My family has 

made the switch to 

a heart-healthy lifestyle 

to protect us against 

heart disease.

Now we have a new

sense of well-being.

Come on and see 

how we did this! 

National Institutes of Health

National Heart, Lung, and Blood Institute and Office of Research on Minority Health

Featuring the Ramírez Family

Mariano

Virginia

Néstor

Doña Fela

Carmencita

National Heart, Lung,

and Blood Institute

1

JAN. 1998

U.S.

DEPARTMENT 

OF HEALTH 

AND HUMAN

SERVICES

Public 

Health Service

An Ounce Of

A Guide To Heart Health
Dear Reader:

An Ounce of Prevention is a simple and entertaining workbook to help you

and your family protect yourselves against heart disease, the leading cause of

death among Latinos and all Americans.

The workbook introduces you to the Ramírez family: grandmother Doña

Fela; Señor Mariano and Señora Virginia; and their children, Néstor and

Carmencita. The Ramírez family has learned that health is priceless. With

determination and the good example from Doña Fela, the family has made

some simple changes in their lives to protect their heart health.

In these pages, the Ramírez family will show you how to make the same

kind of investment in your own heart health. They will share practical tips

and even tricks that you can use to make simple changes that should help

you and your family enjoy the fruits of your labor and live long, healthy,

happy lives.

This workbook is dedicated to you. So make your pledge to invest in a heart

healthy lifestyle for you and your family. And, now that you have this useful

guide to get you started, hands to work! 

Sincerely,

Claude Lenfant, Director

National Heart, Lung, and Blood Institute
Table of Contents

The Crossword Puzzle: Lower Cholesterol . . . . . . . . . . . . . . . . . . . . . 2

Worksheet 1: Be good to your heart.

Eat less fat, saturated fat,and cholesterol. . . . . . . . . . . . . . . . . . . . . . . . 4

An Unsettling Surprise: Prevent High Blood Pressure . . . . . . . . . . . . 6

Worksheet 2: Keep your heart in mind. Eat less salt and sodium. . . . . . 8

The New Health Machine: Exercise . . . . . . . . . . . . . . . . . . . . . . . . . 10

Worksheet 3: Take heart. Say YES to physical activity. . . . . . . . . . . . 12

I Don’t Like That Boy At All: Watch Your Weight . . . . . . . . . . . . . . . 14

Worksheet 4: Protect your heart. Watch your weight. . . . . . . . . . . . . 16

The Big Game: Quit Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Worksheet 5: Help your heart. Stop smoking. . . . . . . . . . . . . . . . . . 20
2

I’d like a piece

too, Mariano.

This pie 

is delicious.

This crossword 

puzzle gets harder

every day.

I can solve it, mamá.

Just give me the clue.

They call him the 

King of Crossword

Puzzles, mamá.

A 10 letter word. Foods 

high in saturated fats make

this go up and some people

have a high level.

Just give me a tiny piece.

All that cream...it’s too much 

saturated fat for me.

The Crossword Puzzle: Lower Cholesterol
3

In this house, we eat 

too many foods high in 

saturated fats every day 

and do not get enough

physical activity.

What a family! 

“Gordura?”... Saturated

fats?...Ten letters and 

some people have 

it too high?

Ten letters...Why 

are you looking at

me that way?

I have it “gordura!”

Don’t be silly,

Néstor,“gordura”

has only seven 

letters.

Food rich 

in fats...?

“COLESTEROL!” With this 

pie so high in saturated 

fat, our cholesterol 

levels will rise.

Bingo! 

“Co-les-te-rol.”

Exactly, Doña Fela! Know your cholesterol level 

and protect your heart.

Eat less saturated fats.

An ounce of prevention is 

worth a pound of cure!
4

Eating low fat, low cholesterol foods can help you reduce your 

blood cholesterol level and your weight and prevent heart disease.

It also sets a good example for your children.

Do you know your cholesterol number?

A total blood cholesterol level of less than 200 is desirable.

A level of 240 or higher is high blood cholesterol.

But even a level between 200 and 240 can increase your risk of heart disease.

