping and eating habits. In this way, we meet patients where they are at and intervene to help them achieve and maintain good nutritional habits in the short and long-term.
Third, focus on what’s working! Propose small steps and substitutions the client can incorporate into her daily life. So instead of giving her a long list of “don’ts,” consider giving her a short list of things “to do,” such as:
- Do drink eight to ten glasses of water each day
- Do get plenty of fiber – Choose “whole” foods such as brown rice, whole wheat bread, whole grain cereal. Choose a whole apple rather than apple juice or sweetened drink
- Do eat less processed, preserved, and packaged foods
- Do choose grilled foods over breaded and deep fried entrees
- Do increase the consumption of plant based sources of proteins and calcium
- Do choose fruits and vegetables in each color category every day
- Do include three to five fresh fruits and four to nine fresh raw vegetables every day (as recommended by the American Cancer Society, The American Diabetes Association and the American Heart Association)
- Do pay attention to labels – learn to spot foods with hidden sugars (high fructose corn syrup), partially/hydrogenated oils, saturated fats, and excessive sodium
- Do choose whole
food based supplements if supplements are desired or recommended.
When patients focus on what they should be doing, they are more likely to skip some of the less nutritious things they have been doing. Also, though “eating organic” may be the best source of food for our bodies, many people cannot afford to shop in the organic produce markets. It is more important that they start eating “whole food”, eliminating processed and packaged items, than finding excuses not to consume fruits, vegetables, and grains due to the expense or shortened shelf life of organic items.
Fourth, we can provide follow-up, feedback, and support at every visit. When our patient presents for her clinic visit and has a water bottle with her, we can take the opportunity to congratulate her on making a healthy choice for herself and her baby. Asking her what she had for breakfast gives us insight to her dietary practices and an opportunity to reinforce the development of good habits.
Finally, the potential payoff is well worth the effort. Not only can we improve the outcome of this pregnancy, but we can also have an impact on the entire family. The mothers we serve are the primary caregivers for their extended families and the first educators for the next generation.
Web Sites and Resources
General Nutrition
The American Dietetic Association
Dietary Guidelines for Americans, 2005
Eat 5 to 9 A Day for Better Health
Food Pyramids
Harvard School of Public Health’s Food Pyramids
HHS Dietary Guidelines for Americans 2005
Tufts Nutrition, Modified Food Pyramid for Older Adults
The Importance of Color
Good Food Books Review of “The Color Code”
InteliHealth article, Personal Health: The Color of Nutrition”
Tufts Nutrition, “Color Code Your Diet”
WebMD article, "Purple Berries Pack Potent Antioxidant Punch"
More on Colorful Eating
Ask Dr. Sears: "Kids And Food Colors: The Nutrients That Give Foods Their Color"
Ethnic Food Pyramids and Information
Are All Food Pyramids Created Equal?
Food Guide for African Americans
African American Dietary Issues
African American Health and Diary Foods
Five a Day for African American Women
Improving Cardiovascular Health in African Americans Package of Seven Easy-To-Read Booklets
Heart-Healthy Home Cooking African American Style
Latino Cardiovascular Health Resources
Delicious Heart-Healthy Latino Recipes
National Diabetes Education Program (Spanish guide)
Specific Dietary Practices
American Dietetic Association and Dietitians of Canada Position on Vegetarian Diets
BabyCenter.com article, “No Meat? No Worries: Diet For A Healthy (Vegetarian) Pregnancy”
Heart Healthy Diets: The Vegetarian Way
Veg Family, the Magazine for Vegan Family Living
Diets That Do And Don’t Work
American Heart Association’s Position on High-Protein Diets
Dean Ornish MD’s Lifestyle Diet
National Heart, Lung and Blood Institute
Children’s Nutrition
Baylor College of Medicine’s Kids Nutrition
Harvard School of Public Health
Healthy-Living.org’s Children’s Nutrition
InteliHealth’s Children’s Nutrition
Keep Kids Healthy’s Nutritional Guide For Your Child
Nike Go: We’re Getting Kids Moving
National Head Start Association
Physicians’ Committee for Responsible Medicine Parents’ Guide to Building Better Bones
Healthful Recipe Sources
Better Homes and Gardens Healthy Recipes
WebMD’s Opening Your Heart Recipes
Helpful Organizations
The National Women's Health Information Center
Recommended Books
Campbell, Collin T. (2005). The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. Benbella Books.
Cordain, Loren. (2002). The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. Wiley.
Joseph, James, PhD., Nadeau, Daniel, MD and Underwood, Anne. (2003). The Color Code: A Revolutionary Eating Plan for Optimum Health. Hyperion Books.
Katz, David. L., Gonzalez, Maura. (2001). The Way to Eat: A Six-Step Path to Lifelong Weight Control. Sourcebooks.
Kitzinger, Sheila. (2003). The Complete Book of Pregnancy and Childbirth. Knopf.
Ray, Mitra. (2002). From Here to Longevity: Your Complete Guide for a Long and Healthy Life. Shining Star Publications.
Schlosser, David. (2002). Fast Food Nation: The Dark Side of the All-American Meal. Perennial.
Sears, Martha, Sears, William, et al. (2002). Eat Healthy, Feel Great. Little, Brown.
Shapiro, Howard MD. (2002). Dr Shapiro’s Picture Perfect Weigh Loss 30 Day Plan. Rodale Books.
Simkin, Penny, Whalley, Janet, Keppler, Ann. (2003). Pregnancy, Childbirth, and the Newborn: The Complete Guide. Meadowbrook Press.
Vartabedian, Roy,
Matthews, Kathy. (1989). Nutripoints: The Breakthrough Point System
For Optimal Health. Harpercollins.