Medical knowledge | Dietetics, human nutrition » Danielle Hood - Nutrition Basics, Balanced Meals for a Healthy Lifestyle

BALANCED MEALS FOR A HEALTHY LIFESTYLE Nutrition Basics: Balanced Meals for a Healthy Lifestyle Danielle Hood NED 690: Thesis Seminar in Nutrition Education Spring 2017 Immaculata University Dr. Rena Quinton, PhD, RD, LDN 1 BALANCED MEALS FOR A HEALTHY LIFESTYLE Table of Contents List of Figures and Tablespg.3 Abstractpg.4 Chapter One: Problem, Purpose, Hypothesis.pgs5-8 Chapter Two: Literature Reviewpgs.9-18 Chapter Three: Methodology.pgs19-22 Chapter Four: Resultspgs.23-26 Chapter Five: Discussion.pgs27-29 References.pgs30-32 Appendices.pg33 Appendix A: Pre-Test pgs.34-35 Appendix B: Post Test .pgs36-37 Appendix C: Lesson Plan .pgs38-41 Appendix D: Authorization Letter.pg42 Appendix E: Ethics Training Certificates .pg43 Appendix F: Ethics Training Certificate pg.44 Appendix G: Consent Form.pg46 2 BALANCED MEALS FOR A HEALTHY LIFESTYLE List of Figures and Tables Table 1 Subjects Pre-Test and Post-Test Scores.23 Figure 1 Subjects Pre-Test and Post-Test Scores. 24 Table 2

Pre-Test and Post-Test Questions Answered Correctly.25 3 BALANCED MEALS FOR A HEALTHY LIFESTYLE Abstract The World Health Organization (WHO) states there are more than a billion overweight adults globally. Key factors associated with obesity are increased consumption of energy-dense foods that are high in saturated fats and sugars paired with a reduction in physical activity. Combining nutrition education delivered by a nutrition professional in combination with physical activity may have a positive impact on weight reduction and weight management. Creating a balanced meal plan that incorporates healthy dietary recommendations from the World Health Organization that supports physical activity can be a challenge; however, with proper education and planning it can be done successfully. While Personal Training Plus (PTP) offers nutrition education to their clients, it is not delivered by a person with a degree in nutrition or a nutrition expert such as a registered dietitian to

create long-term results. To maximize health benefits, healthy behaviors such as proper nutrition and exercise should be changed simultaneously to yield positive results (Fleig et al., 2014) After participating in an educational lesson at Park Plaza Condominiums Community Center on how to identify healthier foods to clients of Personal Training Plus, the participants improved their knowledge of proper portion sizes, appropriate energy needs and balanced meals as measured by the change in their scores on a pre and post-test. 4 BALANCED MEALS FOR A HEALTHY LIFESTYLE Chapter 1 Introduction Statement of the Problem Excess energy intake paired with a lack of physical activity is a problem in the United States and is considered the leading cause of obesity in the country, triggering many Americans to carry an abundance amount of unhealthy body weight. The World Health Organization (WHO) states there are more than 1.9 billion overweight adults globally At least 600 million adults are

considered obese and obesity and overweight pose a major risk for such chronic diseases as type 2 diabetes, cardiovascular disease, hypertension, stroke, as well as certain forms of cancer (WHO, 2016). Key factors associated with obesity are increased consumption of energy-dense foods that are high in saturated fats and sugars paired with a reduction in physical activity. According to the Center for Disease Control and Prevention (2016), more than one-third of American adults are obese, and approximately 12.5 million American children and adolescents ranging in ages 2-19 years of age are considered obese with these numbers continuing to rise. The organization found obesity is higher among middle-aged adults’ ages 40-59 years old and older adults’ ages 60 years and older (Center for Disease Control and Prevention, 2016). Studies have shown that selected behaviors associated with weight-gain include frequently dining out. In addition, researchers found larger portion sizes were being

prepared at restaurants that were high in energy content, which contributed to excessive energy intake during the meal (Bezerra, Curioni, & Sichieri, 2012). Increased portion sizes leading to excess calories, and unhealthy nutrition and inactivity give way to a multitude of diseases which in many cases leads to death. A combination of 5 BALANCED MEALS FOR A HEALTHY LIFESTYLE balanced nutrition along with physical activity may help to reduce and in some cases reverse diseases caused by obesity and practicing unhealthy lifestyle behaviors. The problem of excess energy intake has been linked to a high consumption of calorically dense foods that lack vitamins and minerals, yet contain saturated fats, sugar, and a multitude of processed ingredients. Obesity has been linked with increased mortality in adults 65 years and older, coronary heart disease, type 2 diabetes, and some types of cancers (LeBlanc, O’Connor, Whitlock, Patnode, & Kapka, 2011). Making significant changes

to a person’s diet requires not only basic knowledge about nutrition, but also a willingness to make a change to daily nutritional intakes (Fleig, Kerschreiter, Schwarzer, Pomp, & Lippke, 2014). Therefore, consuming a diet rich in fruits and vegetables that includes lean protein, healthy fats, and whole grains will provide balanced nutritional intake. The World Health Organization (2015) recommends energy intake should be in balance with energy expenditure and total dietary fat should not exceed thirty percent of total energy intake to avoid weight-gain. Additionally, the organization recommends keeping sodium intake to less than five percent per day to help prevent hypertension and to reduce the risk of heart disease in adults as well as consuming at least five servings of fruits and vegetables daily. Creating a balanced meal plan that incorporates healthy dietary recommendations from the World Health Organization that supports physical activity can be a challenge; however,

with proper education and planning it can be done successfully. Researchers McKean Slater, Oprescu, & Burkett (2015) found physical activity in combination with nutrition therapy had a greater impact on health outcomes than physical activity alone. During the study, the researchers found fitness professionals did not have adequate training nor experience to provide sufficient nutrition education to their clients (McKean et al., 2015) Another study found coaching and 6 BALANCED MEALS FOR A HEALTHY LIFESTYLE nutrition education provided by a registered dietitian improved patients glycemic control and reduced some risk of cardiovascular risk factors for diabetic patients (Battista et al., 2012) Personal Training Plus (PTP) is an exclusive fitness firm located in Philadelphia, Pennsylvania that provides health and fitness services to luxury apartment complexes. The firm offers personal training and nutrition education to the residents using the apartment complex’s gym facility.

