Healthy eating on a plate: eating for health for CALD communities

Module 2: General Healthy Eating- Part 2

Healthy eating on a plate: eating for health for CALD communities

Module 2: General Healthy Eating- Part 1, June 2013 P a g e | iii

Healthy eating on a plate: eating for health for CALD communities

Module 2: General Healthy Eating- Part 1, June 2013 P a g e | i

Healthy eating on a plate: eating for health for CALD communities

Table of Contents

Learning Outcomes ............................................................................................................................. 1

Key Messages ...................................................................................................................................... 1

Checklist for session ............................................................................................................................ 1

Session outline: General Healthy Eating- Part 2 ................................................................................. 2

Presenter notes for Module 2: General Healthy Eating- Part 2 .......................................................... 3

Salt ...................................................................................................................................................... 3

Fats and oils ........................................................................................................................................ 6

Sugar ................................................................................................................................................. 10

Evaluation ......................................................................................................................................... 12

Some things to consider when presenting this module: .................................................................. 13

Website Resources ............................................................................................................................ 14

Appendix A – Resources………………………………………………………………………………………………………….15

Activity sheet – ‘’Which is the healthier choice?’ Activity sheet - Answers – ‘Which is the healthier choice?’ Appendix B – Script and flashcards………………………………………………………………………………………18

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Healthy eating on a plate: eating for health for CALD communities

Module 2: General Healthy Eating- Part 2

New arrivals may not have had the opportunity to learn about healthy eating and its importance for good health. The Australian food supply consists of many foods which may not have been as readily available to migrants in their country of origin. This module discusses foods and nutrients that can have negative consequences on health if eaten in excess and offers practical tips to reduce consumption of these foods.

Learning Outcomes: By the end of the session participants will be able to:

• Understand that our bodies do not need large amounts of fat or added salt and added sugar and that over consumption of these nutrients can have negative consequences on health

• Be able to identify ways to limit saturated fat and added salt and added sugar

Key Messages:

• Moderate overall fat consumption and limit saturated fat , added salt and added sugar • Choose plant-based fats and oils • Foods high in fat, salt and sugar can be eaten occasionally as part of a healthy balanced diet.

Checklist for session:

• Flashcard set for Module 2 – General Healthy Eating Part 2 • Salt shaker (filled with salt) and coloured plate • Variety pack of cereals including, Coco Pops®, Froot Loops®, Nutri-Grain®, Rice Bubbles® • 2 x Weet-Bix™ • ½ cup of raw oats • 6 x plastic bowls to display cereals • Packet of sugar cubes (you will need to cut one cube to display ½ and ¼ teaspoon of sugar) • Activity sheet ‘Which is the healthier choice?’ • Answer sheet ‘Which is the healthier choice?’ • Pens

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Session outline: General Healthy Eating- Part 2

Time Activity Resources required 2 mins Introduction and overview of the session

• The amount of salt, fat and sugar we need in our diet • How these nutrients impact on health • Which foods are high in saturated fat, added salt and added sugar • Ways to reduce saturated fat, added salt and added sugar

7 mins Salt Discussion Points: • Discussion of high salt foods and health consequences of eating too much

salt • Demonstration of how much salt might be added at the table • Maximum recommended amount of salt per day • How to reduce salt intake

Demonstration: How much salt do you add to your food?

Flashcards: ‘What happens when we eat too much salt?’ ‘Foods high in salt’ ‘Maximum amount of salt per day’ ‘Reduce salt’ x 2

5 mins Fat Discussion Points • Health consequences of eating too much fat • Types of fat – saturated and unsaturated • Choosing healthy fats • How to reduce overall fat intake

Flashcards: ‘Foods high in saturated fat’ ‘What happens when we eat too much saturated fat?’ ‘Choose healthy fats’ ‘Reduce fat ’

8 mins Sugar Discussion Points: • High sugar foods • Recommended limit of added sugar per day • Discussion of how easy it is to exceed recommended added sugar intake • How to reduce added sugar intake

Flashcards: ‘Foods high in added sugar’ ‘Maximum added sugar per day’ ‘Reduce added sugar’

Demonstration: Amount of sugar in common breakfast cereals

3 mins Recap of main points 5 mins In-class activity

• Participants will complete the activity sheet ‘Which is the healthier choice?’ • Discuss answers as a group.

Activity sheet - ‘Which is the healthier choice?’ Answer sheet - ‘Which is the healthier choice?’ Pens

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Presenter notes for Module 2: General Healthy Eating- Part 2

Give an overview of what participants can expect to learn during the session • The amount of salt, fat and sugar we need in our diet • How these nutrients impact on health • Which foods are high in saturated fat, added salt and added sugar • Ways to limit saturated fat, added salt and added sugar

Salt

Display ‘What happens when we eat too much salt’ flashcard

Salt is made up of two naturally occurring chemicals in equal parts (sodium and chloride). When we talk about salt, it is the sodium half of salt that we are referring to. Sodium is found naturally in most of the foods we eat. Salt (and therefore sodium) is also added to many packaged foods as a preservative (to prolong shelf life) and to enhance flavour.

Our bodies need a small amount of sodium each day to help maintain correct blood volume and the amount of fluid in body tissues. However, most people living in Australia consume too much sodium, which has been linked to fluid retention, high blood pressure, cardiovascular disease, kidney stones and osteoporosis (as salt can leach calcium out of the body). (Heart Foundation, 2010)

When too much sodium is consumed the body starts to hold on to fluid (water) to try and get rid of the excess salt. This increased fluid leads to an increase in blood volume. This causes the heart to work harder to push that extra fluid through the blood vessels. If this happens often enough arteries start to thicken and stiffen and blood pressure rises.

