1. The Red Dress Campaign: The Red Dress Campaign: A Heart Healthy Lifestyle Tanya Williams, MS, RD, LDN Bucknell University February 5, 2008

2. The Facts don't seriously personally. 1.Women don't take their risk of heart disease seriouslyor personally. risk factors*their own chance 2.Women often fail to make the connection between risk factors* and their own chance of developing heart disease. –HIGH blood pressure* –HIGH cholesterol* –Being Overweight or Obese* –Diabetes* # 1 killer American women. 3.Heart disease is the # 1 killer of American women.

3. Risk Factors Associated with Heart Disease 1.Genetics 2.Weight OverweightOverweight ObeseObese 3.Smoking 4.Diet 5.Inactivity 6.Excessive Etoh

4. The Steps For a Heart Healthy Lifestyle 1.Eat less Cholesterol Saturated fat Trans fat Sodium 2.Eat more Fiber Soy-based products

5. The Steps For a Heart Healthy Lifestyle 3.Reduce your weight 4.Increase physical activity level 5.Learn to Shop smart Cook smart Dine out more healthy

6. ATP III Classifications/Guidelines TestLevel Health Impression TotalCholesterol <200 mg/dl 200-239 mg/dl >240 mg/dlDesirable Borderline High High LDLCholesterol <100 mg/dl 100-129 mg/dl 130-159 mg/dl 160-189 mg/dl >190 mg/dlOptimal Near Optimal Borderline High High Very High HDLCholesterol <40 mg/dl >60 mg/dl LowHigh Triglycerides <150 mg/dl 150-199 mg/dl 200-499 mg/dl >500 mg/dlNormal Borderline High High Very High Blood Pressure 140 mm Hg (systolic BP) 90 mm Hg (diastolic BP) High

7. Step # 1 Lowering Cholesterol & LDL Levels Eat less fat.Eat less fat. –Avoid fried foods, fatty meats, & whole milk products. Eat less cholesterol.Eat less cholesterol. –Cholesterol is found only in foods from animals (foods from plants contain no cholesterol).

8. Step # 1 Lowering Cholesterol & LDL levels Eat less saturated fat.Eat less saturated fat. usually –Saturated fats are usually found in animal products. should avoid coconut, palm, and palm kernel oil –However you should avoid coconut, palm, and palm kernel oil as they are high in saturated fat.

9. Step # 1 Lowering Cholesterol & LDL levels Use less hydrogenated or partially hydrogenated fats.Use less hydrogenated or partially hydrogenated fats. –Select tub or liquid margarine vs. stick margarine. Consider adding specialty spreads.Consider adding specialty spreads. –BenecolTake Control –Benecol or Take Control are made from plants and have been shown to help lower cholesterol.* *Talk with a dietitian about adding these products.

10. Step # 1 Lowering Trigylcerides Avoid Alcohol.Avoid Alcohol. –Beer, wine, or hard liquor. Avoid Sugar.Avoid Sugar. –Candy & regular soda. Eat Fewer Carbohydrates.Eat Fewer Carbohydrates. –Breads, cereals, rice, pasta, fruits, & dairy products.

11. What is Trans Fat? Trans fatty acids.Also known as Trans fatty acids. hydrogenationType of fat formed when liquid oils are made into solid fats (process called hydrogenation). –Shortening –Hard margarine can be found naturally,Trans fat can be found naturally, in small amounts, in some animal-based foods. packaged cookies, crackers, other baked goods, commercially prepared fried foods, chips, doughnuts, some margarines & most shortenings.Trans fats are in packaged cookies, crackers, other baked goods, commercially prepared fried foods, chips, doughnuts, some margarines & most shortenings.

12. Why is it Bad? is as bad saturated fat.Trans fat is as bad for you as saturated fat. It has been shown to –raise LDL levels –lower HDL levels –increase –increase your risk for heart disease

13. Step # 1 Lowering Trans Fat 1.Choose liquid or soft tub margarines & use in moderation. 1 gm saturate fat/serving First ingredient should read liquid vegetable oil 2.Use olive or canola oil (natural, un- hydrogenated oils). 3.Look for processed foods that use un-hydrogenated oils. 4.Limit intake of foods high in trans- fat (see pictures).

14. Step # 1 Decrease Sodium (Salt) Intake increaseEating a diet high in sodium (salt) can increase blood pressure. –Canned foods, dried meats or fish, packaged foods, frozen meals, lunch meats, salad dressings, marinades, and any salted food item (i.e. pretzels) reduces the riskHaving a normal blood pressure reduces the risk of heart disease. –Talk to a dietitian about a low salt diet plan. –Talk to a dietitian about the DASH diet.

15. Step # 2 Increase Soluble Fiber Intake oats, barley, dry beans & peas, fruits & vegetables lowerThe type of fiber found in oats, barley, dry beans & peas, fruits & vegetables may help to lower cholesterol levels. –Choose 5 or more servings of vegetables & fruits/day. –Choose 6 or more servings of whole grain breads, cereals, pasta, rice, & dry beans/day.