While PTP offers nutrition education to their clients, it is not delivered by a person with a degree in nutrition or a nutrition expert such as a registered dietitian to create long-term results. To maximize health benefits, healthy behaviors such as proper nutrition and exercise should be changed simultaneously to yield positive results (Fleig et al., 2014) Can a brief nutrition lesson on proper portion sizes, appropriate energy needs and balanced meals to Personal Training Plus clients improve their ability to select nutrient dense foods? Statement of the purpose The purpose of this study was to develop, implement, and evaluate an interactive lesson for Personal Training Plus clients on proper portion sizes, appropriate energy needs and balanced meals. This education was intended to provide information to help Personal Training Plus clients’ choose appropriate foods and snacks to help improve their ability to select nutrient dense foods. The individuals were tested prior to the

education to determine their level of knowledge before the education and then tested after the education to determine what knowledge they had gained from the education. The individuals have been able to immediately determine if certain foods, snacks, and portion sizes are supportive of their health. 7 BALANCED MEALS FOR A HEALTHY LIFESTYLE Hypothesis After participating in an educational lesson at Park Plaza Condominiums Community Center on how to identify healthier foods to clients of Personal Training Plus, the participants were expected to demonstrate an improved knowledge of proper portion sizes, appropriate energy needs and balanced meals as measured by the change in their scores on a pre and posttest. 8 BALANCED MEALS FOR A HEALTHY LIFESTYLE Chapter 2 Review of Literature Obesity Definition The definition of obesity is having excess body fat. To be considered obese, the weight of an individual is higher than what is regarded as fit for his or her health. Obesity, in

many instances occurs over time when one consumes more calories than he or she uses or needs. The relationship between calories consumed and calories released from the body varies for each individual based upon genetics, physical activity, and lifestyle. Health professionals see obesity as a major health issue because of its relationship with chronic diseases such as diabetes, hyperlipidemia, hypertension, stroke, and some forms of cancer. The emotional health of an individual may become affected by obesity as well resulting in major depressive disorder and in some cases, may result in one taking his or her own life. Obesity, argued by many to be among the leading risk factors to contribute to death in the United States behind smoking, hypertension, and high cholesterol levels. For people identified as obese, the risks of poor health do increase sharply with increasing body mass index. Statistics on Obesity In reviewing statistical data on obesity, one may conclude that the United

States may have a hold on combating the epidemic and may think that the nation is out of danger of the “pandemic” (Chen, Beydoun, & Wang, 2008). Conversely, the data only reveals part of the story Chen et al. (2008) states that obesity levels have become stable since 2004 having an increase from 1981 until 2004. However, the researchers found obesity levels continuing to rise primarily among industrialized nations globally. As Chen et al (2008) note, obesity may have a 9 BALANCED MEALS FOR A HEALTHY LIFESTYLE substantial burden on American culture and tribal societies as compared to others, with rates of obesity rising at a disturbing rate. Researchers, Flegal, Carroll, Kuczmarski, and Johnson, (2008), found various results in their study. On average four out of six people in the United States were obese, translating to 70 percent. Three out of four were considered overweight, translating to 37 percent (Flegal et al, 2008). Obesity levels are elevated in those who are not

Hispanic black, Hispanic, and Mexican American individuals as compared to non-Hispanic whites, with a 12 percent difference. As concluded in the study, non-Hispanic African American females have the highest rates of obesity in America-approximately 61 percent, 54 percent in Mexican-American females, 45 percent in Hispanic females, and 33 percent in Non-Hispanic American females. The rates among obese American men have continued to climb in men as well as non-Hispanic females, and Mexican American females (Flegal et al., 2008) Among adults, the pervasiveness of obesity has risen sharply during the 1970s and early 1980s. The percentage of people classified as obese with a Body Mass Index of 30kg/m2 or more did increase from 13.3 percent of men in 1974 to 278 percent in 1999 and from 175 percent of women in 1974 to 26.8 percent in 1999 (Flegal et al, 2008) By 2040, the prevalence of this epidemic is forecast to affect 65 percent of adult males and 55 percent of adult females. When it

comes to children, the difference in obesity frequency among school-aged children in the most and least poor regions has risen with time. This is according to a study conducted by French, Story, and Perry (2015). For instance, French et al (2015) say more than two in six children in 2003, and two in three children in 2009 were estimated to be obese or overweight. In 2003, 10 percent of children were obese, compared to 11 percent in 2001. In 2009, 20 percent of children were obese, in comparison to 18 percent in 2001 (French, et al, 2015). Between years 2005 to 10 BALANCED MEALS FOR A HEALTHY LIFESTYLE 2006 and 2012-2013, the difference between the most and least poor regions has risen from 7.9 to 13.0 percentage peaks (Hill & Melanson, 2009) Between these years, French et al (2015) realized that the obesity frequency levels were ranging from 17 percent for white Americans and non-African American children to 29 percent for African American children. While trying to determine