Foods high in salt • Sauces, gravy, salad dressings,

stock (including liquid stock), tomato paste, marinades

• Ready-to eat soups and noodles

• Cooking and simmer sauces • Yeast spreads e.g. Vegemite,

meat pastes • Take away and ready-to-eat

meals • Snack foods (salted nuts,

chips and biscuits) • Olives, canned vegetables,

canned beans, canned fish • Cheese, butter, margarine • Ready-to-eat cereals, bread • Salt added in cooking and at

the table

Check the label Sodium is required to be listed on the Nutrition Information Panel (NIP) on the back of food labels. To check whether a food is high in sodium or to compare products, look at the 100 g column.

• Low salt foods contain less than 120 mg sodium per 100 g

• Moderately salty foods contain between 120 mg to 500 mg of sodium per 100 g

• High salt foods contain greater than 500 mg sodium per 100 g

Choose reduced-salt or no-added salt products where possible and avoid adding salt at the table.

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Display ‘Foods high in salt’ flashcard

Some foods are obviously salty, but there are others that may not be so obvious. Discuss foods that are likely to be high in salt, such as: • Sauces, gravy, salad dressings, stock cubes (including liquid stock), tomato paste, marinades • Ready-to eat soups and noodles • Cooking and simmer sauces • Soy sauce, fish sauce, hoisin sauce • Foods soaked in brine – pickled cucumbers, olives, feta cheese • Yeast spreads e.g. Vegemite, meat pastes • Take away and ready-to-eat meals • Snack foods (salted nuts, chips, crackers and biscuits) • Olives, canned vegetables, canned beans, canned fish • Cheese, butter, margarine • Ready-to-eat cereals (1 ½ cups of an average sweet processed cereal is likely to have more

sodium in it than a teaspoon of vegemite) • Bread Sodium is also added to some medicines

• Tablets that fizz in water – sodium bicarbonate is what makes them fizz. • Tablets that dissolve in water (soluble) – including headache tablets …

and of course

• Salt added in cooking and at the table

Demonstration – How much salt do you add to your food?

Involve participants in a demonstration to show how much salt they might be adding to food at the table. Use a salt shaker over a coloured plastic/paper plate as it will make the salt more visible.

1. Shake some salt onto the plate and ask whether that is about how much they would add to their food

2. Continue shaking salt until the majority of the participants think that it is about the amount they would add to their food.

3. Tap the plate to form the salt into a heap. Estimate how many teaspoons of salt is on the plate.

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Display ‘Maximum amount of salt per day’ flashcard

Recommended salt intake The National Heart Foundation recommends consumption of less than 2300 mg of sodium per day, which is equivalent to approximately 6 grams or 1 teaspoon of salt (Heart Foundation, 2010). This recommendation includes salt that is already present in food (approximately 75% of the salt (sodium) we eat comes from processed food) as well as the amount of salt added during cooking and at the table. Explain that the maximum recommended amount of salt per day is about one teaspoon. This amount includes salt in processed food, salt added during cooking and salt added at the table. Refer to the salt shaker activity and compare how much of the daily recommendation would already be used by the salt added to one meal.

Types of salt There are a few different types of salt on the market. The sodium content of different salts does not vary very much, regardless of the type of salt. However, there may be some differences in taste. • Some salt is iodised – and it’s best to use this type of salt if you choose to use salt • Table salt, sea salt, kosher salt, rock salt, river salt, celery salt, vegetable salt, garlic salt and

cooking salt should all be kept to a minimum. Some of these salts are seen by consumers as being healthier than others, however they all contain roughly the same amount of sodium and none are healthier options

• ‘Light salt’, substitutes some of the sodium with potassium – but you need to check with your doctor before trying this alternative as potassium might not be suitable for some people with specific medical conditions (where retention of potassium might be a problem).

Display ‘Reduce salt’ flashcard x 2

It’s easy to consume more than the recommended amount of sodium in a day. Two slices of bread spread with butter served with some olives and feta cheese would be enough to meet the daily recommendation. If salt is then added to cooking and at the table it is easy to see how the daily recommendation could be exceeded. Discuss how simple swaps can reduce your salt intake, for example: • Buy salt-reduced or no-added salt products wherever possible (salt-reduced stock, salt-reduced

tomato paste, tuna in spring water instead of brine) o Canned foods often include added salt. Choose canned foods that have no added

salt if possible • Cut down on salty snacks – (crisps, salted nuts, olives in brine) eating salty foods creates the

desire to eat more salty foods o Choose unsalted snacks - swap salted nuts for unsalted nuts

• Remember that sweet foods – such as ready-to-eat cereals can also be masking added salt • Eat more fresh foods – remember that processed foods is where most of the salt comes from –

so eating more fresh foods will automatically cut down on your salt intake

Taste change Taste buds change over time. Gradually reduce salt intake over several weeks to give your taste buds time to adjust.

Iodine is needed for the proper function of the thyroid gland and inadequate amounts can lead to an enlarged thyroid or other iodine deficiency disorders.

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Some other practical ways to reduce salt intake • Cut back gradually on the salt added to cooking and at the table • Cook meals from scratch where possible (eating more fresh foods will limit salt intake) • Start by cutting back by a quarter or half of what the recipes says and gradually reduce it over

time • Beware of hidden salt e.g. stocks , soy sauce, fish sauce, oyster sauce, tomato paste, simmer

sauces and cooking sauces etc. • If cooking with other salty ingredients like bacon, stock, soy sauce or fish sauce – re-think adding

any more salt • Herbs and spices are a good way to add flavour to a meal instead of using salt – chilli, mustard,

lemon, garlic Look at the labels • Check the Nutrition Information Panel and choose the food with the lowest sodium content per

100 grams – (aim for less than 120mg per 100g) • Choose foods with the Heart Foundation Tick™ as they have to meet specific nutrition criteria

including criteria for sodium. Keep in mind however that many other products without the Heart Foundation Tick™ may also be good choices with lower sodium, so always check the label

