Community nutrition in action an entrepreneurial approach 7th edition boyle solutions manual 1

Solution Manual for Community Nutrition in Action An Entrepreneurial

Approach

7th Edition by Boyle ISBN 1305637992

9781305637993

Full download link at: Solution manual: https://testbankpack.com/p/solution-manual-for-communitynutrition-in-action-an-entrepreneurial-approach-7th-edition-by-boyle-isbn-13056379929781305637993/

Test bank: https://testbankpack.com/p/test-bank-for-community-nutrition-in-action-anentrepreneurial-approach-7th-edition-by-boyle-isbn-1305637992-9781305637993/

Instructor’s Manual1 for Community Nutrition in Action 6e Chapter 5 – Program Planning for Success

Learning Objectives

5.1 Describe six factors that can trigger program planning.

5.2 Describe seven steps in designing, implementing, and evaluating nutrition programs.

5.3 Describe three levels of intervention.

5.4 Discuss three reasons for conducting evaluations of programs.

5.5 Discuss three major principles to consider when preparing an evaluation report.

5.6 Describe the steps of the nutrition care process.

Lecture Launcher

What makes a nutrition program a success? What could make a program fail?

In-Class Discussion Starters

 What experiences do you have with planning programs?

 What experiences do you have with planning large, detailed events?

 Would you rather plan a program/event or actually carry out the program/event? Why?

 What is the nutrition care process?

 How does the nutrition care process relate to community nutrition?

1 By Melanie Tracy Burns of Eastern Illinois University

Chapter Outline

I. Introduction

A. Program planning is the process of designing a program to meet a nutritional need or fill a gap in services.

B. The process of program evaluation is described, including why evaluation is important, who conducts the evaluation, how the findings are used, and how to prepare an evaluation report.

II. Factors That Trigger Program Planning

A. The decision to develop a nutrition program or modify an existing one is usually made in response to some background event.

B. Factors that trigger program planning include:

1. Results of the community needs assessment.

2. Mandate from an organization’s national office or from a federal agency.

3. Research findings.

4. Community leader or coalition.

5. Availability of funding for new programs.

6. Government policy.

C. Regardless of the impetus, the nutritionist considers developing a program when there is a perceived nutritional or health problem in the community that has not been addressed adequately.

III. Steps in Program Planning

A. Introduction

1. The nutritionist should review his or her organization’s mission statement before developing or modifying a program.

2. A mission statement is a broad declaration of the organization’s purpose and a guideline for future decisions.

3. If the match between the organization’s mission and the program concept is good, then senior management will support the program.

4. The program planning process consists of several steps.

B. Step 1: Review the Results of the Community Needs Assessment

1. The community needs assessment provides information about the target population’s nutritional problem or need and is the impetus for program planning.

2. When the assessment identifies a gap in services, a new program may be developed to fill the gap.

3. Case Study 1: Women and CHD Risk

a. The results of the needs assessment are presented and used to identify areas in which interventions might be useful.

4. Case Study 2: Nutritional Status of Independent Older Adults

a. The results of the needs assessment are presented and used to identify areas in which interventions might be useful.

C. Step 2: Define Program Goals and Objectives

1. Goals are broad statements of desired changes or outcomes, and provide a general direction for the program.

2. Objectives are specific, measurable actions to be completed within a specified time frame.

3. Objectives have four components:

a. The action or activity to be undertaken.

b. The target population.

c. An indication of how success will be measured or evaluated.

d. The time frame in which the objective will be met.

4. SMART objectives are those that are specific, measureable, achievable, and relevant, and that occur within a given time frame.

5. There are three types of objectives:

a. Outcome objectives are measurable changes in a health or nutritional outcome, such as a decrease in blood cholesterol or a change in functional status.

b. Process objectives are measurable activities carried out by the nutritionist and other team members in implementing the program that specify the manner in which the outcome objectives will be achieved.

c. Structure objectives are measurable activities surrounding the budget, staffing patterns, management systems, use of the organization’s resources, and coordination of program activities.

6. Case Study 1: Women and CHD Risk

a. Goals and outcome objectives are identified.

