# Presentation: 868574

## BRIGHT FUTURES FOR WOMEN’S HEALTH AND WELLNESS 

**BRIGHT FUTURES ****FOR WOMEN’S HEALTH ****AND WELLNESS**** **

**Physical Activity and Healthy Eating****Guide for Young Women**

## INTRODUCTION

**Purpose of module:**
- Explain how a patient and her health care provider use the Guide
- Explain the importance of different sections and questions in the Guide
- Introduce the Wallet Card

**Notes:**
The purpose of this module is to introduce the Guide and Wallet Card to you and discuss how it can be best used in the clinical setting.
Specifically, this module will:
Explain how you and your patients can use the Guide
Explain the importance of different sections and questions in the Guide
Introduce the Wallet Card as a companion to the Guide

## To help young women:
Assess current behaviors
Talk with their health care providers
Set goals
Learn basic physical activity and healthy eating information

- Assess current behaviors
- Talk with their health care providers
- Set goals
- Learn basic physical activity and healthy eating information

- PURPOSE OF THE GUIDE

**Notes:**
The purpose of the Guide is to help young women (ages 11–20) to:
Assess their current physical activity and healthy eating behaviors
Talk with you—the health care provider—about physical activity and healthy eating, and ask any questions they have. 
Set goals with you around areas that need improvement or change
Learn basic information on physical activity and healthy eating to get them started on reaching their goals
The Guide is divided into specific sections that address each of these.

## Review Getting Started answers 
Complete My Health Care Visit 
Make recommendations
Assist with goal setting

- Complete My Health Care Visit
- Make recommendations
- Assist with goal setting

- ROLE OF THE HEALTH CARE PROVIDER

**Notes:**
Your role is to:
Review the answers that the patient gives to the Getting Started questions using the Counseling Support Tool
Complete the My Health Care Visit section. This is only two pages (pages 11–12) of the Guide. The patient is responsible for the rest
Make recommendations. The Counseling Support Tool, which we’ll discuss later, will help you match your patient’s answers to appropriate recommendations
Assist with goal setting. You can help the patient set goals and also direct her to the Reaching My Goals section for ideas on how to reach her goals
The slides that follow provide a layout of the Guide to show you what the different sections look like and how they can be used by you and your patients.

## GETTING STARTED, pp. 3–8

**Goal:** Gather information about patients’ current behaviors
**Format:** Questions
**Roles:**
- 	Patient fills out on her own
- 	You review answers

**Notes:**
The Getting Started section is found on pages 3–8 of the Guide.
This section includes questions that ask a patient about her current physical activity and healthy eating behaviors. There are three questions related to physical activity and nine questions related to healthy eating. 
The patient completes the questions on her own in the waiting room and then shares her answers with you during the health care visit.
Reviewing the answers will help you quickly gain an understanding of your patient’s current behaviors. It will help you identify areas that need improvement or change and give you ideas for making recommendations.

## GETTING STARTED, pp. 3–8

- Only 23% of young women engage in moderate physical activity.

- Source: CDC, National Health Interview Survey, 2001.

**Notes:**
Questions 1–3 of the Getting Started section ask about current physical activity behaviors.
Physical activity is a major focus of this Guide because, along with healthy eating, it helps to lower the risk for certain diseases, control weight, and build and maintain healthy bones. It also helps young women feel more energetic and can improve their self-esteem and well-being.
Despite these benefits, only 23% of young women in the United States engage in moderate physical activity.
Answers to these questions will help you and your patient gain an understanding of how physically active she is, how often she is physically active, and what activities she usually does.

## GETTING STARTED, pp. 3–8

- These answers will help with ideas for incorporating physical activity.

**Notes:**
The answers that a patient gives for question 3 will help you get a sense of what she does in her free time. The answers can also help you with ideas for how your patient can incorporate more physical activity into her daily life.

## GETTING STARTED, pp. 3–8

- Young women typically consume one serving of fruit and three servings of vegetables daily.

- Source: CDC, Behavioral Risk Factor Surveillance System, 2000.

