Nutrition for Special Populations

by: Cathy Leman, RD, LD

nu t r i t i o n f o r special populations What are the unique nutritional needs for individuals managing obesity, diabetes or cardiovascular disease? By Cathy Leman, RD, LD O IDEA PERSONAL TRAINER besity, diabetes and cardiovascular disease. As most personal trainers know, these three conditions not only share some of the same precursors, they also can affect one another as predeterminers of disease. For example, obesity can be linked to genetics, pregnancy, dietary choices, sedentary lifestyle, gender, ethnicity, age or even income bracket. Diabetes, depending on the type, may be linked to genetics, pregnancy, sedentary lifestyle, stress factors like viral infections, obesity, ethnicity or age. Cardiovascular disease can be linked to genetics, dietary choices, gender, sedentary lifestyle, obesity, ethnicity or age. Regardless of the origin of these conditions, each carries the potential for development of other diseases (Mahan & Escott-Stump 1996). People who are overweight, for instance, have a greater chance of developing type 2 diabetes than persons of optimal weight. So obesity acts as a predisposing factor to type 2 diabetes (Solomon & Manson 1997). SEPTEMBER 2000 nu t r i t i o n f o r special populations In addition to health considerations, persons who are diagnosed as obese often are subject to psychosocial ramifications, such as discrimination, alienation, low self-esteem and decreased mobility. Conversely, type 1 diabetes is not often associated with excess body fat; genetics appears to have a stronger influence (Holler & Pastors 1997). For individuals with diabetes, coronary heart disease (CHD) is more common, tends to occur at an earlier age and often can be more severe than for individuals without the malady. So diabetes can act as a predisposing factor to heart disease (Holler & Pastors 1997). In June 1998, obesity officially joined the American Heart Association's (AHA 2000) list of risk factors for CHD, which strongly underscored the link between the two conditions. While the links exist, it is important to realize that an overweight person will not ultimately be destined for a battle with type 2 diabetes, nor will someone diagnosed with diabetes categorically suffer a heart attack. Still, for an individual who currently exhibits positive risk factors, or for someone who has received a confirmed diagnosis for any of these conditions, nutrition intervention plays a dual role: proper nutrition can either (1) decrease the likelihood of risk factors escalating into disease or (2) minimize the rate and severity of disease progression. If you currently work with clients who fall into one or more of these categories, increasing your awareness about nutrition management for these conditions can be beneficial. Note: Nutrition counseling, especially for people with diabetes, is outside the scope of practice for personal trainers. This article is designed to help trainers better understand the unique nutritional needs of these special population clients and how such needs impact their overall health. addition to health considerations, persons who are diagnosed as obese often are subject to psychosocial ramifications, such as discrimination, alienation, low self-esteem and decreased mobility. Nutrition for Obesity Encouraging overweight clients to adopt a low-fat diet is the standard knee-jerk reaction. But low fat can mean different things to different people. Quite often, individuals struggling with weight issues and searching for ways to change their eating habits lump foods into "good" and "bad" categories. Consequently, any processed foods advertised as "no fat," "low fat" or "reduced fat" find their way into the grocery cart and are deemed good foods; anything else falls into the bad category, even if the food is high fat and nutrientpacked, such as nuts and avocados. Some people may say they heard that eating fruit all day is bad because of all the sugar--yet the same thought never occurs to them when choosing candy bars from the office vending machine. They fail to look at the big picture while dissecting intake on a food-by-food basis. As a trainer, it is within your scope of practice to urge clients to examine what they're eating. One of the more popular approaches is using a daily food log. Encouraging clients to write down their food intake for a week or two can help them see differences between single food items versus meals and snacks. Reviewing a completed food log can help shift the focus away from individual foods while becoming a tool for identifying and managing eating patterns. Perhaps there are certain triggers that set off poor eating habits. Trainers can help clients manage those triggers with exercise instead of food. Following is a one-day sample food log from a client: 8:15 AM: Obesity According to the U.S. National Institutes of Health (NIH 1998), an estimated 97 million adults--in the United States alone--are overweight or obese. Whether or not obesity should be classified as a disease continues to be debated. Still, experts do agree that obesity greatly increases the risk for a host of other diseases, including diabetes mellitus, hypertension, dyslipidemia (abnormality in blood lipid profile), CHD, stroke, gallbladder disease, osteoarthritis, sleep apnea and other respiratory conditions, and endometrial, breast, prostate and colon cancers. In the United States, obesity is the second-leading cause of preventable death (NIH 1998). There is a distinction between overweight and obesity. Overweight is defined as a body mass index (BMI) of 25 to 29.9. Obesity is defined as a BMI of more than 30. In IDEA PERSONAL TRAINER SEPTEMBER 2000 Noon: 6:30 PM: 8:00 PM: 1 slice of toasted, nine-grain bread with 3 tablespoons of peanut butter 1 small Granny Smith apple 12 ounces of 1 percent milk 6 ounces of grilled cod on white bun with 1/4 cup tartar sauce, onions, lettuce and pickles 12 ounces of lemonade 1 large chocolate frosted brownie