16. Step # 2 Increase Soy Intake reduceSoy protein has been shown to reduce the risk of heart disease. Add soy to your diet. –Tofu, soynuts, soymilk, or other whole soy products. –Dont count on powdered soy drinks as a good source of soy protein.

17. Heart Healthy Diet Recommendations Nutrient Recommended Intake CaloriesReduction of 500 to 1000 kcals/day Total Fat*30% or less of total kcals/day Saturated Fat*8 to 10% of total kcals/day Monounsaturated FatUp to 15% of total kcals/day Polyunsaturated FatUp to 10% total kcals/day Cholesterol200 to <300 mg/day Protein15% of total kcals/day Carbohydrates55% or more of total kcals/day Sodium2.0 mg to 4.0 mg/day Calcium1,000 to 1,200 mg/day Fiber20 to 35 gm/day Soy~ 35 gm/day *Total Fat/day = 40-60 gm/day **Saturated fat/day = 10-15 gm/day

18. The Benefits of Weight Loss

19. What is Ideal Body Weight (IBW)? A term describing the weight that people are expected to weigh based on age, sex and height.A term describing the weight that people are expected to weigh based on age, sex and height. A recommended weight for individuals as provided in the Suggested Weights for Adults chart published periodically by the USDA and US Health and Human Services Department. The weight appropriate for an individual that results in a body mass index of 20-25.

20. What Does it Mean to Your Health? underweightBeing underweight can also lead to health conditions such as: –Anemia, heart problems, and chronic fatigue –An obsession with weight loss may also lead to eating disorders and nutritional deficiencies that may be life threatening overweightPeople who are overweight are at increased health risk for diseases including: –Heart disease –Heart disease, diabetes, stroke, osteoarthritis, gallbladder disease, gout, and certain types of cancer.

21. What is Body Mass Index (BMI)? A measure to determine the amount of body fat and amount of lean body mass.A measure to determine the amount of body fat and amount of lean body mass. The number, derived by using height and weight measurements, that gives a general indication if weight falls within a healthy range. BMI Class Value (Kg/m 2 ) Underweight< 18.5 Normal Weight 18.5-24.9 Overweight25.0-29.9 Obese I30.0-34.9 Obese II35-39.9 Obese III 40.0

22. Health Risks of Obesity

23. What is a Waist Circumference? A measurement of the waist. A measurement of the waist.

24. What Does it Mean to Your Health? increasesFat around the waist increases the risk of obesity-related health problems. Womenmore than 35 incheshigher riskWomen with a waist measurement of more than 35 inches have a higher risk of developing obesity-related health problems. heart disease. – Diabetes, high blood pressure, & heart disease.

25. Step # 3 Reduce Your Weight overweight or obese,10% reductionIf you are overweight or obese, a 10% reduction in BWT may help to… –Lower Blood pressure –Lower Cholesterol level –Lower Triglyceride level –Lower Blood Sugar Levels –Improve overall health –Lower risk of heart disease

26. Calculating Kcals The Short Method SedentaryModerately Active Very Active LoseWeight 15 kcals/kg 20 kcals/kg 25 kcals/kg MaintainWeight 20 kcals/kg 25 kcals/kg 30 kcals/kg GainWeight 25 kcals/kg 30 kcals/kg 35 kcals/kg *Pounds (lbs) can be converted into kilograms (kg) by dividing lb value by 2.2. **To lose 1 pound of body weight in 1 week, you must reduce your intake by 500 calories each day. **To lose 2 pounds of body weight in 1 week, you must reduce your intake by 1000 calories each day.

27. Convert Calories into Meal Patterns 1200 kcals/day – 2 D, 2 Fr, 6 Gr, 4 M, 3 V, & 2 F 1400 kcals/day – 2 D, 2 Fr, 7 Gr, 5 M, 2 V, & 3 F 1600 kcals/day – 3 D, 2 Fr, 9 Gr, 5 M, 3 V, & 3 F 1800 kcals/day – 3D, 3 Fr, 9 Gr, 6 M, 3 V, & 4 F 2000 kcals/day – 3 D, 3 Fr, 10 Gr, 7 M, 3 V, & 4 F 2200 kcals/day – 3 D, 3 Fr, 12 Gr, 7 M, 3 V, & 5 F Ddairy Frfruit Grgrain Mmeat Vvegs Ffat *All kcals associated with meal patterns above are based on correct portion size/serving consumed.

28. What Counts as a Portion? Food GroupServing Size Grain 1 slice of bread, ½ small bagel, 1 oz. cold cereal, ½ cup cooked cereal, or 4 small crackers Vegetable 1 cup raw, leafy vegs, ¾ cup veg juice, or ½ cup other vegs chopped, cooked or raw. Fruit 1 medium whole fruit, ½ cup chopped, cooked or canned, or ¾ cup juice. Dairy 1 cup of milk or yogurt, 1 ½ oz. natural cheese, or 2 oz. processed cheese. Meat & Meat Substitutes 2-3 oz. cooked lean meat, ½ cup cooked dry beans, 1 egg, or 2 T. peanut butter. Fat 1 tsp. butter or margarine, 2 T. dry non-dairy creamer, 1 tsp. oil, or 4 T. whipped topping.