D. Step 3: Develop a Program Plan

1. Introduction

a. The program plan consists of a description of the proposed intervention, the nutrition education component, and the marketing plan.

b. The program plan is usually developed after reviewing existing programs and talking to colleagues and other professionals who have worked with similar programs or with the target population.

2. Design the Intervention

a. The intervention or intervention strategy is the approach for achieving the program’s goals and objectives by addressing “how” the program will be implemented to meet the target population’s nutritional need.

b. The intervention strategy can be directed toward one or more target groups: individuals, communities, and/or systems.

c. The intervention strategy can encompass one or more levels of intervention, such as building awareness (Level I), changing lifestyles (Level II), and/or creating a supportive environment (Level III).

d. Intervention strategies that increase awareness among individuals (Level I) include health fairs, screenings, flyers, posters, table tents, newsletters, and Internet websites.

e. Level II interventions reach individuals through one-on-one counseling and small-group settings, and usually involve a formal program of assessing the individual’s current attitudes, beliefs, and behaviors; setting goals for behavior change; developing the skills needed to change behavior; providing support for change; and evaluating progress.

f. Level III interventions target individuals through worksite health promotion and cafeteria programs, as well as policy changes.

3. Design the Nutrition Education Component.

a. Case Study 1: Women and CHD Risk: A nutrition education plan with Level I, II and III interventions is proposed.

4. Heartworks for Women Program: Assessing Participants’ Needs. The community nutritionist responsible for developing the Heartworks for Women program first identifies the target population’s educational needs by reviewing the community needs assessment results and by conducting formative evaluation research.

5. Set Goals and Objectives. Using the established objectives as a guide, the community nutritionist sketches a rough outline of the program sessions, showing the link between the program objectives and the individual sessions.

6. Specify the Program Format. Program formats vary, depending on what the program is intended to accomplish, what resources are available to implement it, and the fit with the topic and amount of information to be presented. When choosing the format, the community nutritionist considers many details related to implementing the program, such as group size and layout and equipment needed.

7. Choose Program Identifiers. Program identifiers include the program name, a logo, an action figure, or a tagline, which is a short, simple message that conveys the key theme of the program.

8. Develop a Marketing Plan. The marketing plan for the Heartworks for Women program is presented in Chapter 17

9. Specify Partnerships. Forming partnerships with grocery stores, local farmers, retail establishments, government agencies, nonprofit organizations, and other groups is one way of controlling the cost and increasing the reach of programs.

E. Step 4: Develop a Management System

1. Management refers to two types of structures needed to implement the program: personnel and data systems.

a. Personnel structure refers to the employees responsible for overseeing the program and determining whether it meets its objectives.

b. The structure of the data management system refers to the manner in which data about clients, their use of the program, and the outcome measures are recorded and analyzed.

2. An important part of program planning is calculating the management costs of the program, including direct and indirect costs.

a. Direct costs include the salaries and wages of program personnel, materials needed, travel expenses, and equipment.

b. Indirect costs include office space rental, utilities, and janitorial services.

F. Step 5: Identify Funding Sources

1. Nutritionists in nonprofit organizations and government agencies face many challenges in securing funding for all aspects of a program.

2. The nutritionist may review the program elements and consider whether outside funding in the form of cash grants or in-kind contributions from partners can be found.

3. The Logic Model: A Framework for Planning, Implementing, and Evaluating Programs

a. Components of the Logic Model include situation and priorities, inputs, outputs, outcomes, assumptions, and external factors.

b. Situation describes the current state of affairs, including needs and available assets.

c. Priorities should be identified as the most pressing needs since needs usually outweigh assets.

d. Inputs are the resources invested to achieve desired outputs and outcomes.

e. Outputs are the activities performed and products developed to address priorities and reach the target audience.

f. Outcomes are the ultimate goal.

g. Assumptions are the beliefs held concerning inputs and outputs.

h. External factors are environmental conditions interacting with and influencing the program’s outcomes.

G. Step 6: Implement the Program

1. Implementation is the action phase of the program planning process.

2. The key to successful implementation is to observe all aspects of program delivery and consider ways in which delivery can be improved.