Fats and oils

Display ‘Foods high in saturated fat’ flashcard

Fat is an essential part of the diet. It has a range of functions in the body such as hormone production, protection and insulation of organs as well as being a component of cell structure. Types of fats and oils Fats are solid at room temperature and oils are liquid at room temperature. Fats and oils are classified as saturated or unsaturated according to their chemical structure. Saturated fat comes from animal foods (e.g. red meat, chicken, full-fat milk, cheese, yoghurt and cream), as well as some plant foods such as coconut oil (90% saturated fat) and palm oil (50% saturated fat). Saturated fat is also found in most processed snack foods, cakes and biscuits as well as take-away foods. Unsaturated fat is found in plant foods (e.g. nuts, seeds, avocado and olives). All fats contain a mixture of saturated and unsaturated fats, however their overall classification is determined by the type of fat which occurs in the greatest amount e.g. butter is approximately 50% saturated fat and margarine generally contains a maximum of 20% saturated fat. So butter is classified as a saturated fat and margarine as an unsaturated fat. Module 2: General Healthy Eating- Part 1, June 2013 P a g e | 6

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What happens when you eat too much saturated fat?

Display ‘What happens when we eat too much saturated fat?’ flashcard

Fat is the most energy dense food, which means that it contains a high amount of kilojoules (energy) per gram (almost twice as many kilojoules per gram as either protein or carbohydrates). Both fat and oil have the same amount of kilojoules per gram and eating too much of it or foods that contain it, can lead to weight gain. Being overweight or obese, is associated with a range of diseases including high cholesterol, heart disease, diabetes and some cancers. The Australian Guide to Healthy Eating recommends cutting down on the overall amount of fat and oil eaten and in particular those saturated fats that come from animal products (as well as coconut oil and palm oil). When too much saturated fat is eaten a fatty substance (called plaque) can build up on the inside of the blood vessels and harden. Over time the blood vessels get narrower making the heart work harder to pump the blood around the body. The hardened plaque can break off and travel through the body causing a heart attack (when blood flow to the heart is interrupted) or stroke (when blood flow to the brain is interrupted).

Display ‘Choose healthy fats’ flashcard

What type of fat should you eat? The fat story is a bit more complicated than just cutting down on the amount of fat we eat and reducing saturated fat. As stated previously, eating too much saturated fat in particular is associated with an increased risk of heart disease; however eating small amounts of unsaturated fats can actually lower the risk of heart disease. Cutting down on the amount of fat you eat, replacing saturated fats with unsaturated fats and including fish and nuts in your diet on a regular basis are great ways to help protect your heart health.

• Swap animal fats (e.g. butter) for plant oils (e.g. avocado) • Use plant oils when cooking – and use spray to cut down on the

amount o look for the words monounsaturated and polyunsaturated o avoid blended oils – these can contain palm oil, which is high

in saturated fat • Snack on unsalted, unroasted nuts • Include fish in your diet on a regular basis

The Australian Guide to Healthy Eating includes a daily allowance of 1 – tablespoons of unsaturated oil per day. This includes unsaturated spreads and oils or extra quantities of the nuts and seeds from which these oils and spreads are made from. (e.g. olive, avocado, canola, safflower)

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Display ‘Reduce fat’ flashcard

Some ways to reduce your overall fat intake (especially saturated fat) include:

• Cut the visible fat off meat (including removing the skin from chicken) • Use cooking methods that don’t require fat or that reduce the amount of fat used

o Grilling, stir-frying, steaming, microwaving and baking • For roast meats, place the meat on a rack and let the fats drip into a tray • Roast vegetables in a separate pan – and spray or brush with a small amount of oil • For soups, stews and gravy, skim off any excess fat that floats to the top – if you can leave it

to cool in the fridge the fat is easier to skim off • Swap coconut cream for evaporated milk

o The fat content of light coconut milk can be anywhere from 8 – 16% and most of it is saturated fat, compared with only 1.6% for light evaporated milk. You can even get evaporated milk that is flavoured with coconut essence so that it tastes similar to coconut milk.

• Swap a large amount of oil for a small amount of oil – lightly pan fry instead of deep frying • Swap full-fat milk and yoghurt for mostly reduced, low or no-fat varieties • Use reduced fat cheeses (ricotta and cottage cheese are good choices)

o Limit full fat cheese to 2-3 times per week • Swap butter for soft spreads made from plant oils (sunflower, safflower, soy, olive, avocado)

or use mashed avocado • Avoid creamy salad dressings. Make a simple dressing with a small amount of olive oil and

some vinegar or lemon juice – or buy light dressings • Limit take-away meals • Limit processed snack foods, cakes and biscuits

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Cholesterol There are two types of cholesterol, LDL and HDL. LDL is the one people are generally concerned about and it is often referred to as ‘bad’ cholesterol. HDL is often referred to as ‘good’ cholesterol.

An easy way to remember the difference is the ‘H’ in HDL stands for ‘healthy’.

Cholesterol in food makes very little difference to the cholesterol level in the blood. The best way of reducing the cholesterol level in the blood is to: • Limit saturated fat

o these types of fat can build up in the blood vessels causing plaque which contributes to heart disease

• Include a small amount of healthy fats in your diet each day from plants and seeds such as sunflower, safflower, canola, soybean, olive, sesame or nuts

• Eat fish two to three times a week o the type of fat in fish, plants and seeds has been shown to lower the risk of heart

disease.

Food high in saturated fat …choose this instead Full fat cheese (hard and soft) Reduced fat cheese Full fat dairy (milk, yoghurt) Reduced fat milk and yoghurt Butter Mashed avocado

Hummus Margarine or spreads made from plants or seeds (sunflower, safflower, canola, soybean, olive, sesame, avocado or nuts)

Cream Light n’ Creamy Carnation milk Crème fraiche Reduced fat sour cream Chicken skin and visible fat on meat Remove the skin from chicken and remove visible

fat from meat Processed meat (sausages, luncheon meat, burgers, salami, bacon)

Choose lean meat

Pastry made with animal fats such as lard or butter

Make dough or pastry with oil or spreads made from plants or seeds (sunflower, safflower, canola, soybean, olive, sesame or nuts)

Coconut oil, milk* and cream *Coconut milk refers to the milk made from soaking desiccated coconut in water – not the clear liquid that is poured from a coconut, which is low in fat.

