Question 3
Question 3: Imagine as a clinical RD you are required to give a cardiac education to a patient status post acute MI. As part of your cardiac education, should you ask for a past 24-hour recall of their typical intake? What are the main points you would stress when educating the patient on decreasing their risk of a reoccurring MI?
posted by Breine @ 6:03 PM
58 comments
58 Comments:
I don't think a 24 hour recall would be the most effective tool because one day may not be indicative of their regualar diet. I would ask about foods usually eaten and ask probing questions to determine usual intake and protion size. Then I would explain that it is important to choose healthier fats over saturated fats, explaining sources and poriton sizes. It is also important to explain that fat should not be minimized in the diet or completely eliminated. I would also stress the importance of increasing physical activity once cleared by the doctor.
I would definitely ask for a 24-hour recall. I would also ask questions as to whether or not this recall represents a typical day. Whether or not the client is honest about the recall we need the recall to base our education off of. If we had no idea what the client's diet consisted of, then we would only have vague recommendations to make, which would not help the client much. The client needs specific individualized advice about how to change his/her eating patterns to promote health. So the main points I would stress when educating the patient are dependent on the recall. They go hand in hand. For example, if a client tells me that a typical day of eating includes fried fast foods I might focus on methods to choose more healthy fast foods. On the other hand, a client who tells me that he/she rarely eats out, but regularly consumes doughnuts would not necessarily need tips to finding healthy fast food options. In addition to food recommendations I would also, as Mary Ellen pointed out, suggest increasing physical activity as recommended by the physician. Physical activity has been shown to raise HDL levels, which could be beneficial in decreasing risk of recurrent MI.
While a 24-hour recall may not be the most accurate source of information on the patient’s normal diet, it would be a fast way to initiate conversation as to what the patient’s normal diet does consist of. As Andrea mentioned, the information gained from the 24-hour recall and from the conversation that follows, would dictate the specific areas of education that would be most benefit the patient.
In general, the consult would cover control of blood pressure, control total cholesterol levels, smoking cessation, consumption of a low fat diet rich in fruits and vegetables and low in animal fat, diabetes control if applicable, weight loss information, if overweight, and encouragement of daily exorcises or several times a week by walking and other exercises to improve heart fitness.
I think that a 24 hour recall may not be the best option but it does give you a place to start. By asking them what they would typically eat in a 24 hour period you can get a pretty good idea of the types of foods they eat. I would explain that eliminating or drastically cutting back on fat is not recommended but it is important to be conscious of the types of fats you are choosing. I would talk about choosing monounstaturated and polyunstaturated fats over saturated and trans fats. After looking over the current diet I would try to give some suggestion of how to add or modify the current diet to include more healthy fats. Lastly I would explain the importance of consuming a diet rich is varieties of fruits, vegeatalbles and whole grains. To close I would say that excercise is helpful in increasing HDL levels and improving ciculation.
A 24-hr recall could be very helpful; but you would need to focus on a time when the patient was at home and eating normally. This would help you to identify any habits that could be a problem for the patient, while also saving you time from educating on other dietary habits that may not be relevant in that particular case. For example, patients don’t need to hear about the problems associated with dessert intake if they aren’t a big “sweets” eater. The 24-hr recall would then help you to determine what habits you should stress in your education. The main points for a heart-healthy intervention should include information on fat and total caloric intake, fruit/vegetable/fiber intake, physical activity and weight loss (if applicable).
The previous posts outlined great suggestions for topics to discuss with the patient regarding decrease a reoccurring MI. One suggestion included discussing maintaining a healthy weight. If a patient is overweight or obese, how would you sensitively approach this subject?
I would also start with asking a client what their typical diet consists of and portion sizes. I would then identify problem areas that need to be addressed. If the client is overweight/obese and would benefit from weight management then I might focus more specifically on smaller portion sizes. I would also ask the client what type of physical activity they typically engage. I would try to identify if the client is unmotivated or if they are in need of confidence building. I would then counsel them on healthy weight loss in regard to their needs. For example if someone lacks confidence but is very motivated to exercise then I would focus on helping them find an activity they feel comfortable doing and how to start slow. I would not waste time trying to convince them of the importance of exercise if they are already motivated to do so.
While weight loss can be a sensitve issue, it needs to be adressed. I would specificaly talk about overweight and obesity as a risk factor for cardiovascular disease. I would give the clients tips on how to reduce their weight. I think that a 24-hr recall would help to identify specific areas for the client to work on. I agree with eariler posts that it is probably not the most accurate, but it does give you a starting place.
