Nutrition & Food Prep

Meeting Individual Needs and Preferences

Most people have food they like or prefer to eat and most people have some foods they don’t like and avoid. Some food preferences relate to what each person ate while growing up. Cultural and religious traditions also can influence what foods people prefer to eat or avoid. For example, people of the Muslim faith do not eat pork or in many Asian cultures rice is included with most meals. It’s best to ask and not assume about what someone wants. Typically, the DSP can respond sensibly to preferences, unless whole classes of important foods are ruled out. In that case, seek advice from the individual’s doctor and others such as a dietician or behavior specialist. Many individuals may have complex nutritional needs because of a chronic health condition. For example, someone with cerebral palsy may have difficulty chewing and swallowing, or a person with diabetes has to limit sugar and the type of carbohydrates he or she eats. You must know each individual’s health history and health care protocols in their Person Centered Plan to assure each individual’s nutritional needs are met.

The different types of specialized diets are:

• Regular

A balanced diet that includes a variety of foods. The type most of us should be eating.

• Modified

A doctor prescribed diet altered in texture, such as pureed, chopped, or cut into small bites. If a person has trouble chewing and swallowing due to cerebral palsy, absence of teeth, or some other condition, a modified diet may be prescribed. Always notify the individual’s doctor if he or she is observed to have a new onset of difficulty chewing, swallowing, or coughing during mealtime. An order can be written for a person’s beverages (including water) to be thickened.

• Content Modified

A doctor-prescribed diet that contains certain nutrients and eliminates others which are problematic to the individual because of a health condition. For example, the diabetic diet has a reduced amount of sugar. Following a content modified diet is similar to taking medications. Both are prescribed by the doctor to treat a health condition and if not taken or followed regularly can result in severe health problems.

A Note on Dietary Supplements

Food is the best source for vitamins and minerals. If people eat a nutritious, well-balanced diet, most do not need food supplements in the form of vitamin and mineral formulas. There are exceptions, however, especially if a person is taking certain medications regularly. The use of supplements should be discussed with each individual’s doctor. Individuals should not take vitamin, mineral, or herbal supplements unless they are prescribed.

Food Restrictions

Sometimes people need to avoid or restrict specific foods because of a sensitivity or food allergy, such as peanuts, or to a food group, such as dairy products. Food allergies can make a person have symptoms such as a stomachache, diarrhea, hives (red, blotchy skin bumps), itchy and watery eyes, or a runny nose. When a food allergy is suspected, be careful to keep the individual away from such foods and have the individual see a doctor.

When an individual has a known allergy to a food or medication, all records must be marked with this information. Marking it in red to ensure that it will be easily noticed by all caregivers is a good idea. Important: Some severe food allergies can cause anaphylactic shock. Anaphylactic shock is life threatening. Extreme respiratory distress can cause a person to stop breathing if emergency medical treatment is not immediately available.

Weight Management and Reduction

A person is considered obese if he or she weighs 15 or more pounds than the largest healthy weight for that person’s height and sex. Obesity is common in individuals with developmental disabilities. This is most often due to lack of physical activity, poor diet, and for some disabilities, a decreased need for calories. Another contributing factor can be the use of high calorie foods for rewards in behavior intervention programs. Obesity can cause heart disease, high blood pressure, and diabetes. Obesity also causes problems in day-to-day living for individuals. Obesity can make the following activities more difficult:

• Walking

• Replacement of braces or orthotics; that is, more frequently.

• Self-care and maintaining good hygiene.

• Transferring for wheelchair users

Treatment of obesity involves changing the food the individual eats, decreasing the total daily caloric intake, offering foods low in fat, serving smaller portions, and increasing the daily activity level by walking or other exercise programs. The planning team, including the individual’s doctor, should be involved in developing plans and a dietician may also be helpful.

In general, treating obesity requires changing daily routines for eating and activities. Some routines to look at include:

Amount of TV watching

• Snacking throughout the day

• Receiving food as a reward for preferred behavior.

• Eating as a social activity; for example, a weekly outing to a fast-food restaurant can be replaced by a weekly outing to the bowling alley.

A Note about Calories:

• What happens if we take in too many calories and slow down our activity level? We gain weight.

• What happens if we take in more calories and increase our activity? We stay the same in weight or lose a little.

• What happens if we take in fewer calories and increase our activity? We lose weight. We need to balance calories from a variety of food with daily exercise.

Remember: Consult with the individual’s doctor before beginning any weight loss program.

Estimates of Daily Caloric Need

• Older adults and women who are not active need approximately 1,600 calories per day.

• Most children, teenaged girls, active women, and inactive men need approximately 2,200 calories per day.

• Teenaged boys, active men, and some very active women need approximately 2,800 calories per day.

Learn to recognize a serving size on a plate, in your hand, and in a bowl. To help visualize a tablespoon or other common portion size, measure it out and compare its size to a common item like a quarter or deck of playing cards. Soon it will become second nature. Try remembering these serving sizes:

• 1⁄2 cup fruit, vegetable, cooked cereal, pasta or rice = a small fist

• 3 ounces cooked meat, poultry, or fish = a deck of cards

• 1 muffin = a large egg

• 1 teaspoon butter or margarine = a thumb tip

• 1 small baked potato = a computer mouse

• 1 pancake or waffle = a 4-inch CD

• 4 small cookies (like vanilla wafers) = 4 casino chips

• 1 medium apple or orange = a baseball (not softball)

• 2 tablespoons peanut butter = a golf ball

If you calculate calories, be honest about the portion consumed and multiply it by the correct number of servings contained. Tips for Assisting Individuals with Weight Loss

• Stress good eating, not dieting.