3. Enhancing Program Participation

a. Participation is the number of people who take part in a health promotion activity.

b. Participation rates vary, depending on how new the activity is and whether an incentive for participating is offered.

c. Participation rates can be improved by understanding the target population and their needs and interests; using evaluation research to improve on program design; making the activity enjoyable and relevant to their needs; removing barriers to participation; enhancing the immediate benefits of participation; making registration easy; scheduling the activity at a convenient time; using incentives; and promoting the program.

H. Step 7: Evaluate Program Elements and Effectiveness

1. Evaluation refers to the use of scientific methods to judge and improve the planning, monitoring, effectiveness, and efficiency of programs.

2. The purpose of program evaluation is to gather information for making decisions about redistributing resources, changing program delivery, or continuing a program.

3. Why Evaluation Is Necessary. Evaluation is necessary to inform the community at large about a program’s success or failure. Evaluation can be used for different purposes:

a. To determine whether progress is being made towards meeting goals and if the goals are still appropriate.

b. To determine whether some elements of a program should be changed.

c. To identify ways in which interventions can be improved.

d. To pinpoint weaknesses in program content.

e. To meet certain accountability requirements of a funding agency or senior management.

f. To ensure that program resources are being used properly.

g. To conduct a cost-benefit analysis.

h. To determine whether objectives have been met or whether priorities need to be changed.

4. How Evaluation Findings Are Used. Evaluation findings have many uses:

a. They may be used to influence an executive or politician who has the authority to distribute resources and shape public policy.

b. They may alert managers and policy makers to the need for expanding or refining programs.

c. Evaluation findings may be applied to an immediate problem, and used by managers who are focused on the problem, or they may be used to shape policies and services beyond the scope of the original problem.

5. Who Conducts the Evaluation? Evaluations may be conducted by program staff or outside consultants. The objective evaluator is responsible for all aspects of the evaluation, from negotiating the evaluation focus to collecting data and preparing the final report.

6. The Program Evaluation Process. The purpose and scope of an evaluation depend on the questions being asked about the program.

a. It may focus on one specific program element or it may be comprehensive and examine the design of the program, how it is delivered, and whether it is being used properly.

b. Evaluation occurs across all areas of program planning, from design to implementation.

7. Evaluation as a Planning Tool. During program planning, evaluation occurs at each step.

a. Formative Evaluation. Managers conduct formative evaluation to achieve a good fit between the program and the target population’s needs, to develop appropriate nutrition messages, and to design a marketing plan. Formative evaluation is the process of testing and assessing certain elements of a program before it is implemented fully.

b. Process Evaluation. Process evaluation is a measure of program activities or efforts that is, how a program is implemented and helps managers decide which services to provide, how to provide them, and for whom. In process evaluation, the evaluator examines the target population to determine how they were attracted to the program and to what extent they participated.

c. Impact Evaluation. Impact evaluation is used to determine whether and to what extent a program or an intervention accomplished its stated goals by describing the specific effect of program activities on the target population.

d. Outcome Evaluation. The purpose of outcome evaluation (also referred to as summative evaluation) is to determine whether the program or intervention had an effect on the target population’s health status, food intake, morbidity, mortality, or other outcomes.

e. Structure Evaluation. Structure evaluation refers to personnel and environmental factors related to program delivery, such as training of personnel or adequacy of the facility.

f. Fiscal or Efficiency Evaluation. Fiscal or efficiency evaluation is the process of determining a program’s benefits relative to its cost.

(i) There are two types of efficiency evaluation, including cost-benefit analysis and cost-effectiveness analysis.

(ii) A cost-benefit analysis estimates both the tangible and intangible benefits of a program and the direct and indirect costs of implementing the program, and everything is translated into a common measure, usually a monetary unit.

(iii) The cost-effectiveness analysis relates the effectiveness of reaching the program’s goals to the monetary value of the resources going into the program.

8. Communicating Evaluation Findings. Evaluation findings should be compiled into a final report, which tends to include the following sections:

a. Front cover: includes the title and location of the program, the name of the evaluator, the period covered by the report, and the date of submission.

b. Summary (or executive summary): a brief overview of the evaluation.

c. Background information: places the program in context and describes what the program was designed to do and how it began.

d. Description of the evaluation: states the purpose of the evaluation, including why it was conducted and what it was intended to accomplish.

e. Results: presents the results of the outcome or process evaluation.

f. Discussion of results: includes the interpretation of the results and explores the reasons why a certain outcome was reached and how the program compares to similar programs.

g. Conclusions, recommendations, and options: an influential section.

