# Presentation: 561839

## 
  HealthierUS Veterans

**  ****HealthierUS** **Veterans**

## What is HealthierUS Veterans?

- Initiative sponsored by Departments of Veterans Affairs and Health and Human Services
- Focus on improving health of veterans and family members by encouraging healthy eating and physical activity
- Aim to reduce risk of obesity and diabetes

**Notes:**
The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Health and Human Services (HHS) have joined forces in an unprecedented manner in an effort to improve the health of the nation. 
The focus of this joint initiative, HealthierUS Veterans, is to educate veterans, their families, and communities about the health risks of obesity and diabetes and ways to reduce risk - eating healthy and being active. 

VA Secretary James Nicholson said, “Obesity and diabetes are major threats to the health and lifestyles of our veterans, deserving a robust campaign to better educate them on healthy habits.”
HHS Secretary Michael Leavitt said, “We are working to encourage Americans to adopt a healthy lifestyle and to take responsibility for making wise choices to improve their fitness and health.”

## Why Focus on Obesity and Diabetes?

- Obesity and Diabetes are significant problems for veterans who receive care from VA
- Overweight/obese individuals are at risk for a number of chronic health conditions
- 20.8 million people in the US have diabetes

**Notes:**
Both national and VA-specific rates are high and are continuing to increase. 
The national prevalence of overweight/obesity is 64% .  There has been a steady increase in overweight/obesity over the last 20 years.  That trend is continuing.  Maintaining a healthy weight is difficult for the general public and veterans.
Diabetes is a problem for many veterans receiving care in VA.
By focusing efforts to address these conditions on the population of veterans and their families, up to a quarter of the entire US population, about 70 million people, can be reached.  

## Obesity Trends Among US Adults

- No Data

- <10%

- 10%-14%

- 15%-19%

- 20%-24%

- Source: Behavioral Risk Factor Surveillance System, CDC.

-  25%

**Notes:**
This series of maps shows how quickly rates of obesity have risen over the past 15 years. These rates are slightly lower than on the previous slide, probably because these are based on self-report, whereas the previous figures are based on actual measured heights and weights.

## HealthierUS Veterans 

- 5 components
- VA’s *MOVE!* Weight Management Program
- Prescription for Health
- Fitness Challenges
- Partnerships between VA medical facilities and community-based programs funded by HHS
- Fit for Life Veteran Volunteer Corps

**Notes:**
HealthierUS Veterans has a number of components to help you:
The VA’s MOVE! Weight Management Program for veterans
A “Prescription for Health” to encourage physical activity
Fitness Challenges
Partnering of VA medical facilities with “Steps to a HealthierUS” and other HHS funded prevention programs, and a
A volunteer corps of active veterans and others, called Fit for Life

## www.healthierusveterans.va.gov 

**Notes:**
A website has been developed that explains the HealthierUS Veterans initiative, suggests ways to get involved and provides links to nutrition and physical activity resources that have been specially chosen for this initiative. 

## Am I at risk for diabetes or obesity?

- Obesity is an excessive amount of body fat in relation to lean body mass.
**Determined by BMI**
**B**ody **M**ass **I**ndex is a number that shows body weight adjusted for height
- A higher BMI means increased risk for weight-related diseases.

| BMI | Weight Status |
| --- | --- |
| Below 18.5 | Underweight |
| 18.5-24.9 | Normal weight |
| 25.0-29.9 | Overweight |
| 30.0 and above | Obese |

**Notes:**
How do you know if you are at risk for diabetes or obesity?  
You need to know your Body Mass Index, or BMI.  This is a measure that shows body weight adjusted for height.
A higher BMI means an increased risk for weight-related diseases.
The table here shows what weight status corresponds to each BMI number.
Use the following chart to see what your BMI is.

## What is my BMI?

## 
  Eat Healthy

**  ****Eat Healthy**

## What Can I Do?Eat Healthy

- Keys to healthy eating~
- 	balance, variety and moderation
- Aim for at least 5 servings of colorful vegetables or fruit each day

**Notes:**
How can you eat healthy?
First, always practice balance, variety, and moderation.   Remember all foods can fit into a healthy diet.  The key is balance the foods you eat with the activity you do, to use high fat calorie foods and beverages in moderation, and to include a wide variety of foods from all food groups.
Next, aim for at least 5 cups of colorful vegetables or fruit each day.  To get all of the health benefits of fruits and vegetables, choose the whole food more often than juices.  Whole fruits and vegetables are lower in calories and contain more fiber which helps you eat less and feel fuller longer.  Not to mention fiber is also important for heart health, colon health, and can help you gain better control of diabetes.