with nuts 1/3 cup salted pumpkin seeds 1 cup of Caesar salad with 2 tablespoons of dressing, 1 /4 cup of croutons, 2 tablespoons of grated Parmesan cheese 1 large slice of garlic bread 1 large piece of bruschetta with tomatoes and onions 2 12-ounce cans of soda When reviewing a food log, keep the following areas in mind for obese clients: Fruits and Vegetables. Are fruits and vegetables prominent in the diet? These foods not only are naturally low in fat, but they are also a great source of fiber. Fiber adds no calories to the diet, yet creates a feeling of fullness. So your clients may eat less while getting a natural source of vitamins, minerals and antioxidants. (Because everyone has unique calorie needs, it's difficult to indicate exactly how many servings of fruits and vegetables obese clients need. An acceptable recommendation is to eat the minimum number of servings indicated on the U.S. Department of Agriculture's Food Guide Pyramid: two servings of fruit and three servings of vegetables daily.) Dairy Products. Are the dairy foods being consumed labeled nonfat or low fat? Sticking with non- or low-fat items reduces total fat intake as well as consumption of saturated fat. Calcium is critical for bone health, so unless clients suffer from lactose intolerance or an allergy, encourage them to consume dairy products daily (Guthrie & Picciano 1995). However, full-fat dairy products are high in total fat as well as saturated fat. Saturated fat tends to elevate blood cholesterol, so it's wise to reduce the amount in the diet (Mahan & Escott-Stump 1996). For example, an 8-ounce glass of whole milk has 150 calories and 8 grams (g) of fat, 5 of which are saturated. In comparison, an 8-ounce glass of skim milk has 90 calories and no fat, saturated or otherwise. Red and White Meats. If red meat is included in the diet, are the cuts lean, like sirloin or round? Are they being trimmed of excess fat? If poultry is part of the diet, is it primarily white meat without the skin? Skinless, white poultry is lower in fat than dark poultry with the skin (National Live Stock and Meat Board 1994). Do preparation methods aid in reducing fat, such as grilling, broiling or baking? Or are foods being cooked in ways that add excess fat, such as deep frying? Pasta, Rice and Bread. Be sure clients are not shortchanging themselves by skipping foods that are good carbohydrate sources. Carb sources such as pasta, rice and bread are naturally low in fat, provide the body's preferred source of fuel and typically contain a healthy dose of B vitamins. Note: Low in fat does not always translate to low in calories, so verify that clients are not consuming gargantuan portions that bump up daily calorie intake. Try to steer clients toward whole-grain choices, such as brown rice and 100 percent whole wheat products. Not only will clients benefit from additional nutrients, they will also increase their fiber intake. When it comes to weight loss, the bottom line is to take in fewer calories than those expended and a nutritious, low-fat diet can help accomplish this safely. While the main motivation for losing weight is often to look better, a decrease in weight of even 5 to 10 percent can result in improved medical conditions. Focusing on small changes over time results in long-term, permanent reduction in weight and associated risk factors. Eating nutritiously sounds easy enough in theory, but real-world application tends to make it more complicated than it has to be. Presenting different nutrition strategies can help clients stay focused on losing weight. Here are three examples: 1. Practice the 80/20 Rule. No one eats perfectly 100 percent of the time. Focusing on healthy, nutritious choices 80 percent of the time leads to flexibility and permission to enjoy all foods. For example, if a client has a weakness for chocolate, encourage the person to enjoy it weekly rather than daily. 2. Reduce Portion Sizes. Too much of any food, regardless of how nutritious it is, can put clients over their calorie limit. If they are not burning off the calories (even if the calories come from broccoli and tofu), they set themselves up for weight gain. While it may sound simplistic, serve meals in smaller dishes. Eat dinner off a lunch plate versus a dinner plate. Serve pasta in the smaller cereal bowl and salad in the larger pasta bowl. 3. Eat Several Small Meals Each Day. Eating small meals may not appeal to everyone, but many individuals function better when they regularly eat small amounts. Here is a one-day example (which meets the Food Guide Pyramid recommendations) of minimeals. Breakfast: 1/2 Midmorning: Lunch: Midafternoon: Dinner: Evening: of a whole grain bagel with 1 tablespoon natural peanut butter 6 ounces of orange juice 8 ounces of low- or nonfat yogurt 1/4 cup of raisins 2 cups of mixed salad greens with 3 ounces of grilled chicken breast and 2 tablespoons of reduced-fat salad dressing 1 whole grain roll 2 slices of whole-grain bread with 1/4 cup of hummus, lettuce and onion 2 ounces of grilled salmon 1 cup of steamed broccoli 1 cup of wild rice 1/2 cup of mixed fruit 8 ounces of skim milk 2 tablespoons of chocolate syrup This approach not only keeps blood sugar levels stable and energy levels up, it also staves off the "everything but the kitchen sink" hunger level. IDEA PERSONAL TRAINER SEPTEMBER 2000 nu t r i t i o n f o r special populations Maintaining good blood glucose levels through nutrition and medication helps prevent and treat short-term as well as long-term complications. Precautions and Notes

IDEA Personal Trainer , Volume 2001, Issue 5

© 2000 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

About the Author

Cathy Leman, RD, LD

Cathy Leman, RD, LD IDEA Author/Presenter

Cathy Leman is a registered dietitian, NSCA-certified personal trainer, and the owner of NutriFit, a nutrition therapy practice and personal fitness training studio in Glen Ellyn, IL. Cathy specialize...

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