I would ask the patient for a typical day’s intake in order to note major areas of concern that may increase risk of reoccurring MI, as well as their likes and dislikes which will be helpful when offering dietary suggestions. I would briefly explain the importance of healthy fats, whole grains, fruits, vegetables, etc. that also fit their food preferences. It would also be important to ask who is in charge of grocery shopping, meal planning, and/or cooking—and include this person in the diet education—since this will greatly influence what the pt will ACTUALLY eat once they go home. Of course, it is important to address weight management/physical activity, as well as other factors that increase their risk.
I agree with Mary Ellen and Annie that it is important to address portion sizes since overconsumption may be a problem, as it is with many people today. Thorough education on proper portion sizes and other habits that influence size of portions (such as size of plates, eating out, etc.) will truly benefit the patient.
I would start out asking the pt what their normal diet consists of, including times of meals, snacks, portion sizes, food preferences, cooking methods, etc. Asking for a specific 24 hr recall may help out in giving a general understanding of what the pt consumes, however they could have had an abnormal day. The main points that I would stress to the pt to decrease the risk of a reoccurring MI would include types of fat consumed, portion sizes, cooking methods, importance of fruits and vegetables, etc. However, I would make sure to not overload the pt at once with a lot of information. Hopefully, you would have a few opportunities to talk with them and follow-up. It is also important to educate pt's on how to incorporate a more healthy diet into their lifestyle. This would ensure more success.
Although a 24-hour recall would be quick and easy, it does rely on memory, requires knowledge of portion sizes and may not represent what they usually eat, I do agree this could be a way to start talking and interviewing the patient on their dietary habits. I think maybe a food frequency maybe be an easier way to get that overall picture of the clients usual intake. When educating a patient on their diet, it is important to remember that they can’t change their diet in one day. It is important to start out and make small, easy changes and then progress to a healthier way of life. It would be important to gradually explain healthy fats, snack options, portion sizes and how important exercise is to one’s health.
Vanessa,
I agree with you that you should discuss who does the shopping and cooking in the household. Sometimes the education is given to the patient and they don’t ever shop or cook, therefore the information that you are giving them is almost pointless because someone else is going to be preparing the patients meals. Informing the patient and educating the person who does the shopping and the cooking is essential if they want to see changes and develop a healthier lifestyles.
No, a 24-hour recall of his/her typical intake would not be beneficial for either party. The main points I would stress for preventing another MI occurrence would include altering his/her diet and physical activity. I would stress the importance of choosing heart healthy foods such as whole grains, dietary fiber, fruits, vegetables, lean meats, and low-fat dairy. High, saturated fatty foods should be eliminated or kept to a minimum and foods should be cooked in healthy oils such as canola, olive, or soybean oil. Omega 3 & omega 6 fatty acids should also be addressed and incorporated into his/her daily diet. In addition to diet alterations, physical activity (including cardio and weight-bearing activities) should be included on a daily basis.
I agree with Mary Ellen and Andrea that 24-hour recalls are not necessarily indicative of the pts regular diet. Not to mention, they would be very unreliable since they have been put on a cardiac diet in the hospital leaving them with possibly healthier choices than they would normally pick.
AS a clinical RD, the first thing I would want to find out is whether the pt has had any previous experience with a cardiac diet. This allows me to determine how indepth I would go, assuming they wish for me to stay and provide them with information.
I would emphasize how to make better fat choices. First, I would briefly and simply explain that fat is like trash in a river. The more trash we put in the river the more likely we are to damn it up!
Some things I bring up to my current MI pts: 1-The fewer legs an animal has, the less saturated fat it has (of course you have to be careful to elaborate, but emphasizing that fish (no legs)should be eaten 2-3 times/week, chicken or turkey (two legs) 2-3 times/week, and beef or pork (you get the picture?) less than twice a week. Since most Americans are big beef and pork eaters, I usually don't put a number to how much beef and pork to eat each week. 2-Instead, I would teach them what kind of numbers to look for when buying meats at the store; Or 3-Choose foods at restraraunts that are grilled, broiled, or baked rather than "sizzling, smothered, or battered"; 4-Lastly, emphasize that our heart can act like a high pressure hose pushing blood quickly through our body to help things from getting damned up creating a blockages in our leg (blood clot), heart (creating another MI), or even our head (causing a stroke). This analogy speaks for EXERCISE!!! In closing, I would remind them to take one step at a time in order to avoid failure and achieve goals. Outpt cardiac rehab is also recommmended for further assistance.
