Test Bank Chapter 9 Dietary Approaches To Weight Management

Chapter 9

Dietary Approaches to Weight Management

Learning Outcomes

Upon successful completion of this chapter, students should be able to:

1. Maintain, analyze, and interpret a 3-day diet record and discuss the limitations and challenges of using diet records to assess dietary intake.
2. Utilize dietary guidelines to estimate an appropriate caloric intake for weight loss, gain, or maintenance.
3. Discuss the roles of fruits and vegetables, starches and grains, dairy products, and dietary fat in health and weight management.
4. Describe diet plans that have been effective in weight management, consuming a healthier diet, and reducing the comorbidities of obesity: Dietary Guidelines for Americans, the U.S. Food Exchange System, DASH diet, Mediterranean diet, vegetarianism, high carbohydrate diets, the diabetic diet, and low-fat diets.
5. Discuss dietary considerations for infants, young children, and adolescents that are important for promoting health and reducing the risk of obesity and its comorbidities.
6. Comment on the occasions when micronutrient supplements might be beneficial, and list precautions necessary when consuming dietary supplements.

Chapter Outline/Summary

1. Dietary assessment
   1. The three-day diet record:

Diet assessment can help estimate caloric intake and prove useful in planning for change. The 3-day diet record requires the client to record all foods and beverages consumed for three typical days (usually two week days and one weekend day). Clients may be assisted in estimating quantity of foods by using photos of food or food models. Analysis of food records may use any of a variety of computerized diet analysis products. Limitations of diet records include client motivation and honesty, literacy, changing one’s eating patterns, and selecting non-typical days for analysis. Both quantitative and nonquantitative data are useful in interpreting diet records.

1. Diet planning: How much to eat:
   1. Appropriate caloric intake for weight loss, gain, or maintenance

The 2010 Dietary Guidelines for Americans provide general guidelines for caloric intake for males and females. For weight loss, a 500 kcal/day deficit is safe, although as noted in Chapter 4, any combination of reduced caloric intake and increased energy expenditure should not exceed 1,000 kcal/day. Portion control is a useful way to reduce caloric intake.

1. Diet planning: What to eat
   1. The role of fruits and vegetables in health and weight management:

Fruits and vegetables are rich in phytochemicals, including antioxidants, that can reduce the risk of cardiovascular disease, cancer, and other conditions associated with oxidative damage to cells. Foods are the best sources of antioxidants. Fruits and vegetables are also low in energy density, giving them low caloric value per unit of weight, and high in fiber, which makes them filling.

• 1. The role of starches and grains in health and weight management:

Whole grains are excellent sources of fiber and vitamin E, an antioxidant.

• 1. Dairy products and weight loss:

Calcium intake from dairy products seems to play a role in weight loss, when there is also a reduction in caloric intake.

• 1. How fat intake affects weight and health:

Polyunsaturated and monounsaturated fats are associated with a reduced risk of cardiovascular disease. The type of fat may also play a role in weight management. Long-chain triglycerides, which make up most dietary fat, may be oxidized at a lower rate in obese individuals.

1. Diet planning guides

The 2010 Dietary Guidelines for Americans feature MyPlate, rather than the Food Guide Pyramid, to promote a healthy eating pattern at each meal.

• 1. The U.S. Food Exchange System:

The U.S. Food Exchange System was developed by the American Diabetes Association and the American Dietetic Association to help diabetics with meal planning. The Exchange System can also be used to plan a healthy, calorie-controlled diet. It classifies foods into seven lists according to their carbohydrate, fat, and protein content; one serving of any foods on the same list will have approximately the same number of kcals.

1. Dietary approaches that address health concerns in overweight/obesity
   1. Dietary Approaches to Stop Hypertension (DASH):

The DASH diet includes generous amounts of fruit and vegetables, at least three whole-grain foods daily, as well as nuts, seeds, and legumes, limited fats and sweets, and low-sodium food choices. Research has verified that DASH helps lower blood pressure in hypertensive men and women.