9. The Challenge of Multicultural Evaluation. Multiculturalism poses some unique and difficult problems for program evaluation.

a. The evaluator must strive to remain neutral in the face of competing minority interests.

b. The evaluator must search out and define the views and interests of the minority groups to ensure that their needs are being met.

c. The evaluator must be sensitive to the cultural differences that make implementing the evaluation difficult.

I. Spreading the Word about the Program’s Success.

1. A good, effective nutrition program is not achieved by accident, but by planning today to meet the needs of tomorrow.

IV. Programs in Action: A Learn-and-Serve Nutrition Program: The Food Literacy Partners Program

A. Suggestions on how to provide nutrition education to enhance health literacy are presented.

V. Use Entrepreneurship to Steer in a new Direction

A. Program planning is one of the most exciting aspects of the community nutritionist’s job. It requires a great deal of creativity and offers opportunities to learn new skills and work with people in public relations, marketing, design, and communications.

VI. Professional Focus: The Nutrition Care Process: A Road Map to Quality Care

A. The Academy of Nutrition and Dietetics' nutrition care process and model (NCP) is described.

VII.Case Study: Program Planning

A. Scenario

1. A registered dietician is hired to design and conduct a wellness program on-site at a large accounting firm.

B. Learning outcomes

1. Identify the steps needed for planning a program.

2. Classify information to complete a needs assessment.

3. Describe the components of a program plan.

4. Summarize an evaluation process to determine whether the goals and desired outcomes of a program are met.

Activities

Answers to Global Nutrition Watch Activities

1. b

Activity 5-1

Use the Internet to obtain information about the older population. For example, access the Web sites for the Food and Nutrition Service (http://www.fns.usda.gov/), the National Center for Health Statistics (http://www.cdc.gov/nchs/), and Fedstats (https://fedstats.sites.usa.gov/) to obtain data on participation rates of the older adult population in food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP). For Canadian statistics, access Statistics Canada at http://www.statcan.gc.ca/. How would you use these data to design a program to improve the nutritional status of this population?

OBJ: 5.1 Describe six factors that can trigger program planning.

Activity 5-2

Study the results of the needs assessment for Case Study 2, Nutritional Status of Independent Older Adults. Imagine that you have been charged with developing a program to improve the nutritional status of this population. Define at least one goal and two or more outcome objectives for each of the following areas:

1. Nutritional status

2. Community-based programs and services

3. Partnerships (partnerships apply to the linkages that your agency should develop or strengthen to implement this program)

OBJ: 5.2 Describe seven steps in designing, implementing, and evaluating nutrition programs.

Activity 5-3

Evaluate the 2015 Dietary Guidelines for Americans Executive Summary (http://www.cnpp.usda.gov/DietaryGuidelines) using the three major principles to consider when preparing an evaluation report. Explain how the results from the Executive Summary could be utilized. Identify the major sections of the Executive Summary.

OBJ: 5.4 Discuss three reasons for conducting evaluations of programs.

5.5 Discuss three major principles to consider when preparing an evaluation report.

2. d 3. Portugal

Critical Thinking Questions2

A key with sample answers is provided here; note, however, that correct answers will often vary due to the open-ended nature of the questions. These questions are also available for students to complete online and submit to you via e-mail through the book’s website.

1. Give an example from your own community of each of the six factors that can trigger program planning.

Key (pp. 150-151):

Results of the community needs assessment

Example: finding that many teenage girls have iron-deficiency anemia.

Mandate from an organization’s national office or a federal agency

Example: the FDA wants to know the extent of a community’s use of non-pasteurized milk.

Research findings

Example: preliminary studies indicate that many Mexican/Mexican-American Women underreport their food intake.

Community leader or coalition

Example: the school board is concerned about the number of school-age children who do not take advantage of their eligibility to participate in the National School Lunch Program.

Availability of funding for new programs

Example: the U.S. President has made more funding available to communities that can demonstrate the success of nutrition education in reducing the incidence of new cases of type 2 diabetes.