the body images among sixteen-year olds, these pollsters noted that about 47 percent of sixteen-year-old girls came to report that they were “too fat” in comparison to 24 percent of boys. Out of this, 35 percent of the sixteen-year-olds who believed that they were “too fat” came to report that “other people made fun of them because of their body weights” compared to 7 percent who believed they were the “right size” (French et al., 2015) Adulthood Obesity A study performed by researcher, Bray (2008), found obesity has grown to be a global problem that affects both wealthy and poor nations. So what is the total number of adults who are overweight or obese? It is a common question- and a difficult one for those conducting research to answer. Bray (2008), describes the data from certain areas as inconsistent making the estimations from one region to be different from another. However, the author notes that all the data point to the remarkable rises in intercontinental

obesity rates in the last couple of years and comes to realize that the endemic shows no sign of reduction even though interventions are in place aimed at combating obesity. One estimations by researchers, Flegal et al (2008) found that close to 400 million adults are obese worldwide. This is almost 12 percent of males and 15 percent of females and is virtually twice the rate of obesity in 1982 (Flegal et al, 2008). Approximately 1.6 billion adults globally were overweight or obese and by the year 2040, 2 billion adults worldwide will be considered obese. Doty (2008), notes that several years ago, obesity was, for the most part, a problem for the richer members of the society, mainly in 11 BALANCED MEALS FOR A HEALTHY LIFESTYLE wealthy nations. Globalization, has caused the world to become more affluent resulting in poorer nations continue to climb the income ladder. Humans have changed from surviving on customary diets to filling themselves on western diets and obesity turns to

be a disease for the deprived. The result over the past years, as found by Doty (2008), is that obesity has in silence grown to be a “pandemic” in emerging states. II. Obesity Consequences With the numbers climbing year by year, many medical and health professionals consider obesity as an epidemic that must be reversed immediately. Abnormal and excessive fat accumulation especially around the waist and trunk area has shown to have a negative effect on the human body (Doyle, 2014). Americans with a body mass index of 30 or greater are at an increased risk for cardiovascular disease, type 2 diabetes, stroke, and some forms of cancer. Obesity may bring about many problems in the life of an individual that can be prevented. Smoking and obesity are considered the leading cause of avertable deaths in the United States and worldwide. Diabetes and Heart Diseases Obesity tends to carry the danger of contracting type 2 diabetes, heart-related diseases, and various types of cancer. Hill and

Melanson (2009) stated that “health care practitioners say they are seeing an outbreak of potentially deadly type 2 diabetes, once identified as the growncommencement version of the illness, amongst children as young as 12 and 13.” Kannel and Gordon (2009) states that symptoms include excess fatty tissue and excessive weight gain, bringing about arthritis, lower back pains, hernia, heartburn, adult-onset asthma, higher cholesterol levels, high blood pressure, gum disease, gallstones, skin disorders, and social problems. Kannel and Gordon (2009) found that the exact deposit of fats in the body does make 12 BALANCED MEALS FOR A HEALTHY LIFESTYLE a difference in the risk of contracting an ailment. Abdominal fats are extremely dangerous because fat cells generate harmful chemical substances that move to the liver. “Lipacidemia”-the presence of fatty acids in the blood stream- blocks oxygen and glucose from being transferred to the muscles, hence heightening the ability of the

body to resist insulin. Kannel and Gordon (2009) show data that support that adults who are diagnosed with onset diabetes are most susceptible to weight gain. Kannel and Gordon (2009) argue that “A gradient in risk of more than 50-fold is seen from the leanest to the heaviest men and women, and even modest increases in weight from 18 to midlife are associated with an increase in risk several times greater than that of a person who maintained a stable weight.” Cancer Cancer is the general name given to a collection of more than a hundred diseases. Scientists have confirmed all cancers begin when free radicals or abnormal cells grow uncontrollably in the body and if left untreated the result could be serious illness or death. Obese males are the most likely people as compared to other males to develop cancer of the colon, rectum, or of any other part of the body (Hill & Melanson, 2009). According to Hill and Melanson (2009), obese women are the most likely group as compared to

other females to develop cancers of the breasts, gallbladder, uterus, or cervix. Various other forms of cancer can also be associated with being obese. Kamaraj et al (2009) studied an antioxidant present in fruits and vegetables called hesperidin which is a naturally occurring flavonid found commonly in citrus fruits. Flavonoids are naturally occurring molecules abundant in fruits, vegetables, nuts, seeds, tea and wine. Researchers found flavonoids not only provided antioxidant protection but acted as an anti-inflammatory, prostaglandin-synthesis inhibition, and enzymes (Kamaraj et al., 13 BALANCED MEALS FOR A HEALTHY LIFESTYLE 2009). Consuming a diet rich in fruits, vegetables, nuts, and seeds similar to the Mediterranean diet will help to reduce excess body fat and serve as a protective measure against the disease. Depression and Quality of Life Being obese also means putting too much pressure on joints and limbs, which may make activities relatively difficult and, at times,

all the movements may be painful. Having excess body fat may bring about emotional anguish. Physical beauty and an individual feeling attractive are some of the main valued qualities in the community and may only make obese individuals depressed. Research has shown that obesity can impact the psychological well-being of an individual (Carter and Assari, 2016). Researchers, Carter and Assari (2016) found although obesity and physical activity may influence psychological well-being in a positive manner it seemed to vary based on race and gender. Researchers found, White women aged 50 years and older with a high BMI had high depressive symptoms. Creating public health and clinical interventions tailored to meet the needs of the targeted population would be more effective in treating both obesity and the psychological issues that may result. Economic Cost of Obesity – Insurance, Work, Wages – Associated With Lower Income Klein, Allison, Heymsfield, Kelley, Leibel, Nonas, and Kahn