• 1. The Mediterranean diet:

A Mediterranean diet includes substantial amounts of monounsaturated fats, fish, legumes and grains, lots of fruit and vegetables, and moderation in dairy, meat, and eggs. It is associated with lower rates of cancer and cardiovascular disease.

• 1. Vegetarian diets:

Vegetarian diets emphasize intake of plant proteins.

• 1. High-carbohydrate diets:

Carbohydrates can be a valuable adjunct to a weight-loss diet, when consumed in appropriate quantities.

• 1. The “diabetic diet”:

The glycemic index describes the extent to which specific foods raise blood glucose. The basis of a diabetic diet has been to limit high-glycemic foods and to monitor carbohydrate consumption so that blood glucose is stabilized. There is no one “diabetic diet,” but rather a recommendation that foods be consumed that normalize blood glucose and that saturated fats be limited.

• 1. Low-fat diets:

Low-fat diets have been successful in helping people to lose weight and maintain weight losses. Even if a specific low-fat regimen is not followed, most people would benefit from a diet that reduces intake of added fats and oils, high-fat dairy products, and meat.

1. Dietary considerations for children
   1. Healthy diets in infancy:

For the first six months (one year, if possible), breastfeeding and restricted access to juice is recommended by the American Academy of Pediatrics. Non-infant cereals should not be given before age 1 year.

• 1. Dietary considerations for toddlers and young children

Over Consumption of juice and fruit drinks, low-nutrition snack foods, and fast foods are problem areas for toddlers and young children.

• 1. Promoting healthy eating for older children

As children grow older and are able to consume more food away from the home, even vigilant parents cannot assure consumption of a healthy diet. After age 10 years breakfast consumption declines, fruit and vegetable intakes decrease, and more fried, nutrient-poor foods are consumed. Soda and juice drinks contribute to a rise in empty calories. Adolescents who want to diet to lose weight should be counseled to avoid fad diets, maintain at least 1,500 kcal intake, and incorporate physical activity into their lives.

1. Micronutrient supplements for health and weight management
   1. When micronutrient supplements are beneficial:

Vitamins and minerals are usually best absorbed through foods, but there may be occasions when a supplement is beneficial. No vitamin or mineral supplement promotes weight loss.

• 1. Precautions advisable when taking supplements:

Supplements should never exceed the tolerable upper intake level (UL), as described in Chapter 8.

Suggested Activities and Applications

Application 9.1 Diet Analysis

This application gives students hands-on experience in using a three-day diet record and interpreting its results. Students can use the Cengage product, Diet & Wellness Plus, if the instructor made this a requirement of the course, or the online SuperTracker, available at http://www.choosemyplate.gov/supertracker-tools/supertracker.html. After recording everything they eat and drink for three typical days, students can export and print reports. Students will discuss:

• Any difficulties they had using food records and how these difficulties might be overcome with clients.
• How close they came to the DRIs. What changes would they like to make to improve their diets?
• Any areas of concern that the diet analysis brought to light, including any social barriers to eating well and recording intake.
• How caloric intake relates to caloric expenditure estimated in Application 6.2

Application 9.2 Micronutrient Supplements

Looking at the SuperTracker or other dietary analysis reports, students will comment on the potential value of taking specific vitamin or mineral supplements. What precautions should they follow if using a supplement?

Activity 9.1 Building a Diet with the U.S. Exchange System

For instructors who wish to give students hands-on experience using the Exchange System to build diets, the following scenarios are suggested: Students can work in groups to plan the diets for the individuals in the scenarios. They will use Table 9-5 and the exchange lists in Appendix C for this activity.

• Male who should get no more than 50% of calories from CHO; 1800 kcal/day
• Male who can eat 2000 kcal/day, hates diet soda and wants to incorporate one regular soda each day
• 70-yr old woman weighing 150 lb; dietitian wants her to have 1 g protein/kg BW and stay under 1400 kcal/day
• 42-yr old female with hypertension and type 2 diabetes mellitus, who should stay at 1500 kcal/day

This table can be reproduced for student use. (The columns will be a more appropriate size if saved in landscape.)