Government policy

Example: the government now prohibits those participating in SNAP from purchasing nonU.S. grown fruits and vegetables.

2. Chi-Chi, the community nutritionist for a rural community in Ohio, is trying to secure funding for a weight-loss program called “Nutrition and Your Jeans.” What program planning steps should she have already completed and what steps does she still have to accomplish?

Key (pp. 151-165):

She should have accomplished:

Step 1 Review the results of the community needs assessment. Step 2 Define program goals and objectives.

Step 3 Develop a program plan. (Design the intervention and the nutrition education component.)

Step 4 Define the management system.

This is the step she is currently working on:

Step 5 Identify funding sources.

2 Contributed by Carolyn H. La Potin of SUNY Oneonta and Jamie A. Benedict of University of Nevada, Reno

She still has these steps to do: Step 6 Implement the program. Step 7 Evaluate program elements and effectiveness.

3. What is meant by a SMART objective? Explain. Next, review the objectives listed below in light of the characteristics of a SMART objective. Re-write each objective so that it corresponds to the characteristics of a SMART objective.

1. Decrease the risk of obesity among children.

2. Increase fruit and vegetable consumption among older adults.

3. Decrease the number of food insecure households.

Key (pp. 154-155):

SMART objectives are objectives that specify the action to be taken and the target population (specific); identify the standards and parameters used to measure success (measurable); reflect action that is feasible and realistic (achievable); consider the mission of the organization and the goals of the project (relevant); and specify a time frame for achievement (time frame).

In writing SMART objectives, these are questions to consider (from Table 5-3):

• What exactly are we going to do?

• What strategies will we use?

• Who will be involved?

• Is the outcome specified?

• How will we know that change has occurred?

• Are we able to gather these measurements?

• Can the objective be achieved in the proposed time frame?

• Can we achieve the objective with the resources available?

• Will the data or information be relevant to the goals?

• Will this objective lead to the desired results?

• When will the objective be accomplished?

• What is the stated deadline?

Original objective 1: Decrease the risk of obesity among children.

Improved objective 1: By January of 2018, the proportion of children, age 6-18, who are identified as obese based on BMI for age and gender will decrease from 22% to 20% in _____ County, USA as assessed through school-based surveillance of student adiposity.

Original objective 2: Increase fruit and vegetable consumption among older adults.

Improved objective 2: Increase the proportion of adults age 65 years and older who consume fruits and vegetables five or more times per day from 23% (in 2016) to 25% (in 2018) per the results of the BRFSS for _____ County, USA.

Original objective 3: Decrease the number of food insecure households.

Improved objective 3: Decrease the proportion of households in _____ [state] that are designated as “food insecure” from the current level of 18% to 12% by 2018 based on the annual survey of households conducted by the Economic Research Service.

4. Rob, Clarissa, and CJ are community nutritionists who are working on a program to encourage college-aged students to eat more whole-grain breads and cereals. Rob wants to distribute flyers that will tell students the nutritional advantages of whole-grain products. Clarissa wants to work with university food services to offer more whole-grain selections in the cafeteria, and CJ suggests that they persuade the cafeterias to offer, on a number of different occasions, free samples of some of the students’ favorite dishes made with wholegrain products rather than the refined products that have been used to date. She has asked that the cafeterias also display simple catch-phrases about the nutritional benefits of whole grains. What type of intervention has each of the nutritionists designed and what benefits can that type of intervention be expected to yield?

Key (pp. 157-159):

Rob has recommended a Level I intervention that focuses on increasing awareness of a health or nutritional topic or problem. Yield: Awareness programs can be very successful in helping change attitudes and beliefs and increasing knowledge of risk factors, but they seldom result in actual behavior changes.

CJ has suggested a Level II intervention designed to help participants make a lifestyle change. Yield: These interventions can be successful when they call for small changes over time and when they use a combination of behavior modification and education.

Clarissa has suggested a Level III intervention: working toward creating an environment that supports the behavior changes made by individuals. Yield: Because Level III interventions work toward creating environments that support the behavior changes made by individuals, they can be successful in creating change over time.