(2007), suggest that some individuals might view an obese person as one who lacks willpower and as a result may face limited opportunities in the occupation market causing one to live in poverty or below their means. Key security associations do further the coverage for obesity treatments and avoidance, and an individual’s lifetime might be cut short by obesity. One hundred and forty seven billion dollars is the estimated medical cost of obesity related conditions in the United States in 2008 according to the Center for Disease Control (2016). The medical cost for those considered obese was approximately $1,400 dollars higher compared to those with a healthy weight, (Center for 14 BALANCED MEALS FOR A HEALTHY LIFESTYLE Disease Control, 2016). Obesity and some of its health problems have significant economic impacts on the American healthcare system. Medical expenses that come with obesity entail both direct and indirect expenses. These include precautionary, diagnostic, and

treatment services associated with being obese. III. Causes Prenatal/Postnatal Health Wolf and Colditz (2008) found in the course of their study that nearly two in five (25.8 percent) women are usually obese before they become pregnant. This, according to Wolf and Colditz (2008), can increase a wider variety of health-related complications for both the infant and the mother. Higher birth weights are associated with obesity as well as other adult ailments During the period of child development, there are many factors that do influence the development of weight and obesity in adults. Weight gain during pregnancy primarily involves fatty tissues. Production of the fatty tissue mostly comes with a condition of virtual resistance to insulin that starts in the mid-pregnancy period. This adaptive reaction will allow for adequate transportation of glucose and other vital substances into the placenta to ensure that the fetus grows. However, it might also subject the unborn infant to periods of

high blood glucose and elevated insulin (Wolf & Colditz, 2008). These will bring about increased body fats that, manifest a larger size during delivery. Studies by Wolf and Colditz (2008) show that birth weight is linked to later body mass index and this does make sense since the setting of the uterus that is warmer and has various nutrients and hormones does have profound effects on the fatal developments of a child. As explained, the fluctuating alterations in the intrauterine context at responsive moments of the development procedure may have permanent and lasting consequences such as obesity. 15 BALANCED MEALS FOR A HEALTHY LIFESTYLE Unhealthy Diets Ogden, Carroll, Kit, and Flegal (2014) describes some research that has been carried out to try and find out if obesity can be regarded as a drug addiction disorder. Food can at times be a very significant psychoactive object, and the only way to regard an eating disorder is to understand that food is a composite combination

and that the body of a person does respond to food the same way it does to chemical compounds like those in psychoactive drugs. This is what makes an eating disorder a chemical disorder. The unhealthy diets and type of food consumed in the United States are some of the factors that do contribute to the country’s obese populace (Carroll, Kit, & Flegal, 2014). The craving for junk food has quickly substituted the need for fruits and vegetables and some healthy diets. No one can be blamed for buying it as it is much cheaper and can be afforded by everyone. What individuals should be held responsible for are the quantities they consume. Junk food, as defined by Ogden et al (2014) is food made with chemical mixtures, sugar, and sodium like french fries and hamburgers. Even though most healthcare authorities maintain that junk food does not exist, those who consume it find it a useful term that they can use to distinguish healthy food from those whose principle request is fun,

expediency, and addictive flavor. Lack of Physical Activity Even though metabolism deals with the manner in which an individual burns the food that he or she consumes, it does not necessarily imply that the metabolism he or she gets from the parent will make him or her obese. Puhl and Heuer (2009) found that lack of physical activity is the leading cause of the obesity epidemic. An individual should not expect to maintain a healthy weight if he or she does not exercise. This is because exercise has a positive effect on the body when it comes to losing weight. 16 BALANCED MEALS FOR A HEALTHY LIFESTYLE IV. Prevention Finding proper treatments for obesity at early stages is helpful to the health and selfesteem of individuals. A parent can prevent the child from being obese later in life Nutrition Education- Health Professionals Through the help of health professionals, a person will be informed on the unhealthy diets that are very dangerous and may increase the dangers of fatal

diseases. Nutrition learning is mostly behavior-based and teaches people to learn and understand the fat content and general nutritional value of most foods. Dietitians are regarded as nutrition experts and have the unique ability of being able to translate science of nutrition into practical information for their clients and promoting independence with optimal health as the focus and goal (Zinn, Schofield, and Hopkins (2012). Mediterranean Diet The Mediterranean diet is a relatively healthier eating plan that might protect against gaining excess weight. The Mediterranean Diet is composed of plant-based foods that offer large quantities of nutritional fiber. This has been shown by Wang, Beydoun, Liang, Caballero, and Kumanyika (2008) to increase satiety as well as satisfaction through various means like delayed mastication, better gastric detention and better release of cholecystokinin. Energy bulk plays a significant part when it comes to weight gain, as delicious energy-packed foods

may lead to lack of food control and in consequence to too much consumption. The Mediterranean diet tends to have lower energy density than other nutritional foods. These characteristics, plus higher water content, bring about increased satiation and lower intakes of calories, and hence help in preventing weight gain and obesity. 17 BALANCED MEALS FOR A HEALTHY LIFESTYLE Education and the Adult Learner The challenging task of educating adults can be tedious and difficult. Chen (2014) concluded that educators noted traditional approaches to teaching were not well received by their adult students and, in many cases, were ineffective in helping their adult students learn. Chen, Kim, Moon and Merriam (2008) found older adults have been portrayed as a similar group in terms of age, gender, race, class, ethnicity, their ability to learn, and their limitations. Upon further research, Chen (2014) found in the 1950s and 1960s, more cohesive, explanatory, and unifying adult-centric models