The hospitals aren't always the greatest place to be giving information, however, it seems like the only place these pts are going to get it! As dietitians, we have to be brief, concise, and most importantly, simplicitic in our word choices so we speak to them not over them!
I would have them fill out both a 24-hour recall and a FFQ. I think that the 24-hour recall is good to have because it tells you how often they eat and how much they consume when they do eat. I would also have them fill out a FFQ because it would give me more of a general idea of the types of foods they consume and how often they consume them. After I had gathered the information about their diet I would begin to educate them on proper eating habits and exercise. I know that if they are used to consuming high fat foods that they are not going to all of a sudden just start consuming low fat foods. One example I would have them do that I know many of us are familiar with is that I would have them go from drinking whole milk to 2% and so on until they got to skim milk. I would not have them go straight to skim milk because they are not going to have time to adjust to it and they will be less likely to continue to drink it. I would make the diet changes a gradual process so that they would have time to get used to it and therefore be more likely to stick with the changes. I would also educate them about how they should focus on consuming more of the “good” fats and less of the “bad” fats.
Suzie-
I think your analogies are great! I think they would really help to explain things more clearly to patients who are confused about the information being given to them. I think all the advice you give to your patients is really good. I think it was smart of you to ask if the patient had any previous experience with a cardiac diet because someone could have tried to put them on a similar diet before to prevent MI and they just did not listen to them.
First off, I would make sure that the pt understands portion sizes and honesty when giving the 24 hour recall. Then I would inform them about certain foods to minimize and others to maximize. So, if the pt only ate one fruit and one veggie then I would tell them to focus on making those parts of every meal along with whole grain breads. Another key point would be to decrease the amount of saturated and trans fats. Staying away from deep fat fried foods and fatty cuts of meat is important. Finally, including 30-60 minutes of exercise per day would decrease the chances of having another MI.
I think that a 24 hour recall may be more usefult in an outpatient situation where you have more time to spend with the patient. In order, to get a 24 hr recall that is the most accurate you may need to do serveral "passess."
I would ask for a 24 hour recall and then ask if that is a normal day of eating. I would explain portion sizes and educate them on the benefits of less saturated and trans fat and more nutrient intensive foods. They would also need to know to not cut anything completely out of their diet. They can still eat foods similar to their previous diet, but modified so they won't feel like they have to change all their habbits. Give them some healthier option recipies that are along the lines of what they are used to eating.
mary ellen
I disagree with you because I think a 24 hour recall can give you a basic idea of what they eat. You just have to make sure and ask the right follow up questions and make sure they are painting you an acurate discription.
Andrea said...
Beverly,
Working as a clinical RD we definitely do not have time to cover everything you mentioned as prevention for secondary MI. In addition, if presented with too much information clients may feel overwhelmed and compliance may be affected. When you have a limited amount of time, and attention, with the client it is important to focus on one or two modifications that the client is willing and able to successfully execute in order to better their lifestyle. These will be unique to each patient.
Andrea said…
Suzie,
Your post was excellent. I think clients can simply relate to analogies of everyday life. This can be a straightforward and effective way to teach most people. Your recommendations were specific and easily modifiable to individualize your education with each patient. I especially enjoyed your last comment. My outcomes research proposal project deals with the issue of in-patient nutrition education not being optimal for long-term change.
I think asking the patient what they normally eat on a typical day or what their favorite foods to eat are would be a more effective approach than the 24 hour recall. I feel this way because the patient may not remember an exact past 24 hour recall. I think getting them to tell you what foods they generally eat on a regular basis would be just fine. The first point that I would stress when educating this patient on decreasing their risk of a reoccurring MI would be to eat less saturated fats and more PUFA and MUFA for their total fat intake. I would go through examples of foods that contain these types of beneficial fats. I would also stress to limit their intake of cholesterol and sodium to reduce the risk of hypertension. I definitely would mention to eat more fruits, vegetables, and whole grains. Other risk factors to talk to the patient about would be whether or not they smoke or drink alcohol. If they do I would suggest they try to limit the use of or quit all together. Lastly I would inform them that keeping a healthy weight is very important and to exercise regularly. There is no need for heavy exercise but just brisk walking for 30 minutes a day would be beneficial.
I think a 24 hour recall could help to see if this person is eating the wrong types of food. Also I would like to find out what the diet was like before the patient had MI. When educating this patient I would like to find out what age this person is. The older the person is the less likely that person might not want to change. If the patient is on the young side I would encourage more exercise like short walks and to limit the intake of high fat foods and encourage fruits and vegetables.