If you don’t know your number, ask your doctor about it.

Write your blood cholesterol number here: 

Make the switch to heart-healthy eating today!

Doña Fela has learned that it’s not difficult 

to get your family to eat low fat, low cholesterol foods.

Be good to your heart. Eat less fat, saturated fat, and cholesterol.

To switch my family from drinking

whole milk to skim milk, I served

them whole milk mixed with 

2% milk for a month.

During the next month,

I served them 2% milk mixed 

with 1% milk, then 1% milk 

mixed with skim milk,

until they were drinking only 

skim milk. Soon they couldn’t 

even taste the difference.

Skim


Milk

How I switched my family from whole to skim milk.
5

Virginia has learned that eating foods high in

saturated fat can raise her blood cholesterol

level. So she’s modified her favorite pie recipe

by using margarine,skim milk,and low fat

cream cheese. Now the pie is lower in fat,

saturated fat,and cholesterol,and it still tastes great.

Make your personal pledge to do what Virginia 

has done! Look at these examples:

Breakfast

Use 1% milk in coffee or cereal.

Lunch

Use leftover turkey to make a sandwich. Eat it 

with some raw carrots and a banana for dessert.

Dinner

Bake chicken with lime juice, cilantro, and 

tomatoes. Take the skin off and throw it 

away before cooking.

Snack

Eat an apple instead of fatty tortilla chips.

Write the changes you will try to make this week:

Your health and your family’s health is priceless.

Make an investment in it!

Try some of these 

simple changes:

Buy 1% or skim milk and 

low fat or fat free cheese.

Buy nonstick cooking oil

spray. Spray it on baking pans

and skillets instead of using a

lot of fat for greasing pans.

Use the food label to help 

you choose foods lower in fat,

saturated fat, and cholesterol.

Trim the fat from meat and

the skin and fat from chicken

and turkey before cooking.

Cook ground meat and 

drain the fat.

Cool soups and remove 

the layer of fat that rises 

to the top.

Use fat free or low fat 

salad dressing, mayonnaise,

or sour cream.

Use small amounts of 

margarine instead of butter.

Choose fruits and vegetables

instead of high fat foods like

chips or fries.

When Shopping

When Cooking

When Eating

1.

2.

3.

1.

2.

3.

1.

2.

3.
6

An Unsettling Surprise: Prevent High Blood Pressure

Marianooooo! 

Did you take your

high blood pressure

pills, dear?

Yesss Virginia! 

Why do you ask,

my dearest?

For no reason,

my love, no reason 

at all. You know 

what the doctor said.

If you stop taking 

them, you could 

have a stroke.

My son loves to 

practice his favorite sport.

There he is navigating the

channels on his remote 

control. How is he not

going to have high 

blood pressure? 

Mariano, fix your collar! 

What will our little girl’s 

boyfriend think?!

What?...Who?...

Whose boyfriend?

My God, that must

be Lolo! You’ll 

see mamá, he’s 

so handsome.
7

We might lack 

certain things in this

house, but emotions, we

always have

more than

enough of.

Lolo, this is my father.

Papa, this is Lolo. Papa?...

Do you feel OK? 

Mariano, I found your pills,

and you haven’t taken them.

If you don’t take them, you

will not get to enjoy your

grandchildren.

If you have high 

blood pressure, you can 

control it. Take your pills,

cut down on salt and 

sodium, watch your

weight, and be more 

active. An ounce 

of prevention is worth 

a pound of cure!

How can my daughter

fall for this kid?
8

Eating less salt and sodium can help prevent and lower your 

high blood pressure, and it sets a good example for your children.

Do you know your blood pressure reading?

Desirable blood pressure is 120/80.

If your blood pressure is 140/90 or higher, you have high blood pressure.

High blood pressure does not go away by itself.

Ask your doctor for help in lowering it.

If you don’t know your blood pressure reading, ask your doctor about it.

Write down your blood pressure reading here:

Doña Fela has learned that it’s 

not hard to get your family to 

eat less salt and sodium.