of education were developed. This formed several tenets that are currently foundational to adult learning. The first tenet, adult learners are self-directed and their learning is heighted when their experience is utilized during the learning process. The second tenet, is “transformative and leads to personal growth”, and the final tenet is when considering the adult leaner is critical reflection. This involves challenging assumptions and being open to alternatives in delivering education (Chen, 2014). Most adults are able to communicate which tenet style works best and provide their educator with feedback that will help develop and transform the learning experience. 18 BALANCED MEALS FOR A HEALTHY LIFESTYLE Chapter 3 Methodology Research Design This quasi experimental research followed a pre and posttest design. The clients of Personal Training Plus, where the researcher serves as a Certified Health Coach, served as a convenience population for this study. Subjects The

clients of Personal Training Plus, served as a convenience population for this research; the researcher has access to this population because she is a Certified Health Coach for the fitness consulting firm. It was expected that, in total, roughly twenty clients would participate in the study. The participants were expected to be male and female, of all ethnicities and roughly middle to upper socio-economic class. Ages were expected to range from mid-20’s to late 60’s with clients under the age of 18 years being excluded. All participants would have a high school diploma at minimum. Further education attained would range from bachelor’s degrees to postgraduate degrees. Recruitment was accomplished through fliers that were posted to inform clients of the upcoming education program as well as an email blast that was sent from the owner of Personal Training Plus, Samuel Simmons. Incentives to participate included a fruit bowl, cheese, crackers, and water bottles that were available

during the presentation. All email blasts and fliers were sent and posted one week prior to the intervention. 19 BALANCED MEALS FOR A HEALTHY LIFESTYLE Instrumentation The instrumentation used to assess knowledge of balanced meals was a 10 question multiple-choice test representing information presented in the lesson; the test was designed by the researcher. The same instrument was used as the pre and the post-test (Pre-test can be found in Appendix A; post-test, in Appendix B).The test was developed to assess knowledge of proper portion sizes, appropriate energy needs, and composition of a balanced meal. Test content, as well as the nutrition presentation used in the in-service lesson; was based primarily on the United States Department of Agriculture Choose My Plate website, Academy of Nutrition and Dietetics EatRight website, and the American Heart Association website. A lesson plan can be found in Appendix C. Procedure Approval to conduct this study was granted by Samuel

Simmons, owner of Personal Training Plus. The Letter of Authorization can be found in Appendix D Prior to the intervention, the researcher completed the National Institute of Health (NIH) tutorial entitled, “Protecting Human Research Participants.” Her Certificate of Completion can be found in Appendix E. The proctor, Eric Hood, has also completed the tutorial noted above; his Certificate of Completion can be found in Appendix F. The intervention was held in the Community Room at Park Plaza Condominiums, the researcher closed the door, distributed the consent documents (Appendix G), read the consent document aloud, and answered all questions about the research and the procedures prior to starting the intervention. Participants were told to keep the consent document, but not to write their names on it. The researcher then exited the room 20 BALANCED MEALS FOR A HEALTHY LIFESTYLE The proctor entered the room, closed the door, and randomly distributed the numbered self-seal

manila envelopes and pens to the participants. The proctor ask the participants not to write their names on any of the materials to protect their confidentiality. Each of the numbered self-seal envelopes contained a copy of the pre-test questionnaire and the post-test questionnaire coded to match the individual self-seal envelope. The proctor asked the participants not to talk or share information while filling out the pre-test questionnaire. The proctor asked the participants to remove the blue paper entitled “Nutrition Questionnaire”, check the appropriate box if they agree with the content of the consent document, and then complete the pre-test questionnaire. The participants were given ten minutes to complete the pre-test questionnaire. After all participants had completed the pre-test questionnaire, the proctor asked them to return the blue form to the envelope. The proctor notified the researcher to return to the Community Room to deliver the intervention. After the

researcher returned to the Community Room, the nutrition education session began. The researcher told the participants that they are permitted to prepare and eat a healthy snack of fruits, cheese, crackers and water if they desired, during the presentation. The snack served solely as an incentive to participate. The snacks provided were low in calories and nutrient dense in order to strengthen the educational message delivered by the researcher; however, the snack was not intended to be part of the curriculum. The participants were given a handout regarding proper portion sizes, how to calculate energy needs, risks of obesity, benefits of eating a healthy diet, and recipe ideas for creating a well-balanced meal. The session would last for thirty minutes. Questions were answered aloud at the conclusion of the educational session. 21 BALANCED MEALS FOR A HEALTHY LIFESTYLE After the session, the researcher exited the room while the proctor instructed the participants to remove the

pink form entitled “Nutrition” from their envelope and began answering the questionnaire. Ten minutes was allowed to complete the questionnaire The proctor instructed the participants to return their completed questionnaire in their manila envelope and place the sealed envelope into the portable file box. When all sealed envelopes were in the portable file box, the proctor notified the researcher to return to the room. Once in the room, the researcher thanked the participants for their attendance and reminded them to take their consent document with them. Any and all final questions were answered by the researcher. The participants were dismissed Data Analysis The results included test-question answers for both pre and post-tests. The results were organized, by question, for each participant. Number of correct answers for pre and post-tests were obtained for each participant. The mean correct post-test answers were assessed against the mean correct pre-test answers. Following the