5. You have been assigned to evaluate “A Learn and Serve Nutrition Program: The Food Literacy Partners Program” that is summarized on pages 175-176 in your text. Evaluate this program by answering the questions that community nutritionists address when evaluating their programs (p. 170)

Key (pp. 167-174 and 175-176):

Question: Did the intervention reach the target population?

Answer: The description of the program in the text does not indicate how many they had planned to serve nor the breakdown expected in terms of the backgrounds of those who participated.

Question: For which participants was the program most effective?

Answer: Tools used for the evaluation included key informant interviews, individual course evaluations, the Physical Activity and Nutrition Behaviors (PAN) questionnaire, and an original 31-item survey with questions about motivation for taking the course, use of the online distance education site after graduation, value of the supermarket tour, and FLPP as a volunteer experience. Although the program reported that graduates were able to quickly find ways to pass on their newly acquired nutrition knowledge at home and in the community, the report did not identify which participants benefited the most from the program.

Question: For which participants was the program least effective?

Answer: Report did not identify which participants benefited the most from the program.

Question: Was the intervention implemented according to the original program plan?

Answer: One change was made and described as follows: “The PAN questionnaire was administered to a subset of more recent participants, both before (baseline) and after completing the training. The survey was e-mailed to 186 graduates with active e-mail addresses, and 39% completed the questionnaire posted on Survey Monkey.”

Question: Was the program effective that is, did it accomplish what it was supposed to accomplish?

Answer: At the outset, the program was intended to demonstrate that a nutrition “learn and serve” program could be used effectively to prepare volunteers to deliver nutrition education to consumers in rural areas. At some point, it seems that the program goals were altered to also include fostering of (self-reported) positive behavior changes in participants. “The respondents reported behavior changes: 51% ate more vegetables; 49% ate more fruit; 31% consumed less soda and sweetened beverages; and 36% engaged in more physical activity. These self-reported behavior changes were complemented by survey responses that indicated increased knowledge and attitudes about the nutrition and physical activity topics covered in the FLPP.”

Question: How much does the program cost?

Answer: No information was provided.

Question: What are the program’s costs relative to its effectiveness and benefits?

Answer: No information was provided.

6. A local Cooperative Extension program has been evaluated and the community nutritionists are planning to disseminate the results to key stakeholders including their advisory committee, their funding agency, and local program service providers who also provide programs for the same target audience. What methods of communication should they consider using? Should the communication form be the same or different for each stakeholder group?

Key (pp. 176-178):

The Extension nutritionists should consider providing a copy of a written report to both the advisory committee members and the funding agency. A personal presentation may also be appropriate for the funding agency and the local program service providers. The latter group may also benefit from receipt of other materials (e.g., workshop, brochure, memorandum), which may serve to increase referrals and reduce duplication of services. Due to the convenience and significant use of the Internet, all groups mentioned above (as well as others) may find it convenient to be able to access the evaluation results on a related website.

7. Write a nutrition diagnosis (problem, etiology, signs/symptoms) statement and label each of the required components for the following scenario: Female student members of the varsity soccer team at Best University are responsible for bringing their own water and/or sports beverages to their games; many forget to do so. The coach is concerned that many players lose 3-4 pounds of weight during a game, and insists that all the women weigh themselves just prior to and following each game.

Key (pp. 180-183):

Dehydration (problem) related to inadequate fluid intake (etiology) as evidenced by loss of 34 pounds of body weight (signs/symptoms) during games.

Sample Answers for Case Study: Program Planning

Foundation: Acquisition of Knowledge and Skills

1. Steps in Program Planning:

Step 1: Review the results of the community needs assessment.

Step 2: Define program goals and objectives.

Step 3: Develop a program plan.

Step 4: Define the management system.

Step 5: Identify funding sources.

Step 6: Implement the program.

Step 7: Evaluate program elements an effectiveness.

2. The diagnosis of metabolic syndrome is based on the results of a physical exam and blood tests. To be diagnosed with metabolic syndrome, you must have at least three out of five of the following risk factors:

• A large waistline. This means that you carry excess weight around your waist (abdominal obesity). Your doctor will measure your waist to determine whether you have abdominal obesity. A waist measurement of 35 inches or more for women and 40 inches or more for men is a component of metabolic syndrome and indicates an increased risk for heart disease and other health problems. A large waistline also is called “having an apple shape.”