29. Guesstimated Portion Sizes 1 cup the amount that would fit into a tea cup or the size of a tennis ball.1 cup of potatoes, rice, or pasta is equal to the amount that would fit into a tea cup or the size of a tennis ball. to-go coffee lid.Bagels should be the size of a to-go coffee lid.

30. Guesstimated Portion Sizes tennis ball.Whole fruits should be about the size of a tennis ball. –apples –oranges –peaches –pears dollar bill.Bananas should be the size of a dollar bill.

31. Guesstimated Portion Sizes Fresh veggies the ½ cup 3 ice cubes.Fresh veggies should be measured by the ½ cup and should look like 3 ice cubes.

32. Guesstimated Portion Sizes cheese tube of lipstick 3.5 inch computer disk.A serving of cheese is equal to a tube of lipstick or if sliced, a 3.5 inch computer disk.

33. Guesstimated Portion Sizes Meats 2-3oz. servings a palm of a womans hand, or a deck of cards.Meats should be between 2-3oz. servings or the size of a palm of a womans hand, or a deck of cards.

34. Guesstimated Portion Sizes 3 oz. serving3 oz. serving of chicken or turkey with the bone equals: –2 thighs –2 drumsticks –1 drumstick & 1 thigh

35. Guesstimated Portion Sizes 2 T. of peanut butter a golf ball.2 T. of peanut butter should be the size of a golf ball.

36. Guesstimated Portion Sizes 1 tsp of butter foil- wrapped restaurant type (1 package).1 tsp of butter equals the foil- wrapped restaurant type (1 package). 1 tsp. of oil is the correct serving size.1 tsp. of oil is the correct serving size.

37. What Counts as a Portion/Serving? Alcohol Type Serving Size Recommended # of Drinks/day Beer12 oz. Females = 1 drink/day* Males = 2 drinks/day* Wine5 oz.Same as above Hard Liquor 1.5 oz.Same as above Note: 4 or more drinks/setting is considered binge drinking for females. 5 or more drinks/setting is considered binge drinking for males.

38. Step # 4 Increase Physical Activity & Raise HDL level Regular physical activityRegular physical activity –Reduces your risk of heart disease –Aids in weight loss How do you do it?How do you do it? before –Talk with your doctor before you start a formal program. –Begin slowly. –Choose an activity you like. –Meet with an exercise professional. –Goal: –Goal: at least 30 minutes or more of moderate activity, most days of the week.

39. Step # 5 Shop Smart 1.Shop the outside aisles of the grocery store, they contain healthier food choices. 2.Avoid the middle aisles, they contained processed/high calorie products. 3.Choose fresh fruits, vegetables, milk, breads, and meats. 4.Read food labels.

40. Food Labels The Healthy Eaters Guide Indicate portion size Servings per container Amount of Calories/serving Amount of CHO/serving Amount of Fat/servingAmount of Fat/serving Amount of Saturated Fat/servingAmount of Saturated Fat/serving Amount of Trans Fat/servingAmount of Trans Fat/serving Amount of Cholesterol/servingAmount of Cholesterol/serving Amount of Sugar/servingAmount of Sugar/serving Amount of Sodium/servingAmount of Sodium/serving Amount of Fiber/servingAmount of Fiber/serving Amount of Protein/serving Amount of Vit & Min/serving

41. Step #5 Cook Smart 1.Sauté vegetables in a non-stick pan. 2.Use non-stick spray or broth instead of butter or oil. 3.Use egg whites or cholesterol-free egg substitutes to replace eggs. 4.Use skim milk to replace whole or 2% milk. 5.Use unsaturated oils and liquid margarine to replace butter. 6.Use herbs, spices, flavored vinegars, lemon juice, or fat-free/salt-free condiments to add flavor to foods.

42. Step # 5 Dine Out Smart 1.Split an entrée, or eat half and take the rest home. 2.Order baked, broiled, or grilled food. 3.Avoid breaded, fried, or creamed foods. 4.Ask for gravy, sauce, butter, and salad dressing on the side. 5.Limit fast food to 1x/week. 6.Ask a dietitian for a meal plan to be followed when eating out.

43. Interested in learning more?

44. On Campus Contact Information Tanya Williams, MS, RD, LDN Clinical Nutritionist 577-1401 (SHS desk) tlw014@bucknell.edu By appointment only Hours available Monday-Friday* Note: Not all Fridays are available

45. Off Campus Contact Information Tanya Williams, MS, RD, LDN Kelly Hoffheins RD, LDN Market Street Counseling 424 ½ Market Street Lewisburg, PA 523-1212 or 745-3776 asktanyard@gmail.com askkellyrd@gmail.com

46. Happy Birthday Roz!