Milk with coconut essence added Almost all the fat in coconut oil, milk and cream is saturated, so even reduced fat versions are high in saturated fats

Palm oil Unbleached (red palm oil) is often described as healthier; however it contains the same amount of saturated fat

Choose cooking oils made from plants or seeds (sunflower, safflower, canola, soybean, olive, sesame or peanut)

Fried take away foods Limit take away foods Packaged cakes, biscuits, crisps and chocolate

Limit these foods

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Sugar

Display ‘Foods high in added sugar’ flashcard

Unlike salt and fats, including sugar in the diet is not essential; however small amounts add to the enjoyment of food and are unlikely to cause harm. Although sugar by itself is not linked to any chronic diseases, it can contribute to tooth decay and if eaten in excess is an indirect factor associated with being overweight – which does have health implications. The discussion about sugar will focus on added sugar, not the naturally occurring sugar found in fruit (fructose) or milk (lactose). Honey, syrups, brown or raw sugar are not healthier options than white table sugar and are included in the discussion on added sugar. Terms like ‘brown’ and ‘raw’ are misleading when talking about sugar. Brown rice is definitely better than white rice; however brown sugar is no better than white sugar. It is 95% sucrose (sugar) with 5% molasses added. Raw sugar is 99% sucrose (sugar); it has been subjected to slightly less processing, so it retains some colour. A teaspoon of honey has slightly fewer kilojoules than a teaspoon of sugar; however you are likely to use more honey – so the benefit is lost. Any trace minerals found in honey and raw sugar are not present in significant enough amounts to give a health advantage over white sugar. The different sweeteners are used according to taste and they can also add colour when baking, but none can be considered a healthier option over another. Honey also has a history of being used in traditional medicines and as an antibacterial; however the honey we buy in jars at the store is unlikely to have a benefit. What happens when you eat in excess? Eating large amounts of added sugar (or foods that are high in added sugar) provides the body with little else other than extra kilojoules (energy) and can contribute to tooth decay and weight gain. Sugar sticks to teeth. Bacteria in the mouth are attracted to the sugar and produce acid; which then attack the tooth surface making them vulnerable to decay. Another important consideration is that foods high in added sugar may often be high in fat; for example chocolate. Regular over-consumption of sugar or fat can lead to weight gain.

Display ‘Maximum added sugar per day (if you decide to eat foods with added sugar)’ flashcard

Recommended amount As previously stated, there is no requirement for sugar in a healthy diet. Most experts agree that 10 teaspoons of added sugar a day should be the maximum amount consumed. With the many opportunities to consume foods and drinks with added sugar these days, it’s easy to see how this limit could easily be reached or exceeded. There are many opportunities to eat added sugar throughout the day, in the form of sweet spreads like honey, jam or syrup on bread, sweetened breakfast cereal plus the sugar or honey added to breakfast cereals, ice creams, soft drinks, biscuits, cakes and confectionary, including chocolate and sugar or honey added to hot beverages.

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Go through the examples on the flashcard, highlighting how easy it is to go over the recommended 10 teaspoons limit. These types of foods are extras to a healthy diet and should only be eaten occasionally.

Demonstrations: Teaspoons of sugar in common ready-to-eat cereals

Cereal is a common choice for breakfast in Australia, and other children can influence the food choices of children who have immigrated. Many of the cereals popular with children are also high in added sugar. To demonstrate this, display cereals such as Coco Pops®, Froot Loops®, Nutri-Grain®, Rice Bubbles® , Weet-Bix™ and plain oats in bowls. Place sugar cubes in front of the bowls to depict the amount of sugar found in that serving size of cereal (1 sugar cube = 1 teaspoon of sugar). Note: A variety pack of small cereals is perfect for this demonstration and can be used more than once. If you are using other cereals calculate the teaspoons (cubes of sugar), by looking at the per serving size column on the Nutrition Information Panel. Divide by 4 to get teaspoons of sugar e.g. 12 grams of sugar/ per 25 g serve = 3 teaspoons of sugar (cubes) in a 25 g serve. Use a scale to measure out the correct amount of cereal.

Cereal (25g serve) Teaspoons of sugar per serve (1 teaspoon sugar = 4 grams)

Coco Pops® 3 Froot Loops® 2½ Nutri-Grain® 2

Rice Bubbles® ½ Weet-Bix™ ¼

Oats 0 These serve sizes are very small. It is likely people will eat 2-3 times more than this – and of course that means 2-3 times the amount of sugar.

Remind people that added sugar should be kept to a maximum of 10 teaspoons per day, this includes the sugar already in the product plus any sugar or sweeteners added at the table. Weet-Bix™ and porridge (oats) are low sugar options; however if sugar or honey are added at the table the sugar content will quickly rise. Adding fresh, canned or frozen fruit to cereal is a good alternative; and you will also be adding extra vitamins and fibre.

Food labels list the total amount of sugar. For milk products such as yoghurt and flavoured milk and products that contain dried fruit, some of the sugar listed will come from fructose (fruit) and lactose (milk).

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Display ‘Reduce added sugar’ flashcard

As highlighted above eating excess added sugar is not desirable; listed below are some simple ways to significantly reduce the amount of added sugar in the diet. • Swap soft drinks for plain water (preferably tap water)

o A can of soft drink contains the maximum recommended daily amount of sugar in one drink!

o Offer children plain water or milk instead of soft drink or cordial o Fruit drinks contain very little fruit. Choose a small glass of 100% fruit juice with no added

sugar instead or better still – eat a piece of fruit and get the additional fibre as well • Swap a large piece of iced cake for a small un-iced fruit muffin

o Cakes, lollies, chocolates and the like can be eaten occasionally, but not every day o For a snack, have a piece of fresh fruit or some yoghurt with fresh fruit

• Swap sugary cereals for unsweetened cereals o Cut down on the amount of extra sugar added to cereals and top with fruit for sweetness

and extra fibre instead of sugar or honey • Cut back on the amount of sugar added to hot drinks. If you do it gradually you are less likely to

notice the difference.