• A higher than normal triglyceride level, or you are taking medicine to treat high triglycerides. Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher is a component of metabolic syndrome.

• A lower than normal level of HDL (high-density lipoprotein) cholesterol, or you are taking medicine to treat low HDL. HDL is considered “good” cholesterol because it lowers your chances of heart disease. An HDL cholesterol level less than 50 mg/dL for women and less than 40 mg/dL for men is a component of metabolic syndrome.

• Higher than normal blood pressure, or you are taking medicine to treat high blood pressure. A blood pressure of 130/85 or higher is a component of metabolic syndrome. If only one of your two blood pressure numbers is high, it’s still a risk factor for metabolic syndrome.

• Higher than normal fasting blood sugar (glucose), or you are taking medicine to treat high blood sugar. A normal fasting blood sugar is less than 100 mg/dL. Fasting blood sugar between 100 and 125 mg/dL is considered prediabetes. Fasting blood sugar of 126 mg/dL or higher is considered diabetes. A fasting blood sugar of 100 mg/dL or higher (prediabetes or diabetes) is a component of metabolic syndrome.

About 85% of people who have type 2 diabetes (the most common type) also have metabolic syndrome. These people have a much higher risk for heart disease than the 15% of people with type 2 diabetes who don’t have metabolic syndrome.

Step 1: Identify Relevant Information and Uncertainties

1. To determine the incidence of metabolic syndrome, you would need additional medical parameters including serum glucose and serum triglyceride, HDL, and LDL levels.

Step 2: Interpret Information

1. Obesity (NC-3.3) related to excess energy intake and physical inactivity as evidenced by BMI ≥30 and waist circumference more than normative standard for age and sex

and /or

Altered nutrition-related laboratory values (NC-2.2) related to abnormal serum lipids (cholesterol, LDL, HDL, triglycerides) and abnormal plasma glucose and/or HbA1c levels (can be included or not it is not known from the case) as evidenced by food and nutritionrelated knowledge deficit

2. Goals of Treatment:

The major goal of treating metabolic syndrome is to reduce a person’s risk for heart disease. Treatment is directed first at reducing LDL cholesterol (low-density lipoprotein cholesterol), high blood pressure, and diabetes (if these conditions are present).

The second goal of treatment is to prevent the onset of type 2 diabetes (if it hasn’t already developed). Long-term complications of diabetes often include heart and kidney disease, vision loss, and foot or leg amputation. If diabetes is present, the goal of treatment is to reduce the increased risk for heart disease by controlling all of the risk factors.

The main emphasis in the treatment of metabolic syndrome is to lessen the effects of the underlying risk factors that can be controlled, such as overweight, lack of physical activity, and an unhealthy diet.

Specific Types of Treatment:

Weight Loss. In general, people with metabolic syndrome who are overweight or obese are urged to reduce their weight by 7% to 10% during the first year of treatment. For example, a person weighing 250 pounds should try to lose 18 to 25 pounds. A person weighing 300 pounds should try to lose 21 to 30 pounds.

After the first year, people are urged to continue to lose weight to the extent possible, with a long-range target of lowering their body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for prevention and treatment of metabolic syndrome.

You can calculate your BMI using the National Heart, Lung, and Blood Institute’s (NHLBI’s) online calculator, or your health care provider can calculate your BMI. For more information on losing and maintaining your weight, see the “Diseases and Conditions Index” article on “Overweight and Obesity.”

Healthy Eating Plan. For a healthy eating plan, go to the NHLBI’s “Aim for a Healthy Weight” Web site (http://www.nhlbi.nih.gov/health/educational/lose_wt/index.htm) and the NHLBI’s “Your Guide to Lowering Cholesterol with TLC” (http://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf). This booklet describes the Therapeutic Lifestyle Changes (TLC) diet.

With the TLC diet, less than 7% of your daily calories should come from saturated fat, and no more than 25-35% of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats. You also should consume less than 200 mg a day of cholesterol. The amounts of fat and cholesterol in prepared foods can be found on the food’s nutritional label.