research intervention, the testing materials will remain locked in a locked file cabinet located in the researcher’s basement for a minimum of five years. After this period, the materials will be destroyed through shredding. 22 BALANCED MEALS FOR A HEALTHY LIFESTYLE Chapter 4 Results Five participants attended the 6:00pm-7:00pm nutrition education presentation on identifying healthy foods and creating balanced meals. The group of participants consisted of one African-American man, one African-American woman, one Caucasian man, one Caucasian woman, and one Hispanic woman. All participants were college educated, working professionals and roughly middle to upper socio-economic class and were between the ages of 51 to 60 years old. The mean pre-test score was 4.80 correct and the mean post-test score was 86 correct See Table 1 for details of each participant’s pre-test and post-test raw scores with percentage changes. Table 1: Pre-test and Post-test Scores Participants Pre-test

Post-test Percentage Change One 6 10 66.67% Two 3 6 100% Three 7 10 42.86% Four 2 7 250% Five 6 10 66.67% Mean Score 4.80 8.6 105.24% 23 BALANCED MEALS FOR A HEALTHY LIFESTYLE Figure 1 Participants Pre-test and Post-test Scores 10 9 8 7 6 5 4 3 2 1 0 Partcipant 1 Partcipant 2 Partcipant 3 Pre-test Score Partcipant 4 Partcipant 5 Post-test Score No participant answered all the pre-test questions correctly. Only one question was unanswered by one participant. Participant 4 skipped question number 6 which asked, “Women should consume ounces of protein at each meal.” Questions number 1 and number 8 were the only two questions that were answered correctly by all participants. Both questions required either a true or false answer while the other questions were multiple choice. After the nutrition education, three of the five participants successfully answered all ten questions correctly. Figure 1 shows improvements made after education was

provided. Participants two and four had the largest percentage increase comparing their pre-test and post-test scores, with a percentage change of 100% and 250%, respectively (see Table 1). Each of the ten questions focused on how to build a balanced meal by asking: daily recommendations for fruits, vegetables, lean proteins, and sodium. See Table 2 for details of the 24 BALANCED MEALS FOR A HEALTHY LIFESTYLE pre-test and post-test questions that were answered correctly by the participants as well as percent changes. Table 2 Pre-test and Post-test Questions Answered Correctly Questions # Pre-Test Answered Correctly Post-Test Answered Correctly % Change 1 5 5 0 2 3 4 +33.33 3 4 4 0 4 3 5 +66.66 5 3 4 +33.3 6 3 4 +33.33 7 3 4 +33.33 8 5 5 0 9 3 4 +33.33 10 4 4 0 Prior to the intervention, question 4 was answered correctly by three of the five participants. This question asked, “How many servings of fruit should you consume daily?”

After the intervention, all five participants answered this questioned correctly and this was the only question that received the greatest improvement percent change in the study. Participants’ 25 BALANCED MEALS FOR A HEALTHY LIFESTYLE responses remained the same for four out of the ten questions on the pre and posttests. Questions 1, 3, 8, and 10 focused on consumption of fats, sodium, and identifying a meal that was well balanced meal. 26 BALANCED MEALS FOR A HEALTHY LIFESTYLE Chapter 5 Discussion Interpretation of Results The results of this study supported the hypothesis that, after the education lesson on how to identify healthier foods the participants would demonstrate an improved knowledge of proper portion sizes, appropriate energy needs, and balanced meals as measured by the change in their scores on a pre and post-test. All participates improved their scores increasing their post-test scores by a minimum of 42.86% Delivering the lesson to a smaller group of

participants provided less distractions which allowed the group to focus on the lesson. While delivering the lesson, the participants seemed alert and eager to learn. They were an interested audience that had many questions once the lesson was over and the post-tests were collected. The expected number of participants was twenty; however, only five clients actually participated in the lesson. Only one lesson was delivered during a week day from 6:00-7:00pm The low number of attendees could be related to the facility not advertising the nutrition program until the day before the session. Posters were to be placed in all public areas such as the elevators, gym doors, and restrooms. Only a few posters were placed and the posters did not provide information regarding the session except a time and location. An email blast was sent to the clients of Personal Training Plus by the owner but many of his clients either did not read the email in time or simply disregarded it. Those who did

arrived to the education program reported heavy traffic during rush hour. Posters and an email blast was drafted and provided to the facility providing the title of the program, time, location, and free healthy snacks. The posters were never used. 27 BALANCED MEALS FOR A HEALTHY LIFESTYLE Questions and comments during the question/comments section were indicative of how interested and informed the participants were regarding nutrition: 1. “I watch my diet very carefully Diabetes runs in my family and I know diet can help prevent it.” 2. “I have lost 15 pounds since coming to Personal Training Plus and I want to continue losing weight. I feel so much better” 3. “I have been vegan for five years and have seen great improvements in my health removing animal products from my diet.” 4. “I have read about the ketogenic diet What are your thoughts?” 4. “I try to have a green smoothie every morning to help me with increasing my veggie intake” Strengths and

limitations. A strength of this study was the use of evidenced based research primarily from the United States Department of Agriculture Choose MyPlate website, Academy of Nutrition and Dietetics Eat Right website, and the American Heart Association website. A weakness of the study included the non-validated assessment instrument and the small group size. The results of this study does not capture the general knowledge of the public The participants in this study seemed to be highly educated and aware of general nutrition information. Application of Results In the future, several education programs offered at different times and possibly days should be offered to generate more participation from Personal Training Plus clients. Advertising a week in advance via email and posters with sufficient incentives could be explored. Future 28 BALANCED MEALS FOR A HEALTHY LIFESTYLE research regarding education programs might be better assessed using alternative methods than a pre and