**Notes:**
Questions 4–12 ask about a patient’s eating behaviors and how much she eats from different food groups.
This is important to know because young women should eat a variety of foods from all the food groups in order to meet their nutritional needs. 
Many young women in the United States aren’t doing this. For example, they:
Consume one serving of fruit per day compared with the recommended 11⁄2 - 2 cups of fruit or 100% fruit juice daily
Consume approximately three servings of vegetables per day compared with the recommended 2-3 cups daily
Note that the questions ask about the number of times per day a woman eats foods from different food groups rather than number of servings. This is because most people tend to think about and describe their eating in terms of frequency rather than serving sizes. The Counseling Support Tool will help you make appropriate recommendations about how much your patient should eat on a daily basis from the different food groups.

## GETTING STARTED, pp. 3–8

- Testimonials throughout the Guide show how health challenges were met by other young women.

**Notes:**
Throughout the Guide, you’ll find stories from young women, telling how they overcame a physical activity or healthy eating challenge.
These testimonials offer tips on how to make changes and talk about the benefits that came from them.
They also offer motivation and encouragement to the patient for adopting healthy behaviors, especially because they’re told by peers.

## GETTING STARTED, pp. 3–8

- 31% of young women are at risk for overweight; 15% are overweight.

- Source: JAMA 2004; 291: 2847-2850.

**Notes:**
Question 11 asks the patient to describe whether she is underweight, at a healthy weight, or overweight. You can compare your patient’s answer to actual weight and BMI measurements. Her answer will also give you insight into her self-image and whether her physical activity and eating behaviors are appropriate for her weight. 
It is important to note that 31% of young women in the United States are at risk for overweight, and 15% are overweight. This has significantly increased over the past two decades.

## GETTING STARTED, pp. 3–8

- Nutrients, such as iron, calcium, and folate are vital to young women’s health.

**Notes:**
Question 12 asks the patient if she takes vitamin, mineral, or dietary supplements and, if so, which ones.
In addition to the answers she gives to questions 4–10, this will give you an understanding of the types of nutrients that she is getting or may be lacking. 

## TALKING WITH MY 

- HEALTH CARE PROVIDER, pp. 9–10

**Goal:** Encourage and enhance the patient-provider dialogue
**Format:** Tips, sample questions
**Roles: **Patient reads on her own and prepares questions for her health care provider

**Notes:**
The Talking With My Health Care Provider section is found on pages 9–10 of the Guide.
This section includes tips on how the patient can start a conversation with you about physical activity and healthy eating. It also gives sample questions that she can ask and spaces to fill in with her own questions.
The patient completes this section on her own and shares any questions that she has with you during the health care visit.

## TALKING WITH MY 

- Patients are open to talking with their health care providers about physical activity and healthy eating.

- TALKING WITH MY
- HEALTH CARE PROVIDER, pp. 9–10

**Notes:**
In a pretest of the Guide, young women (ages 11–20) indicated that they are open to talking with their health care providers about physical activity and healthy eating. 
The young women also asked for sample questions and tips on how to start the conversation, so this has been added to the Guide on page 10. 
There are also blank spaces for the patient to write down the questions that she wants to ask you.

## MY HEALTH CARE VISIT, pp. 11–12

**Goal:** Assess behaviors and make recommendations
**Format:** Height, weight, BMI, and other measurements; recommendations
**Roles: **Health care provider fills out measurements and makes recommendations

**Notes:**
The My Health Care Visit section is found on pages 11–12 of the Guide.
This is the only section of the Guide that you complete. This should be done during the health care visit.
Specifically, this section includes spaces for you or another staff member to fill in a patient’s BMI and other measurements, including height and weight. It also includes spaces for growth comments and your recommendations.

## MY HEALTH CARE VISIT, pp. 11–12

- The health care provider calculates BMI and explains what the patient’s BMI means.

**Notes:**
Page 11 prompts you or a clinical staff member to calculate and record the patient’s measurements, including BMI and BMI-for-age percentile.
Calculating BMI and determining the age percentile that the patient falls into is a two-step process:
Step 1—Locate the BMI formula found on the CDC chart “BMI-for-Age Percentiles” and calculate the patient’s BMI. You will need a calculator for this. Alternatively, an online BMI calculator is available at www.shapeup.org/oap/entry.php. Record the BMI in the Guide
Step 2—Plot the BMI on the CDC chart “BMI-for-Age Percentiles.” Then record the percentile in the Guide 
This is a good time for you to explain to the patient that BMI is a measure of her body fat and that it is based on height and weight, not just weight. You can also discuss its significance. For example, a high BMI (>95th percentile) means that she is overweight and at risk for obesity and other diseases, such as high blood pressure, heart disease, stroke, and type II diabetes.