Distribute the ‘which is the healthier choice?’ activity sheet to participants

Give participants enough time to fill in the activity sheet and then go through the answers. Clarify any other points and collect the sheets. Make notes of how many participants complete the activity sheet correctly. Recap the main points • Cut down on the amount of added salt – in cooking and added at the table. Cut down gradually

to allow your taste buds time to adjust • Cut down on fats (especially saturated fats - from animals) and from coconut oil and palm oil • Choose plant oils and include fish and nuts in your diet several times a week to protect your

heart • Cut down on the amount of added sugar. Don’t worry about the naturally occurring sugars from

fruit and milk • Foods high in fat, added sugar and added salt should only be eaten occasionally Evaluation

Group discussion & evaluation • What will you take away from today’s session? • Do you feel more confident that you can limit the amount of added sugar, salt and saturated

fat you eat? • What changes, if any, do you plan to make as a result of today’s session?

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Make notes of comments throughout the session and questions asked during completion of the activity sheet ‘Which is the healthier choice?’ An overall evaluation will be conducted at the end of all the sessions.

Some things to consider when presenting this module:

• Honey is considered a food significant in the Qu’ran (Book of Islam) which is said to have healing properties. It is important to acknowledge that honey may be an integral part of participants’ diets, so the emphasis is more about quantity and acknowledging that it is a source of sugar rather than suggesting they avoid it altogether.

• The terms saturated, unsaturated fat may be confusing or difficult for some participants to understand, especially if literacy levels are low. In this case it is acceptable to refer to saturated fats as ‘unhealthy fats’ (animal fats including palm and coconut oils) and healthy fats as (nuts, avocadoes, seeds and fish).

• Some parents may be concerned if children cannot take peanut paste sandwiches or nuts to school because of school nut policies. Emphasise that there is plenty of opportunity for these foods to be eaten outside of school.

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Website Resources

Eat for Health http://www.eatforhealth.gov.au/ The revised Australian Dietary Guidelines (2013) and related information can be found on this website. Pamphlets and posters can be printed from the site. Hardcopies can also be ordered. Australian Government, 2010, http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/dietary-guidelines-lp Measure Up, This website is part of the national Measure Up campaign and provides easy to follow tips and guidelines for healthy eating and physical activity.

Heart Foundation, 2010 http://www.heartfoundation.org.au/healthy-eating/food-labels/Pages/salt.aspx, ‘Salt’, The Heart Foundation is a not-for-profit organisation that raises money for research into cardiovascular research. The results of this research are then provided to the public in an easy to read format. This webpage briefly details what to look for on a label if you are trying to reduce your salt intake. State Government of Victoria, 2011 ‘Iodine’ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Iodine_explained

The Government of Victoria has developed the Better Health Channel website, which includes short information sheets on health and lifestyle topics. This factsheet provides a summary of the role of iodine in the body.

State Government of Victoria, 2011 ‘Healthy Eating Tips,’ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Water_a_vital_nutrient The Government of Victoria has developed the Better Health Channel website, which includes short information sheets on health and lifestyle topics. This factsheet provides healthy eating tips and is consistent with the Australian Guide to Healthy Eating.

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Appendix A: Resources

Module 2: General Healthy Eating Part 2

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Which is the healthier choice?

OR

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OR OR

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Which is the healthier choice? ANSWER SHEET

OR

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OR

Trim off visible fat

Choose no added salt where possible

Swap a cake with icing for and un-iced cake. Cakes should only be eaten occasionally.

Use herbs and spices to add flavour instead of salt

Use small amounts of oil

Choose un-sweetened cereals – and watch the amount of sugar or honey you add. Top with fruit instead.

Swap animal fats (butter) for plant oils.

Appendix B: Script & flashcards

Module 2: General Healthy Eating Part 2

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Script for Module2: General Healthy Eating- Part 2

In Part 1 of Module 2 we went through the importance of eating a variety of foods and the benefits each of the different food groups have to offer. We also briefly touched on discretionary foods.

In Part 2 of Module 2 - we are going to be talking about three nutrients that get a special mention in the Australian Guide to Healthy Eating - they are - salt, fat (in particular saturated fat) and sugar (in particular added sugar). We will be discussing

• How much of these to include in our diet • How they impact on our health • The types of foods that are likely to be high in saturated fat, added sugar and added salt • Ways to limit them to improve general health.

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Module 2 General Healthy Eating

Part 2

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Script for Module2: General Healthy Eating- Part 2

Salt

Salt is made up of two naturally occurring chemicals in equal parts (sodium and chloride). When we talk about salt, it’s actually the sodium half of salt that we are referring to.

Sodium is a naturally occurring substance, but salt (and therefore sodium) is also added to many packaged foods as a preservative (to prolong shelf life) and to add flavour. On top of this our tastebuds don’t even recognise a lot of the foods with added salt as being ‘salty’.

Do we need it? Our bodies need a small amount of sodium each day to help maintain correct blood volume and the amount of fluid in body tissues. The trouble is when we eat more sodium than we need, the body starts to hold on to fluid (water) to try and get rid of the excess salt. Increased fluid leads to an increase in blood volume which means the heart has to work harder to push that extra fluid through the blood vessels. If this happens often enough arteries start to thicken and stiffen and blood pressure rises. So while our bodies have good systems to deal with excess sodium – it has its limits and for some people it gets to the point where it can’t deal with it anymore and it can start affecting our health. So excess sodium can lead to fluid retention and high blood pressure, which puts a strain on the heart and kidneys.