posttest model. Possible recommendations could be asking the participants what new information they would like to learn or having them create a healthy meal using sample foods offered at the program. Suggestions for Future Research A common thread that links all the literature together is that additional research is greatly needed to assess the reality of using nutrition programs in combination with physical activity to help combat obesity. Eating a diet rich in fruits, vegetables, whole grains, and lean protein will help maintain health and decrease risk of developing diabetes, heart disease, certain cancers, and stroke. Providing nutrition education programs by a nutrition professional in combination with exercise will improve quality of life and have a positive effect on the rate of obesity in the United States. Summary Despite the low turnout for the intervention, nutrition education should continue for Personal Training Plus clients. The knowledge gained by the participants was

increased based on the improvements made in the post-test scores. Combing both physical fitness along with nutrition education can have long lasting results for the clients. Future programs, using larger groups that are more diverse along with follow-up assessments may provide more insight on how to tailor the nutrition education to better meet the needs of the clients. 29 BALANCED MEALS FOR A HEALTHY LIFESTYLE References Battista, M., LaBonte, M, Menard, J, Jean-Denis, F, Houde, G, Ardilouze, J, and Perron, P (2012). Dietitian-coached management in combination with annual endocrinologist follow up improves global metabolic and cardiovascular health in diabetic participants after 24. Applied Physiology, Nutrition, and Metabolism, 37, 610-620 Bezerra, I. N, Curioni, C & Sichieri, R (2012) Association between eating out of home and body weight. Nutrition Reviews, 70 (2), 64-79 Bray, G. A (2008) Obesity in America An overview of the second fogarty international center conference

on obesity. International Journal of Obesity, 3(4), 363-375 Carter, J. D and Assari, S (2016) Sustained obesity and depressive symptoms over 6 years Race by gender differences in the health and retirement study. Frontiers in Aging Neuroscience, 8 (312), 1-11. Chen, X., Beydoun, M A, & Wang, Y (2008) Is sleep duration as2016) associated with childhood obesity? A systematic review and meta‐analysis. Obesity, 16(2), 265-274 Chen, Joseph C. (2014) Teaching non-traditional Teaching nontraditional adult students: adult learning theories in practice. Teaching in higher education, 19(4), 406-418 Doty, N. (2008) Obesity in America ABNF Journal, 19(3), 83 30 BALANCED MEALS FOR A HEALTHY LIFESTYLE Flegal, K. M, Carroll, M D, Kuczmarski, R J, & Johnson, C L (2008) Overweight and obesity in the United States: Prevalence and trends, 1960–1994. International Journal of Obesity, 22(1), 39-47. Fleig, L., Kerschreiter, R, Schwarzer, R, Pomp, S, and Lippke, S (2014) Sticking to a

healthy diet is easier for me when I exercise regularly’: Cognitive transfer between physical exercise and healthy nutrition. Psychology and Health, 29 (12), 1361-1372 French, S. A, Story, M, & Perry, C L (2015) Self‐esteem and obesity in children and adolescents: A literature review. Obesity, 3(5), 479-490 LeBlanc, E., O’Connor, E, Whitlock, E, Patnode, C, and Kapka, T (2011) Effectiveness of primary care-relevant treatments for obesity on adults: a systematic evidence review for the U.S preventive services task force Annals of Internal Medicine, 155, 434-447 Hill, J. O, & Melanson, E L (2009) Overview of the determinants of overweight and obesity: current evidence and research issues. Medicine and Science in Sports and exercise, 31(11), 515-21. Kamaraj, S., Ramakrishnan, G, Anaadakumar, P, Jagan, S and Devaki, T (2009) Antioxidant and Anticancer Efficacy of Hesperidin in Benzo(a)pyrene induced Lung Carcinogenesis in Mice. Invest New Drugs, 27, 214-222 Kannel, W. B,

& Gordon, T (2009) Physiological and medical concomitants of obesity: The Framingham Study. Obesity in America, 359, 125-163 McKean, M., Slater, G, Oprescu, F, and Burkett, B (2015) Do the nutrition qualifications and professional practices of registered exercise professionals align? International Journal of Sport Nutrition and Exercise Metabolism, 25, 154-162. 31 BALANCED MEALS FOR A HEALTHY LIFESTYLE Ogden, C. L, Carroll, M D, Kit, B K, & Flegal, K M (2014) Prevalence of childhood and adult obesity in the United States, 2011-2012. Jama, 311(8), 806-814 Puhl, R. M, & Heuer, C A (2009) The stigma of obesity: A review and update Obesity, 17(5), 941-964. Wang, Y., Beydoun, M A, Liang, L, Caballero, B, & Kumanyika, S K (2008) Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity, 16(10), 2323-2330 West, K. M (2000) Obesity in America Annals of Internal Medicine, 92(6), 854-855 Wolf, A. M, & Colditz,