Foods high in soluble fiber also are part of a healthy eating plan. These foods include:

• Whole-grain cereals such as oatmeal and oat bran

• Fruits such as apples, bananas, oranges, pears, and prunes

• Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans Fish are an important part of a heart-healthy diet. Fish are a good source of omega-3 fatty acids, which may help protect the heart from blood clots and inflammation and reduce the risk for heart attack.

You also should try to limit the amount of sodium and salt that you eat. This means choosing low-sodium and low-salt foods and “no added salt” foods and seasonings at the table or when cooking. The nutritional label on food packaging shows the amount of sodium in the item.

Try to limit alcoholic beverages. Too much alcohol will raise your blood pressure and triglyceride level. It will also add extra calories, which will cause weight gain. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.

Increased Physical Activity. In general, people with metabolic syndrome are urged to keep up a moderate level of activity, such as brisk walking for at least 30 minutes at least three days of the week. This activity can be broken into shorter periods as needed for example, three 10-minutes sessions.

The ultimate goal is for people to maintain a moderate level of physical activity 60 minutes a day for five days a week, but preferably daily. You should talk with your doctor about the best kind of physical activity for you before starting any kind of program.

Step 3: Draw and Implement Conclusions

1. There may be many ways to set up a wellness program. An example could be:

A six-month program: participants will meet every two weeks for an educational seminar on nutrition and physical activity that relates to metabolic syndrome. It can be at the lunch hour where participants bring their own lunch. Food demonstrations can be included. Employees that participate will receive pedometers. Employees that meet their exercise goal will receive rewards (purchase water bottles, gym bags, etc. for prizes). Free samples of healthy foods could be given away as well. The RD could conduct all of the classes so no other staff is needed. The “game room” can be used to conduct physical activity classes. The RD could hire a personal trainer to conduct these classes: aerobics, free weights, yoga, etc.

Based on the information gathered from federal agencies, these are some resources that can be ordered and used (they are free):

Cholesterol:

 Know the Facts about High Blood Cholesterol

(http://www.cdc.gov/cholesterol/docs/ConsumerEd_Cholesterol.pdf)

 High Blood Cholesterol: What You Need to Know

(http://www.nhlbi.nih.gov/files/docs/public/heart/wyntk.pdf)

High Blood Pressure:

 Know the Facts about High Blood Pressure

(http://www.cdc.gov/bloodpressure/docs/ConsumerEd_HBP.pdf)

 Your Guide to Lowering Your Blood Pressure with DASH

(http://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf)

Overweight and Physical Activity:

 Aim for a Healthy Weight Web Site, includes links to a range of materials suitable for use with the general public.

(http://www.nhlbi.nih.gov/health/educational/lose_wt/index.htm)

 Walking: A Step in the Right Direction (http://www.niddk.nih.gov/healthinformation/health-topics/weight-control/walking-step-rightdirection/Documents/WIN_Walking.pdf)

There are many educational resources that can be used.

Step 4: Engage in Continuous Improvement

1. The purpose of the outcome evaluation is to determine whether the program or intervention had an effect on the target population’s health status. Data collected should include: weights/BMI calculations, waist measurements, LDL and HDL cholesterol, serum triglyceride and glucose levels, and blood pressure measurements. These can be taken after a specified time period, i.e., three or six months (whenever the program is completed). These values should be compared to the desired outcomes.

2. There may be many ways to evaluate the program but it should include the following types of evaluations:

• Process evaluation to monitor how the program operated, which can include examining program activities such as: attendance at biweekly meetings; how the planned activities compared with the actual results (using food and exercise logs 35 of 42 participants handed in food and exercise logs which equal 83%); and how many participants completed the program.

• Impact evaluation to determine whether the program’s methods and activities resulted in desired outcomes for the employees, which can include: administration of a metabolic syndrome risk factor knowledge and behavior survey at the beginning of the program and at the end.

• Outcome evaluation to determine whether the program had an effect on the target populations’ health status, which could be accomplished by obtaining follow-up lab data, weights, etc. as noted in the previous question.

Turn static files into dynamic content formats.

Create a flipbook

Articles inside

Solution Manual for Community Nutrition in Action An Entrepreneurial

27min

pages 1-15