• Keep food out of sight and unavailable except during meal and snack time.

• Limit drinks other than water to meal and snack times; dilute other drinks with water.

• Avoid regular sodas and other sugary drinks.

• Serve larger portions of lower calories foods (vegetables and fruits) and smaller portions of higher calorie foods.

• Keep low fat, low calories foods, such as fruits and vegetables, available at all times.

• Check the portion size chart for recommended serving size.

• Look for fat-free and other non-fat dairy products.

• Look for non-fat or low-fat desserts such as fat-free pudding or gelatin.

• Do not reward good eating with dessert.

• Use non-food rewards such as books, outings, or cosmetics.

Food Safety and Preparation

Four Simple Steps to Food Safety

1. Clean – Wash Hands and Surfaces Often

• Bacteria can spread throughout the kitchen on cutting boards, utensils, sponges, and counter tops.

• Wash your hands with hot, soapy water before handling food. Wash your cutting boards, dishes, utensils, and counter tops with hot, soapy water after preparing each food item and before you go on to the next food.

• Use plastic or other non-porous cutting boards. Wash cutting boards in hot soapy water or run through the dishwasher after use.

• Consider using paper towels to clean up kitchen surfaces. If you use cloth towels, wash them often in the hot cycle of your washing machine.

• Kitchen Clean –Up when a dish washer is not available involves: washing in hot soapy water, rinsing, and sanitizing. For sanitizing step: mix 1 1⁄2 teaspoons of bleach with one gallon of water. Then completely immerse all dishes, utensils and glasses for one minute. There are two acceptable ways to dry dishes; use the heated drying cycle on the dishwasher or air dry.

2. Separate – Don’t Cross-Contaminate

Cross-contamination is the scientific word for how bacteria can spread from one food product to another. This is especially true when handling raw meat, poultry, and seafood. So keep these foods and their juices away from ready-to-eat foods.

• Separate raw meat, poultry, and seafood from other foods in your grocery shopping cart and in your refrigerator.

• If possible, use a different cutting board for raw meat products.

• Always wash hands, cutting boards, dishes and utensils with hot, soapy water after they come in contact with raw meat, poultry and seafood.

• Never place cooked food on a plate that previously held raw meat, poultry or seafood.

3. Cook – Cook to Proper Temperature

Food safety experts agree that foods are properly cooked when heated for a long enough time and at a high enough temperature to kill the harmful bacteria that causes food borne illness.

• Use a thermometer, which measures the internal temperature of cooked foods, to make sure meat, poultry, casseroles and other foods are thoroughly cooked.

• Cook roasts and steaks to at least 145 degrees F. Cook whole poultry to 180 degrees F.

• Cook ground beef, where bacteria can spread during processing, to at least 160 degrees F. Do not eat ground beef that is still pink inside.

• Fish should be opaque and flake easily with a fork.

• When cooking in a microwave oven, make sure there are no cold spots in food where bacteria can survive.

• Bring sauces, soups and gravy to a boil when reheating. Heat other leftovers thoroughly to 165 degrees F.

4. Chill – Refrigerate Properly

Most bacteria multiply at temperatures between 40 degrees F and 140 degrees F. This is the “danger zone”. Refrigerate foods quickly because cold temperatures keep harmful bacteria from growing and multiplying. Set your refrigerator no higher than 40 degrees F and the freezer unit at 0 degrees F. Check these temperatures occasionally with an appliance thermometer. Adult Foster Care Licensing regulations outline the “Thaw Law”, which requires the following:

• Refrigerate or freeze perishables and prepared food and leftovers within two hours.

• Never defrost food at room temperature. Thaw food in the refrigerator, under cold running water, or in the microwave.

• Marinate foods in the refrigerator.

• If food is defrosted in the microwave, it should be used immediately.

• Divide large amounts of leftovers into small shallow containers for quick cooling in the refrigerator.

• Don’t pack the refrigerator. Cool air must circulate to keep food safe.

Proper food preparation is also important in making food taste good and easier to eat, for preserving the nutrients, and in reducing fat and cholesterol. Food that is poorly prepared can end up being one- third as nutritious as when it is prepared well.

Vegetables

• Fresh vegetables should be eaten soon after being purchased.

• Vegetables should be washed in running water, but not left to soak.

• Some veggies, such as potatoes, need scrubbing to remove the dirt. It is better not to peel such vegetables, because nutritional value will be lost.

• Avoid boiling vegetables because nutrients will end up in the water. Instead, you can microwave, steam, or stir-fry vegetables in water or a little bit of oil.

• Vegetables should not be overcooked and they should be eaten right away

• Vegetables should maintain their fresh color, and not end up wet and soggy.

• Frying vegetables (or any other items) can make them taste yummy, but excess oil and calories can be a problem.

Meat, Poultry and Eggs

A high amount of bacteria is associated with food that comes from animals; therefore, more preparation is required before eating these items. As with vegetables, there are various methods of cooking these protein foods. The following are some pros and cons:

• Frying in oil or fat will retain most vitamins, but add to the fat content of the food.

• Wok cooking (high heat with little water or oil) works well; however, avoid using too much salt.

• Steaming works well, as does roasting, baking or broiling, although some nutrients will be lost.