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FM6 Family Medicine
Vegetables 50%
Health Promotion and Counselling Toronto Notes 2019 Health Promotion and Counselling
• healthpromotionisthemosteffectivepreventivestrategy
• thereareseveraleffectivewaystopromotehealthybehaviouralchange,suchasdiscussionsappropriate
to a patient’s present stage of change
• formoreinformation,seewww.motivationalinterviewing.org
Motivational Strategies for Behavioural Change
Meat and Alternatives 25%
Figure 3. Plate layout
Grain Products 25%
Table 2. Motivational Strategies for Behavioural Change
Handy Serving Size Comparisons
• 3 oz meat, fish, poultry g palm of hand
• 1 cup dairy (milk/yogurt)gsize of fist
• Bread/grains g one slice, palm of hand
• 1⁄2 cup rice/pasta g one hand cupped
• 1 cup of fruit/vegetablesgtwo cupped
hands
• 1 oz cheesegfull length of thumb
• 1 tsp oil/buttergtip of thumb
• Nuts/chips/snacks g palm covered
Energy Content of Food
• Carbohydrates 4 kcal/g • Protein 4 kcal/g
• Fat 9 kcal/g
• Ethanol 7 kcal/g
Calculating Total Daily Energy Expenditure (TDEE)
• Roughly 35 kcal/kg/d
• Varies by age, weight, sex, and activity
level
• Average 2000-2100 kcal/d for women,
2700-2900 kcal/d for men
Canadian Cancer Society (CCS) Recommendations for Vitamin D Use
• Based on CCS research on Vitamin D and
the prevention of colorectal, breast and
prostate cancer
• In consultation with their healthcare
provider, the Society recommends that:
• Adults living in Canada should consider
taking Vitamin D supplementation of 1,000 international units (IU) a day during the fall and winter
• Adults at higher risk of having lower Vitamin D levels should consider taking Vitamin D supplementation of 1,000 IU/d all year round. This includes people: who are older, with dark skin, who do not go outside often, and who wear clothing that covers most of their skin
• Babies who are exclusively breast-fed: 400 IU/d
Patient’s Stage of Change
Pre- Contemplation
Contemplation Preparation
Action
Maintenance Relapse
Physician’s Aim
Encourage patient to consider the possibility of change Assess readiness for change
Increase patient’s awareness of the problem and its risks
Understand patient’s ambivalence and encourage change Build confidence and gain commitment to change
Explore options and choose course most appropriate to patient Identify high-risk situations and develop strategies to prevent relapse
Continue to strengthen confidence and commitment
Help patients design rewards for success
Develop strategies to prevent relapse
Support and reinforce convictions towards long-term change
Help patient maintain motivation
Review identified high-risk situations and strategies for preventing relapse
Help patient view relapse as a learning experience Provide support appropriate to present level of readiness post-relapse
Physician’s Plan
Raise issue in a sensitive manner
Offer (not impose) a neutral exchange of information to avoid resistance
Offer opportunity to discuss pros and cons of change using reflective listening
Offer realistic options for change and opportunity to discuss inevitable difficulties
Offer positive reinforcement and explore ways of coping with obstacles Encourage self-rewards to positively reinforce change
Discuss progress and signs of impending relapse
Offer a non-judgmental discussion about circumstances surrounding relapse and how to avoid relapse in the future
Reassess patient’s readiness to change
Adapted from: Hunt P. Motivating Change. Nurs Stand 2001;16:45-52, 54-55 Nutrition
General Population
• Canada’sFoodGuideisappropriateforindividualsage≥2
• counselonvariety,portionsize,andplatelayout
• vitaminsandminerals:see“FunctionsandFoodSourcesofSomeCommonVitamins”and“Functions
and Food Sources of Some Common Minerals” - available from https://www.dietitians.ca/
Table 3. Canada’s Food Guide 2011 Recommendations for Children ≥2 and Adults (# of servings/d)
Age in Years
Grain Products
Vegetables and Fruit
Milk and Alternatives
Meat and Alternatives
Children
2-3 4-8 9-13 3 4 6
4 5 6 2 2 3-4 1 1 1-2
Teens Adults
14-18 19-50 51+
F:6 F:6-7 F:6 M:7 M:8 M:7
F:7 F:7-8 F:7 M:8 M:8-10 M:7
F:3-4 F:2 F:3 M:3-4 M:2 M:3
F:2 F:2 F:2 M:3 M:3 M:3
Choose More From
Whole grain and enriched grain products
Dark green vegetables, orange vegetables and fruit Lower-fat dairy products
Lean meat, poultry, fish, peas, beans, lentils