To break your family’s habit 

of using the salt shaker at 

the table, try Doña Fela’s

secret recipe!

Keep your heart in mind.

Eat less salt and sodium.

SPICE IT UP! 

Discover how much f lavor you can add by using spices and herbs.

To make food taste good

without salt,I use cilantro,

cumin,fresh garlic,parsley,

onion,green pepper,

oregano,and even a

dash of hot pepper

when I cook.

Everyone in my

family got used to

the taste of foods

with less salt.

Desirable!

120

80

Fill the salt shaker with this 

combination of herbs and

spices and use it, instead of

salt, to f lavor foods:

1/4 cup chili powder

2 tablespoons paprika

2 teaspoons oregano

1/2 teaspoon dry mustard

1 teaspoon garlic powder

1 teaspoon black pepper

1/2 teaspoon red pepper
9

Take the lead and try

these simple changes:

Buy fresh plain, frozen,

or no salt added canned

vegetables.

Buy fresh garlic 

or garlic powder

instead of garlic salt.

Choose foods labeled “low

sodium,”“sodium free,” or

“no salt added.”

Use half the amount of salt 

you normally use.

Add little 

or no salt to

the water when

cooking beans, rice,

pasta, and vegetables.

Cut back on smoked, cured,

and processed beef, pork, and

poultry like bologna, ham,

and sausage.

Fill the salt shaker

with a mixture of

herbs and spices.

Use small amounts of

margarine instead of butter.

Choose fruits and vegetables

instead of salty snacks like

chips, fries, and pork rinds.

When Shopping

When Cooking

When Eating

1.

2.

3.

1.

2.

3.

1.

2.

3.

Mariano has learned to control his high blood

pressure: He takes his blood pressure pills with

breakfast every morning to make sure that he

doesn’t forget to take them. He has stopped

smoking and walks daily. And he’s found that

food can still taste good with less salt and sodium.

Make your personal pledge to do what Mariano 

has done! Look at these examples:

Breakfast

Prepare oatmeal with 1% milk,raisins,

cinnamon,and no salt.

Lunch

Use leftover chicken to make a sandwich

instead of using luncheon meats.

Dinner

Make your own soup with vegetables and

half the amount of salt.

Snack

Eat an orange without salt instead of salty chips.

Write the changes you will try to make this week:

Your health and your family’s health is priceless.

Make an investment in it!
10

The instructions say you have 

to “insert the tube perpendicular 

to the main axle of your Health

Machine.Then tighten the two 

lateral screws...”

The Ramírez family just got their new “health machine.” I told you, mamá, my friend Ana lost

10 pounds, and her machine isn’t

even a shadow of ours ...

I hope it’s easier to 

use than it is to 

put together!

Hi everybody! I just took a

brisk 30-minute walk with 

the neighbor and I feel like 

a 20-year-old again.

What’s this? Are you 

building a missile to 

send me to the

moon?

It’s the new exercise

machine, Grandma.

Life is good, but you

have to keep active.

You have to move.

The New Health Machine: Exercise
Take the stairs!

Walk! Dance!

Stay active!

Exercise machines usually

give excellent results,

but you don’t have to wait 

to be able to buy the 

latest model to start 

getting in shape.

The real exercise is

to assemble it!

Two hours later ... To stay in 

shape, all 

you need is 

discipline and

the desire 

to live a 

happy life.

Keep active.

Get 30 minutes 

of physical activity

every day.

An ounce of 

prevention is 

worth a pound 

of cure!

11
12

Regular physical activity can help your heart and lungs work better,

lower your blood pressure and blood cholesterol, lower your blood

sugar,and help you control your appetite and weight. What’s more,

it can help you relax and feel less tense and sleep 

better,as well as feel more energetic and

good about yourself.

Take heart. 

Say YES to physical activity.

Doña Fela has learned that the more 

physical activity you do, the easier it gets.

I do not wait until the end 

of the day. I am active throughout

the day. I take the stairs instead of the

elevators and walk everywhere I can.

Now I am up to walking 30 minutes

a day with Leticia,my neighbor.