While the body is trying to get rid of the excess sodium it may also be getting rid of other important nutrients, like calcium which can lead to osteoporosis.

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What happens when we eat too much salt?

Normal blood vessel

+

Added salt

Heart works harder to pump extra blood around body

Drinking more fluid which is retained in

the body

Blood volume increases

High blood pressure

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Script for Module2: General Healthy Eating- Part 2

Demonstration – How much salt do you add to your food?

Involve participants in a demonstration to show how much salt they might be adding to food at the table. Use a salt shaker over a coloured plastic/paper plate as it will make the salt more visible.

1. Shake some salt onto the plate and ask whether that is about how much they would add to their food

2. Continue shaking salt until the majority of the participants think that it is about the amount they would add to their food

3. Tap the plate to form the salt into a heap. Estimate how many teaspoons of salt are on the plate.

Foods high in salt

You can probably list the foods that are obviously salty -

• Snack foods (salted nuts, chips and crackers) and take away foods • Yeast spreads e.g. Vegemite, meat pastes and soy sauce • Olives and feta cheese (anything soaked in brine – which is salty water)

But there are also other foods that you might not recognise as being salty

• Cheese, butter, margarine • Sauces, gravy, salad dressings, stock cubes and powder (including liquid

stock), tomato paste, marinades • Ready-to eat meals including soups and noodles • Cooking and simmer sauces • Canned vegetables, canned beans, canned fish • Ready-to-eat cereals – (1 ½ cups of your average sweet processed cereal

may have more sodium in it than a teaspoon of vegemite) • Bread • Processed meat (bacon, salami, ham, luncheon meat)

Sodium is also added to some medicines

• Tablets that fizz in water – sodium bicarbonate is what makes them fizz. • Tablets that dissolve in water (soluble) – including headache tablets • …and of course salt added in cooking and at the table

1 teaspoon of vegemite = 207 mg sodium Cereal (1 ½ cups) Milligrams of

sodium Coco Pops® 340

Froot Loops® 200 Nutri-Grain® 280

Rice Bubbles® 300 Weet-Bix™ (3 biscuits) 130

Oats 3

Demonstration

How much salt do you add to food?

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Script for Module2: General Healthy Eating- Part 2

Foods high in salt

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Script for Module2: General Healthy Eating- Part 2

Recommended salt intake

The National Heart Foundation recommends we eat less than a teaspoon of salt a day.

This recommendation includes salt that is already present in food as well as the amount of salt added during cooking and at the table.

About 75% of our salt intake comes from foods that we buy in packages.

Types of salt

The sodium content of different salts does not vary very much, regardless of the type of salt. However, there may be some differences in taste.

• Some salt is iodised – and it’s best to use this type of salt if you choose to use salt • Table salt, sea salt, kosher salt, rock salt, river salt, celery salt, vegetable salt, garlic salt and cooking salt should

all be kept to a minimum – they all contain roughly the same amount of sodium and none are healthier options • ‘Light salt’, substitutes some of the sodium with potassium – but you need to check with your doctor before

trying this alternative as potassium might not be suitable for some people with specific medical conditions (where retention of potassium might be a problem)

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Script for Module2: General Healthy Eating- Part 2

Maximum amount of salt per day

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Script for Module2: General Healthy Eating- Part 2

Ways to reduce salt

If you have a couple of slices of bread spread with butter, some olives and feta cheese, you will may have already reached the sodium recommendation for the day.

If you add up how much salt you eat over the day, including processed food, salt added to cooking and salt added at the table – you are probably well over the recommended intake. If you want to cut back on the amount of salt you use, cut back a little bit at a time. You will need to let your tastebuds adjust gradually over a couple of weeks though! Don’t try and cut back too quickly. Simple swaps to cut down on the amount of salt you eat. • Buy salt-reduced or no-added salt products whenever you can (salt-reduced stock, salt-reduced tomato paste,

tuna in spring water instead of brine) o Canned foods often include added salt. Choose canned foods that have no added salt if possible

• Cut down the amount of salty snack foods you eat – (crisps, salted nuts, olives in brine) eating salty foods creates the desire to eat more salty foods o Choose unsalted snacks - swap salted nuts for unsalted nuts , swap salty crisps for air popped popcorn

(without added butter) • Remember that sweet foods – such as ready-to-eat cereals can also be masking added salt • Eat more fresh foods – remember that processed foods is where most of the salt comes from – so eating more

fresh foods will automatically cut down on your salt intake

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Script for Module2: General Healthy Eating- Part 2

Reduce salt

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Script for Module2: General Healthy Eating- Part 2

Ways to reduce salt cont’d

• Cut back gradually adding salt to cooking or at the table

o Cook meals from scratch where possible (fresh foods will limit your salt intake) o Start by cutting back by a quarter or half of what the recipes says and gradually reduce it over time o Beware of hidden salt e.g. stocks , soy sauce, fish sauce, oyster sauce, tomato paste, simmer sauces and

cooking sauces etc. o If you are cooking with other salty ingredients like bacon, stock, soy sauce or fish sauce – re-think adding any

more salt o Herbs and spices are a good way to add flavour to a meal instead of using salt – chilli, mustard, lemon, garlic

Look at the labels • Check the Nutrition Information Panel and choose the food with the lowest sodium content per 100 grams – (aim

for less than 120mg per 100g) • Choose foods with the Heart Foundation Tick™ as they have to meet specific nutrition criteria including criteria for

sodium. Keep in mind however that many other products without the Heart Foundation Tick™ may also be good choices with lower sodium, so always check the label

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Script for Module2: General Healthy Eating- Part 2

Reduce salt

Eat mostly fresh foods including fruit and vegetables which are naturally low in sodium

Check the label and choose foods with less than 120mg of sodium per 100g

Swap the salt shaker for herbs and spices

Use salty ingredients sparingly and avoid adding extra salt at the table

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Script for Module2: General Healthy Eating- Part 2

Now we are going to look at different types of fats and oils

• Fats are solid at room temperature and oils are liquid at room temperature • You may have heard of the terms saturated or unsaturated fat • Saturated fat comes from animal foods (e.g. red meat, chicken, full-fat milk, cheese,

yoghurt and cream), as well as some plant foods such as coconut oil and palm oil • Saturated fat is also found in a many processed foods such as biscuits, crisps and cakes

• Unsaturated fat is found in plant foods (e.g. nuts, seeds, avocado and olives) • All fats contain a mixture of saturated and unsaturated fats, however they are classified according to the type of

fat which occurs in the greatest amount • For example butter is approximately 50% saturated fat and margarine generally only contains about 20% saturated

fat. So butter is classified as a saturated fat and margarine is an unsaturated fat.

