Transcript A Nutrition History in TWO Minutes!

A Workshop on Obesity and Pregnancy
A Dietary History in
TWO Minutes!
(Can it be done?)
Susan van Maanen
Dietitian, Diabetes in Pregnancy
Nutrition Services
Auckland City Hospital
August 2011
What do Pregnant Women
Eat in NZ?
Eat more than recommended:
 Fat, especially saturated fat and sugar
Eat less than recommended:
 Vegetables & fruit leading to less fibre and
folate eaten than recommended
 Calcium, Iron, Zinc and Selenium
504 pregnant women, 1x24hr diet recall, 3x1 day food records,
2 day activity record, Ht, Wt, skinfolds, blood sample at mth 5,
demographic, medical and lifestyle details
Nutrition in Pregnancy- Report to MoH. Watson P. 1999
What do Pregnant Women
Eat in Australia?

Women (52%) are piling on extra weight &
keeping on the weight gained, post-natally

Choosing fatty food over vegetables & fruit

Iron, calcium & folate requirements not met
50 overweight and obese pregnant women, diet history at 12,
28, 36 wks, food frequency questionnaire, Ht, Wt –
prepregnancy, 12, 28, 36 wks and 6 weeks P/N
Nutrition and Dietetics. De Jersey et al. Vol. 68, No 1,P 53-59
March 2011
My Clinical Observations:

Women are shocked at how little weight gain is
recommended in pregnancy & that no-one had
told them sooner what was appropriate

Women want to do well for their baby & family
but don’t know how to eat well

They feel they will never achieve weight loss
post-natally

Embarrassment & feelings of hopelessness
Observations:

Eating too much!

Poor food choices (finances)

No exercise

Skipping meals, hunger, then over
eating
The Challenge: How to
give personally relevant
advice?
Diet history
 Food record
 Food frequency
questionnaire
 24 hour dietary
recall

Taking a Diet History:
Compared to giving out a generic
pamphlet, personally relevant advice
has been shown to:

Be remembered

Effect change more readily

Build confidence and rapport so that
disclosure is more likely
A Diet History will Identify:

The adequacy of the woman’s usual
food/ nutrient intake

Frequency of eating: regular meals and
snacks?

Takeaways?

Excess energy from added sugars/drinks,
cooking & spreading fat

Portion sizes?

Who cooks?
Easy Portion Measures:
Healthy Eating Plate:
Dietary HistoryAdvantages:



Identify where changes can be made
Negotiate ‘actual’ change
See through their ‘outside’ layer
Disadvantages:



Relies on honesty
Underestimates intake
Not precise
What is the goal?
To gain enough information to advise
the woman on achieving:
 Nutritionally adequate diet
 Appropriate weight gain in pregnancy
 Encourage weight loss post-natally &
future disease prevention - Diabetes,
Cardiovascular Disease
 Healthy baby
 Positive attitude to health - now & for
the future.
A Dietitian’s Request to Midwives:
Please weigh women every visit if you can
(including out of pregnancy if appropriate),
so they know how they are progressing
Failing to receive any weight gain advice
during pregnancy favours excessive weight
gain!
Remember PREVENTION is easier than CURE
Food for a Healthy Mother and
Baby:
Lean Meat, Chicken, Fish etc
- 2 servings/day
Bread & Cereals - 6 servings/day
Vegetables & Fruit - 6 servings/day
Milk & Milk Products - 3 servings/day
Drink plenty of fluids every day - 9 cups
Choose & prepare foods low in Fat, Salt &
Sugar
Keep Active
Food Safety
Eating for Healthy Pregnant Women.
MoH. August 2010.
So - do you think
you can do a
Dietary History in
TWO minutes
Self completed questionnaires:
Advantages:
 Save health professionals time
 Bring to clinic completed or complete
while waiting in clinic
Disadvantages:
 Needs to be short and simple or
women will lose interest
 Literacy barriers
Handbook for Lead Maternity Caregivers.
Canterbury District Health Board. 2004
A Nutrition Guide for Health Professionals,
Resources Tool Kit, ADHB. 2011.
A Nutrition Guide for Health Professionals,
Resources Tool Kit, ADHB. 2011.
Time Well Spent:
Whatever method you use,
I recommend spending as much time
as you can, getting information on the
woman’s usual eating habits and
giving sensible nutrition advice.
Your time will never be wasted!
Websites/ Resources Available:
www.dietitians.org.nz
www.moh.govt.nz
www.healthpoint.co.nz
Eating for Healthy Pregnant Women
Healthy Eating for South Asian
People
Thank You