I would probably start with a 24 hour recall as it is a good way to probe a pt to collect data and initiate conversation. I would ask things about how often they ate out and how often they ate certain food groups and some details about their typical dietary habits (use salt shaker?, fry foods? whole milk? do they have family meals or cook themselves?) I would show them some areas where a small change could add up to a big difference in their overall health. I would also ask them if they were comfortable with their wt and if there has been a recent change. I think it also important to consider the pts work and stressors, their exercise regimen (if any), and the importance of making a lifestyle changes that include quiting smoking and perhaps attending cardiac rehab classes. I don[t think a half hour with a pt is enough time to truly help them learn all of the steps to a healthy life. I think in order to give the pt a fighting chance at preventing another MI they should attend rehab classes, nutrition counseling etc, on a continous basis for about a year.
Yes, I would definitely conduct a 24-hour diet recall on the patient. But, no, I would not base too many conclusions on my findings. While a 24-hour recall would provide me with a particular day's food intake of the patient, it may NOT be a representation of what he/she eats regularly. However, the 24-hour recall would help and can be a good starting point. I would also meet with the spouse or close relative of the patient and discuss typical eating behaviors and choices of the MI patient. Since it is obvious that the patient might not recall all foods eaten or the amounts, or that they might not WANT to tell you, it is important to assess the patient in many different ways. Based on the patient's typical food choices and portions, as gathered from the patient, family, and numbers, I would then begin the cardiac education. I would stress reducing saturated fats in the diet, as well as reducing sodium, sugar, and total calories. Additionally, I would explain to the patient the importance of consuming at least 5 servings of fruits and vegetables every day, as well as getting at least 25 grams of fiber in his/her diet. Fried foods, desserts, and red meats should be greatly reduced in order to decrease the risk for a second occurance of a myocardial infarction. I would also educate the patient on the fact that exercise will play a key role in improving his health, but to start off slow and ask his doctor. A portion size education might be beneficial in losing weight, which may lead to weight loss and reduced risk for another MI.
Suzie,
I love your analogy that fats are like "trash in a river." This immediatley got my imagination firing and right away I told myself that I did not want to put trash in my body! My point here is that with this analogy, you are really getting into the mind of the patient, and they can actually, when they hear that put that into their heads as a picture. It is a strong possibility that, the next time the PT was craving something fatty, he/she would say to him/herself "I am not going to choose that food because I do not want to keep putting trash into my body!" I think it is an excellent way to get through to a PT and prevent them from making poor food choices and possibly having another MI.
I think a 24-hour diet recall should not be overlooked. Any evidence of diet behavior would benefit an analysis, however I think a more thorough analysis is necessary. A 24-diet recall may not illustrate typical consumption. It is important to get an idea of the individual’s usual diet in order to address all areas that need improvement. When educating the patient on decreasing their risk of a reoccurring MI, I would stress avoiding saturated and trans fatty acids and cholesterol, while limiting sodium and alcohol intake.
In most situations that a clinical R.D. may encounter, the discussion of the patient's usual diet can be a great tool. This helps to outline and organize what your particular patient needs to work on and what the order of importance may be. For a patient suffering post acute MI, a cardiac diet of healthier fats and portion sizes should be stressed.
As far as dealing with a patient that has a weight issue, I think, the dietitian neeeds to feel out the situation because some people are more sensitive than others and you do not want to discourage your patient. I would imagine if this MI patient was serious about changing their lifestyle habits to accomodate their current condition this weight loss may occur as a healthy side effect. This would be something that as one becomes more experienced one would be able to assess and handle in a more professional, sensitive manner.
I would request a 24 hour recall from the individual because it is important to see the composition of his or her diet. Measures must be taken to reduce that individual’s risk for another MI. Adjusting the individual’s diet is necessary to help him or her lower their risk for another MI. A 24 hour recall is a great place to start with regards to understanding where trouble areas exist in the individual’s diet. I would then educate the individual about the dangers of a high calorie, high saturated fat, high trans fat, and high cholesterol diet. I would emphasize the importance of incorporating vegetable oils, plant fats, and fatty fish as the primary sources of fat in the diet. I would tell the individual to try to eat lean meats and dairy products. I would also talk to the individual about incorporating an exercise regiment into his or her daily routine.
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Suzie
I like your analogies you have for helping patients to understand what we are trying to teach them. This is a great way to help people understand what we mean without having the intricate details laid out. I never thought about animals with fewer legs having better fats.