Activity 9.2 DASH and Mediterranean Diets

This activity could be introduced prior to the instructor’s lecture about the two diets, so that students are expected to read about both diets and be prepared to report to the class.

Considerable evidence exists that both Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean Diet are effective in lowering the prevalence of cardiovascular disease and, perhaps, cancer. Students may use material in the text, as well as outside reading, to compare and contrast the two diets. Discuss:

• Which (if either) would be easiest to follow within our culture?
• How would socioeconomic status impact one’s ability to follow one or both diets?
• How closely does your own diet conform to these diets? If recommended by a health care provider, what would you need to do to conform?

Chapter 9

Test Questions

True/False

1. The human hand can be used as a guide to portion control. (True/ False)

2. There is evidence that the color of the table cloth and dinnerware can influence portion sizes. (True/ False)

3. The composition of calories is as important as the number of calories in maintaining good health. (True/ False)

4. Vitamin E is able to help stabilize free radicals. (True/ False)

5. A lack of calcium in the diet may stimulate appetite for calcium-containing foods and drive people to eat more. (True/ False)

6. When evaluating the impact of fat on health, the type of fat consumed may be more important than the amount of fat consumed. (True/ False)

7. Even one fish meal a week offers protection against cardiovascular disease. (True/ False)

8. Scientists have found that all fish have the same health effects. (True/ False)

9. Research suggests that all fats similarly impact obesity. (True/ False)

10. The DASH diet is considered appropriate for children, as long as adequate protein and calorie intake are assured. (True/ False)

11. The research on the Mediterranean Diet shows that adherence rates to this type of diet are better than for other traditional low-fat diets. (True/ False)

12. The Dietary Guidelines for Americans has yet to recognize vegetarian diets as meeting nutritional recommendations. (True/ False)

13. Carbohydrates are blameless in weight gain; high carbohydrates are often recommended for weight loss. (True/ False)

14. High carbohydrate diets (> than 55% of calories) will raise plasma triglyceride levels in some people, increasing the risk of cardiovascular disease. (True/ False)

15. The glycemic effect of a food can depend upon how it is cooked. (True/ False)

16. It is far better to encourage activity than to restrict calories for children, even among children who are overweight. (True/ False)

17. Most vitamins and minerals are best absorbed through food. (True/ False)

Multiple Choice

18. After determining an estimated number of calories to consume each day, an individual trying to gain weight should increase that by about ______ kcal.

A. 200 kcal

B. 500 kcal

C. 1,000 kcal

D. 1,500 kcal

19. After determining an estimated number of calories to consume each day, an individual trying to lose weight should decrease that by about ______ kcal per day.

A. 200 kcal

B. 400 kcal

C. 500 kcal

D. >600 kcal

20. Other than infants and young children, no one should consume fewer than ______ kcal without medical supervision.

A. 2,000

B. 1,800

C. 1,500

D. 1,200

21. ____________________________ are compounds produced by plants that have antioxidant or hormone like molecules; they include isoflavones, phytoestrogens, carotenoids, flavonoids, terpenes, sterols, indoles, and phenols.

A. Carotenoids

B. Free Radicals

C. Phytochemicals

D. All of the above

22. ____________________________ are oxygen atoms that have unpaired electrons that attack lipids, proteins, nucleic acids, and other cell components, causing oxidative damage, aging, and perhaps cancer, cataracts, and heart disease.

A. Carotenoids

B. Free Radicals

C. Phytochemicals

D. All of the above

23. ____________________________ are red, orange, and yellow pigments found in plant foods; beta-carotene, alpha-carotene, and beta-cryptoxanthin are vitamin A precursors, and include lycopene, lutein, and zeaxanthin.

A. Carotenoids

B. Free Radicals

C. Phytochemicals

D. All of the above

24. Whole grain rice and whole grain flour (from wheat, oats, barley, millet, rye, and bulgur) are an excellent source of vitamin ______.