Note:

• You will notice most of the foods high in fat are also high in salt • The Australian Guide to Healthy Eating recommends people aged over 2 years should eat mostly reduced fat

milk, cheese and yoghurt • Full fat cheese should be limited to 2-3 times per week • Oils that don’t specify the type of oil e.g. blended oil, are likely to contain palm oil which is high in saturated fat

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Script for Module2: General Healthy Eating- Part 2

Foods high in saturated fat

Blended oil

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Script for Module2: General Healthy Eating- Part 2

What happens when you eat excess fat (especially saturated fat)?

We need fat in our diet. It has a range of functions in the body including transport of nutrients, protection of vital organs and it also makes up the wall of all the cells in our body.

But it is very high in kilojoules. If you compare a teaspoon of butter to a teaspoon of sugar. The teaspoon of butter will have almost twice the amount of kilojoules in it. So when we eat foods that are high in fat it is very easy to eat a lot of kilojoules without realising it.

All fats and oils have roughly the same amount of kilojoules (butter, margarine, oil) and eating more than we need can lead to weight gain.

Being overweight is associated with a range of diseases, including high cholesterol, heart disease, diabetes and some cancers.

As well as cutting down on the overall amount of fat and oil we eat, it is important to also look at the type of fat we eat. In particular those saturated fats that come from animal products (as well as coconut oil and palm oil).

When too much saturated fat is eaten a fatty substance can build up on the inside of the blood vessels

over time the blood vessels can get narrower making the heart work harder the hardened fat can then break off travel through the body and cause a heart attack or stroke.

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Script for Module2: General Healthy Eating- Part 2

What happens when we eat too much saturated fat?

Normal blood vessel

+

Fatty substance builds on

vessel wall

Over time the blood vessel

gets narrower

Heart works harder to pump blood around body

Fatty substance can breakaway and cause a stroke or

heart attack

Saturated fat

Butter

Coconut cream

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Script for Module2: General Healthy Eating- Part 2

What type of fat should you eat?

The fat story is a bit more complicated than just cutting down on the amount of fat we eat and reducing the amount of saturated fat.

Eating oils from plants and fish actually protects your heart (but you still have to watch how much) – a tablespoon a day is enough. The Australian Guide to Healthy Eating includes an allowance for unsaturated spreads and oils or extra quantities of the nuts and seeds from which they are made.

Protect your heart by doing these three things:

• Cut down on the overall amount of fat you eat • Replace saturated fats with unsaturated fats (look for the words polyunsaturated and monounsaturated) • Include fish and nuts in your diet a few times a week ( watch the serve size of nuts – they still contain a lot of

kilojoules)

• Note: The Australian Guide to Healthy Eating includes a daily allowance for unsaturated fats of 1-2 tablespoons for adults from nut or seed oils, spreads made from nut or seed oils, nuts and nut pastes.

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Script for Module2: General Healthy Eating- Part 2

Choose healthy fats

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Script for Module2: General Healthy Eating- Part 2

Some ways to reduce your overall saturated fat intake include:

• Cut the visible fat off meat (including removing the skin from chicken) • Use cooking methods that don’t require fat or that reduce the amount of fat used

o Grilling, stir-frying, steaming, microwaving and baking • For roast meats, place the meat on a rack and let the fats drip into a tray • Roast vegetables in a separate pan – and spray or brush with a small amount of oil • For soups, stews and gravy, skim off any excess fat that floats to the top – if you can leave it to cool in the fridge

the fat is easier to skim off • Swap coconut cream for evaporated milk

o The fat content of light coconut milk can be anywhere from 8 – 16% and most of it is saturated fat, compared with only 1.6% for light evaporated milk. You can even get evaporated milk that is flavoured with coconut essence so that it tastes similar to coconut milk.

• Swap a large amount of oil for a small amount of oil – lightly pan fry instead of deep frying • Swap full fat milk and yoghurt for reduced, low or no fat most of the time • Use reduced fat cheeses (ricotta and cottage cheese are good choices)

o Limit full fat cheese to 2-3 times a week • Swap butter for soft spreads made from plant oils (sunflower, safflower, soy, olive, avocado) or use mashed

avocado • Avoid creamy salad dressings. Make a simple dressing with a small amount of olive oil and some vinegar or

lemon juice – or buy light dressings • Limit take-away foods and deep fried foods

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Script for Module2: General Healthy Eating- Part 2

Reduce fat

Reduced fat

MILK

Swap coconut cream for evaporated milk

Cut off visible fat from meat

Swap a large amount of oil for

a small amount oil

Swap full-fat milk for reduced -fat milk

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Script for Module2: General Healthy Eating- Part 2

Sugar

So we discussed how we need to be eating some salt and fats; however we actually don’t need to eat sugar. Most people sweeten their food in some way or another because it adds to the enjoyment of food…and that’s fine, because a small amount of sugar is unlikely to do any harm and isn’t linked to any chronic diseases – unlike salt and saturated fats.

The problem is when we eat too much sugar – because it doesn’t give us any vitamins or nutrients…only kilojoules, and eating too much of it can contribute to tooth decay and lead to a person putting on more weight than is healthy – and being overweight can harm your health.