## Eat Healthy

- Have 3 servings of lowfat milk, cheese, yogurt or other calcium-rich foods each day

**Notes:**
Calcium is important to keep our heart beating and our muscles and bones strong.
To get enough calcium we need to have 3 servings of lowfat milk, cheese, or yogurt each day.
What is a serving of dairy?
8 ounces (1 cup) of lowfat milk or yogurt
1 1⁄2 ounces of natural cheese, 2 ounces of processed cheese
1 cup of pudding made with lowfat milk

If you don’t or can’t drink milk, choose lactose-free milk products and/or calcium rich foods, like deep green vegetables, or calcium-fortified foods and beverages (cereal, 100% juice, and fortified soy milk).

## Eat Healthy

- Make half your grains whole grains

**Notes:**
Whole grains give you energy and important nutrients, such as vitamins, minerals and fiber, for health.  Fiber helps with controlling hunger and weight, reducing blood cholesterol, reducing the risk of certain cancers, and controlling blood sugar.
Just because a grain is brown or dark in color does not mean it is a whole grain.  Check the ingredient list for the word “whole” before grains (examples: whole wheat, whole grain oats, whole grain cornmeal).
What is a serving?
1  ounce of grain
1  slice of bread
1  cup of ready-to-eat cereal, or
1⁄2 cup of cooked cereal, pasta, or rice 

## Eat Healthy

- Know the limits on fat, salt and sugar

**Notes:**
Know the limits on fat, salt and sugar...
Read the Nutrition Facts label on foods.  
Look for foods low in saturated fats and trans fats. 
Broil, bake, steam or grill your food instead of frying it. 
Choose lean cuts of meat; cut off visible fat.
Choose and prepare foods and beverages with little salt (sodium) and/or added sugars (caloric sweeteners like sucrose or high fructose corn-syrup).
All foods can be enjoyed in moderation once you know the limits.

## Eat Healthy

- Go lean with protein
- Control calories

**Notes:**
Next, be sure to go lean with protein.  Choose lean meats like fish, poultry, and lean red meat.  
A couple of tips to help you cut the calories from your protein sources:
	1) Take the skin off of your chicken or turkey
	2) Include fish three times per week
	3) Choose lean ground beef and steaks with little marbling
	4) Do not add fat and calories to your meat when cooking, try cooking sprays, grilling, or baking instead
To manage your weight, balance what you eat and drink with how active you are.  
You should also balance foods higher in calories, fat, and sugar with choices that are lower in calories, fat, and sugar.  
Eat more fruits, vegetables, whole grains, and low fat dairy products.  These are good for you and help to fill you up.

## How Do I Know How Much to Eat?

- Estimate your calorie needs!
- Take your weight in pounds and divide by 2.2
**This is your weight in kilograms**
- Multiply your weight in kilograms by the number of calories according to the chart

|  | Sedentary | Moderate | Active |
| --- | --- | --- | --- |
| Overweight | 25 | 30 | 35 |
| Normal | 30 | 35 | 40 |
| Underweight | 35 | 40 | 45 |

**Notes:**
Using balance and variety is important, but practicing moderation and controlling how much you eat is also important.  Follow these simple steps to estimate how many calories you need each day:
Take you weight in pounds and divide by 2.2, this gives you your weight in kilograms.
Next, multiply your weight in kilograms by calories according to the chart.  For example if you are overweight and do moderate activity, you would multiply your weight in kilograms by 30.
The number you get is how many calories you need on a daily basis.

## What Can I Do?Be Active

- Use the stairs instead of the elevator, if possible
- Take the long way to walk to meetings

**Notes:**
You might be wondering what you can do to get more active.  Remember that looking for extra steps in your normal day can impact your weight and health status.  Consider wearing a pedometer, a small device that counts how many steps you take each day.  The first step is to wear your pedometer for a week and record how many steps you take each day and then find your average.  Then, set a goal to increase your average by 500 steps each week.  Adding steps in this gradual way will help you become more fit and you will be walking 10,000 steps in no time.  The following are some ideas of where to find extra steps.
Whenever you can use the stairs instead of the elevator. 
Walking up stairs burns almost 5 times more calories than riding an elevator.
Small steps make big differences.