A. Vitamin B

B. Vitamin C

C. Vitamin E

D. All of the above

25. Omega-3 polyunsaturated fats can be found in ________________________.

A. Fish

B. Poultry

C. Red meat

D. All of the above

26. The DASH diet includes _____ to _____ servings of fruit and vegetables each day.

A. 6-8

B. 8-10

C. >10

27. Consumption of fish and shellfish is recommended at least _____ per week on the Mediterranean diet.

A. Once

B. Twice

C. Three times

D. Four times

28. _____________________________ are vegetarians that exclude all animal products.

A. Lacto-ovo vegetarians

B. Pesco-vegetarians

C. Vegans

D. All of the above

29.____________________________ are vegetarians who exclude meat, fish and poultry from their diets but who eat dairy and eggs.

A. Lacto-ovo vegetarians

B. Pesco-vegetarians

C. Vegans

D. All of the above

30. ____________________________ are vegetarians who eat dairy, eggs, and fish.

A. Lacto-ovo vegetarians

B. Pesco-vegetarians

C. Vegans

D. All of the above

31. Bread has a glycemic index of ____________.

A. 25

B. 50

C. 75

D. 100

32. The American Academy of Pediatrics recommends that, when possible, infants be breast fed exclusively for _____ months, at which point foods rich in iron can be gradually introduced. Breastfeeding should continue for at least _____ months.

A. 3 months and 6 months

B. 6 months and 12 months

C. 12 months and 18 months

D. 18 months and 24 months

33. Not a characteristic of Mediterranean diets is:

A. low intake of saturated fats

B. moderate use of wine at every meal

C. abundant use of olive oil

D. less use of red meat than fish

Short Answer/Fill in the Blank

34. Describe the 3-day diet record. What are the benefits and limitations of diet records?

35. What are the benefits to advising individuals to reduce portions without counting calories?

36. A qualitative study revealed several factors that influence choices in portion size. What are three barriers to making healthy choices about portion sizes?

1)______________________________________________________________________________________________

2)______________________________________________________________________________________________

3)______________________________________________________________________________________________

37. Fruits and vegetables are low in energy density. What does this mean? Why is this important when considering weight management?

38. How does the allowance of a larger quantity of fruits and vegetables make it easier for people to adhere to a diet?

39. Do dairy products help people lose weight? Why/why not?

40. Provide two examples of sources of monounsaturated fatty acid in the diet:

1)______________________________________________________________________________________________

2)______________________________________________________________________________________________

41. In 2011 the MyPlate guide replaced the U.S. Food Guide Pyramid as the official food guide for the United States. Describe the MyPlate food guide. Why is the plate method a better guide than the food pyramid?

42. Describe the DASH diet.

43. Describe the Mediterranean diet. What are the proposed health benefits from this type of diet?

44. __________________________ is a system of classifying carbohydrates based upon their ability to raise the blood glucose level.

45. What are two recommendations for lowering fat consumption?

46. Describe some of the problems with the diets of toddlers and young children in the United States. What are some of the ways that parents can help improve the diets of toddlers and young children?

47. The goal for children should be weight management and not weight loss. Why is weight management a better goal for children? What considerations should be given when advising parents on how to promote healthy eating for children?

48. What are three important points that you should convey when counseling an adolescent who wants to lose weight?

49. Provide three examples of when consuming micronutrients could be beneficial or even necessary for health.

1)______________________________________________________________________________________________

2)______________________________________________________________________________________________

3)______________________________________________________________________________________________

50. Your slightly overweight client, who has no known medical problems, confides that she is thinking of going on a low-carbohydrate diet. What critical information would you provide about the risks or benefits of this?

51. Your client points out that the Atkins diet induction phase allows no fruits and very few vegetables. Yet, many health groups recommend consuming 5-7 servings of fruits and vegetables each day. Explain some values, both in terms of health and weight management, of following a diet rich in fruits and vegetables.