Sweet foods used to be a once in a while treat, however these days they are more likely to be eaten everyday – and sometimes several times a day. Foods with added sugar are also likely to be high in fat as well – like biscuits, chocolate, cakes and icecream and these foods are easy to overeat.

Today’s discussion will be about added sugar, not the naturally occurring sugar found in fruit (fructose) or milk (lactose).

Honey, syrups, brown or raw sugar are not healthier options than white table sugar and are also included in the discussion on added sugar.

It is a common misconception that brown or raw sugars are healthy options. Brown rice is definitely better than white rice, but the same is not true for sugar. Brown sugar is white sugar with a bit of molasses added for flavour and colour. Raw sugar is white sugar that has gone through slightly less processing – again for flavour and colour.

Honey has some trace minerals in it – but not in large enough amounts to make a health difference. Honey also has a history of being used as an antibacterial – but the honey you buy in a jar from the store is unlikely to have a benefit.Page |11

Script for Module2: General Healthy Eating- Part 2

Foods high in added sugar

Honey

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Script for Module2: General Healthy Eating- Part 2

Recommended amount of sugar

As previously stated, there is no requirement for sugar in a healthy diet.

But most experts agree there should be a limit on how much added sugar people eat in a day – about 10 teaspoons of added sugar.

There are so many opportunities to add sugar to your diet – and it’s so easy to reach 10 teaspoons plus more!

Just thinking about some typical foods and drinks that you might have as a morning or afternoon snack

Go through the examples on the flashcard, highlighting how easy it is to go over the recommended 10 teaspoons limit. These types of foods are extras to a healthy diet and should only be eaten occasionally.

Note: Food labels list total sugar. For milk products such as yoghurt and flavoured milk and products that contain dried fruit, some of the sugar listed will come from fructose (fruit) and lactose (milk). The second example on the flashcard is a fruit drink – not a fruit juice. Fruit drinks typically have less than 35% fruit juice in them – the rest is sugar and water. A small glass of 100% fruit juice with no added sugar would be a good snack on its own.

Cereal (25g serve) Teaspoons of sugar per serve

Coco Pops® 3 Froot Loops® 2½ Nutri-Grain® 2

Rice Bubbles® ½ Weet-Bix™ ¼

Oats 0 These serve sizes are very small. It is likely people will eat 2-3 times more than this – and of course that means 2-3 times the amount of sugar.

Demonstration

Teaspoons of sugar in common ready-to-eat cereals.

Demonstrate how many teaspoons of sugar are in common ready-to-eat cereals. A variety pack of small cereals is perfect for this demonstration and can be used more than once.

1. Display cereals in bowls 2. Place sugar cubes in front of the bowls to depict the teaspoons of sugar in each serve

( 1 sugar cube = 1 teaspoon of sugar) 3. Highlight that theses serve sizes are very small and it is likely that people will eat more

than this – and of course this means more sugar 4. Highlight that the sugar content can quickly rise if sugar or honey is added at the table.

If you are using other cereals calculate the teaspoons (cubes of sugar), by looking at the per serving size column on the Nutrition Information Panel. Divide by 4 to get teaspoons of sugar e.g. 12 grams of sugar/ per 25 g = 3 teaspoons of sugar (cubes) in a 25 g serve. Use a scale to measure out the correct amount of cereal.

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Script for Module2: General Healthy Eating- Part 2

Maximum added sugar per day (if you decide to eat foods with added sugar

Cola

10 teaspoons sugar =

+

+

+

=

=

=

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Script for Module2: General Healthy Eating- Part 2

Ways to limit the amount of added sugar

• Swap soft drinks for tap water o A can of soft drink contains the maximum recommended daily amount of sugar in one drink! o Offer children plain water or milk instead of soft drink or cordial o Fruit drinks contain very little fruit. Choose a small glass of 100% fruit juice with no added sugar instead - or

better still – eat a piece of fruit and get the additional fibre as well • Swap a large piece of iced cake for a small un-iced fruit muffin

o Cakes, lollies, chocolates and the like can be eaten occasionally, but not every day o For a snack, have a piece of fresh fruit or some yoghurt with fresh fruit

• Swap sugary cereals for unsweetened cereals o Cut down on the amount of extra sugar added to cereals - top with fruit instead of sugar or honey

• Cut back on the amount of sugar added to hot drinks. If you do it gradually you are less likely to notice the difference.

Recap the main points:

• Cut down on the amount of salt you use. Cut down gradually to allow your taste buds time to adjust • Cut down on fats (especially saturated fats - from animals) and from coconut oil and palm oil • Choose plant oils and include fish and nuts in your diet several times a week to protect your heart • Cut down on the amount of added sugar. Don’t worry about the naturally occurring sugars from fruit and milk • Foods high in fat, added sugar and added salt should only be eaten occasionally

Before we finish today – I have one more activity for you to do.

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Script for Module2: General Healthy Eating- Part 2

Reduce added sugar

Swap sugary snacks for those with no added sugar

Swap sugary cereals for non-sugary cereals

Swap an iced cake for a small un-iced fruit muffin

Cola Swap soft drinks for water

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Script for Module2: General Healthy Eating- Part 2

Distribute the ‘Which is the healthier choice?’ activity sheet to participants

Explain the activity to participants

• Draw a circle around the healthier choice.

• Give participants about 3 minutes to complete the activity and then discuss the answers as a group or alternatively get participants to work in pairs and call the answers out.

Group discussion & evaluation

• What will you take away from today’s session?

• Do you feel more confident that you can limit the amount of added sugar, salt and saturated fat you eat?

• What changes, if any, do you plan to make as a result of today’s session?

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Script for Module2: General Healthy Eating- Part 2

Which is the healthier choice?

OR

OR

OR

OR

OR

OR

OR

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Script for Module2: General Healthy Eating- Part 2

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