I would ask them to tell me what they eat in a typical day. I may also even give them a food questionnaire and focus on hearty healthy foods to see what they are consuming. I would start with explaining the importance of lowering saturated fat and cholesterol in the diet. I would encourage the consumption of whole grains and omega three's for heart health. I would also ask the patient if they did a lot of the cooking in the house. If so, I would give them so ideas on how to reduce the fat in recipes through substitution. An example is substituting applesauce for oil in baking.
Vanessa,
I really like your point about making sure to find out who is in charge of cooking and grocery shopping for the patient since it may not be the patient but actually a parent or spouse. It is really important to educate that person as well since they have such a big impact on what the patient will eat on a regular basis.
It is probably also a good idea to educate families as well and encourage them to modify their eating habits to be supportive of the patient. It is hard for one person to change when everyone else does not support the habit.
Mary Ellen,
I completely agree with you that asking the patient his or her favorite foods or the foods mostly consumed by them is a better approach than the 24 hour recall. It is also a good idea to stress the good fats and explaining that taking fats completely out of the diet would not be healthy. I also think that it is important to address portion sizes for a patient who may be overweight or obese, since overconsumption may be a problem, as it is with many people today.
I would ask for their typical intake, this would give an overall, more accurate picture of what the pt. would normally consume. As part of the cardiac education, I would emphasize small, easy, realistic changes that the pt. could make to increase fruits/vegetable, decrease saturated fat intake, and increase physical activity. Encourage the pt. to want a healthy heart and start with substitutions such as using low-fat or skim milk, trim fat off, and remove skin from chicken. Perhaps using rice or pasta as the main dish and have lean meats as a side dish as well as substitute liquid oil for solid fats.
Yes, the 24 hour recall will help us to understand what type of diet that patient had prior to the MI. It will help us know what areas of their diet need to be addressed. The patient will need to be introduced to a heart-healthy diet, which includes fruits, vegetables, whole grains and most importantly healthy fats. Depending on their eating habits you may need to address proper portion sizes, meal times, education on the importance of different types of foods and other areas. The patient will also need to begin a regular exercise regimen, which may or may not include weight loss.
Annie,
You made a great point about identifying problem areas. By identifying certain areas that the client needs to improve, it is more individualized. If a client is motivated to improve on a certain area, you wouldn't need to convince them to improve on it.
Well I think a 24 hr recall would be great. First of all you get to take a tiny look into their eating patterns. And hopefully you can determine some foods that can be eliminated. More importantly you'll be able to help them a great deal by showing them foods that they can substitue or correct that might in turn make a big difference. After surgery i would stress low sodium, lean meats, as low as possible with saturated and transfatty acids. Increase omega's. Increase fruits/vegtables. Increase exercise gradually. And maintain a healthy weight.
Mary Ellen,
Though a 24hr recall might not be the best tool. It might be your only option because of the fact that your doing this post surgery. I think that if I just had surgery my mind wouldn't be able to remember that far back because of stress or trama. Also this is a tool that most patients can fill out because it is a short time span. I think really after getting the 24hr recall you will be able to feed off of it with lots of questions for your pt.
I think that a 24 recall would be helpful, possibly because it could be a clue to a typical dietary schedule for the patient. Although they may have had a “good” eating day or a “bad” one, you can then look at that to develop questions that may help the dietitian get more useful information. No two clients will eat exactly the same diet, so when educating them post MI, it is important to remember to individualize your education session based on what they already/do not know! I would stress the fact that healthier options need to be chosen starting with including less saturated fats and more unsaturated fats (not limiting or completely disregarding them in the diet), a variety of fruits and vegetables, larger amounts of carbohydrates coming from whole grains and complex carbs rather than simple sugars, and choosing proteins with lower amounts of cholesterol (usually compromising very lean or lean proteins).
blradwan,
I think you made a great point in your response to question three concerning the risk of a reoccurring MI. Exercise is crucial and I think many people forget to suggest this type of prevention. A patient may not realize the importance of exercise in combination with healthy food choices while trying to make those significant lifestyle changes following a MI.
Suzie, I love the direct comparison between the number of legs an animal has and the amount of saturated fats its meat contains. Ideally, every time a pt was at the grocery store, or choosing an item at a restaurant, they would think of the animal and how many legs it has, and then directly relate this to how much saturated fat it contains. I just think that’s a very unique way of putting it, one that I will definitely remember which probably means that a pt would remember it as well. And with quick nutrition interventions, anything that packs some “creative” punch is going to help.