G A (2008) Current estimates of the economic cost of obesity in the United States. Obesity, 6(2), 97-106 Zinn, C., Schofield, G, and Hopkins, W G (2013) Management of adult overweight and obesity: Consultation characteristics and treatment approaches of private practice dietitians. Nutrition and Dietetics, (70), 113-119 Center for Disease Control and Prevention. (2016) Overweight and Obesity Retrieved from www.cdcgov/obesity World Health Organization. (2016) Obesity and Overweight Media Center Retrieved from www.whoint/nutrition/topics/obesity/en/ 32 BALANCED MEALS FOR A HEALTHY LIFESTYLE APPENDIX A-G 33 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix A By checking this box, I indicate that I have received, read, and understand the consent document and agree to participant in this research study. I acknowledge that I am 18 years of age or older. Nutrition Knowledge Questionnaire Pre-Test Instructions: Please circle the letter of the best answer to the question. 1. Make

half your plate fruits and vegetables A. True B. False 2. Which nutrient in your diet can help slow the absorption of sugar? A. Protein B. Fiber C Fats D. Water 3. This food group is our body’s best source of energy A. Fiber B Fats C Carbohydrates D Protein 4. How many servings of fruit should you consume daily? A. One B Two C Three 5. How many servings of vegetables should you consume daily? A. Four B Three C Two 34 BALANCED MEALS FOR A HEALTHY LIFESTYLE 6. Women should consume ounces of protein at each meal A. 3-4 ounces B. 1-2 ounces C. The amount does not matter 7. Men should consume ounces of protein at each meal A. 3-4 ounces B 4-6 ounces C The amount does not matter 8. You should drink and eat less sodium, saturated fat, and sugar A. True B. False 9. Consuming no more than mg of sodium day is the current 2015-2020 Dietary Recommendation. A. 1500mg B 2300mg C 3000mg 10. A balanced meal would be: A. Slice of pizza and a 12 ounce soda B.

Baked chicken, roasted potatoes, salad with dressing and a glass of water C. Soup with grilled cheese and a glass of milk 35 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix B Nutrition Knowledge Questionnaire Post-Test Instructions: Please circle the letter of the best answer to the question. 1. Make half your plate fruits and vegetables A. True B. False 2. Which nutrient in your diet can help slow the absorption of sugar? A. Protein B. Fiber C Fats D. Water 3. This food group is our body’s best source of energy A. Fiber B Fats C Carbohydrates D Protein 4. How many servings of fruit should you consume daily? A. One B Two C Three 5. How many servings of vegetables should you consume daily? A. Four B Three C Two 6. Women should consume ounces of protein at each meal A. 3-4 ounces B. 1-2 ounces C. The amount does not matter 36 BALANCED MEALS FOR A HEALTHY LIFESTYLE 7. Men should consume ounces of protein at each meal A. 3-4 ounces B 4-6 ounces C

The amount does not matter 8. You should drink and eat less sodium, saturated fat, and sugar A. True B. False 9. Consuming no more than mg of sodium day is the current 2015-2020 Dietary Recommendation. A. 1500mg B 2300mg C 3000mg 10. A balanced meal would be: A. Slice of pizza and a 12 ounce soda B. Baked chicken, roasted potatoes, salad with dressing and a glass of water C. Soup with grilled cheese and a glass of milk 37 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix C 38 BALANCED MEALS FOR A HEALTHY LIFESTYLE 39 BALANCED MEALS FOR A HEALTHY LIFESTYLE 40 BALANCED MEALS FOR A HEALTHY LIFESTYLE 41 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix D Personal Training Plus The Fitness Solution for Luxury Apartments Samuel Simmons, Owner of Personal Training Plus 10/30/16 Dear members of the Immaculata University RERB, I, Samuel Simmons, authorize Danielle Hood to conduct a research study at Park Plaza Condominiums for the clients of Personal Training

Plus. I understand that Danielle Hood is an Immaculata University student who is performing this research as part of the requirements of her Master’s degree program. I realize that the purpose of this study is to provide basic nutrition education on creating balanced meals for a healthy lifestyle. In conducting this study, Danielle Hood will be asking Personal Training Plus’s clients to complete a pre-test, attend a 30 minute lecture, and complete a post-test. I understand that Danielle Hood will follow proper ethical procedures in conducting this study. If we have any concerns or require additional information, we will contact the researcher, Danielle R. Hood. Sincerely, Samuel Simmons Personal Training Plus, Owner 42 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix E 43 BALANCED MEALS FOR A HEALTHY LIFESTYLE Appendix F Appendix G 44 BALANCED MEALS FOR A HEALTHY LIFESTYLE CONSENT FORM I am currently engaged in a study of “Nutrition Basics: Balanced Meals

for a Healthy Lifestyle” as part of my Master’s Degree studies at Immaculata University. To help me gain further insights into this area I will ask you to fill out a 10 minute questionnaire, participate in a 30 minute nutrition education presentation on portion sizes, energy needs, and how to create a balanced meal, then complete a second 10 minute questionnaire. The data you will provide will be recorded anonymously and your participation and anything you say during the session will be held in the strictest confidence. I welcome questions about the experiment at any time. Your participation in this study is on voluntary basis, and you may refuse to participate at any time without consequence or prejudice. Any questions you have about the research can be directed to me, Danielle Hood, at my home 267355-3830, my mobile 267-977-2774, or at my email address healthyandhappywithdanielle@gmail.com My advisor is Dr Rena Quinton, (610) 647-4400 extension 3444, rquinton@immaculata.edu

Any questions about your rights as a research subject may be directed to Dr. Thomas F O’Brien, at 610-647-4400 ext. 3221, tobrien@immaculataedu 45 BALANCED MEALS FOR A HEALTHY LIFESTYLE Checking the checkbox and filling out the questionnaires indicates you have read and understand the contents of this consent form and that you agree to take part in this study. Researcher's Signature Date Phone: 610-647-4400 Ext. 3220 / 3221 • Fax 610-647-6409 • tobrien@immaculataedu 46