## MY HEALTH CARE VISIT, pp. 11–12

- The health care provider reviews the patient’s answers to the Getting Started questions and uses the Counseling Support Tool to make recommendations.

**Notes:**
After measurements are recorded in the Guide, you then review the answers that the patient gave to the questions in the Getting Started section, using the Counseling Support Tool. This will help you to determine whether your patient’s behaviors are on target or need improvement and to identify areas where she can make changes.
You can then use the Counseling Support Tool to make appropriate recommendations about what specific behaviors to change and how to start.
If the patient’s parent or caregiver is present during the health care visit, take this opportunity to talk with them as well. You can talk about the importance of the parent or caregiver’s role in supporting the patient’s healthy development by encouraging and facilitating physical activity and healthy eating. 

## COUNSELING SUPPORT TOOL

**Goal:** Assists with making recommendations based on patient’s answers in the Guide
**Format:** Questions and answers, Federal guidelines, and general recommendations
**Roles: **Health care provider uses Tool to assess patient’s behaviors and to make recommendations

**Notes:**
The Counseling Support Tool for young women is designed is to help you:
Review your patient’s answers to the Getting Started questions in the Guide
Make physical activity and healthy eating recommendations, based on these answers, to help change or improve patient behaviors
The Tool links unhealthy answers to relevant federal guidelines and general recommendations that you can make to your patient.

## COUNSELING SUPPORT TOOL

**Notes:**
The first section or column of the Tool shows the actual questions in the Getting Started section of the Guide. The questions provide an assessment of your patient’s daily physical activity and eating behaviors and lend themselves to general recommendations based on the U.S. Dietary Guidelines. The highlighted answers are the ones that do not meet the guidelines, meaning behavior change is needed. 
Please note that questions 3, 4, 10, and 11 ask about a patient’s preferences and barriers to physical activity and healthy eating. Because these questions do not provide a direct assessment of current behaviors, they are not part of the Tool. 
The second column of the Tool provides the relevant federal guideline for a specific question.
The third column of the Tool provides the recommendations that you can make for answers that require behavior change. Along with these recommendations, your knowledge of the patient’s history and your professional judgment should be used to determine the areas that your patient may need to change.
You then record these recommendations on page 10 of the Guide. You can also direct your patient to pages 16–24 of the Guide and to the Wallet Card for additional information. The Wallet Card reinforces key messages that are presented in the Guide. It is discussed in more detail at the end of this module.

## COUNSELING SUPPORT TOOL

**Notes:**
Let’s see how the Counseling Support Tool works while reviewing two of the questions.
Question 1: How many days a week do you do physical activity? (There are five possible answers.) 
If your patient answered either 7 days or 5–6 days, then no change is needed since she is meeting the guidelines
If your patient gave any of the highlighted answers, then she is not meeting the guidelines of engaging in at least 60 minutes of physical activity most days of the week, preferably daily. So the recommendation that you can write down in the Guide is to “be physically active more days of the week,” and you can refer her to pages 16–18 of the Guide. 

## COUNSELING SUPPORT TOOL

**Notes:**
Question 6: How often do you have foods from the meat and beans group? (There are four possible answers.) 
If your patient answered “twice a day,” then no change is needed since she is meeting the guidelines 
If your patient gave any of the highlighted answers, then she may not be meeting the guideline to “eat two servings from the meat group each day for a total of 5–6 1⁄2 ounces.” If this is the case, then the recommendation that you can write down in the Guide is to “choose low-fat or lean meats and poultry. Eat more fish, beans, nuts, and seeds” and you can refer your patient to pages 19–24 of the Guide. Please note that Healthy Eating questions 5–9 ask about food frequency or how many times a day your patient eats from a particular food group rather than the number of servings that she eats each day. This is because people find it easier to think about how often they eat a type of food. Also, since a patient may eat more servings during a meal than what is defined by the U.S. Dietary Guidelines, it’s a good idea to ask your patient about the size of the serving that she typically chooses, so you’ll get an idea of whether she’s meeting the guidelines.

## SETTING MY GOALS, pp. 13–14

**Goal:** Assist patients in setting goals
**Format:** Charts
**Roles: **Patient fills out charts with guidance from you
- (See the module on goal setting for more information.)

**Notes:**
The Setting My Goals section is found on pages 13–14 of the Guide.
Goal setting is an important activity for you to do with your patient. It helps patients develop realistic expectations and plans for changing or improving their physical activity and eating behaviors. Setting goals together with your patient will also enhance the patient-provider relationship.
Since more detailed information about goal setting and communication is provided in the final module of the training, we’ll quickly review this section now. 