A 24 hour recall would be helpful to look over and get a quick estimate of the type of diet one is consuming. While it may not be the most efficient way of understanding a patients overall diet, it would be a great way to start. It is important to give the patient small changes to make overtime instead of changing everything about their diet in one big step. The patients need to be eased into a new lifestyle of eating healthy and exercising. Once again education about eating styles, portion sizes, food choices, and exercise is key. By giving them specific food options they will know exactly what they should and should not eat. Any amount of change would benefit the patient and reduce the chances for another MI.
I agree with Samantha when she said that it’s important to gradually explain healthy fats, snack options, portion sizes and how important exercise is to one’s health. Educating the patient first is the most important job of a dietitian. You are right when you say that they can’t change their diet in just one day. It takes time and plenty of advice and encouragement to get someone on the right track. After it’s all done and said it can be a very rewarding experience.
Suzie,
I like your methods of talking with the clients. I think it makes it fun and easy to get your point across. Any type of analogy helps the client to better understand and more likely to remember what you talked about.
I think a 24-hour recall of some other diet analysis tool would be helpful. This would help me determine where they stand as far as a healthy diet goes. I would stress to them the importance of limiting their saturated fat, trans fat, and cholesterol intake. I would give them example of “good” fats, such as olive oil or fatty fish. They should be getting plenty of whole grains, fruits, and vegetables in their diet and limiting sodium to less than 2400 mg/d. I would also remind them of the importance of exercise along with a healthy diet.
Lynn2552,
I completely aggree that a 24 hour food recall would be a conversation starter and would help the R.D. develop educational advise. Also, I complete agree with you that not only nurtitional/food advise should be given during the education program...but you should also focus on lifestyle changes. Incorporating an exercise program, quit smoking or excessive alcohol consmption, and wt loss are all very good ideas that R.D.'s must remember when educating a patient who has just suffered an acute MI.
beth c,
I think you make a good point that after a MI, an individual will be on a new diet regimen which will not reflect his previous patterns of food consumption. Maybe being more general with the individual and simply talking to him or her about their current plans for a future diet is a better, more efficient use of the RD’s time. At that point, the RD can make simple adjustments regarding problem areas of the individual’s current plan for a more heart healthy diet.
Dana...
I agree that a 24 hr recall will give you an idea about a pt's eating habits, you can also go into questions like what foods do you typically eat, how do you prepare your foods, etc. You also gave great suggestions on what you would suggest to the pt like low saturated and trans fat, increased fruits and vegetables, exercise, etc.
Sam – It is very true that dietary change, or any permanent change for that matter, cannot occur overnight. Small changes are the one’s that usually stick. Also, the idea of a food frequency questionnaire is an interesting thought. In this case, the 24-hour recall may not be as beneficial or accurate when compared to the food frequency questionnaire.
Lori
I think having the patient answer a questionnaire on top of a 24 hour recall is helpful in determining what the patient really had to eat. The questionnaire can also be a way to show the patient what a proper food portion is and explain what heart healthy foods are.
I really agree with slgaitr who said that the biggest thing to do first is get a good feel for the patients diet and then to alter the worst foods that the patient indulges in. A good way to do this is ask about a typical breakfast, a typical lunch, etc and get many ideas of what that patient may eat or enjoys eating at these times rather than just a 24 hr recall that may be skewed because it was a unusual day. From there (like slgaitr) you can then make the necessary changes while helping the patient understand and visualize what exactly in their diet may be a problem and something they should work towards changing.
Suzanne,
I like your emphasis on gradual change. I too believe this is the only thing that will successfully work. Changing everything at once is too overwhelming and almost impossible. I agree with you in that they should try changing portion sizes first since this would allow them to eat their favorite foods in moderation.
Suzie,
I really like this saying, “I would briefly and simply explain that fat is like trash in a river. The more trash we put in the river the more likely we are to damn it up!” That’s such a good way of explaining this without wording things in a way that bore people. You made a lot of excellent points. As you mentioned it is important to educate people on keeping down their saturated fat intake, choose lean meats, choose foods that aren’t breaded or fried, and, of course, exercise. Keeping down their sodium and cholesterol intake will also aid in trying to avoid another MI.
Annie
I liked how you pointed out that taking a different perspective/take on the situation in order to accommodate the patient’s strength. This would allow for optimal motivation and determination for the pt. to make a change and stick to it. A pt. might start small and change what they are willing to change as a jumping off point. People are not always willing to give up their large satisfying portion sizes. Exercising is a great counterpart to start focusing on first and work towards changing dietary habits.
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