## Be Active

- Take a walk (or roll) each day
- Find a partner to motivate each other

**Notes:**
Take a walk or roll each day, rain or shine.
Walk the dog.
Walk and talk with a friend or loved one.

## Be Active

- Park farther away from your destination
- Take short walks during lunch and breaks

**Notes:**
Park farther away and walk or roll to your destination.
You’ll spend less time looking for a parking space close the entrance and burn more calories. 

## Portion Distortion

## Creeping portion distortion

## Keep an “eye” on your food portion sizes

**Avoid portion distortion!**

## Larger portions add up

**100 *****extra***** calories per day**

**10 pound ****weight gain per year**

**Maintaining a Healthy Weight is a Balancing Act**
**Calories In = Calories Out**

## 210 calories!

- Bagel

**350 calories**

**140 calories**

**210 calories****!**

**20 Years Ago**

**3-inch diameter**** **

**Today**

**6-inch diameter**

## to rake leaves to burn about 210 calories*?

-  ***Based on 130-pound person**

**How long would you have **
**to rake leaves to burn about**** ****210**** calories*****?**

**Increased size****:** **210**** MORE calories**

**50 minutes**

## Coffee

**Coffee**

**350** **calories**

**45 calories**

-  **305** **calories!**

## to walk to burn about 305 calories*?

-  ***Based on 130-pound person**

**How long would you have **
**to walk to burn about**** ****305**** calories*****?**

**Increased size: ****305**** MORE calories**

**1 hour and 20 minutes**

## Cheeseburger

**590 calories**

**333 calories**

**257 calories!**

**Notes:**
Burger		257 extra

## French Fries

**610**** calories**

**210**** calories**

**400**** calories!**

**Notes:**
Fries		400 extra

## 1 hour and 30 minutes

-  ***Based on 130-pound person**

**1 hour and 30 minutes**

**Notes:**
To exercise off that extra would take 2 hours and 40 minutes and if we wash it down with a soda, we need even more exercise. 

## to walk leisurely to burn approximately 400 calories*?

-  ***Based on 160-pound person**

**How long would you have **
**to walk leisurely to burn approximately**** ****400**** calories*****?**

**Increased size:****400**** MORE calories**

**1 hour and 10 minutes**

**Notes:**
To exercise off just the extra calories would take 2 hours and 40 minutes out of our afternoon

And what if we washed it down with a soda...

## Soda

-  **85 calories**

-  **250 calories**

**165 calories!**

## 35 minutes

** *****Based on 160-pound person**

**35 minutes**

**Notes:**
So exercising off the extra calories really is not feasible – we must begin controlling our portions.

A few more examples of our creeping portion sizes:

## 525 calories!

**Spaghetti and Meatballs**

**1,025**** calories**

**500**** calories**

**525**** ****calories!**

## Muffin

**Muffin**

**500 calories**

**210 calories**

**290** **calories!**

## Pepperoni Pizza

**500 calories**

**850 calories**

**350 calories!**

## Popcorn

**5 cups**

**Popcorn**

**270 calories**

**630 calories**

**360 calories!**

## Chocolate chip cookie

**220 calories!**

**20 Years Ago**

** ****1.5 inch diameter**

**Today**

**3.5 inch**** diameter**

-  **55 calories**

**275 calories**

## Control Portion Sizes

**Notes:**
KEY MESSAGE: Controlling portion sizes helps ensure you get the right amount of calories and carbohydrates each day. 

Supporting Points
• Moderation is key to healthy eating. Knowing how much of a food to eat is just as important as knowing what to eat. Eating too much of almost any food can lead to weight gain and raise blood glucose above the target range. 
• Portion sizes for many fast foods and convenience foods have grown enormously in recent years. For example, a typical hamburger in 1957 weighed 1 ounce and had 210 calories. By comparison, a typical plain hamburger today weighs 6 ounces and has 618 calories, while a double cheeseburger with fixings has over 1,000 calories. Larger serving sizes can lead to more food intake and weight gain. When faced with large portions, most people cannot easily stop eating after consuming an appropriate amount.
• Some simple rules can help people estimate healthy portion sizes. As shown in the slide, a single serving of cooked meat (about 3 ounces) is about the size of a deck of cards. One serving of pasta or cooked vegetables is about the size of a tennis ball (or roughly the amount that will fit in the palm of the hand), while 1 serving of raw vegetables (1 cup) is about the size of a light bulb. One serving of cheese (1 ounce) is about the size of 4 dice. 