It helps to like what you do and to

do it with someone else.

We are so busy talking we 

walk even longer.

Make staying active a lifelong habit.
13

Keep moving. 

Start slowly and 

work your way up!

Use the stairs

instead of the

elevator.

Get off the bus

one or two stops

early and walk.

Walk

Rake leaves

Dance

Jump rope

Garden

Ride a 

stationary 

bike

Running

Aerobic dancing

Swimming

Floor exercises

Sports

Jumping jacks

Soccer

Bicycling

A good place 

to start

Move to these

activities

Increase to this

higher level

Strive to do 30 minutes of

activity every day. If you’re

short on time, try three 

10-minute periods.

Other things to do to help you and 

your family get started: 

Leave a pair of walking shoes in your car.

Set a date and time with a co-worker to begin walking.

Carmencita,Virginia, and Néstor have all increased their physical

activity. They now dance and use their exercise machine almost

every day. And Mariano also jogs in place each day.

Make your personal pledge to exercise like the Ramírez

family does! Look at these examples:

Morning

Park the car a few blocks away and walk for 10 minutes.

Noon

During lunch, walk with a friend for 10 minutes.

Evening

After dinner, ride a stationary bike for 10 minutes while 

watching television.

Write the changes you will try to make this week:

Your health and your family’s health is priceless.

Make an investment in it!
14

Carmencita, I don’t like that new

boyfriend of yours at all.

Oh, but mamá,

he’s gorgeous.

Papa, can you pass

me more ham?

Néstor, can you pass

me more rice?

That kid is STRANGE.

Mamá, can I have some 

more beans?

While they tear apart 

my granddaughter’s

boyfriend, they are 

eating too much.

It’s proof that this 

family doesn’t lose 

its appetite, even 

under the most 

dramatic of 

circumstances.

I Don’t Like That Boy At All: Watch Your Weight
15

You should’ve invited him, little

sister. Come on, be good and

pass me more butter...

Don’t get into 

this, Néstor. Lolo

graduated with 

honors from

Engineering School.

The fact that he’s 

a modern guy 

doesn’t mean that 

he is a loser...

Pass me 

more sauce!

Please, would 

you pass me the 

salt again?

Pass me...

Pass me...

Would you allow 

me to speak? 

My dear family, don’t you 

realize that if you eat so much, you 

will get fat? Pass me more of this ...

pass me more of that. We are what 

we eat, and this family is eating 

enough for a family of ten.

To prevent heart disease,

watch your weight, serve yourself 

small portions, and eat foods lower 

in fat and calories! An ounce of 

prevention is worth a pound of cure!
16

Maintaining a healthy weight can reduce your risk of 

having a heart attack or stroke, and you will feel better.

Do you know your weight and whether it’s right for you?

Check the chart to see how much 

someone your height should weigh.

Is your weight within the range suggested for people your height? 

If it’s higher, you need to think about losing weight.

Protect your heart.

Watch your weight.

Your 

weight:

Your 

weight range:

Set your goal — aim for a healthy weight.

Try not to gain more weight if you’re at the right weight for your height. To keep

your weight stable, eat food lower in fat and calories and get regular physical activity.

If you need to lose weight, go slowly. Aim to lose about 1/2 to 1 pound a week.

If you have a lot of weight to lose, ask your doctor or a dietitian to help you.

Inches/

 Meters

6'0"/1.83

5'11"/1.80

5'10"/1.78

5'9"/1.75

5'8"/1.73

5'7"/1.70

5'6"/1.68

5'5"/1.65

5'4"/1.63

5'3"/1.60

5'2"/1.57

5'1"/1.55

5'0"/1.52

4'11"/1.50

4'10"/1.47

Pounds/

 Kilograms

50/

 22.7

75/

 34.1

100/

 45.5

125/

 56.8

150/

 68.2

175/

 79.5

200/

 90.9

225/

 102.3

250/

 113.6

Healthy Weight

Moderate

Overweight

Severe

Overweight

Source: Dietary Guidelines for Americans, 1995
17

Losing weight means making long-term changes.