## SETTING MY GOALS, pp. 13–14

- The patient fills out these charts with help from her health care provider.

- The sample goal chart introduces the different elements involved in goal setting.

**Notes:**
The sample goal chart on page 13 includes the different elements in setting realistic, specific, and measurable goals involved in goal setting. You can use the sample chart to point out these elements to your patient, including:
Reasons for the goal
Steps for reaching the goal
Helpful persons
Timelines for meeting the goal
Rewards toward meeting the goal
Page 14 has blank charts for the patient to fill out with guidance from you. The patient’s goals should be based on her answers to questions in the Guide, your assessment, and recommendations that you make to her. 
Take a few minutes to help your patient complete one of the blank goal charts. Setting goals together can make a difference in whether or not she tries to make any physical activity or healthy eating changes at home.

## REACHING MY GOALS, pp. 15–26

**Goal:** Provide patients information to help them reach their goals
**Format:** Tips, charts
**Roles:**
- 	Patient reviews this section on her own
- 	Health care provider refers to it when making	recommendations

**Notes:**
The Reaching My Goals section is found on pages 15–26.
The goal of this section is to provide your patient with information and ideas that help her learn about physical activity and healthy eating and the ways in which she can reach the goals that she sets.
The patient reviews the section on her own.
You can also make references to this section and its specific segments when making recommendations to your patient about how she can improve her behaviors.

## REACHING MY GOALS, pp. 15–26

- Pages 16–18 present benefits of being physically active and tips to help the patient add physical activity in her daily life.

**Notes:**
Pages 16–18 give information on physical activity.
This includes:
Benefits of physical activity
Quick and easy ideas to help the patient add physical activity in her daily life
Tips for staying safe when doing physical activity

## REACHING MY GOALS, pp. 15–26

- Pages 19–24 provide information to help the patient make healthy eating choices and get a variety of nutrients in her daily eating pattern.

**Notes:**
Pages 19–24 give information on healthy eating.
This includes:
Tips to help the patient get variety and balance in what she eats.
Information about foods the patient can eat to get specific nutrients
Tips for making healthy choices during meals, when snacking, and when eating out
Discussion of serving sizes and examples of what different serving sizes look like
Discussion of the Nutrition Facts Label 

## REACHING MY GOALS, pp. 15–26

- Hints to help the patient get started on improving physical activity and healthy eating.

**Notes:**
Page 26 offers hints to help the patient get started on physical activity and healthy eating and to get started on reaching goals.
These hints provide quick reminders of things to think about and do as she makes changes and adopts healthy behaviors.
You can refer to this page when making recommendations to your patient.

## BACK COVER

- Resources that the patient can go to for more information.

**Notes:**
The back cover of the Guide provides resources that the patient can consult for more information.
It includes the Web site addresses of physical activity and healthy eating campaigns and ideas for local resources. These are:
Public library
Health newsletter at grocery store checkouts
Community recreation center
You can encourage your patient to think about other resources in her neighborhood that she can go to for more information or help with reaching her goals.

## WALLET CARD

- Take-home item for young women
- Reinforces messages from the Guide
- Quick reference for “on the go”

**Notes:**
The Bright Futures Wallet Card for young women is a small card that folds out with six panels. The patient takes the card home with her and can keep it in her purse, wallet, locker, backpack, or another convenient place.
The Card reinforces key messages from and includes brief versions of some of the tips and charts in the Guide.
The patient can carry the Card with her and can refer to it quickly and easily for information on physical activity and healthy eating.
You can reference the Wallet Card (on page 12 of the Guide) as a general resource in your recommendations.

## SUMMARY

- Reviewing Getting Started answers
- Completing My Health Care Visit
- Making recommendations
- Assisting with goal setting

- The health care provider can use the Guide to help a patient improve her physical and healthy eating habits by:

**Notes:**
In summary, you can use the Guide to help a patient improve her physical activity and healthy eating habits by:
Reviewing the answers that the patient gives to the questions in the Getting Started section
Completing the My Health Care Visit section
Using the Counseling Support Tool to make recommendations for behaviors that the patient can improve or change
Assisting with goal setting, that is, helping the patient make plans for how she will achieve the physical activity and healthy eating goals that she sets