Tip: Advise people to watch for words that signal supersized portions, such as jumbo, grande, giant, and double. Discuss ways to practice portion control when eating out, such as buying a “kiddie cone” instead of a regular ice cream, ordering an appetizer instead of an entrée in a restaurant, or asking the waiter to set aside half of a large serving in a take-home container to eat later. Another tip: order a smaller “lunch size” or “senior” portion of food at a sit-down restaurant.

## Try the Plate Method of Portion Control

**Notes:**
KEY MESSAGE:  The plate method is another easy way to “eyeball” portion sizes.  

Supporting Points
• Advise people to divide the plate into 3 sections: one half is for vegetables, one fourth is for protein (e.g., poultry, fish, beef), and one fourth is for starchy foods (e.g., rice, potatoes).
• Suggest using smaller, salad-size plates to serve meals. With this visual trick, smaller food servings will fill the plate and appear larger, helping people to feel more satisfied with smaller portions.

## The Supersizing of America

## Ethnic Foodthe Healthy Way 

** **

## Choosing a Restaurant

- Quest for good food.
- What are you hungry for.
- Look for variety and healthy choices.
- Consider your price range.

## At the Restaurant

- Ask how foods are prepared.
- Think fish, poultry, and lean meats.
- Remember 5-9 a day.
- Look for whole grains and calcium sources.
- Identify high fat, salt and sugar items.
- Order salad dressings on the side.

## Asian Food:  Eat More Of

- Lightly stir-fried or steamed vegetable dishes
- Steamed rice, tofu items (not fried)
- Teriyaki chicken bowls
- Lightly stir-fried or broiled chicken or fish dishes
- Fortune cookies, green tea

## Eat Less Of:  

- Egg rolls, fried rice, fried noodles,
- 	Lo Mein dishes
- Breaded and deep fried meats
- Dishes with lobster sauce
- Chicken wings
- Crab puffs
- Vegetable tempuras

## Italian:  Eat More Of

- Pasta or chicken dishes with tomato, clam or garlic sauce
- Minestrone soup
- Italian bread (plain)
- Salad with olive oil and vinegar
- Ices or fresh fruit for dessert

## Eat Less Of:

- Dishes with cheese or cream sauces
- Garlic bread
- Cheesecake, ice cream or pastries
- Breaded meats
- Sausage

## Mexican:  Eat More Of

- Lean chicken, lean beef, shrimp
- or vegetable fajitas with salsa
- Flour or corn tortillas (baked)
- Gazpacho
- Chicken tostada or chicken enchilada (plain)
- Salad bars (avoid high fat toppings)

## Eat Less Of:

- Fried tortillas or tortilla chips
- Extra cheese
- Sour cream and guacamole
- Refried beans and fried rice
- Milkshakes made with whole milk or ice cream

## Spice Up Your Life! 

- Be on a quest for **Good Food**
- Remember balance, variety, and moderation.
- Have fun, be healthy, and MOVE!

## What Are My Next Steps?

- Wear a pedometer and get more
- 	active.
- Practice balance, variety, and
- 	moderation for good nutrition.
- If you are at a healthy weight,
- 	work to maintain it. If you are
- 	overweight, work to lose a little
- 	– even a 10% loss can make a
- 	big difference.

**Notes:**
So how can you participate in HealthierUS Veterans? 
Being a positive role model for others – getting healthy is contagious!
Start by wearing a pedometer and getting more active!
Remember that all foods can fit as long as you practice balance, variety, and moderation.
Keep your health a priority, if you are at a healthy weight work to maintain it.  If you are overweight work to lose a little – even losing just 10% of your body weight can make a big difference in how you feel!

## How can I participate in HealthierUS Veterans?

- Be a positive role model
- Be a health conscience consumer
- Encourage your friends and families to get healthy with you.
- Participate in VAMC fitness challenges and activities.
- Register for the President’s Challenge and track fitness activities on-line
- _[www.healthierusveterans.va.gov/FitnessChallenges.asp](http://www.healthierusveterans.va.gov/FitnessChallenges.asp)__ _

**Notes:**
Be a health conscience consumer - choose healthy food items at stores and restaurants.
Encourage your friends and family to get healthy with you, it is always more fun when you can do it together!
Participate in the VAMC fitness challenges and activities.
And do not forget to go on-line and register for the President’s Challenge.  It is a great way to track your activity and really helps keep you motivated.

## Content Provided by:Linda Kinsinger MD, MPHEllen Bosley MS, MBA, RD Shari Kerns-Smith, RD Barbara E. Hartman, MS, RD, LDHillary Chrastil, RD Sue James, RDNicole Kleist, RD Thank you