How Doña Fela has found success.

I still eat the foods I like,

but I eat smaller portions.

I also eat fewer fatty foods

and sweets and more fruits

and vegetables. The key 

is to eat a variety of foods

and enjoy what you 

are eating.

Try these tips to get started.

Eat fewer foods high in fat — like fried

chicken,pork rinds,and sausage.

Cut down on cakes, pastries, candy,

and soft drinks.

Eat more fruits, vegetables,

and grains.

Make stews with lean meat 

and vegetables.

Serve small portions and do not 

go for seconds. Don’t skip meals.

Aim for 30 minutes of physical 

activity each day.

Your health and your family’s health is priceless. Make an investment in it!

Make your personal pledge to do

what the Ramírez family is doing!

Look at these examples:

When shopping

Read labels to choose foods lower 

in calories.

When cooking

Bake fish instead of frying it.

Use non-stick cooking oil spray

instead of greasing the pan with oil.

When eating

Have green beans and rice with one

piece of chicken instead of three pieces

of chicken alone.

Get active

Walk for 10 minutes, three times a day.

Small Portions

Coo

Oil Spking


ray

Write the changes you will

try to make this week.
18

Ladies and gentlemen,

it’s getting tense. Carlos Cartin 

is near the gate. The goalie

advances, he falls. Carlos Cartin

touches the ball and...

Nobody wins until you

both stop smoking.

Don’t you know what

smoking is doing to

your health and to

the health of the

entire family.

Keep your

promise!

The Big Game: Quit Smoking

Goooooal!

Gooooooal! 

Goooooal!

Gooooooal! 

We won, Dad! 

We won!
19

Your grandmother 

is right.

Now we are 

all winners!

You put your life and

your family’s life at risk

when you smoke.

Break the habit now.

An ounce of 

prevention is worth 

a pound of cure!

one must 

fulfill.

What one 

promises...
20

Quitting smoking will lower your risk of heart attack, stroke,

and lung disease and help you breathe more easily and feel

less tired. What’s more, your clothes, hair, and breath will 

smell fresher, and you will save money by not buying cigarettes.

Most important, when you quit smoking, your children won’t be

exposed to your second-hand smoke, and they will have your 

good example to follow.

Help your heart. 

Stop smoking.

Quit smoking and add years to your life!

2. 

Get support.

“I also attended a 

quit-smoking program

in the clinic every

Thursday night.

And I got a lot 

of support from 

my family.”

“Every time I felt

under stress, I wanted

to smoke. Instead of

smoking, I went to

play soccer or talked

to a friend.”

Mariano and Néstor decided to quit smoking. Néstor

made a firm pledge one morning, threw away his cigarettes, and quit for good. Mariano used the following

three tips and quit too.

“The doctor at the 

clinic suggested that 

I use the patch. The

patch helped me 

slow down the urge

to smoke.”

3. 

Learn how to 

handle urges 

to smoke.

Even if you do not smoke, it is important that you 

become informed about the best ways to quit.

Help those around you and keep your children smoke-free.

1. 

Use the nicotine 

patch or gum.
21

Break free from the smoking habit.

Protect your children!

When a friend comes to 

our house and lights up a 

cigarette, I say very politely,

“I’m sorry, we are a smoke-free

house. Please smoke outside.”

And I keep a sign in my 

home that says,“Thank You 

for Not Smoking.”

Doña Fela says it’s not hard to make your home smoke-free.

Talk to your children about the harm 

that smoking will do to their health.

Practice with them saying,“No, thanks,

I don’t smoke.”

Make your personal pledge to

do what the Ramírez family

has done to protect your

family from cigarette smoke.

Look at the examples:

If you smoke

I will set a quit date today.

To protect your family

from a smoker

I will put a “Thank You for Not

Smoking” sign in my house.

To help your child 

stay smoke-free

I will practice with my child 

saying “NO” to cigarette smoking.

Write the changes you will

try to make this week.

Your health and your family’s health is priceless. Make an investment in it!
Remember, an ounce 

of prevention is worth a pound of cure!